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Cinca-Morros S, Álvarez-Herms J. The Importance of Maintaining and Improving a Healthy Gut Microbiota in Athletes as a Preventive Strategy to Improve Heat Tolerance and Acclimatization. Microorganisms 2024; 12:1160. [PMID: 38930542 DOI: 10.3390/microorganisms12061160] [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: 04/17/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Exposure to passive heat (acclimation) and exercise under hot conditions (acclimatization), known as heat acclimation (HA), are methods that athletes include in their routines to promote faster recovery and enhance physiological adaptations and performance under hot conditions. Despite the potential positive effects of HA on health and physical performance in the heat, these stimuli can negatively affect gut health, impairing its functionality and contributing to gut dysbiosis. Blood redistribution to active muscles and peripheral vascularization exist during exercise and HA stimulus, promoting intestinal ischemia. Gastrointestinal ischemia can impair intestinal permeability and aggravate systemic endotoxemia in athletes during exercise. Systemic endotoxemia elevates the immune system as an inflammatory responses in athletes, impairing their adaptive capacity to exercise and their HA tolerance. Better gut microbiota health could benefit exercise performance and heat tolerance in athletes. This article suggests that: (1) the intestinal modifications induced by heat stress (HS), leading to dysbiosis and altered intestinal permeability in athletes, can decrease health, and (2) a previously acquired microbial dysbiosis and/or leaky gut condition in the athlete can negatively exacerbate the systemic effects of HA. Maintaining or improving the healthy gut microbiota in athletes can positively regulate the intestinal permeability, reduce endotoxemic levels, and control the systemic inflammatory response. In conclusion, strategies based on positive daily habits (nutrition, probiotics, hydration, chronoregulation, etc.) and preventing microbial dysbiosis can minimize the potentially undesired effects of applying HA, favoring thermotolerance and performance enhancement in athletes.
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Affiliation(s)
- Sergi Cinca-Morros
- Microfluidics Cluster UPV/EHU, Analytical Microsystems & Materials for Lab-on-a-Chip (AMMa-LOAC) Group, Analytical Chemistry Department, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain
- Microfluidics Cluster UPV/EHU, BIOMICs Microfluidics Group, Lascaray Research Center, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain
| | - Jesús Álvarez-Herms
- Physiology and Molecular Laboratory (Phymolab), 40170 Collado Hermoso, Spain
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Wang J, Sun Z, Jiang L, Xuan L, Ma Y, Wang J, Gu Y, Zhang Y. Activation of Pink1/Parkin-mediated mitochondrial autophagy alleviates exertional heat stroke-induced acute lung injury in rats. Clin Hemorheol Microcirc 2024:CH242100. [PMID: 38788061 DOI: 10.3233/ch-242100] [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: 05/26/2024]
Abstract
OBJECTIVE To investigate the role of Pink1/Parkin-mediated mitochondrial autophagy in exertional heat stroke-induced acute lung injury in rats. METHODS Sixty SD rats were divided into four groups: normal group (CON group), normal Parkin overexpression group (CON + Parkin group), exertional heat stroke group (EHS group), and exertional heat stroke Parkin overexpression group (EHS + Parkin group). Adeno-associated virus carrying the Parkin gene was intravenously injected into the rats to overexpress Parkin in the lung tissue. An exertional heat stroke rat model was established, and survival curves were plotted. Lung micro-CT was performed, and lung coefficient and pulmonary microvascular permeability were measured. RESULTS Compared with the EHS group, the survival rate of rats in the EHS + Parkin overexpression group was significantly increased, lung coefficient and pulmonary microvascular permeability were reduced, and pathological changes such as exudation and consolidation were significantly reduced. The levels of inflammatory factors IL-6, IL-1β, TNF- α, and ROS were significantly decreased; the degree of mitochondrial swelling in type II alveolar epithelial cells was reduced, and no vacuolization was observed. Lung tissue apoptosis was reduced, and the colocalization fluorescence of Pink1 and Parkin, as well as LC3 and Tom20, were increased. The expression of Parkin and LC3-II/LC3-I ratio in lung tissue were both increased, while the expression of P62, Pink1, MFN2, and PTEN-L was decreased. CONCLUSION Impairment of Pink1/Parkin-mediated mitochondrial autophagy function is one of the mechanisms of exertional heat stroke-induced acute lung injury in rats. Activation of the Pink1/Parkin pathway can alleviate acute lung injury caused by exertional heat stroke.
