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Saz-Lara A, Cavero-Redondo I, Del Saz-Lara A, Rodríguez-Gutiérrez E, Bizzozero-Peroni B, Pascual-Morena C. The acute effect of exercise on the endothelial glycocalyx in healthy adults: A systematic review and meta-analysis. Eur J Clin Invest 2024; 54:e14240. [PMID: 38747101 DOI: 10.1111/eci.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND In recent years, it has been demonstrated that when the endothelial glycocalyx, composed of proteoglycans, glycosaminoglycans and glycoproteins, is altered or modified, this property is lost, playing a fundamental role in cardiovascular pathologies. Cardiovascular risk factors can destroy the endothelial glycocalyx layer. Exercise has a positive effect on cardiovascular risk factors, but little is known about its direct effect on the integrity of the endothelial layer. METHODS The Cochrane Library, PubMed, Web of Science and Scopus databases were searched from their inception to June 30, 2022. The DerSimonian and Laird method was used to compute pooled effect size estimates and their respective 95% confidence intervals for the acute effect of exercise (within 24 h) on the endothelial glycocalyx and its components in healthy adults. RESULTS Ten studies were included in the meta-analysis, with a total of 252 healthy subjects. The types of exercise included were resistance training, interval training, resistance training and maximal incremental exercise, with a duration range of 30-60 min. Glycocalyx assessment times included ranged from 0 to 90 min post-exercise. Our findings showed that endothelial glycocalyx increases after acute effect of exercise in healthy population (.56, 95% CI: .38, .74). The acute effect of exercise on endothelial glycocalyx components were .47 (95% CIs: .27, .67) for glycosaminoglycans, .67 (95% CIs: .08, 1.26) for proteoglycans and .61 (95% CIs: .35, .86) for glycoproteins. CONCLUSIONS In a healthy population, various types of exercise showed an acute improvement of the endothelial glycocalyx and its individual components.
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Affiliation(s)
- Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Andrea Del Saz-Lara
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, Madrid, Spain
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, Madrid, Spain
| | | | - Bruno Bizzozero-Peroni
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Departamento de Educación Físicay Salud, Instituto Superior de Educación Física, Universidad de la República, Rivera, Uruguay
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2
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Connes P. Blood rheology and vascular function in sickle cell trait and sickle cell disease: From pathophysiological mechanisms to clinical usefulness. Clin Hemorheol Microcirc 2024; 86:9-27. [PMID: 38073384 DOI: 10.3233/ch-238122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Sickle cell disease (SCD) is an autosomal recessive disorder. Although the molecular mechanisms at the origin of SCD have been well characterized, its clinical expression is highly variable. SCD is characterized by blood rheological abnormalities, increased inflammation and oxidative stress, and vascular dysfunction. Individuals with only one copy of the mutated β-globin gene have sickle cell trait (SCT) and are usually asymptomatic. The first part of this review focuses on the biological responses of SCT carriers during exercise and on the effects of combined SCT and diabetes on vascular function, several biomarkers and clinical complications. The second part of the review focuses on SCD and shows that the magnitude of red blood cell (RBC) rheological alterations is highly variable from one patient to another, and this variability reflects the clinical and hematological variability: patients with the less deformable RBCs have high hemolytic rate and severe anemia, and are prone to develop leg ulcers, priapism, cerebral vasculopathy, glomerulopathy or pulmonary hypertension. In contrast, SCD patients characterized by the presence of more deformable RBCs (but still rigid) are less anemic and may exhibit increased blood viscosity, which increases the risk for vaso-occlusive events. Several genetic and cellular factors may modulate RBC deformability in SCD: co-existence of α-thalassemia, fetal hemoglobin level, oxidative stress, the presence of residual mitochondria into mature RBCs, the activity of various non-selective cationic ion channels, etc. The last part of this review presents the effects of hydroxyurea and exercise training on RBC rheology and other biomarkers in SCD.
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Affiliation(s)
- Philippe Connes
- Laboratory LIBM EA7424, University of Lyon 1, "Vascular Biology and Red Blood Cell" Team, Lyon, France
- Laboratory of Excellence Labex GR-Ex, Paris, France
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3
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Lower Muscle and Blood Lactate Accumulation in Sickle Cell Trait Carriers in Response to Short High-Intensity Exercise. Nutrients 2022; 14:nu14030501. [PMID: 35276859 PMCID: PMC8838817 DOI: 10.3390/nu14030501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
It remains unclear whether sickle cell trait (SCT) should be considered a risk factor during intense physical activity. By triggering the polymerization-sickling-vaso-occlusion cascade, lactate accumulation-associated acidosis in response to high-intensity exercise is believed to be one of the causes of complications. However, our understanding of lactate metabolism in response to high-intensity exercise in SCT carriers is incomplete. Thirty male SCT carriers (n = 15) and healthy subjects (n = 15) with and without α-thalassemia performed a 2-min high-intensity exercise. Blood and muscle lactate concentrations were measured at exercise completion. Time courses of blood lactate and glucose concentrations were followed during the subsequent recovery. Additional biochemical analyses were performed on biopsies of the vastus lateralis muscle. SCT was associated with lower blood and muscle lactate concentrations in response to the short high-intensity exercise. Compared to controls, the muscle content among SCT carriers of lactate transporter MCT4 and β2-adrenergic receptor were higher and lower, respectively. During recovery, the lactate removal ability was higher in SCT carriers. In the present study, no effect of α-thalassemia was observed. The lower blood and muscle lactate accumulations in SCT carriers may, to some extent, act as protective mechanisms: (i) against exercise-related acidosis and subsequent sickling, that may explain the relatively rare complications observed in exercising SCT carriers; and (ii) against the deleterious effects of intracellular lactate and associated acidosis on muscle function, that might explain the elevated presence of SCT carriers among the best sprinters.
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4
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Messonnier LA, Bartolucci P, d'Humières T, Dalmais E, Lacour JR, Freund H, Galactéros F, Féasson L. Preventive measures for the critical postexercise period in sickle cell trait and disease. J Appl Physiol (1985) 2021; 130:485-490. [PMID: 33270510 DOI: 10.1152/japplphysiol.00855.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The immediate postexercise/physical activity period is critical for sickle cell trait (SCT) carriers and disease (SCD) patients. Exercise-related blood acidosis is known to trigger the cascade of HbS deoxygenation and polymerization, leading to red blood cell sickling and subsequent complications. Unfortunately, two facts worsen exercise-related blood acidosis during the initial postexercise period: First, blood lactate and H+ concentrations continue to increase for several minutes after exercise completion, exacerbating blood acidosis. Second, blood lactate concentration remains elevated and pH altered for 20-45 min during inactivity after intense exercise, keeping acid/base balance disturbed for a long period after exercise. Therefore, the risk of complications (including vasoocclusive crises and even sudden death) persists and even worsens several minutes after intense exercise completion in SCT carriers or SCD patients. Light physical activity following intense exercise (namely, active recovery) may, by accelerating lactate removal and acid/base balance restoration, reduce the risk of complications. Scientific evidence suggests that light exercise at or below the first lactate threshold is an appropriate strategy.
