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Malheiro LFL, Fernandes MM, Oliveira CA, Barcelos IDS, Fernandes AJV, Silva BS, Ávila JS, Soares TDJ, Amaral LSDB. Renoprotective mechanisms of exercise training against acute and chronic renal diseases - A perspective based on experimental studies. Life Sci 2024; 346:122628. [PMID: 38614303 DOI: 10.1016/j.lfs.2024.122628] [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] [Received: 11/23/2023] [Revised: 03/22/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
Regular exercise training can lead to several health benefits, reduce mortality risk, and increase life expectancy. On the other hand, a sedentary lifestyle is a known risk factor for chronic diseases and increased mortality. Acute kidney injury (AKI) and chronic kidney disease (CKD) represent a significant global health problem, affecting millions of people worldwide. The progression from AKI to CKD is well-recognized in the literature, and exercise training has emerged as a potential renoprotective strategy. Thus, this article aims to review the main molecular mechanisms underlying the renoprotective actions of exercise training in the context of AKI and CKD, focusing on its antioxidative, anti-inflammatory, anti-apoptotic, anti-fibrotic, and autophagy regulatory effects. For that, bibliographical research was carried out in Medline/PubMed and Scielo databases. Although the pathophysiological mechanisms involved in renal diseases are not fully understood, experimental studies demonstrate that oxidative stress, inflammation, apoptosis, and dysregulation of fibrotic and autophagic processes play central roles in the development of tissue damage. Increasing evidence has suggested that exercise can beneficially modulate these mechanisms, potentially becoming a safe and effective non-pharmacological strategy for kidney health protection and promotion. Thus, the evidence base discussed in this review suggests that an adequate training program emerges as a valuable tool for preserving renal function in experimental animals, mainly through the production of antioxidant enzymes, nitric oxide (NO), irisin, IL-10, and IL-11. Future research can continue to explore these mechanisms to develop specific guidelines for the prescription of exercise training in different populations of patients with kidney diseases.
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Affiliation(s)
- Lara Fabiana Luz Malheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil
| | - Mariana Masimessi Fernandes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Caroline Assunção Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil
| | - Isadora de Souza Barcelos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Ana Jullie Veiga Fernandes
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Bruna Santos Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Júlia Spínola Ávila
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil; Programa de Pós-Graduação em Biociências, Brazil
| | - Liliany Souza de Brito Amaral
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Bahia 45029-094, Brazil; Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Brazil; Programa de Pós-Graduação em Biociências, Brazil.
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Saberi S, Askaripour M, Khaksari M, Amin Rajizadeh M, Abbas Bejeshk M, Akhbari M, Jafari E, Khoramipour K. Exercise training improves diabetic renal injury by reducing fetuin-A, oxidative stress and inflammation in type 2 diabetic rats. Heliyon 2024; 10:e27749. [PMID: 38510054 PMCID: PMC10951597 DOI: 10.1016/j.heliyon.2024.e27749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Background Diabetic kidney disease (DKD) stands as a primary contributor to end-stage renal disease, associated with heightened mortality in cardiovascular diseases. This study aimed to explore the impact of an eight-week high-intensity interval training (HIIT) on renal injury in diabetic rats. Methods Twenty-eight male Wistar rats were randomly allocated into four groups: healthy control (CTL), diabetic control (DC), exercise (EX), and diabetes-exercise (D + EX). Induction of diabetes in the DC and D + EX groups occurred through a two-month high-fat diet followed by a single dose of 35 mg/kg streptozotocin (STZ). Rats in the EX and D + EX groups underwent 4-10 intervals of HIIT (80-100% Vmax) over 8 weeks. Subsequently, pathological and biochemical parameters were assessed in the serum and kidney tissue of the experimental groups. Results In the DC group, diabetes led to elevated kidney damage, glomerulosclerosis, fasting blood glucose (FBG), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index, animal weight, kidney dysfunction, albuminuria, and glomerular filtration rate. Additionally, serum and kidney levels of fetuin-A increased, along with kidney levels of KIM-1. Mechanistically, diabetes induction resulted in kidney inflammation by elevating levels of tumor necrosis factor-alpha (TNF-α), transforming growth factor beta (TGF-β), and interleukin 6 (IL-6), while reducing IL-10 levels and increasing the IL-6/IL-10 ratio. Furthermore, diabetes triggered renal oxidative stress, evidenced by increased Malondialdehyde (MDA) levels and decreased levels of glutathione peroxidase (GPx), catalase, and superoxide dismutase (SOD). HIIT mitigated the adverse effects of diabetes in the D + EX group compared to the DC group. Conclusion Our findings suggest that HIIT ameliorates type 2 diabetes (T2D)-induced kidney damage by mitigating inflammation, lowering serum levels of fetuin-A, and bolstering antioxidant defenses. This study highlights the potential of HIIT as a time-efficient intervention for diabetic nephropathy.
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Affiliation(s)
- Shadan Saberi
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Askaripour
- Department of Physiology, School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Mohammad Khaksari
- Endocrinology and Metabolism Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Amin Rajizadeh
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Abbas Bejeshk
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Akhbari
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Jafari
- Department of Pathology, Pathology and Stem Cell Research Center, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Kayvan Khoramipour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Li RY, Guo L. Exercise in Diabetic Nephropathy: Protective Effects and Molecular Mechanism. Int J Mol Sci 2024; 25:3605. [PMID: 38612417 PMCID: PMC11012151 DOI: 10.3390/ijms25073605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Diabetic nephropathy (DN) is a serious complication of diabetes, and its progression is influenced by factors like oxidative stress, inflammation, cell death, and fibrosis. Compared to drug treatment, exercise offers a cost-effective and low-risk approach to slowing down DN progression. Through multiple ways and mechanisms, exercise helps to control blood sugar and blood pressure and reduce serum creatinine and albuminuria, thereby alleviating kidney damage. This review explores the beneficial effects of exercise on DN improvement and highlights its potential mechanisms for ameliorating DN. In-depth understanding of the role and mechanism of exercise in improving DN would pave the way for formulating safe and effective exercise programs for the treatment and prevention of DN.
