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Franco-Obregón A. Harmonizing Magnetic Mitohormetic Regenerative Strategies: Developmental Implications of a Calcium-Mitochondrial Axis Invoked by Magnetic Field Exposure. Bioengineering (Basel) 2023; 10:1176. [PMID: 37892906 PMCID: PMC10604793 DOI: 10.3390/bioengineering10101176] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Mitohormesis is a process whereby mitochondrial stress responses, mediated by reactive oxygen species (ROS), act cumulatively to either instill survival adaptations (low ROS levels) or to produce cell damage (high ROS levels). The mitohormetic nature of extremely low-frequency electromagnetic field (ELF-EMF) exposure thus makes it susceptible to extraneous influences that also impinge on mitochondrial ROS production and contribute to the collective response. Consequently, magnetic stimulation paradigms are prone to experimental variability depending on diverse circumstances. The failure, or inability, to control for these factors has contributed to the existing discrepancies between published reports and in the interpretations made from the results generated therein. Confounding environmental factors include ambient magnetic fields, temperature, the mechanical environment, and the conventional use of aminoglycoside antibiotics. Biological factors include cell type and seeding density as well as the developmental, inflammatory, or senescence statuses of cells that depend on the prior handling of the experimental sample. Technological aspects include magnetic field directionality, uniformity, amplitude, and duration of exposure. All these factors will exhibit manifestations at the level of ROS production that will culminate as a unified cellular response in conjunction with magnetic exposure. Fortunately, many of these factors are under the control of the experimenter. This review will focus on delineating areas requiring technical and biological harmonization to assist in the designing of therapeutic strategies with more clearly defined and better predicted outcomes and to improve the mechanistic interpretation of the generated data, rather than on precise applications. This review will also explore the underlying mechanistic similarities between magnetic field exposure and other forms of biophysical stimuli, such as mechanical stimuli, that mutually induce elevations in intracellular calcium and ROS as a prerequisite for biological outcome. These forms of biophysical stimuli commonly invoke the activity of transient receptor potential cation channel classes, such as TRPC1.
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Affiliation(s)
- Alfredo Franco-Obregón
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore; ; Tel.: +65-6777-8427 or +65-6601-6143
- Institute of Health Technology and Innovation (iHealthtech), National University of Singapore, Singapore 117599, Singapore
- Biolonic Currents Electromagnetic Pulsing Systems Laboratory (BICEPS), National University of Singapore, Singapore 117599, Singapore
- NUS Centre for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore
- Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117544, Singapore
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Brummer C, Pukrop T, Wiskemann J, Bruss C, Ugele I, Renner K. Can Exercise Enhance the Efficacy of Checkpoint Inhibition by Modulating Anti-Tumor Immunity? Cancers (Basel) 2023; 15:4668. [PMID: 37760634 PMCID: PMC10526963 DOI: 10.3390/cancers15184668] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Immune checkpoint inhibition (ICI) has revolutionized cancer therapy. However, response to ICI is often limited to selected subsets of patients or not durable. Tumors that are non-responsive to checkpoint inhibition are characterized by low anti-tumoral immune cell infiltration and a highly immunosuppressive tumor microenvironment. Exercise is known to promote immune cell circulation and improve immunosurveillance. Results of recent studies indicate that physical activity can induce mobilization and redistribution of immune cells towards the tumor microenvironment (TME) and therefore enhance anti-tumor immunity. This suggests a favorable impact of exercise on the efficacy of ICI. Our review delivers insight into possible molecular mechanisms of the crosstalk between muscle, tumor, and immune cells. It summarizes current data on exercise-induced effects on anti-tumor immunity and ICI in mice and men. We consider preclinical and clinical study design challenges and discuss the role of cancer type, exercise frequency, intensity, time, and type (FITT) and immune sensitivity as critical factors for exercise-induced impact on cancer immunosurveillance.