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Affiliation(s)
- Laurent A Messonnier
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Pablo Bartolucci
- INSERM U955, Equipe 2 Transfusion et maladies du globule rouge, Laboratoire d'Excellence GRex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC) Faculté de Médecine, Créteil, France.,Reference Center for Sickle Cell Disease, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Thomas d'Humières
- Service de Physiologie Cardiovasculaire, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Etienne Dalmais
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université Savoie Mont Blanc, Chambéry, France.,Centre d'Evaluation et de Prévention Articulaire, Challes-les-Eaux, France
| | - Jean-René Lacour
- Laboratoire de Physiologie de l'Exercice, Faculté de Médecine Lyon-Sud, Université de Lyon, Université Claude Bernard Lyon 1, Oullins, France
| | - Hubert Freund
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Frédéric Galactéros
- Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC) Faculté de Médecine, Créteil, France.,Reference Center for Sickle Cell Disease, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Léonard Féasson
- University Hospital of Saint-Etienne, Myology Unit, Department of Clinical and Exercise Physiology, Referent Center of Neuromuscular Diseases, Euro-NmD, Saint-Etienne, France.,Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université de Lyon, Université Jean Monnet, Saint-Etienne, France
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5
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Hyacinth HI, Carty CL, Seals SR, Irvin MR, Naik RP, Burke GL, Zakai NA, Wilson JG, Franceschini N, Winkler CA, David VA, Kopp JB, Judd SE, Adams RJ, Longstreth WT, Egede L, Lackland DT, Taylor H, Manson JE, Howard V, Allison M, Gee BE, Correa A, Safford MM, Arnett DK, Howard G, Reiner AP, Cushman M. Association of Sickle Cell Trait With Ischemic Stroke Among African Americans: A Meta-analysis. JAMA Neurol 2019; 75:802-807. [PMID: 29710269 DOI: 10.1001/jamaneurol.2018.0571] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance African Americans and individuals of African ancestry have a higher risk of stroke compared with non-Hispanic white individuals. Identifying the source of this disparity could provide an opportunity for clinical stroke risk stratification and more targeted therapy. Whether sickle cell trait (SCT) is an indicator of increased risk of ischemic stroke among African Americans is still unclear. Objective To examine whether SCT is associated with a higher risk of incident ischemic stroke among African Americans. Design, Setting, and Participants This meta-analysis assessed the association of SCT with the risk of incident ischemic stroke. Four large, prospective, population-based studies with African American cohorts were assessed: Jackson Heart Study (September 1, 2005, through December 31, 2012), Multi-Ethnic Study of Atherosclerosis (July 1, 2002, through December 31, 2012), Reasons for Geographic and Racial Differences in Stroke (January 1, 2003, through December 31, 2014), and Women's Health Initiative (October 1, 1998, through December 31, 2012). Using a Cox proportional hazards regression model adjusted for major stroke risk factors, this study estimated the hazard ratio for incident ischemic stroke associated with SCT. Data analysis was performed from July 10, 2016, to February 2, 2017. Interventions or Exposures Participants' SCT status determined by polymerase chain reaction assay genotyping or a combination of whole-exome sequencing and imputation. Main Outcomes and Measures Incident ischemic stroke. Results This meta-analysis included 19 464 African American individuals (1520 with SCT, 17 944 without SCT, and 620 with ischemic stroke) from 4 studies, with a mean (SD) age of 60.0 (13.0) years (5257 [27.0%] men and 14 207 [73.0%] women). No differences were found in the distribution of risk factors for ischemic stroke comparing participants with and those without SCT at study visit 1 in each cohort. The crude incidence of ischemic stroke was 2.9 per 1000 person-years (95% CI, 2.2-4.0 per 1000 person-years) among those with SCT and 3.2 per 1000 person-years (95% CI, 2.7-3.8 per 1000 person-years) among those without SCT. After stroke risk factors were adjusted for, the hazard ratio of incident ischemic stroke independently associated with SCT in the meta-analysis of all 4 cohorts was 0.80 (95% CI, 0.47-1.35; P = .82). The results of the meta-analysis were similar to those of individual cohorts, in which the results were also similar. Conclusions and Relevance Sickle cell trait may not be associated with incidence of ischemic stroke among African Americans. The results of this study suggest performing a more thorough clinical evaluation of a stroke patient with SCT rather than assuming that SCT is the etiologic factor for the stroke.
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Affiliation(s)
- Hyacinth I Hyacinth
- Aflac Cancer and Blood Disorder Center, Emory Children's Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Cara L Carty
- Women's Health Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Samantha R Seals
- Department of Mathematics and Statistics, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Rakhi P Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Gregory L Burke
- Division of Public Health Science, Wake Forest University, Winston-Salem, North Carolina
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington.,Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson
| | | | - Cheryl A Winkler
- Basic Science Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, National Cancer Institute, Frederick, Maryland
| | - Victor A David
- Basic Science Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, National Cancer Institute, Frederick, Maryland
| | - Jeffrey B Kopp
- National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Suzanne E Judd
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Robert J Adams
- Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle
| | - Leonard Egede
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee
| | - Daniel T Lackland
- Stroke Center, Department of Neurology, Medical University of South Carolina, Charleston
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Virginia Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Matthew Allison
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego
| | - Beatrice E Gee
- Department of Pediatrics, Morehouse School of Medicine, Atlanta, Georgia
| | - Adolfo Correa
- Jackson Heart Study, University of Mississippi Medical Center, Jackson
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Donna K Arnett
- College of Public Health, University of Kentucky College of Public Health, Lexington
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Alexander P Reiner
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington.,Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington
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6
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Camp AS, Read SP, Lee RK. Peripheral Vaso-Occlusive Events Following Trauma in Patients With Sickle Cell Trait. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e84-e87. [PMID: 30893463 DOI: 10.3928/23258160-20190301-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/04/2018] [Indexed: 11/20/2022]
Abstract
Sickle cell trait (SCT) is a common hemoglobin variant, particularly in patients of African descent. Patients with SCT have an increased risk of adverse ocular events following trauma with subsequent elevated intraocular pressure (IOP). The authors describe three cases of young males with peripheral vaso-occlusive events following ocular trauma with subsequent elevated IOP. These cases demonstrate the importance of careful peripheral exams in young patients with SCT following trauma. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e84-e87.].