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Affiliation(s)
- Ruo-Ying Li
- School of Exercise and Health, Collaborative Innovation Center for Sports and Public Health, Shanghai University of Sport, Shanghai 200438, China;
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai 200438, China
- Key Laboratory of Exercise and Health Sciences of the Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
| | - Liang Guo
- School of Exercise and Health, Collaborative Innovation Center for Sports and Public Health, Shanghai University of Sport, Shanghai 200438, China;
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai 200438, China
- Key Laboratory of Exercise and Health Sciences of the Ministry of Education, Shanghai University of Sport, Shanghai 200438, China
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Salehpoor Z, Rezapourmoghadam M, Tanideh N, Jahromi MK. The effect of pentoxifylline and different types of exercise training on coagulation factors in a rat endometriosis model. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100292. [PMID: 38419652 PMCID: PMC10899071 DOI: 10.1016/j.eurox.2024.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives This study evaluated the effects of high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), and pentoxifylline (PTX) on coagulation factors, including the amount and percentage of lymphocytes, PLC, PLR, aPTT, PT, PT.I.N. R in a model of rats with endometriosis. Methods Endometriosis was surgically induced in female Sprague-Dawley rats. The rats with confirmed endometrial implants were divided into control, MICT, pentoxifylline (D), HIIT+D, and MICT+D, HIIT groups. D and exercise interventions were performed for eight weeks. Then, the macroscopic size of endometriosis lesions was measured, and inflammatory factors (count and percentage of lymphocytes) and coagulation factors, including PLC, PLR, aPTT, PT, PT.I.N. R, and PLR in blood samples were evaluated. Results D significantly decreased the volume of lesions and significantly increased PT and PT.I.N. R in blood. HIIT decreased the volume of lesions and significantly increased PT. MICT did not cause significant effects on the target variables. MICT+D decreased the volume of lesions. HIIT+D significantly decreased the volume of lesions and PLC and increased aPTT as well as the count and percentage of lymphocytes, PT, and PT.I.N. R, and decreased PLR. Conclusions All interventions(except for MICT) especially HIIT+D and D by priority, induced a significant effect on reducing some indices of inflammation and coagulation.
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Affiliation(s)
- Zahra Salehpoor
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Mohamad Rezapourmoghadam
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Nader Tanideh
- Stem Cells Technology Research Center, Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Iran
| | - Maryam Koushkie Jahromi
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Shiraz, Iran
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Costanti-Nascimento AC, Brelaz-Abreu L, Bragança-Jardim E, Pereira WDO, Camara NOS, Amano MT. Physical exercise as a friend not a foe in acute kidney diseases through immune system modulation. Front Immunol 2023; 14:1212163. [PMID: 37928533 PMCID: PMC10623152 DOI: 10.3389/fimmu.2023.1212163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
Regular and moderate exercise is being used for therapeutic purposes in treating several diseases, including cancer, cardiovascular diseases, arthritis, and even chronic kidney diseases (CKDs). Conversely, extenuating physical exercise has long been pointed out as one of the sources of acute kidney injury (AKI) due to its severe impact on the body's physiology. AKI development is associated with increased tubular necrosis, which initiates a cascade of inflammatory responses. The latter involves cytokine production, immune cell (macrophages, lymphocytes, and neutrophils, among others) activation, and increased oxidative stress. AKI can induce prolonged fibrosis stimulation, leading to CKD development. The need for therapeutic alternative treatments for AKI is still a relevant issue. In this context arises the question as to whether moderate, not extenuating, exercise could, on some level, prevent AKI. Several studies have shown that moderate exercise can help reduce tissue damage and increase the functional recovery of the kidneys after an acute injury. In particular, the immune system can be modulated by exercise, leading to a better recovery from different pathologies. In this review, we aimed to explore the role of exercise not as a trigger of AKI, but as a modulator of the inflammatory/immune system in the prevention or recovery from AKI in different scenarios. In AKI induced by ischemia and reperfusion, sepsis, diabetes, antibiotics, or chemotherapy, regular and/or moderate exercise could modulate the immune system toward a more regulatory immune response, presenting, in general, an anti-inflammatory profile. Exercise was shown to diminish oxidative stress, inflammatory markers (caspase-3, lactate dehydrogenase, and nitric oxide), inflammatory cytokines (interleukin (IL)-1b, IL-6, IL-8, and tumor necrosis factor-α (TNF-α)), modulate lymphocytes to an immune suppressive phenotype, and decrease tumor necrosis factor-β (TGF-β), a cytokine associated with fibrosis development. Thus, it creates an AKI recovery environment with less tissue damage, hypoxia, apoptosis, or fibrosis. In conclusion, the practice of regular moderate physical exercise has an impact on the immune system, favoring a regulatory and anti-inflammatory profile that prevents the occurrence of AKI and/or assists in the recovery from AKI. Moderate exercise should be considered for patients with AKI as a complementary therapy.
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Affiliation(s)
- Ana Carolina Costanti-Nascimento
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Leonilia Brelaz-Abreu
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Welbert de Oliveira Pereira
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Niels Olsen Saraiva Camara
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Mariane Tami Amano
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, Brazil
- Departamento de Oncologia Clínica e Experimental, Escola Paulista de Medicina (UNIFESP), São Paulo, Brazil
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Muñoz-Diosdado A, Solís-Montufar ÉE, Zamora-Justo JA. Visibility Graph Analysis of Heartbeat Time Series: Comparison of Young vs. Old, Healthy vs. Diseased, Rest vs. Exercise, and Sedentary vs. Active. ENTROPY (BASEL, SWITZERLAND) 2023; 25:e25040677. [PMID: 37190463 PMCID: PMC10137780 DOI: 10.3390/e25040677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Using the visibility graph algorithm (VGA), a complex network can be associated with a time series, such that the properties of the time series can be obtained by studying those of the network. Any value of the time series becomes a node of the network, and the number of other nodes that it is connected to can be quantified. The degree of connectivity of a node is positively correlated with its magnitude. The slope of the regression line is denoted by k-M, and, in this work, this parameter was calculated for the cardiac interbeat time series of different contrasting groups, namely: young vs. elderly; healthy subjects vs. patients with congestive heart failure (CHF); young subjects and adults at rest vs. exercising young subjects and adults; and, finally, sedentary young subjects and adults vs. active young subjects and adults. In addition, other network parameters, including the average degree and the average path length, of these time series networks were also analyzed. Significant differences were observed in the k-M parameter, average degree, and average path length for all analyzed groups. This methodology based on the analysis of the three mentioned parameters of complex networks has the advantage that such parameters are very easy to calculate, and it is useful to classify heartbeat time series of subjects with CHF vs. healthy subjects, and also for young vs. elderly subjects and sedentary vs. active subjects.