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Affiliation(s)
- Christina Brummer
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053 Regensburg, Germany;
- Comprehensive Cancer Center Ostbayern (CCCO), 93053 Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, 93053 Regensburg, Germany;
- Comprehensive Cancer Center Ostbayern (CCCO), 93053 Regensburg, Germany
- Bavarian Cancer Research Center (BZKF), 93053 Regensburg, Germany
| | - Joachim Wiskemann
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Christina Bruss
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Ines Ugele
- Department of Otorhinolaryngology, University Hospital Regensburg, 93053 Regensburg, Germany; (I.U.); (K.R.)
| | - Kathrin Renner
- Comprehensive Cancer Center Ostbayern (CCCO), 93053 Regensburg, Germany
- Department of Otorhinolaryngology, University Hospital Regensburg, 93053 Regensburg, Germany; (I.U.); (K.R.)
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Nie M, Liu Q, Jia R, Li Z, Li X, Meng X. Comparative transcriptome analysis of unfractionated peripheral blood leukocytes after exercise in human. Sci Rep 2023; 13:11140. [PMID: 37429969 DOI: 10.1038/s41598-023-38064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/02/2023] [Indexed: 07/12/2023] Open
Abstract
Exercise has profound but variable effects on the immune system. However, only limited information exists about the changes of exercise-induced gene expression in whole immune cells. The aim of this study is to unravel the potential molecular changes of genes which are related to immunity after exercise. The raw expression data and corresponding clinical of GSE18966 were downloaded from Gene Expression Omnibus database. The differentially expressed genes between control group and treat groups were performed by in-house developed perl scripts. A total of 83 differentially expressed genes (DEGs) (|log2 FC|> 1, FDR < 0.05) were identified between control and treat group 1 (0 h after exercise), 128 DEGs (|log2 FC|> 1, FDR < 0.05) between control and treat group 2 (4 h after exercise), and there was no significant difference between control and treat group 3 (20 h after exercise). Next, we identified 51 overlapping genes between treat group 1 (0 h after exercise) and treat group 2 (4 h after exercise) using Venn analysis. Protein-protein interaction (PPI) network was constructed by Cytoscape 3.7.2, and nine hub genes (S100A12, FCGR3B, FPR1, VNN2, AQP9, MMP9, OSM, NCF4, HP) were identified. Finally, 9 hub genes were identified as the potential biomarkers of exercise using validation set (GSE83578) verification analysis. These hub genes might serve as potential molecular targets of monitoring exercise and training processes in the further.
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Affiliation(s)
- Mingkun Nie
- School of Physical Education, Xinxiang University, Xinxiang, 453000, Henan, China
| | - Qingling Liu
- School of Pharmacy, Xinxiang University, Xinxiang, 453000, Henan, China
| | - Ruoling Jia
- School of Pharmacy, Xinxiang University, Xinxiang, 453000, Henan, China.
| | - Zhuoyi Li
- School of Pharmacy, Xinxiang University, Xinxiang, 453000, Henan, China
| | - Xiaoru Li
- School of Pharmacy, Xinxiang University, Xinxiang, 453000, Henan, China
| | - Xiangtao Meng
- School of Pharmacy, Xinxiang University, Xinxiang, 453000, Henan, China
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Liu R, Krüger K, Pilat C, Fan W, Xiao Y, Seimetz M, Ringseis R, Baumgart-Vogt E, Eder K, Weissmann N, Mooren FC. Excessive Accumulation of Intracellular Ca 2+ After Acute Exercise Potentiated Impairment of T-cell Function. Front Physiol 2021; 12:728625. [PMID: 34899372 PMCID: PMC8662941 DOI: 10.3389/fphys.2021.728625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Ca2+ is an important intracellular second messenger known to regulate several cellular functions. This research aimed to investigate the mechanisms of exercise-induced immunosuppression by measuring intracellular calcium levels, Ca2+-regulating gene expression, and agonist-evoked proliferation of murine splenic T lymphocytes. Mice were randomly assigned to the control, sedentary group (C), and three experimental groups, which performed a single bout of intensive and exhaustive treadmill exercise. Murine splenic lymphocytes were separated by density-gradient centrifugation immediately (E0), 3h (E3), and 24h after exercise (E24). Fura-2/AM was used to monitor cytoplasmic free Ca2+ concentration in living cells. The combined method of carboxyfluorescein diacetate succinimidyl ester (CFSE) labeling and flow cytometry was used for the detection of T cell proliferation. The transcriptional level of Ca2+-regulating genes was quantified by using qPCR. Both basal intracellular Ca2+ levels and agonist (ConA, OKT3, or thapsigargin)-induced Ca2+ transients were significantly elevated at E3 group (p<0.05 vs. control). However, mitogen-induced cell proliferation was significantly decreased at E3 group (p<0.05 vs. control). In parallel, the transcriptional level of plasma membrane Ca2+-ATPases (PMCA), sarco/endoplasmic reticulum Ca2+-ATPases (SERCA), TRPC1, and P2X7 was significantly downregulated, and the transcriptional level of IP3R2 and RyR2 was significantly upregulated in E3 (p<0.01 vs. control). In summary, this study demonstrated that acute exercise affected intracellular calcium homeostasis, most likely by enhancing transmembrane Ca2+ influx into cells and by reducing expression of Ca2+-ATPases such as PMCA and SERCA. However, altered Ca2+ signals were not transduced into an enhanced T cell proliferation suggesting other pathways to be responsible for the transient exercise-associated immunosuppression.