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7
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Diaw M, Diop S, Soubaiga FYW, Seck M, Faye BF, Niang MN, Samb A, Connes P. Blood viscosity is lower in trained than in sedentary sickle cell trait carriers. Clin Hemorheol Microcirc 2016; 61:23-9. [PMID: 24961729 DOI: 10.3233/ch-141852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The aim of this study was to compare blood and plasma viscosities, as well as the hematocrit/blood viscosity ratio (HVR), between trained and sedentary SCT carriers. Thirty African male SCT carriers from the city of Dakar (Senegal) participated in the study: one group composed of 15 trained SCT carriers (TSCTc) and one group composed of 15 sedentary individuals (SSCTc). Blood was sampled in resting condition and blood and plasma viscosities were measured using a cone-plate viscometer. After the determination of hematocrit by microcentrifugation, HVR was determined for each subject. Blood and plasma viscosities, as well as hematocrit, were significantly reduced in TSCTc compared to SSCTc. As a consequence, HRV was greater in TSCTc. These findings provide evidence that SCT carriers should be encouraged to practice regular physical activity to limit the cardiovascular strain usually caused by their blood hyperviscosity.
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Affiliation(s)
- Mor Diaw
- Laboratoire de physiologie et explorations fonctionnelles, FMPOS, UCAD, Dakar, Sénégal
| | - Saliou Diop
- Laboratoire d'hémato-immunologie, FMPOS, UCAD, Dakar, Sénégal
| | | | - Moussa Seck
- Laboratoire d'hémato-immunologie, FMPOS, UCAD, Dakar, Sénégal
| | | | - Mbayang Ndiaye Niang
- Laboratoire de physiologie et explorations fonctionnelles, FMPOS, UCAD, Dakar, Sénégal
| | - Abdoulaye Samb
- Laboratoire de physiologie et explorations fonctionnelles, FMPOS, UCAD, Dakar, Sénégal.,"Environnement, Sante, Sociétés", CNRS, CNRST, Université Bamako-UCAD, Dakar, Sénégal
| | - Philippe Connes
- Hôpital Ricou, CHU de Pointe-á-Pitre, Pointe-á-Pitre, Guadeloupe.,Laboratory of Excellence GR-Ex "The red cell: from genesis to death", PRES Sorbonne Paris Cité, Paris, France.,Institut Universitaire de France, Paris, France
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8
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Crabb EB, Franco RL, Caslin HL, Blanks AM, Bowen MK, Acevedo EO. The effect of acute physical and mental stress on soluble cellular adhesion molecule concentration. Life Sci 2016; 157:91-96. [DOI: 10.1016/j.lfs.2016.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/27/2016] [Accepted: 05/29/2016] [Indexed: 12/21/2022]
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9
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Martin C, Pialoux V, Faes C, Charrin E, Skinner S, Connes P. Does physical activity increase or decrease the risk of sickle cell disease complications? Br J Sports Med 2015; 52:214-218. [PMID: 26701924 DOI: 10.1136/bjsports-2015-095317] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2015] [Indexed: 12/11/2022]
Abstract
Sickle cell disease (SCD) is the most common inherited disease in the world. Red blood cell sickling, blood cell-endothelium adhesion, blood rheology abnormalities, intravascular haemolysis, and increased oxidative stress and inflammation contribute to the pathophysiology of SCD. Because acute intense exercise may alter these pathophysiological mechanisms, physical activity is usually contra-indicated in patients with SCD. However, recent studies in sickle-cell trait carriers and in a SCD mice model show that regular physical activity could decrease oxidative stress and inflammation, limit blood rheology alterations and increase nitric oxide metabolism. Therefore, supervised habitual physical activity may benefit patients with SCD. This article reviews the literature on the effects of acute and chronic exercise on the biological responses and clinical outcomes of patients with SCD.
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Affiliation(s)
- Cyril Martin
- Center of Research and Innovation on Sports (CRIS EA647), Team 'Vascular Biology and Red Blood Cell', University of Lyon 1, University of Lyon, Lyon, France.,Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Vincent Pialoux
- Center of Research and Innovation on Sports (CRIS EA647), Team 'Vascular Biology and Red Blood Cell', University of Lyon 1, University of Lyon, Lyon, France.,Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France.,Institut Universitaire de France, Paris, France
| | - Camille Faes
- Center of Research and Innovation on Sports (CRIS EA647), Team 'Vascular Biology and Red Blood Cell', University of Lyon 1, University of Lyon, Lyon, France.,Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Emmanuelle Charrin
- Center of Research and Innovation on Sports (CRIS EA647), Team 'Vascular Biology and Red Blood Cell', University of Lyon 1, University of Lyon, Lyon, France.,Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Sarah Skinner
- Center of Research and Innovation on Sports (CRIS EA647), Team 'Vascular Biology and Red Blood Cell', University of Lyon 1, University of Lyon, Lyon, France.,Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Philippe Connes
- Center of Research and Innovation on Sports (CRIS EA647), Team 'Vascular Biology and Red Blood Cell', University of Lyon 1, University of Lyon, Lyon, France.,Laboratory of Excellence in Red Blood Cell (LABEX GR-Ex), PRES Sorbonne, Paris, France.,Institut Universitaire de France, Paris, France
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10
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Dahhan A. Coronary artery ectasia in atherosclerotic coronary artery disease, inflammatory disorders, and sickle cell disease. Cardiovasc Ther 2015; 33:79-88. [PMID: 25677643 DOI: 10.1111/1755-5922.12106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary artery ectasia (CAE) or aneurysm is usually defined as dilation ≥1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologies-mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.
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Affiliation(s)
- Ali Dahhan
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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11
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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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12
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Seegars MB, Brett AS. Splenic infarction associated with sickle cell trait at low altitude. Hematology 2015; 20:607-9. [DOI: 10.1179/1607845415y.0000000024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Allan S. Brett
- University of South Carolina School of Medicine, Columbia, SC, USA
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13
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Ulven SM, Foss SS, Skjølsvik AM, Stadheim HK, Myhrstad MC, Raael E, Sandvik M, Narverud I, Andersen LF, Jensen J, Holven KB. An acute bout of exercise modulate the inflammatory response in peripheral blood mononuclear cells in healthy young men. Arch Physiol Biochem 2015; 121:41-9. [PMID: 25720858 DOI: 10.3109/13813455.2014.1003566] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Exercise increases the levels of circulating inflammatory mediators. OBJECTIVE Does an acute bout of exercise affect the mRNA gene expression level of inflammatory markers in peripheral blood mononuclear cells (PBMCs) and contribute to the circulating levels of inflammatory mediators? MATERIALS AND METHODS Ten healthy, non-smoking men (22-28 years old) performed 1-hour cycling at 70% of VO2 max. RESULTS The gene transcripts of CXCL16, IL-1β, IL-8, COX-2, TXB21 and GATA3 were significantly up-regulated in PBMCs. Serum levels of CXCL16, IL-6, TNFα and IL-10 were also significantly increased after exercise. DISCUSSION AND CONCLUSION Increased mRNA transcription of inflammatory genes in PBMCs may contribute to increased level of inflammatory markers after an acute bout of exercise. The increased mRNA levels of GATA-3 and TXB21 may indicate that T cell lymphocytes are activated and secrete cytokines into the circulation. It needs to be further investigated if exercise changes the Th1/Th2 balance.