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Affiliation(s)
- Alejandro Muñoz-Diosdado
- Instituto Politécnico Nacional, Unidad Profesional Interdisciplinaria de Biotecnología, Mexico City 07340, Mexico
| | - Éric E Solís-Montufar
- Instituto Politécnico Nacional, Unidad Profesional Interdisciplinaria de Biotecnología, Mexico City 07340, Mexico
| | - José A Zamora-Justo
- Instituto Politécnico Nacional, Unidad Profesional Interdisciplinaria de Biotecnología, Mexico City 07340, Mexico
- Instituto Tecnológico de Santo Domingo (INTEC), Santo Domingo 10602, Dominican Republic
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Salehpoor Z, Jahromi BN, Tanideh N, Nemati J, Akbarzade-Jahromi M, Jahromi MK. High intensity interval training is superior to moderate intensity continuous training in enhancing the anti-inflammatory and apoptotic effect of pentoxifylline in the rat model of endometriosis. J Reprod Immunol 2023; 156:103832. [PMID: 36812774 DOI: 10.1016/j.jri.2023.103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
This study investigated the effects of pentoxifylline (PTX), high intensity interval training (HIIT) and moderate intensity continuous training (MICT) separately and in combination, on inflammatory and apoptotic pathways in the rat model of induced endometriosis. Endometriosis was induced through surgery on female Sprague-Dawley rats. Six weeks after the first surgery, the second look laparotomy was performed. After induction of endometriosis in rats, they were divided into control, MICT, PTX, MICT+ PTX, HIIT, HIIT+PTX groups. Two weeks after the second look laparotomy, PTX and exercise training interventions were performed for eight weeks. Endometriosis lesions were assessed histologically. Proteins content of the NF-κB, PCNA and Bcl-2 were measured by immunoblotting and genes expression of the TNF-α and VEGF were measured by Real-time PCR methods. Findings of the study indicated that, PTX significantly decreased volume and histological grading of lesions, proteins of NF-κB and Bcl-2; and genes expression of the TNF-α, and VEGF in lesions. HIIT significantly decreased volume and histological grading of lesions, NF-κB, TNF-α and VEGF in lesions. MICT did not induce any significant effect on the study variables. Although, MICT+PTX decreased significantly volume and histological grading of lesions, as well as NF-κB, and Bcl-2 in lesions, however, these factors were not significantly different with the PTX group. HIIT+PTX decreased significantly all of the study variables compared to other interventions, except for VEGF when compared to PTX. In summary, combination of PTX and HIIT can induce enhancing effect on suppression of endometriosis through suppressing inflammation, angiogenesis, and proliferation and enhancing apoptosis.
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Affiliation(s)
- Zahra Salehpoor
- Department of Sport Sciences, Shiraz University, Shiraz, Iran.
| | - Bahia Namavar Jahromi
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Nader Tanideh
- Stem Cells Technology Research Center, Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Javad Nemati
- Department of Sport Sciences, Shiraz University, Shiraz, Iran.
| | - Mojgan Akbarzade-Jahromi
- Maternal-fetal medicine Research Center, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Oliveira CA, Mercês ÉAB, Portela FS, De Benedictis JM, De Benedictis LM, da Silva AVB, Campanati JDAG, de Melo FF, Oliveira MV, de Magalhães ACM, Soares TDJ, Amaral LSDB. Benefits of high-intensity interval training compared to continuous training to reduce apoptotic markers in female rats with cisplatin nephrotoxicity - possible modulatory role of IL-11. Apoptosis 2023; 28:566-575. [PMID: 36653732 DOI: 10.1007/s10495-023-01816-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
Apoptotic signaling pathways are involved in acute kidney injury (AKI) induced by the antineoplastic drug cisplatin (Cis). Mechanical stress is known to increase interleukin (IL) -11, a pleiotropic cytokine with antiapoptotic and antinecrotic effects. We compared the impact of high-intensity interval training (HIIT) with low-intensity continuous training (LICT) and moderate-intensity continuous training (MICT) on renal levels of IL-11 and the expression of apoptotic markers in female rats with nephrotoxicity induced by Cis. For that, the animals were divided into five groups (n = 7): control and sedentary (C + S); Cis and sedentary (Cis + S); Cis and LICT (Cis + LICT); Cis and MICT (Cis + MICT) and Cis and HIIT (Cis + HIIT). At the end of 8 weeks of treadmill running, the rats received a single injection of Cis (5 mg/kg), and 7 days later they were euthanized. Serum and kidney samples were collected to assess the blood urea nitrogen (BUN), gene expression of TNF receptor 1 (TNFR1) and 2 (TNFR2), caspase-3, (p38) MAPK (MAPK14), p53, Bax, Bak, Bcl-2, and Bcl-xL, renal levels of IL-11, IL-8, and p53, and immunolocalization of cleaved caspase-3, Bax, Bcl-2, and (p38) MAPK in renal tissue. Our data indicate that all trained groups showed a significant intensity-dependent increase in renal levels of IL-11 associated with reduced local expression of proapoptotic and increased antiapoptotic markers, but these effects were more pronounced with HIIT. So, HIIT appears to provide superior renoprotection than traditional continuous training by modulating apoptotic signaling pathways, and this effect can be related to the increase in renal levels of IL-11.