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Affiliation(s)
- Renyi Liu
- Department of Physical Education, China University of Geosciences (Wuhan), Wuhan, China.,Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Giessen, Giessen, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Giessen, Giessen, Germany
| | - Christian Pilat
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University Giessen, Giessen, Germany
| | - Wei Fan
- Institute for Anatomy and Cell Biology II, Justus-Liebig-University Giessen, Giessen, Germany
| | - Yu Xiao
- Institute for Anatomy and Cell Biology II, Justus-Liebig-University Giessen, Giessen, Germany
| | - Michael Seimetz
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Robert Ringseis
- Institute of Animal Nutrition and Nutrition Physiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Eveline Baumgart-Vogt
- Institute for Anatomy and Cell Biology II, Justus-Liebig-University Giessen, Giessen, Germany
| | - Klaus Eder
- Institute of Animal Nutrition and Nutrition Physiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Norbert Weissmann
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Lung Center (DZL), Justus-Liebig-University Giessen, Giessen, Germany
| | - Frank Christoph Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
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Dorneles GP, Lira FS, Romão PRT, Krüger K, Rosa-Neto JC, Peres A, Antunes BM. Levels of cardiorespiratory fitness in men exerts strong impact on lymphocyte function after mitogen stimulation. J Appl Physiol (1985) 2021; 130:1133-1142. [PMID: 33630676 DOI: 10.1152/japplphysiol.01051.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Relationship between lymphocyte function and cardiorespiratory fitness (CRF) is well-documented at rest; however, upon mitogen stimulation the proliferation and cytokine production alters, but knowledge is incipient about lymphocyte responses after mitogen stimulus according to CRF. So, the purpose of the present study was to analyze the lymphocyte function according to the physical fitness status of healthy young men. The study is divided in two experiments being the first analyzing the lymphocyte phenotypes profile and the inflammatory responses, according to CRF, in lymphocyte cell cultures treated for 48 h with concanavalin A (ConA). The second experiment analyzed the proliferation, reactive oxygen species production, viability, and mitochondrial polarization state in lymphocytes treated with ConA in different concentrations, considering the CRF levels. The results showed a difference in the percentage of total lymphocytes expression between groups (P = 0.011) observing a lower lymphocytes T expression in the group with high maximal oxygen consumption (V̇o2max) when compared with the moderate V̇o2max group. When treated with ConA, the lymphocytes of the low V̇o2max group released higher TNF-α concentration (P = 0.032), reflecting an elevated TNF-α/IL-10 ratio (P = 0.055), parallel with lower IL-6 production (P = 0.027), mainly when compared with the moderate V̇o2max group. In addition, there is a positive relationship between V̇o2max and IL-6 production (r = 0.507; P = 0.016), whereas the percentage of total lymphocytes (LyT%) shows a negative trend with V̇o2max (r = -0.497; P = 0.060). Also, individuals with lower V̇o2max showed reduced absolute and relative ROS production, lower cell proliferation, and higher mitochondrial membrane depolarization. In conclusion, cardiorespiratory fitness degree exerts a strong impact on lymphocyte function after mitogen stimulation.NEW & NOTEWORTHY The innovation of the research is to elucidate the impact of different physical fitness status on metabolism, cell proliferation, and lymphocyte activity and, consequently, on the specific inflammatory response against a mitogen.