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Affiliation(s)
- Stine M Ulven
- Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences , St Olavsplass, Oslo , Norway
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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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15
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Faes C, Balayssac-Siransy E, Connes P, Hivert L, Danho C, Bogui P, Martin C, Pialoux V. Moderate endurance exercise in patients with sickle cell anaemia: effects on oxidative stress and endothelial activation. Br J Haematol 2013; 164:124-30. [DOI: 10.1111/bjh.12594] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/03/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Camille Faes
- CRIS EA647; Université de Lyon 1; Villeurbanne France
| | - Edwige Balayssac-Siransy
- Laboratoire de physiologie et d'explorations fonctionnelles; Unité de Formation et de Recherche en Sciences Médicales; Université Felix Houphouët Boigny; Abidjan Ivory Coast France
- Service des explorations fonctionnelles et endoscopiques; Centre hospitalier universitaire de Yopougon; Abidjan Ivory Coast France
| | - Philippe Connes
- UMR Inserm U665; Université des Antilles et de la Guyanne; Pointe à Pitre Guadeloupe France
- Laboratory of Excellence GR-Ex “The RedCell: from genesis to death”; PRES Sorbonne; Paris Cité France
- Laboratoire ACTES (EA3596); Département de physiologie; Université des Antilles et de la Guyanne; Pointe à Pitre Guadeloupe France
| | | | - Clotaire Danho
- Service des explorations fonctionnelles et endoscopiques; Centre hospitalier universitaire de Yopougon; Abidjan Ivory Coast France
| | - Pascal Bogui
- Laboratoire de physiologie et d'explorations fonctionnelles; Unité de Formation et de Recherche en Sciences Médicales; Université Felix Houphouët Boigny; Abidjan Ivory Coast France
- Service des explorations fonctionnelles et endoscopiques; Centre hospitalier universitaire de Yopougon; Abidjan Ivory Coast France
| | - Cyril Martin
- CRIS EA647; Université de Lyon 1; Villeurbanne France
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Yim ES, Friedberg RP. Case report: lower extremity deep vein thrombosis following an intense calf workout. Curr Sports Med Rep 2013; 11:282-6. [PMID: 23147014 DOI: 10.1249/jsr.0b013e318272c331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report a case of a high-performance athlete with hemoglobin SC who presented with asymmetric calf soreness after an intense calf workout. By ultrasonography, he was diagnosed with a deep vein thrombosis (DVT) of his right calf. Subsequently he presented with a number of sequelae of sickle cell disease: acute chest syndrome, avascular necrosis of the hips, and chronic kidney disease. The case is instructive as an example of DVT after exercise of the lower extremities, which has not been documented well. The case also illustrates a number of health sequelae of sickle cell disease that mimic more common musculoskeletal complaints. Sports medicine providers will have to consider these uncommon but profound diagnostic entities when caring for athletes with sickle cell disease. The case further highlights how research can inform the clinical decisions and policies aimed at reducing the risk of life-threatening and lifelong sequelae of sickle cell disease in athletes.
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Affiliation(s)
- Eugene S Yim
- Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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17
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Increase in IL-6, TNF-α, and MMP-9, but not sICAM-1, concentrations depends on exercise duration. Eur J Appl Physiol 2012; 113:851-8. [PMID: 22990627 DOI: 10.1007/s00421-012-2491-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 09/03/2012] [Indexed: 01/01/2023]
Abstract
It has been suggested that exercise intensity is of importance in the regulation of increase in pro-inflammatory molecules, but there is still a debate about the effect of duration on these molecules. Therefore, the effect of exercise duration on the serum concentrations of interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), soluble form of intercellular adhesion molecule-1 (sICAM-1), and matrix metalloproteinase-9 (MMP-9) was studied in 22 half-marathon (HM) and 18 marathon (M) male amateur runners who completed their exercise task in 1.8 ± 0.2 (mean ± standard deviation) and 3.6 ± 0.4 h, respectively (thus, average speed was 11.7 ± 1.5 and 11.9 ± 1.8 km h(-1), respectively). Blood was sampled 2 days before, 15 min after, and 28 h after the race. IL-6, TNF-α, and MMP-9 always increased immediately after exercise, but the increase was larger (P < 0.05) in M versus HM (∆IL-6: 31 ± 24 vs. 5 ± 4 pg ml(-1); ∆TNF-α: 1.7 ± 1.9 vs. 0.5 ± 0.8 pg ml(-1); MMP-9: 288 ± 216 vs. 145 ± 128 ng ml(-1), respectively). sICAM-1 also increased with exercise, but similarly in M and HM (20 ± 40 vs. 23 ± 32 ng ml(-1), respectively). Only sICAM-1 remained elevated 28 h post-exercise in both HM and M, while IL-6, TNF-α, and MMP-9 returned to pre-exercise levels. Competitive HM and M races induce significant increases in IL-6, TNF-α, sICAM-1, and MMP-9 concentrations. As HM and M runners performed the competition with similar absolute intensity, the difference in response between the groups suggests that exercise duration is of importance in the regulation of IL-6, TNF-α, and MMP-9, but not sICAM-1 concentrations in response to prolonged running.
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Vincent L, Oyono-Enguéllé S, Féasson L, Banimbek V, Dohbobga M, Martin C, Thiriet P, Francina A, Dubouchaud H, Sanchez H, Chapot R, Denis C, Geyssant A, Messonnier L. Effects of regular physical activity on skeletal muscle structural, energetic, and microvascular properties in carriers of sickle cell trait. J Appl Physiol (1985) 2012; 113:549-56. [DOI: 10.1152/japplphysiol.01573.2011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To assess the effects of regular physical activity on muscle functional characteristics of carriers of sickle cell trait (SCT), 39 untrained (U) and trained (T) hemoglobin (Hb)AA (CON) and SCT subjects (U-CON, n = 12; U-SCT, n = 8; T-CON, n = 10; and T-SCT, n = 9) performed a graded exercise and a time to exhaustion (Tex) test, and were subjected to a muscle biopsy. Maximal power, total work performed during Tex, citrate synthase and cytochrome c oxidase (COX) activities, respiratory chain complexes I and IV content, and capillary density (CD), diameter (COD), and surface area (CSA) were upregulated by the same proportion in T-CON and T-SCT compared with their untrained counterparts. These proportionally similar differences imply that the observed discrepancies between U-SCT and U-CON remained in the trained subjects. Specifically, both CD and COX remained and tended to remain lower, and both COD and CSA remained and tended to remain higher in T-SCT than in T-CON. Besides, carriers of SCT displayed specific adaptations with regular physical activity: creatine kinase activity; complexes II, III, and V content; and type I fiber surface area and capillary tortuosity were lower or unchanged in T-SCT than in U-SCT. In summary, our results show that 1) carriers of SCT adapted almost similarly to CON to regular physical activity for most of the studied muscle characteristics, 2) oxidative potential remains altered in physically active carriers of SCT compared with HbAA counterparts, and 3) the specific remodeling of muscle microvascular network persists in the trained state.