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Affiliation(s)
- Caroline Assunção Oliveira
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Érika Azenathe Barros Mercês
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Fernanda Santos Portela
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Júlia Mafra De Benedictis
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Laís Mafra De Benedictis
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Antônio Victor Brito da Silva
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - João de Assis Gonçalves Campanati
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Amélia Cristina Mendes de Magalhães
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil
| | - Liliany Souza de Brito Amaral
- Instituto Multidisciplinar em Saúde, Programa de Pós-Graduação Multicêntrico em Ciências Fisiológicas, Universidade Federal da Bahia, Vitória da Conquista, Rua Rio de Contas, 58, Candeias, 45029-094, Bahia, Brazil.
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Aldahr MHS, Abd El-Kader SM. Impact of exercise on renal function, oxidative stress, and systemic inflammation among patients with type 2 diabetic nephropathy. Afr Health Sci 2022; 22:286-295. [PMID: 36910380 PMCID: PMC9993259 DOI: 10.4314/ahs.v22i3.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Diabetic nephropathy (DN) is a prevalent microvascular diabetic complication all over the world. Objective This study was designed to measure oxidative stress, systemic inflammation and kidney function response to exercise training in patients with type 2 diabetic (T2DM) nephropathy. Material and Methods Eighty obese T2DM patients (50 males and 30 females), their body mass index (BMI) mean was 33.85±3.43 Kg/m2 and the mean of diabetes chronicity was 12.53±2.64 year participated in the present study and enrolled two groups; group I: received aerobic exercise training and group II: received no training intervention. Results The mean values of creatinine, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and malondialdehyde (MDA) were significantly decreased, while the mean values of interleukin-10 (IL-10), glutathione peroxidase (GPx) and glutathione (GSH) were significantly increased in group (A) after the aerobic exercise training, however the results of the control group were not significant. In addition, there were significant differences between both groups at the end of the study (P<0.05). Conclusion There is evidence that aerobic exercise training modulated oxidative stress and inflammatory cytokines and improved renal function among patients with diabetic nephropathy.
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Affiliation(s)
- Mohamed H Saiem Aldahr
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shehab M Abd El-Kader
- Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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10
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Sabet N, Soltani Z, Khaksari M. The effects of exercise on kidney injury: the role of SIRT1. Mol Biol Rep 2022; 49:4025-4038. [PMID: 35449317 DOI: 10.1007/s11033-022-07122-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022]
Abstract
In patients with kidney injury, muscle mass and strength decrease with altered muscle protein synthesis and degradation along with complications such as inflammation and low physical activity. A treatment strategy to maintain muscle metabolism in kidney injury is important. One of the proposed strategies in this regard is exercise, which in addition to inducing muscle hypertrophy, reducing plasma creatinine and urea and decreasing the severity of tubal injuries, can boost immune function and has anti-inflammatory effects. One of the molecules that have been considered as a target in the treatment of many diseases is silent information regulator 1 (SIRT1). Exercise increases the expression of SIRT1 and improves its activity. Therefore, studies that examined the effect of exercise on kidney injury considering the role of SIRT1 in this effect were reviewed to determine the direction of kidney injury research in future regarding to its prevalence, especially following diabetes, and lack of definitive treatment. In this review, we found that SIRT1 can be one of renoprotective target pathways of exercise. However, further studies are needed to determine the role of SIRT1 in different kidney injuries following exercise according to the type and severity of exercise, and the type of kidney injury.
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Affiliation(s)
- Nazanin Sabet
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran.,Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Soltani
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran. .,Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. .,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Khaksari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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11
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Daghigh F, Karimi P, Alihemmati A, Majidi Zolbin M, Ahmadiasl N. Swimming training modulates lung injury induced by ovariectomy in diabetic rats: involvement of inflammatory and fibrotic biomarkers. Arch Physiol Biochem 2022; 128:514-520. [PMID: 31821061 DOI: 10.1080/13813455.2019.1699934] [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] [Indexed: 10/25/2022]
Abstract
CONTEXT Previous studies have noted that the incidence of inflammatory and fibrotic diseases is higher in diabetic menopausal women. OBJECTIVE In the present study, we evaluated effects of swimming training on inflammatory and fibrotic biomarkers in the lung of ovariectomized diabetic rats. MATERIALS AND METHODS Forty female rats were assigned into four groups: sham; rats underwent surgery without ovariectomies, OVX: rats that underwent ovariectomies, OVX.Dia: ovariectomized rats with high-fat diet, OVX.Dia. Exe: ovariectomized diabetic rats with 8 weeks of swimming training. At the end of experiment, protein expressions were assessed with western blot. Lung sections were subjected to immunohistochemical and haematoxylin eosin staining. RESULTS There was a significant difference in the protein expressions between exercise and ovariectomized diabetic groups (p < .05). CONCLUSION The present study showed strong potential of swimming training on oestrogen deficient diabetic lung. These data encourage further investigation into the inclusive effects of exercise in menopausal diabetic women.