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Affiliation(s)
- Gilson P Dorneles
- Cellular and Molecular Immunology Lab., Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fabio Santos Lira
- Exercise and Immunometabolism Research Group, Postgraduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, 19060-900, Brazil
| | - Pedro R T Romão
- Cellular and Molecular Immunology Lab., Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - José Cesar Rosa-Neto
- Immunometabolism Research Group, Institute of Biomedical Sciences, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Alessandra Peres
- Cellular and Molecular Immunology Lab., Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Barbara Moura Antunes
- Exercise and Immunometabolism Research Group, Postgraduation Program in Movement Sciences, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, 19060-900, Brazil
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Sun Y, Ding S. ER-Mitochondria Contacts and Insulin Resistance Modulation through Exercise Intervention. Int J Mol Sci 2020; 21:ijms21249587. [PMID: 33339212 PMCID: PMC7765572 DOI: 10.3390/ijms21249587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
The endoplasmic reticulum (ER) makes physical contacts with mitochondria at specific sites, and the hubs between the two organelles are called mitochondria-associated ER membranes (MAMs). MAMs are known to play key roles in biological processes, such as intracellular Ca2+ regulation, lipid trafficking, and metabolism, as well as cell death, etc. Studies demonstrated that dysregulation of MAMs significantly contributed to insulin resistance. Alterations of MAMs’ juxtaposition and integrity, impaired expressions of insulin signaling molecules, disruption of Ca2+ homeostasis, and compromised metabolic flexibility are all actively involved in the above processes. In addition, exercise training is considered as an effective stimulus to ameliorate insulin resistance. Although the underlying mechanisms for exercise-induced improvement in insulin resistance are not fully understood, MAMs may be critical for the beneficial effects of exercise.
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Affiliation(s)
- Yi Sun
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai 200241, China;
- College of Physical Education and Health, East China Normal University, Shanghai 200241, China
| | - Shuzhe Ding
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai 200241, China;
- College of Physical Education and Health, East China Normal University, Shanghai 200241, China
- Correspondence:
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Alack K, Weiss A, Krüger K, Höret M, Schermuly R, Frech T, Eggert M, Mooren FC. Profiling of human lymphocytes reveals a specific network of protein kinases modulated by endurance training status. Sci Rep 2020; 10:888. [PMID: 31964936 PMCID: PMC6972788 DOI: 10.1038/s41598-020-57676-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/16/2019] [Indexed: 01/01/2023] Open
Abstract
To date, the effects of endurance exercise training on lymphocyte physiology at the kinome level are largely unknown. Therefore, the present study used a highly sensitive peptide-based kinase activity profiling approach to investigate if the basal activity of tyrosine (Tyr) and serine/threonine (Ser/Thr) kinases of human lymphocytes is affected by the aerobic endurance training status. Results revealed that the activity of various tyrosine kinases of the FGFR family and ZAP70 was increased, whereas the activity of multiple Ser/Thr kinases such as IKKα, CaMK4, PKAα, PKCα+δ (among others) was decreased in lymphocytes of endurance trained athletes (ET). Moreover, functional associations between several differentially regulated kinases in ET-derived lymphocytes were demonstrated by phylogenetic mapping and network analysis. Especially, Ser/Thr kinases of the AGC-kinase (protein kinase A, G, and C) family represent exercise-sensitive key components within the lymphocytes kinase network that may mediate the long-term effects of endurance training. Furthermore, KEGG (Kyoto Encyclopedia of Genes and Genomes) and Reactome pathway analysis indicate that Ras as well as intracellular signaling by second messengers were found to be enriched in the ET individuals. Overall, our data suggest that endurance exercise training improves the adaptive immune competence by modulating the activity of multiple protein kinases in human lymphocytes.