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Affiliation(s)
- Lucile Vincent
- Université de Savoie, Laboratoire de Physiologie de l'Exercice EA4338, Chambéry, France
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Samuel Oyono-Enguéllé
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Léonard Féasson
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
- Université de Lyon, Université Jean Monnet Saint-Etienne, Laboratoire de Physiologie de l'Exercice EA4338, Saint Etienne, France
| | - Viviane Banimbek
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Macias Dohbobga
- Institut National de la Jeunesse et des Sports, Yaoundé, Cameroun
| | - Cyril Martin
- Centre de Recherche et d'Innovation sur le Sport EA647, Université Claude Bernard Lyon 1, Université de Lyon, France
| | - Patrice Thiriet
- Centre de Recherche et d'Innovation sur le Sport EA647, Université Claude Bernard Lyon 1, Université de Lyon, France
| | - Alain Francina
- Unité Pathologie Moléculaire de l'Hémoglobine, Hospices Civils de Lyon, Lyon, France
| | - Hervé Dubouchaud
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, Grenoble, France
- Institut National de la Santé et de la Recherche Médicale U1055, Grenoble, France; and
| | - Hervé Sanchez
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Activités Physiques Militaires, La Tronche, France
| | - Rachel Chapot
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Activités Physiques Militaires, La Tronche, France
| | - Christian Denis
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
- Université de Lyon, Université Jean Monnet Saint-Etienne, Laboratoire de Physiologie de l'Exercice EA4338, Saint Etienne, France
| | - André Geyssant
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
- Université de Lyon, Université Jean Monnet Saint-Etienne, Laboratoire de Physiologie de l'Exercice EA4338, Saint Etienne, France
| | - Laurent Messonnier
- Université de Savoie, Laboratoire de Physiologie de l'Exercice EA4338, Chambéry, France
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19
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Faёs C, Martin C, Chirico EN, Féasson L, Oyonno-Enguelle S, Dubouchaud H, Francina A, Thiriet P, Pialoux V, Messonnier L. Effect of α-thalassaemia on exercise-induced oxidative stress in sickle cell trait. Acta Physiol (Oxf) 2012; 205:541-50. [PMID: 22409225 DOI: 10.1111/j.1748-1716.2012.02434.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/14/2011] [Accepted: 03/04/2012] [Indexed: 11/30/2022]
Abstract
AIM Alpha-thalassaemia is known to reduce intra-erythrocyte HbS (sickle haemoglobin) concentration in sickle cell trait (SCT) subjects. Because HbS was shown to increase oxidative stress, the purpose of this study was to assess the effects of the coexistence of α-thalassaemia and SCT on oxidative stress markers and nitric oxide (NO) metabolism after an acute physical exercise. METHODS Forty subjects (age: 23.5 ± 2.21 years), SCT carriers (HbAS) or healthy subjects (HbAA), with (-αT) or without (-NαT) an associated α-thalassaemia took part in the study. Plasma markers of oxidative stress [advanced oxidation protein products (AOPP), protein carbonyl, malondialdehyde (MDA) and nitrotyrosine], anti-oxidant defences and NO metabolism (NOx) were measured at rest (T(rest)), immediately following an incremental maximal exercise test (T(ex)) and during recovery (T(1h), T(2h) and T(24h)). RESULTS Malondialdehyde expressed as the percentage of changes from baseline was significantly higher in the HbAS-NαT compared with HbAS-αT during recovery (+36.3 ± 14.1% vs. -1.8 ± 13.2% at T(1h), P = 0.02; +36.6 ± 13.4% vs. -11.4 ± 12.5% at T(2h), P = 0.004 and +24.1 ± 12.3% vs. -14.4 ± 11.5% at T(24h), P = 0.02 in HbAS-NαT vs. HbAS-αT). Compared with HbAS-NαT, HbAS-αT had a higher NOx change from baseline at T(ex) (-23.4 ± 20.6% vs. +57.7 ± 19.3%, respectively; P = 0.005) and lower nitrotyrosine change from baseline at T(1h) (+7.2 ± 22.2% vs. +93.5%±29.3%, respectively; P = 0.04). CONCLUSION All these data suggest that the presence of α-thalassaemia may blunt the higher level of oxidative stress and the impaired bioavailability of NO observed in the SCT carriers.