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Affiliation(s)
- Faeze Daghigh
- Department of Physiology, Tabriz Branch, Islamic Azad University, Tabriz, Iran
- Tuberculosis and Lung diseases research center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pouran Karimi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Alihemmati
- Department of Histology & Embryology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Majidi Zolbin
- Department of Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadiasl
- Tuberculosis and Lung diseases research center, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Podvigina TT, Yarushkina NI, Filaretova LP. Effects of Running on the Development of Diabetes and Diabetes-Induced Complications. J EVOL BIOCHEM PHYS+ 2022. [DOI: 10.1134/s0022093022010161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Sabet N, Soltani Z, Khaksari M, Raji-Amirhasani A. The effects of two different dietary regimens during exercise on outcome of experimental acute kidney injury. J Inflamm (Lond) 2022; 19:2. [PMID: 35236328 PMCID: PMC8889785 DOI: 10.1186/s12950-022-00299-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a syndrome characterized by rapid loss of excretory function of kidney. Both exercise and some diets have been shown to increase silent information regulator (SIRT1) expression leading to reduction of kidney injury. In this study, the effect of two different diets during exercise on kidney function, oxidative stress, inflammation and also SIRT1 in AKI was investigated. MATERIALS AND METHODS A number of rats were randomly divided into four groups; control without exercise, control with exercise, exercise + calorie restriction (CR), and exercise + time restriction (TR). Each group was divided into two subgroups of without AKI and with AKI (six rats in each group). Endurance exercise and diets were implemented before AKI. Serum urea and creatinine, urinary albumin, kidney malondialdehyde (MDA), total antioxidant capacity (TAC), transforming growth factor (TGF-β1), and SIRT1 levels, glomerular filtration rate (GFR) and relative kidney weight were measured before and 24 h after AKI induction. RESULTS After induction of kidney injury, serum urea and creatinine, urinary albumin, kidney MDA and TGF-β1 levels increased in rats with both previous exercise and no previous exercise, while GFR, and kidney TAC and SIRT1 levels significantly decreased. These changes after AKI were less in the group with previous exercise than in the group that had no exercise (p <0.001). The TR diet during exercise caused a less increase in serum urea (p <0.01) and creatinine (p <0.01), and urinary albumin (p <0.001) levels after the injury compared to the just exercise group. Also, both CR and TR diets during exercise caused less change in MDA (p <0.001) and TAC (p <0.05, p <0.001, respectively) levels compared to just exercise group. CONCLUSIONS The results showed that exercise alone had no effect on preventing function impairment of kidney, oxidative stress, inflammation and also SIRT1 alteration following AKI, although these indexes were less among those with exercise than those without exercise. However, when the CR and TR diets were implemented during exercise, strong renoprotective effects appeared, and the protective effect of TR diet was greater.
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Affiliation(s)
- Nazanin Sabet
- Research Center of Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran.,Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Soltani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran. .,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Khaksari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Raji-Amirhasani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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14
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Leite AB, Lima HN, Flores CDO, Oliveira CA, Cunha LEC, Neves JL, Correia TML, de Melo FF, Oliveira MV, de Magalhães ACM, Soares TDJ, Amaral LSDB. High-intensity interval training is more effective than continuous training to reduce inflammation markers in female rats with cisplatin nephrotoxicity. Life Sci 2020; 266:118880. [PMID: 33310039 DOI: 10.1016/j.lfs.2020.118880] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023]
Abstract
AIMS Cisplatin (CP) is an antineoplastic widely used in the treatment of various solid tumors, however, its clinical application is limited by nephrotoxicity. Here, we compared the impact of preconditioning with high-intensity interval training (HIIT) with continuous training of low (LIT) and moderate (MIT) intensity on innate immunity markers in female rats with CP-induced acute kidney injury. MATERIALS AND METHODS The rats were divided into five groups (n = 7): saline control and sedentary (C + S); CP and sedentary (CP + S); CP and LIT (CP + LIT); CP and MIT (CP + MIT) and CP and HIIT (CP + HIIT). The training intensity was determined by a maximum running test. At the end of training, the rats received a single dose of CP (5 mg/kg), and 7 days later they were euthanized. We evaluated renal function parameters (serum creatinine, glomerular filtration rate and proteinuria), renal structure, macrophage tissue infiltration, immunolocalization of nuclear transcription factor kappa B (NF-κB), renal levels of tumor necrosis factor-alpha (TNF-α), interleukin 1β (IL-1β), and interleukin 6 (IL-6), and gene expression of monocyte chemoattractant protein-1 (MCP-1), toll-like receptor 4 (TLR4), and NF-κB in renal tissue. KEY FINDINGS Although both MIT and HIIT attenuated the degree of renal injury, only the HIIT prevented changes in renal function. The three training protocols mitigated the increase in expression of all inflammatory markers, however, this effect was more pronounced in HIIT. SIGNIFICANCE All training protocols promoted renoprotective actions, but HIIT was more effective in mitigating CP-induced acute kidney injury, in part by modulation of important markers of the innate immune response.
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Affiliation(s)
- Allyne Baía Leite
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Hernando Nascimento Lima
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Caleb de Oliveira Flores
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Caroline Assunção Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Larissa Esterfanne Cavalcante Cunha
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Jonas Luz Neves
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Thiago Macêdo Lopes Correia
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Amélia Cristina Mendes de Magalhães
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Liliany Souza de Brito Amaral
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brazil.
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15
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Ovarian hormones influence immune response to Staphylococcus aureus infection. Braz J Infect Dis 2020; 24:534-544. [PMID: 33186580 PMCID: PMC9392132 DOI: 10.1016/j.bjid.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/01/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Staphylococcus aureus infections remain associated with considerable morbidity and mortality in both hospitals and the community. There is little information regarding the role of ovarian hormones in infections caused by S. aureus. The aim of this study was to evaluate the effects of ovariectomy in the immune response induced by S. aureus. Methods Female mice BALB/c were ovariectomized (OVX) to significantly reduce the level of ovarian hormones. We also used sham-operated animals. The mice were inoculated intraperitoneally with S. aureus. Blood samples were collected for leukocyte count and bacterial quantification. The uterus and spleen were removed and weighed to calculate the uterine and splenic indexes. Lungs were removed and fractionated for immunohistochemical analysis for macrophage detection (anti-CD68) and relative gene expression of IL-6, IL-1β and TNF-α by RT-PCR. Results Ovariectomy enlarged spleen size and generally increased circulating lymphocytes. OVX females experienced a continuation of the initial reduction of lymphocytes and a monocyte and neutrophil late response compared to shams (p ≥ 0.05). Moreover, OVX females showed neutropenia after 168 h of infection (p ≥ 0.05). Macrophage response in the lungs were less pronounced in OVX females in the initial hours of infection (p ≥ 0.01). OVX females showed a higher relative gene expression of IL-1β, IL-6 and TNF-α in the lung at the beginning of the infection compared to sham females (p ≥ 0.01). Among the uninfected females, the OVX control females showed a higher expression of IL-6 in the lung compared to the sham control females (p ≥ 0.05). In this model, the lack of ovarian hormones caused a minor increase in circulating leukocytes during the initial stage of infection by S. aureus and increased pulmonary gene expression of IL-1β, IL-6, and TNF-α. Ovariectomy alone enlarged the spleen and increased circulating lymphocytes. Ovarian hormones acted as immunoprotectors against S. aureus infection.