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Affiliation(s)
- Katharina Alack
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany.
| | - Astrid Weiss
- Member of the German Center for Lung Research (DZL), Cardio-Pulmonary Institute (CPI), Justus-Liebig-University, Giessen, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany
| | - Mona Höret
- Member of the German Center for Lung Research (DZL), Cardio-Pulmonary Institute (CPI), Justus-Liebig-University, Giessen, Germany
| | - Ralph Schermuly
- Member of the German Center for Lung Research (DZL), Cardio-Pulmonary Institute (CPI), Justus-Liebig-University, Giessen, Germany
| | - Torsten Frech
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Sciences, Justus-Liebig-University, Giessen, Germany
| | - Martin Eggert
- Center for Extracorporeal Organ Support, Department of Internal Medicine, Universitätsmedizin Rostock, Rostock, Germany
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Philippe M, Gatterer H, Burtscher M, Weinberger B, Keller M, Grubeck-Loebenstein B, Fleckenstein J, Alack K, Krüger K. Concentric and Eccentric Endurance Exercise Reverse Hallmarks of T-Cell Senescence in Pre-diabetic Subjects. Front Physiol 2019; 10:684. [PMID: 31214051 PMCID: PMC6558034 DOI: 10.3389/fphys.2019.00684] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 05/13/2019] [Indexed: 11/23/2022] Open
Abstract
The peripheral T-cell pool undergoes a striking age associated remodeling which is accelerated by progressive insulin resistance. Exercise training is known to delay several aspects of T-cell senescence. The purpose of the current study was to investigate the effect of 3 weeks regular concentric or eccentric endurance exercise training on the composition of the T-cell compartment in pre-diabetic subjects. Sixteen male older adults with impaired glucose tolerance were recruited and performed either concentric exercise (CE) or eccentric exercise (EE) walking 3 times a week for 3 weeks. Fasting venous blood sampling was performed before training and after the training intervention. Various T-cell subpopulations were analyzed by flow cytometry. We did not find significant time × group effects (interaction) but found several significant time effects for cell type ratios and cell subsets proportions. There was an increase of the CD4+/CD8+ (0.55 ± 0.85%; p = 0.033) and CD4+/CD3+ ratio (5.63 ± 8.44%; p = 0.018) and a decrease of the CD8+/CD3+ ratio (-0.95 ± 1.64%; p = 0.049) after training. We found proportional increases of CD4+/CCR7+/CD45RO+ central memory cells (5.02 ± 7.68%; p = 0.030), naïve CD8+/CCR7+/CD45RO- (3.00 ± 6.68%; p = 0.047) and CD8+/CCR7+/CD45RO+ central memory cells (3.01 ± 3.70%; p = 0.009), while proportions of CD4+/CCR7-/CD45RO- TEMRA cells (-2.17 ± 4.66%; p = 0.012), CD8+/CCR7-/CD45RO- TEMRA cells (-5.11 ± 7.02%; p = 0.018) and CD16+ cells (-4.67 ± 6.45%; p = 0.016) decreased after training. 3 weeks of either CE or EE were effective in reversing hallmarks of T-cell senescence in pre-diabetic subjects. It is suggested that exercise stimulates production and mobilization of naïve T-cells, while differentiated TEMRA cells might disappear by apoptosis.
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Affiliation(s)
- Marc Philippe
- Department of Sports Medicine, Institute of Sports Sciences, Giessen University, Giessen, Germany
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
- Department of Health Promotion and Prevention, Swiss Lung Association, St. Gallen, Switzerland
| | - Hannes Gatterer
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, EURAC Research, Bozen, Italy
| | - Martin Burtscher
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | - Birgit Weinberger
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Michael Keller
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | | | - Johannes Fleckenstein
- Department of Sports Medicine, Institute of Sports Sciences, Giessen University, Giessen, Germany
| | - Katharina Alack
- Department of Sports Medicine, Institute of Sports Sciences, Giessen University, Giessen, Germany
| | - Karsten Krüger
- Department Exercise and Health, Institute of Sports Science, Leibniz University Hannover, Hanover, Germany
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