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Affiliation(s)
- C. Faёs
- Center of Research and Innovation on Sports (CRIS EA647); University Claude Bernard Lyon 1; University of Lyon; Lyon; France
| | - C. Martin
- Center of Research and Innovation on Sports (CRIS EA647); University Claude Bernard Lyon 1; University of Lyon; Lyon; France
| | - E. N. Chirico
- Center of Research and Innovation on Sports (CRIS EA647); University Claude Bernard Lyon 1; University of Lyon; Lyon; France
| | | | - S. Oyonno-Enguelle
- Laboratory of Physiology; Faculty of Medicine and Biomedical Sciences; University of Yaounde I; Yaounde; Cameroon
| | | | - A. Francina
- Unit of Molecular Pathology of the Haemoglobin; Civilian Hospices of Lyon; Lyon; France
| | - P. Thiriet
- Center of Research and Innovation on Sports (CRIS EA647); University Claude Bernard Lyon 1; University of Lyon; Lyon; France
| | - V. Pialoux
- Center of Research and Innovation on Sports (CRIS EA647); University Claude Bernard Lyon 1; University of Lyon; Lyon; France
| | - L. Messonnier
- Laboratory of Exercise Physiology (LPE EA4338); University of Savoie; Chambery; France
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Reihmane D, Jurka A, Tretjakovs P. The Relationship Between Maximal Exercise-Induced Increases in Serum IL-6, MPO and MMP-9 Concentrations. Scand J Immunol 2012; 76:188-92. [DOI: 10.1111/j.1365-3083.2012.02720.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Fidler E. Sickle Cell Trait. Strength Cond J 2012. [DOI: 10.1519/ssc.0b013e3182453c41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Chirico EN, Martin C, Faës C, Féasson L, Oyono-Enguéllé S, Aufradet E, Dubouchaud H, Francina A, Canet-Soulas E, Thiriet P, Messonnier L, Pialoux V. Exercise training blunts oxidative stress in sickle cell trait carriers. J Appl Physiol (1985) 2012; 112:1445-53. [DOI: 10.1152/japplphysiol.01452.2011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to analyze the effects of exercise training on oxidative stress in sickle cell trait carriers. Plasma levels of oxidative stress [advanced oxidation protein products (AOPP), protein carbonyl, malondialdehyde (MDA), and nitrotyrosine], antioxidant markers [catalase, glutathione peroxidase (GPX), and superoxide dismutase (SOD)], and nitrite and nitrate (NOx) were assessed at baseline, immediately following a maximal exercise test (Tex), and during recovery (T1h, T2h, T24h) in trained (T: 8 h/wk minimum) and untrained (U: no regular physical activity) sickle cell trait (SCT) carriers or control (CON) subjects (T-SCT, n = 10; U-SCT, n = 8; T-CON, n = 11; and U-CON, n = 11; age: 23.5 ± 2.2 yr). The trained subjects had higher SOD activities (7.6 ± 5.4 vs. 5.2 ± 2.1 U/ml, P = 0.016) and lower levels of AOPP (142 ± 102 vs. 177 ± 102 μM, P = 0.028) and protein carbonyl (82.1 ± 26.0 vs. 107.3 ± 30.6 nm/ml, P = 0.010) than the untrained subjects in response to exercise. In response to exercise, U-SCT had a higher level of AOPP (224 ± 130 vs. 174 ± 121 μM, P = 0.012), nitrotyrosine (127 ± 29.1 vs.70.6 ± 46.6 nM, P = 0.003), and protein carbonyl (114 ± 34.0 vs. 86.9 ± 26.8 nm/ml, P = 0.006) compared with T-SCT. T-SCT had a higher SOD activity (8.50 ± 7.2 vs. 4.30 ± 2.5 U/ml, P = 0.002) and NOx (28.8 ± 11.4 vs. 14.6 ± 7.0 μmol·l−1·min−1, P = 0.003) in response to exercise than U-SCT. Our data indicate that the overall oxidative stress and nitric oxide response is improved in exercise-trained SCT carriers compared with their untrained counterparts. These results suggest that physical activity could be a viable method of controlling the oxidative stress. This could have a beneficial impact because of its involvement in endothelial dysfunction and subsequent vascular impairment in hemoglobin S carriers.
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Affiliation(s)
- Erica N. Chirico
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
- CarMeN, INSERM, University Claude Bernard Lyon 1, Faculty of Medicine Lyon Sud, Oullins
| | - Cyril Martin
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Camille Faës
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Léonard Féasson
- Laboratory of Exercise Physiology, University of Savoie and University of Saint-Etienne, Le Bourget du Lac and Saint-Etienne, France
- Unit of Myology, University Hospital Center of Saint Etienne, France
| | - Samuel Oyono-Enguéllé
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Emeline Aufradet
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Hervé Dubouchaud
- Laboratoire de Bioénergétique Fondamentale et Appliquée, INSERM, University Joseph Fourier, Grenoble; and
| | - Alain Francina
- Unité de Pathologie Moléculaire de l'Hémoglobine, Hospices Civils de Lyon, Lyon, France
| | | | - Patrice Thiriet
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Laurent Messonnier
- Laboratory of Exercise Physiology, University of Savoie and University of Saint-Etienne, Le Bourget du Lac and Saint-Etienne, France
| | - Vincent Pialoux
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
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Goldsmith JC, Bonham VL, Joiner CH, Kato GJ, Noonan AS, Steinberg MH. Framing the research agenda for sickle cell trait: building on the current understanding of clinical events and their potential implications. Am J Hematol 2012; 87:340-6. [PMID: 22307997 PMCID: PMC3513289 DOI: 10.1002/ajh.22271] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 12/01/2011] [Indexed: 02/02/2023]
Abstract
Sickle Cell Trait (HbAS), the heterozygous state for the sickle hemoglobin beta globin gene is carried by as many as 100 million individuals including up to 25% of the population in some regions of the world (World Health Organization, Provisional agenda item 4.8, EB117/34 (22 December 2005) or World Health Organization, Provisional agenda item 11.4 (24 April 2006)). Persons with HbAS have some resistance to falciparum malaria infection in early childhood (Piel FB, Patil AP, Howes RE, et al., Nat Commun 2010;1104:1-7 and Aidoo M, Terlouw DJ, Kolczak M, et al., Lancet 2002;359:1311-1312) and as a result individuals with HbAS living in malarial endemic regions of Africa have a survival advantage over individuals with HbAA. Reports from the US emphasize possible health risks for individuals with HbAS including increased incidence of renal failure and malignancy, thromboembolic disorders, splenic infarction as a high altitude complication, and exercise-related sudden death. The National Heart, Lung, and Blood Institute, National Institutes of Health convened a workshop in Bethesda, Maryland on June 3-4, 2010, Framing the Research Agenda for Sickle Cell Trait, to review the clinical manifestations of HbAS, discuss the exercise-related sudden death reports in HbAS, and examine the public health, societal, and ethical implications of policies regarding HbAS. The goal of the workshop was to identify potential research questions to address knowledge gaps.
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Affiliation(s)
- Jonathan C Goldsmith
- Blood Diseases Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-7950, USA.
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Abstract
This article highlights the exertional-sickling collapse syndrome in athletes with sickle cell trait (SCT). It covers all aspects of this syndrome, including pathophysiology, new research on microcirculatory changes, clinical features, differential diagnosis, prevention, and treatment. Also covered in this article are other clinical concerns for athletes with SCT, including lumbar myonecrosis, splenic infarction, hematuria, hyposthenuria, and venous thromboembolism. The final section offers practical points on athletes with sickling hemoglobinopathies more serious than SCT.