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16
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Solís-Montufar EE, Gálvez-Coyt G, Muñoz-Diosdado A. Entropy Analysis of RR-Time Series From Stress Tests. Front Physiol 2020; 11:981. [PMID: 32903750 PMCID: PMC7438833 DOI: 10.3389/fphys.2020.00981] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
The RR-interval time series or tachograms obtained from electrocardiograms have been widely studied since they reflect the cardiac variability, and this is an indicative of the health status of a person. The tachogram can be seen as a highly non-linear and complex time series, and therefore, should be analyzed with non-linear techniques. In this work, several entropy measures, Sample Entropy (SampEn), Approximate Entropy (ApEn), and Fuzzy Entropy (FuzzyEn) are used as a measure of heart rate variability (HRV). Tachograms belonging to thirty-nine subjects were obtained from a cardiac stress test consisting of a rest period followed by a period of moderate physical activity. Subjects are grouped according to their physical activity using the IPAQ sedentary and active questionnaire, we work with youth and middle-aged adults. The entropy measures for each group show that for the sedentary subjects the values are high at rest and decrease appreciably with moderate physical activity, This happens for both young and middle-aged adults. These results are highly reproducible. In the case of the subjects that exercise regularly, an increase in entropy is observed or they tend to retain the entropy value that they had at rest. It seems that there is a possible correlation between the physical condition of a person with the increase or decrease in entropy during moderate physical activity with respect to the entropy at rest. It was also observed that entropy during longer physical activity tests tends to decrease as fatigue accumulates, but this decrease is small compared to the change that occurs when going from rest to physical activity.
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Affiliation(s)
- Eric E. Solís-Montufar
- Unidad Profesional Interdisciplinaria de Biotecnología, Instituto Politécnico Nacional, Mexico City, Mexico
- Centro de Investigación en Computación, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Gonzalo Gálvez-Coyt
- Unidad Profesional Interdisciplinaria de Biotecnología, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Alejandro Muñoz-Diosdado
- Unidad Profesional Interdisciplinaria de Biotecnología, Instituto Politécnico Nacional, Mexico City, Mexico
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17
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Amaral LSDB, Souza CS, Lima HN, Soares TDJ. Influence of exercise training on diabetic kidney disease: A brief physiological approach. Exp Biol Med (Maywood) 2020; 245:1142-1154. [PMID: 32486850 PMCID: PMC7400720 DOI: 10.1177/1535370220928986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPACT STATEMENT Diabetic kidney disease (DKD) is associated with increased mortality in diabetic patients and has a negative impact on public health. The identification of potential therapies that help the management of DKD can contribute to the improvement of health and quality of life of patients. Thus, this paper is timely and relevant because, in addition to presenting a concise review of the pathogenesis and major pathophysiological mechanisms of DKD, it addresses the most recent findings on the impact of exercise training on this disease. Thus, since non-pharmacological interventions have gained increasing attention in the fight against chronic diseases, this paper appears as an important tool to increase knowledge and stimulate innovative research on the impact of exercise on kidney disease.
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Affiliation(s)
| | - Cláudia Silva Souza
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo 14049-900, Brazil
| | | | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Bahia 45029-094, Brazil
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18
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Wang SQ, Li D, Yuan Y. Long-term moderate intensity exercise alleviates myocardial fibrosis in type 2 diabetic rats via inhibitions of oxidative stress and TGF-β1/Smad pathway. J Physiol Sci 2019; 69:861-873. [PMID: 31392590 PMCID: PMC10716963 DOI: 10.1007/s12576-019-00696-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2019] [Indexed: 12/25/2022]
Abstract
Exercise has an effect on the reduction of myocardial fibrosis in diabetic rats as previously reported, in which oxidative stress and the TGF-β1/Smad signaling pathway may play key roles. There is little direct experimental evidence that exercise alleviates myocardial fibrosis in type 2 diabetes mellitus (T2DM). Here we established a type 2 diabetic model by using streptozotocin and a high-fat diet. Rats were divided into groups of normal control (NC), T2DM and T2DM plus exercise (T2DME). The T2DME group received further treadmill training at moderate intensity for 8 weeks. Histological and biochemical methods were used to detect the benefits of exercise to T2DM. Results showed that the weight of rats in the T2DM group dropped dramatically, along with significant increases in blood glucose, myocardial fibrosis and oxidative stress, associated with upregulated expression of factors of myocardial fibrosis, except Smad7. Exercise largely reversed T2DM-induced alterations in factors of myocardial fibrosis, including suppressing expression of MMP-2, CTGF, TGF-β1, p-Smad2 and p-Smad3, and increased expression of TIMP-1 and Smad7. Therefore, exercise might be considered an alternative therapeutic remedy for diabetic cardiomyopathy.
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Affiliation(s)
- Shi-Qiang Wang
- Physical Education College, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Dan Li
- Physical Education College, Hunan University of Technology, Zhuzhou, Hunan, China
| | - Yang Yuan
- School of Physical Education, Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong, China.
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19
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Souza CS, de Sousa Oliveira BS, Viana GN, Correia TML, de Bragança AC, Canale D, Oliveira MV, de Magalhães ACM, Volpini RA, de Brito Amaral LS, de Jesus Soares T. Preventive effect of exercise training on diabetic kidney disease in ovariectomized rats with type 1 diabetes. Exp Biol Med (Maywood) 2019; 244:758-769. [PMID: 31042072 PMCID: PMC6567583 DOI: 10.1177/1535370219843830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/18/2019] [Indexed: 12/25/2022] Open
Abstract
IMPACT STATEMENT To date, no studies have been found evaluating the effects of physical exercise on renal function and structure changes in ovariectomized rats with type 1 diabetes. Therefore, this work emerges with an important tool for strengthening and expanding innovative research on exercise with potential for the prevention of renal diseases in ovariectomized diabetic rats, and future development of studies that seek to increase scientific knowledge about the beneficial effects of physical exercise on renal diseases in humans.
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Affiliation(s)
- Cláudia Silva Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
| | - Bianca Silva de Sousa Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
| | - Geovanildo Nascimento Viana
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
| | - Thiago Macêdo Lopes Correia
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
| | - Ana Carolina de Bragança
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Daniele Canale
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
| | - Amélia Cristina Mendes de Magalhães
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
| | - Rildo Aparecido Volpini
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Liliany Souza de Brito Amaral
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
| | - Telma de Jesus Soares
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Programa de Pós-Graduação em Biociências, Vitória da Conquista, Bahia 45029-094, Brasil
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20
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Yaribeygi H, Butler AE, Sahebkar A. Aerobic exercise can modulate the underlying mechanisms involved in the development of diabetic complications. J Cell Physiol 2019; 234:12508-12515. [PMID: 30623433 DOI: 10.1002/jcp.28110] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 12/07/2018] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus is a highly prevalent metabolic disorder that affects many molecular pathways, causing a shift from a physiologic to a pathophysiologic state. Alterations in the molecular pathways promote diabetic complications and, thus, many medical and nonmedical therapies have been directed at preventing these complications. Despite the beneficial effects on moderating glycemic control, medical therapies may also have unfavorable side effects. This makes nonmedical therapeutic approaches more attractive due to lower pharmacological side effects of these strategies compared to medical agents. Aerobic exercise is now considered as a major nonmedical strategy that can promote beneficial and protective effects to counteract the development of diabetic complications via attenuation of the major molecular mechanisms involved in diabetes.
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Affiliation(s)
- Habib Yaribeygi
- Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alexandra E Butler
- Diabetes Research Center, Qatar Biomedical Research Institute, Doha, Qatar
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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21
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Martínez R, Kapravelou G, López-Chaves C, Cáceres E, Coll-Risco I, Sánchez-González C, Llopis J, Arrebola F, Galisteo M, Aranda P, López-Jurado M, Porres JM. Aerobic interval exercise improves renal functionality and affects mineral metabolism in obese Zucker rats. Am J Physiol Renal Physiol 2019; 316:F90-F100. [PMID: 30303711 DOI: 10.1152/ajprenal.00356.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obesity, metabolic syndrome, and renal injury are considered risk factors for type 2 diabetes, as well as kidney disease. Functional and structural changes in the kidney as consequence of obesity and metabolic syndrome may lead to impaired mineral metabolism in what is known as chronic kidney disease-mineral and bone disorder. Lifestyle interventions such as physical activity are good strategies to manage these pathologies and therefore, prevent the loss of kidney functionality and related complications in mineral metabolism. In this study, we have used 40 male Zucker rats that were randomly allocated into four different experimental groups, two of them (an obese and a lean one) performed an aerobic interval training protocol, and the other two groups were sedentary. At the end of the experimental period (8 wk), urine, plasma, and femur were collected for biochemical and mineral composition analysis, whereas the kidney was processed for histological studies. The obese rats exhibited albuminuria, glomerulosclerosis, and hypertrophy in glomeruli and renal tubule in some areas, together with alterations in mineral content of plasma but not of femur. The training protocol prevented the generation of albuminuria and glomerulosclerosis, showing a significant action on plasma and bone mineral levels. Therefore, the specific training protocol used in this study was able to prevent the development of diabetic nephropathy and affected the metabolism of certain minerals.
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Affiliation(s)
- Rosario Martínez
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Garyfallia Kapravelou
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Carlos López-Chaves
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Elena Cáceres
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Irene Coll-Risco
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Cristina Sánchez-González
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Juan Llopis
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Francisco Arrebola
- Department of Histology, Institute of Neurosciences, Centre for Biomedical Research, Universidad de Granada , Granada , Spain
| | - Milagros Galisteo
- Department of Pharmacology, School of Pharmacy, Universidad de Granada, Campus Universitario de Cartuja, Granada , Spain
| | - Pilar Aranda
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - María López-Jurado
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
| | - Jesus M Porres
- Department of Physiology, Institute of Nutrition and Food Technology, Centre for Biomedical Research, Centre for Research in Sport and Health, Universidad de Granada , Granada , Spain
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22
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Tang LX, Wang B, Wu ZK. Aerobic Exercise Training Alleviates Renal Injury by Interfering with Mitochondrial Function in Type-1 Diabetic Mice. Med Sci Monit 2018; 24:9081-9089. [PMID: 30551123 PMCID: PMC6302662 DOI: 10.12659/msm.912877] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Diabetic nephropathy was one of the most serious and harmful diabetic complications, characterized by progressive loss of renal function and renal fibrosis. Aerobic exercise training is an important non-pharmacologic method to prevent and treat diabetes mellitus and diabetic complications. MATERIAL AND METHODS Intraperitoneal (i.p.) injection of streptozocin (STZ) was used to construct a type 1 diabetic mouse model. Renal function and mitochondrial function were measured by urinary protein level, Masson staining and ATP, superoxide production, and membrane potential, respectively. The purpose of the research was to explore the effect of aerobic exercise training on renal and renal mitochondrial function, as well as the expression of Sirt1and PGC1α in type-1 diabetic mice. RESULTS Sedentary diabetic mice exhibited increased urinary protein level, blood glucose, and collagen deposition in renal tissues compared with sedentary control mice, which were significantly mitigated by aerobic exercise training. Diabetic mice displayed renal tissue mitochondrial dysfunction (decreased mitochondrial ATP production and membrane potential), as well as increased mitochondrial superoxide production, which were reversed by aerobic exercise. By using Western blot analysis, we identified the decreased expression of Sirt1 and PGC1α in the renal tissue of diabetic mice, which were partly reversed by aerobic exercise training. Data showed that silencing of Sirt1 abrogated the beneficial effect of aerobic exercise training against diabetes-induced mitochondrial abnormalities and renal damage in mice. CONCLUSIONS Aerobic exercise training alleviates diabetes-induced renal injury by improving mitochondrial function.