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Affiliation(s)
- E Randy Eichner
- OU Sooner Football, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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25
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Beltan É, Chalabi T, Tripette J, Chout R, Connes P. Coagulation responses after a submaximal exercise in sickle cell trait carriers. Thromb Res 2011; 127:167-9. [DOI: 10.1016/j.thromres.2010.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/06/2010] [Accepted: 09/09/2010] [Indexed: 11/24/2022]
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AUFRADET EMELINE, MONCHANIN GÉRALDINE, OYONNO-ENGELLE SAMUEL, FEASSON LÉONARD, MESSONNIER LAURENT, FRANCINA ALAIN, BEZIN LAURENT, SERPERO LAURAD, GOZAL DAVID, DODOGBA MACIAS, WOUASSI DIEUDONNÉ, BANIMBECK VIVIANE, DJODA BERNARD, THIRIET PATRICE, MARTIN CYRIL. Habitual Physical Activity and Endothelial Activation in Sickle Cell Trait Carriers. Med Sci Sports Exerc 2010; 42:1987-94. [DOI: 10.1249/mss.0b013e3181e054d6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Alexy T, Sangkatumvong S, Connes P, Pais E, Tripette J, Barthelemy JC, Fisher TC, Meiselman HJ, Khoo MC, Coates TD. Sickle cell disease: selected aspects of pathophysiology. Clin Hemorheol Microcirc 2010; 44:155-66. [PMID: 20364061 DOI: 10.3233/ch-2010-1270] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sickle cell disease (SCD), a genetically-determined pathology due to an amino acid substitution (i.e., valine for glutamic acid) on the beta-chain of hemoglobin, is characterized by abnormal blood rheology and periods of painful vascular occlusive crises. Sickle cell trait (SCT) is a typically benign variant in which only one beta chain is affected by the mutation. Although both SCD and SCT have been the subject of numerous studies, information related to neurological function and transfusion therapy is still incomplete: an overview of these areas is presented. An initial section provides pertinent background information on the pathology and clinical significance of these diseases. The roles of three factors in the clinical manifestations of the diseases are then discussed: hypoxia, autonomic nervous system regulation and blood rheology. The possibility of a causal relationship between these three factors and sudden death is also examined. It is concluded that further studies in these specific areas are warranted. It is anticipated that the outcome of such research is likely to provide valuable insights into the pathophysiology of SCD and SCT and will lead to improved clinical management and enhanced quality of life.
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Affiliation(s)
- T Alexy
- Department of Physiology and Biophysics, Keck School of Medicine, Los Angeles, CA 90033, USA.
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Vincent L, Féasson L, Oyono-Enguéllé S, Banimbek V, Monchanin G, Dohbobga M, Wouassi D, Martin C, Gozal D, Geyssant A, Thiriet P, Denis C, Messonnier L. Skeletal muscle structural and energetic characteristics in subjects with sickle cell trait, α-thalassemia, or dual hemoglobinopathy. J Appl Physiol (1985) 2010; 109:728-34. [DOI: 10.1152/japplphysiol.00349.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Previous studies have shown that subjects with sickle cell trait (SCT), α-thalassemia (α-t), and the dual hemoglobinopathy (SCT/α-t) manifest subtle, albeit significant, differences during exercise. To better understand such differences, we assessed skeletal muscle histomorphological and energetic characteristics in 10 control HbAA subjects (C), 5 subjects with α-t (α-t), 6 SCT carriers (SCT) and 9 SCT carriers with α-t (SCT/α-t). Subjects underwent a muscle biopsy and also performed an incremental maximal exercise and a time to exhaustion test. There were no observable differences in daily energy expenditure, maximal power output (Pmax), or time to exhaustion at 110% Pmax ( Tex) among the groups. Blood lactate concentrations measured at the end of the Tex, muscle fiber type distribution, and mean phosphofructokinase (PFK), lactate dehydrogenase (LDH), β-hydroxyacyl-CoA-dehydrogenase (HAD), and citrate synthase (CS) activities were all similar among the four groups. However, SCT was associated with a lower cytochrome- c oxidase (COx) activity in type IIa fibers ( P < 0.05), and similar trends were observed in fiber types I and IIx. Trends toward lower creatine kinase (CK) activity ( P = 0.0702) and higher surface area of type IIx fibers were observed in SCT ( P = 0.0925). In summary, these findings support most of the previous observations in SCT, such as 1) similar maximal power output and associated maximal oxygen consumption (V̇o2max) values and 2) lower exercise performances during prolonged submaximal exercise. Furthermore, performances during short supramaximal exercise were not different in SCT. Finally, the dual hemoglobinopathy condition does not seem to affect muscle characteristics.
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Affiliation(s)
- Lucile Vincent
- Laboratoire de Physiologie de l'Exercice EA4338, Université de Savoie, Chambéry and
| | - Léonard Féasson
- Laboratoire de Physiologie de l'Exercice EA4338, Université Jean Monnet and
- Unité de Myologie, Centre Hospitalier Universitaire (CHU) de Saint-Etienne, Saint-Etienne, France
| | - Samuel Oyono-Enguéllé
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Viviane Banimbek
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Géraldine Monchanin
- Centre de Recherche et d'Innovation sur le Sport (CRIS) EA647, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Macias Dohbobga
- Institut National de la Jeunesse et des Sports, Yaoundé, Cameroon; and
| | - Dieudonné Wouassi
- Institut National de la Jeunesse et des Sports, Yaoundé, Cameroon; and
| | - Cyril Martin
- Centre de Recherche et d'Innovation sur le Sport (CRIS) EA647, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - André Geyssant
- Laboratoire de Physiologie de l'Exercice EA4338, Université Jean Monnet and
| | - Patrice Thiriet
- Centre de Recherche et d'Innovation sur le Sport (CRIS) EA647, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Christian Denis
- Laboratoire de Physiologie de l'Exercice EA4338, Université Jean Monnet and
- Unité de Myologie, Centre Hospitalier Universitaire (CHU) de Saint-Etienne, Saint-Etienne, France
| | - Laurent Messonnier
- Laboratoire de Physiologie de l'Exercice EA4338, Université de Savoie, Chambéry and
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Tripette J, Loko G, Samb A, Gogh BD, Sewade E, Seck D, Hue O, Romana M, Diop S, Diaw M, Brudey K, Bogui P, Cissé F, Hardy-Dessources MD, Connes P. Effects of hydration and dehydration on blood rheology in sickle cell trait carriers during exercise. Am J Physiol Heart Circ Physiol 2010; 299:H908-14. [DOI: 10.1152/ajpheart.00298.2010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study compared the hemorheological responses of a group of sickle cell trait (SCT) carriers with those of a control (Cont) group in response to 40 min of submaximal exercise (exercise intensity, 55% aerobic peak power) performed in two conditions: one with water offered ad libitum, i.e., the hydration (Hyd) condition, and one without water, i.e., the dehydration (Dehyd) condition. Blood and plasma viscosities, as well as red blood cell rigidity, were determined at rest, at the end of exercise, and at 2 h recovery with a cone plate viscometer at high shear rate and 37°C. The SCT and Cont groups lost 1 ± 0.7 and 1.6 ± 0.6 kg of body weight, respectively, in the Dehyd condition, indicating a significant effect of water deprivation compared with the Hyd condition, in which body weight remained unchanged. Plasma viscosity increased with exercise and returned to baseline during recovery independently of the group and condition. As previously demonstrated, resting blood viscosity was greater in the SCT carriers than in the Cont group. Blood viscosity increased by the end of exercise and returned to baseline at 2 h recovery in the Cont group in both conditions. The blood viscosity of SCT carriers did not change in response to exercise in the Dehyd condition and remained elevated at 2 h recovery. This extended hyperviscosity, in association with other biological changes induced by exercise, could be considered as a risk factor for exercise-related events in SCT carriers, similar to vasoocclusive crises, notably during the recovery. In contrast, the Hyd condition normalized the hyperviscosity and red blood cell rigidity of the SCT carriers, with blood viscosity values reaching the same lower values as those found in the Cont group during the recovery. Adequate hydration of SCT carriers should be strongly promoted to reduce the clinical risk associated with potential hyperviscosity complications.