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Affiliation(s)
- Lin-Xia Tang
- Department of Sports, Shanghai University of Traditional Chinese Medicine, Shanghai, China (mainland)
| | - Bin Wang
- Department of Sports, Shanghai University of Traditional Chinese Medicine, Shanghai, China (mainland)
| | - Zhi-Kun Wu
- Department of Sports, Shanghai University of Traditional Chinese Medicine, Shanghai, China (mainland)
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Francescato H, Almeida L, Reis N, Faleiros C, Papoti M, Costa R, Coimbra T. Previous Exercise Effects in Cisplatin-Induced Renal Lesions in Rats. Kidney Blood Press Res 2018; 43:582-593. [DOI: 10.1159/000488964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/05/2018] [Indexed: 11/19/2022] Open
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Fazan FS, Brognara F, Fazan Junior R, Murta Junior LO, Virgilio Silva LE. Changes in the Complexity of Heart Rate Variability with Exercise Training Measured by Multiscale Entropy-Based Measurements. ENTROPY 2018; 20:e20010047. [PMID: 33265153 PMCID: PMC7512234 DOI: 10.3390/e20010047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/16/2022]
Abstract
Quantifying complexity from heart rate variability (HRV) series is a challenging task, and multiscale entropy (MSE), along with its variants, has been demonstrated to be one of the most robust approaches to achieve this goal. Although physical training is known to be beneficial, there is little information about the long-term complexity changes induced by the physical conditioning. The present study aimed to quantify the changes in physiological complexity elicited by physical training through multiscale entropy-based complexity measurements. Rats were subject to a protocol of medium intensity training ( n = 13 ) or a sedentary protocol ( n = 12 ). One-hour HRV series were obtained from all conscious rats five days after the experimental protocol. We estimated MSE, multiscale dispersion entropy (MDE) and multiscale SDiff q from HRV series. Multiscale SDiff q is a recent approach that accounts for entropy differences between a given time series and its shuffled dynamics. From SDiff q , three attributes (q-attributes) were derived, namely SDiff q m a x , q m a x and q z e r o . MSE, MDE and multiscale q-attributes presented similar profiles, except for SDiff q m a x . q m a x showed significant differences between trained and sedentary groups on Time Scales 6 to 20. Results suggest that physical training increases the system complexity and that multiscale q-attributes provide valuable information about the physiological complexity.
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Affiliation(s)
- Frederico Sassoli Fazan
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14049-900, Brazil
| | - Fernanda Brognara
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14049-900, Brazil
| | - Rubens Fazan Junior
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14049-900, Brazil
| | - Luiz Otavio Murta Junior
- Department of Computing and Mathematics, School of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-901, Brazil
| | - Luiz Eduardo Virgilio Silva
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14049-900, Brazil
- Department of Computer Science, Institute of Mathematics and Computer Sciences, University of São Paulo, São Carlos, SP 13566-590, Brazil
- Correspondence:
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25
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Amaral LSDB, Souza CS, Volpini RA, Shimizu MHM, de Bragança AC, Canale D, Seguro AC, Coimbra TM, de Magalhães ACM, Soares TDJ. Previous Exercise Training Reduces Markers of Renal Oxidative Stress and Inflammation in Streptozotocin-Induced Diabetic Female Rats. J Diabetes Res 2018; 2018:6170352. [PMID: 29785400 PMCID: PMC5896236 DOI: 10.1155/2018/6170352] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/11/2018] [Indexed: 12/21/2022] Open
Abstract
The aim of this study is to evaluate the effects of regular moderate exercise training initiated previously or after induction of diabetes mellitus on renal oxidative stress and inflammation in STZ-induced diabetic female rats. For this purpose, Wistar rats were divided into five groups: sedentary control (SC), trained control (TC), sedentary diabetic (SD), trained diabetic (TD), and previously trained diabetic (PTD). Only the PTD group was submitted to treadmill running for 4 weeks previously to DM induction with streptozotocin (40 mg/kg, i.v). After confirming diabetes, the PTD, TD, and TC groups were submitted to eight weeks of exercise training. At the end of the training protocol, we evaluated the following: glycosuria, body weight gain, plasma, renal and urinary levels of nitric oxide and thiobarbituric acid reactive substances, renal glutathione, and immunolocalization of lymphocytes, macrophages, and nuclear factor-kappa B (NF-κB/p65) in the renal cortex. The results showed that exercise training reduced glycosuria, renal TBARS levels, and the number of immune cells in the renal tissue of the TD and PTD groups. Of note, only previous exercise increased weight gain and urinary/renal NO levels and reduced NF-κB (p65) immunostaining in the renal cortex of the PTD group. In conclusion, our study shows that exercise training, especially when initiated previously to diabetes induction, promotes protective effects in diabetic kidney by reduction of renal oxidative stress and inflammation markers in female Wistar rats.
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Affiliation(s)
- Liliany Souza de Brito Amaral
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
| | - Cláudia Silva Souza
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
| | - Rildo Aparecido Volpini
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Maria Heloisa Massola Shimizu
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Ana Carolina de Bragança
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Daniele Canale
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Antonio Carlos Seguro
- Departamento de Nefrologia, Laboratório de Pesquisa Básica-LIM12, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, SP, Brazil
| | - Terezila Machado Coimbra
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 14049-900 São Paulo, SP, Brazil
| | - Amélia Cristina Mendes de Magalhães
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
| | - Telma de Jesus Soares
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 45029-094 Vitória da Conquista, BA, Brazil
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Faleiros CM, Francescato HD, Papoti M, Chaves L, Silva CG, Costa RS, Coimbra TM. Effects of previous physical training on adriamycin nephropathy and its relationship with endothelial lesions and angiogenesis in the renal cortex. Life Sci 2017; 169:43-51. [DOI: 10.1016/j.lfs.2016.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/10/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
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