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Affiliation(s)
- Julien Tripette
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Gylna Loko
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Centre Intégré de la Drépanocytose, CH du Lamentin, Martinique-Centre de Références Maladies Rares Antilles-Guyane
| | - Abdoulaye Samb
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Bertin Doubi Gogh
- Laboratoire de Physiologie et d'Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université de Cocody, Abidjan, Côte d'Ivoire
| | - Estelle Sewade
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Djibril Seck
- Institut National Supérieur de l'Education Populaire et du Sport, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Olivier Hue
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Marc Romana
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Saliou Diop
- Centre National de Transfusion Sanguine, Dakar, Sénégal
| | - Mor Diaw
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Karine Brudey
- Unité Transversale de la Drépanocytose, Centre Hospitalier Universitaire, Pointe-à-Pitre, Guadeloupe-Centre de Références Maladies Rares Antilles-Guyane
| | - Pascal Bogui
- Laboratoire de Physiologie et d'Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université de Cocody, Abidjan, Côte d'Ivoire
| | - Fallou Cissé
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Marie-Dominique Hardy-Dessources
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Philippe Connes
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
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Vincent L, Féasson L, Oyono-Enguéllé S, Banimbek V, Denis C, Guarneri C, Aufradet E, Monchanin G, Martin C, Gozal D, Dohbobga M, Wouassi D, Garet M, Thiriet P, Messonnier L. Remodeling of skeletal muscle microvasculature in sickle cell trait and alpha-thalassemia. Am J Physiol Heart Circ Physiol 2009; 298:H375-84. [PMID: 19915173 DOI: 10.1152/ajpheart.00812.2009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The influence of sickle cell trait and/or alpha-thalassemia on skeletal muscle microvascular network characteristics was assessed and compared with control subjects [hemoglobin (Hb) AA] in 30 Cameroonian residents [10 HbAA, 5 HbAA alpha-thalassemia (alpha-t), 6 HbAS, and 9 HbASalpha-t] matched for maximal work capacity and daily energy expenditure. Subjects performed an incremental exercise to exhaustion and underwent a muscle biopsy. Muscle fiber type and surface area were not different among groups. However, sickle cell trait (SCT) was associated with lower capillary density (P < 0.05), lower capillary tortuosity (P < 0.001), and enlarged microvessels (P < 0.01). SCT carriers had reduced counts of microvessels <5-microm diameter, but a higher percentage of broader microvessels, i.e., diameter >10 microm (P < 0.05). alpha-Thalassemia seemed to be characterized by a higher capillary tortuosity and unchanged capillary density and diameter. Thus, while SCT is a priori clinically benign, we demonstrate for the first time that significant remodeling of the microvasculature occurs in SCT carriers. These modifications may possibly reflect protective adaptations against hemorheological and microcirculatory dysfunction induced by the presence of HbS. The remodeling of the microvascular network occurs to a lesser extent in alpha-thalassemia. In alpha-thalassemic subjects, increased capillary tortuosity would promote oxygen supply to muscle tissues and might compensate for the lower Hb content often reported in those subjects.
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Affiliation(s)
- Lucile Vincent
- Laboratoire de Physiologie de l'Exercice, Université de Savoie, Chambéry, France
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HEDREVILLE MONA, CONNES PHILIPPE, ROMANA MARC, MAGNAVAL GUILLAUME, DAVID THIERRY, HARDY-DESSOURCES MARIEDOMINIQUE, BELLOY MARIESYLVAINE, ETIENNE-JULAN MARYSE, HUE OLIVIER. Central Retinal Vein Occlusion in a Sickle Cell Trait Carrier after a Cycling Race. Med Sci Sports Exerc 2009; 41:14-8. [DOI: 10.1249/mss.0b013e31818313d0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Baskurt OK, Meiselman HJ, Bergeron MF. Re: Point:Counterpoint: Sickle cell trait should/should not be considered asymptomatic and as a benign condition during physical activity. J Appl Physiol (1985) 2008; 103:2142; author reply 2143-4. [PMID: 18056523 DOI: 10.1152/japplphysiol.00886.2007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Connes P, Reid H, Hardy-Dessources MD, Morrison E, Hue O. Physiological Responses of Sickle Cell Trait Carriers during Exercise. Sports Med 2008; 38:931-46. [DOI: 10.2165/00007256-200838110-00004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Alterations of blood rheology during and after exercise are both consequences and modifiers of body's adaptation to muscular activity. Sci Sports 2007. [DOI: 10.1016/j.scispo.2007.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Le Gallais D, Lonsdorfer J, Bogui P, Fattoum S. Last Word on Point:Counterpoint “Sickle cell trait should/should not be considered asymptomatic and as a benign condition during physical activity”. J Appl Physiol (1985) 2007. [DOI: 10.1152/japplphysiol.00981.2007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
OBJECTIVE To determine if the time courses of hemorheologic parameters are different between carriers of sickle cell trait (SCT) and subjects with normal hemoglobin in response to exercise. DESIGN Observational and comparative study. SETTING Testing was conducted in a laboratory of exercise physiology. PARTICIPANTS Nine carriers of sickle cell trait (SCT group) and 7 subjects with normal hemoglobin (CONT group) performed an exercise protocol of the repetition of 3 successive maximal ramp exercise tests. INTERVENTIONS Blood was sampled at rest (TR), at the end of each of the 3 tests (T1, T2, T3), and during the immediate (T2h) and late (T24h, T48h) recovery periods. MAIN OUTCOME MEASUREMENTS Blood and plasma viscosity (etab and etap, respectively), hematocrit (Hct), and red blood cell (RBC) rigidity (Tk and k indexes) were determined. RESULTS In both groups, etab significantly increased in response to exercise but the SCT group had significantly higher etab at T3 and T2h. etab then returned to baseline value at T2h in the CONT group and at T24h in the SCT group. Tk and k were not changed by exercise but significantly increased above baseline value in both groups at T24h and T48h. The increase in Tk and k during late recovery was higher in the SCT group than in the CONT group, indicating that SCT carriers had significantly higher RBC rigidity than the CONT group at that time. CONCLUSIONS The hemorheologic changes induced by exercise in the SCT carriers could trigger microcirculatory disorders during the recovery.
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