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Affiliation(s)
- Jiaxing Wang
- Department of Critical Care Medicine, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhengzhong Sun
- Graduate School of Hebei North University, Zhangjiakou, China
| | - Liya Jiang
- Department of Respiratory and Critical Care Medicine, Jingdezhen First People's Hospital, Jingdezhen, China
| | - Lyv Xuan
- Graduate School of Hebei North University, Zhangjiakou, China
| | - Yunya Ma
- Graduate School of Hebei North University, Zhangjiakou, China
| | - Jiao Wang
- Department of Critical Care Medicine, Xuanwu Hospital of Capital Medical University, Beijing China
| | - Yan Gu
- Department of Critical Care Medicine, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuxiang Zhang
- Department of Critical Care Medicine, The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
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Lee BJ, Flood TR, Galan-Lopez N, McCormick JJ, King KE, Fujii N, Kenny GP. Changes in surrogate markers of intestinal epithelial injury and microbial translocation in young and older men during prolonged occupational heat stress in temperate and hot conditions. Eur J Appl Physiol 2024; 124:1049-1062. [PMID: 37815618 DOI: 10.1007/s00421-023-05329-7] [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: 04/06/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Exertional heat stress can cause damage to the intestinal epithelium and disrupt gastrointestinal barrier integrity, leading to microbial translocation (MT) linked to the development of heat stroke. This study aimed to assess age-related differences in markers of intestinal epithelial injury and MT following non-heat stress and high-heat stress exercise in healthy young and older men. METHODS Markers of intestinal epithelial injury (intestinal fatty acid-binding protein-'IFABP') and MT (soluble cluster of differentiation 14-'sCD14'; and lipopolysaccharide-binding protein-'LBP') were assessed in healthy young (18-30 y, n = 13) and older (50-70 y) men (n = 12). Blood samples were collected before, after 180 min of moderate-intensity (metabolic rate: 200 W/m2) walking and following 60 min recovery in either a non-heat stress [temperate: 21.9 °C, 35% relative humidity (RH)] or high-heat stress (hot: 41.4 °C, 35% RH) environment. RESULTS There were no differences in IFABP and sCD14 between the young and older groups in the temperate condition, while LBP was greater in the older group (+ 0.66 ug/mL; + 0.08 to + 1.24 ug/mL). In the hot condition, the older group experienced greater increases in IFABP compared to the young group (+ 712 pg/mL/hr; + 269 to + 1154 pg/mL/hr). However, there were no clear between-group differences for sCD14 (+ 0.24 ug/mL/hr, - 0.22 to + 0.70 ug/mL/hr) or LBP (+ 0.86 ug/mL/hr, - 0.73 to + 2.46 ug/mL/hr). CONCLUSION While older men may experience greater intestinal epithelial injury following exercise in the heat; this did not lead to a greater magnitude of microbial translocation relative to their younger counterparts.
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Affiliation(s)
- Ben J Lee
- Occupational and Environmental Physiology Group, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, UK
| | - Tessa R Flood
- Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Natalia Galan-Lopez
- Occupational and Environmental Physiology Group, Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - James J McCormick
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Ave., Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Kelli E King
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Ave., Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada
| | - Naoto Fujii
- Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Ave., Room 367, Montpetit Hall, Ottawa, ON, K1N 6N5, Canada.
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Conrad NJ, Heckler EP, Lee BJ, Hill GW, Flood TR, Wheeler LEV, Costello R, Walker EF, Gillum TL, Willems MET, Kuennen MR. New Zealand blackcurrant extract modulates the heat shock response in men during exercise in hot ambient conditions. Eur J Appl Physiol 2024:10.1007/s00421-024-05439-w. [PMID: 38448730 DOI: 10.1007/s00421-024-05439-w] [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: 11/03/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To determine if 7d of New Zealand blackcurrant (NZBC) extract alters the heat shock, inflammatory and apoptotic response during prolonged exertional-heat stress. METHODS Ten men (Age: 29 ± 2 years, Stature: 1.82 ± 0.02 m, Mass: 80.3 ± 2.7 kg, V̇O2max: 56 ± 2 mL·kg-1·min-1) ingested two capsules of CurraNZ™ (NZBC extract: 210 mg anthocyanins·day-1) or PLACEBO for 7d prior to 1 h treadmill run (65% V̇O2max) in hot ambient conditions (34 °C/40% RH). Blood samples were collected before (Pre), immediately after (Post), 1 h after (1-Post), and 4 h after (4-Post) exercise. Heat shock proteins (HSP90, HSP70, HSP32) were measured in plasma. HSP and protein markers of inflammatory capacity (TLR4, NF-κB) and apoptosis (BAX/BCL-2, Caspase 9) were measured in peripheral blood mononuclear cells (PBMC). RESULTS eHSP32 was elevated at baseline in NZBC(+ 31%; p < 0.001). In PLACEBO HSP32 content in PBMC was elevated at 4-Post(+ 98%; p = 0.002), whereas in NZBC it fell at Post(- 45%; p = 0.030) and 1-Post(- 48%; p = 0.026). eHSP70 was increased at Post in PLACEBO(+ 55.6%, p = 0.001) and NZBC (+ 50.7%, p = 0.010). eHSP90 was increased at Post(+ 77.9%, p < 0.001) and 1-Post(+ 73.2%, p < 0.001) in PLACEBO, with similar increases being shown in NZBC (+ 49.0%, p = 0.006 and + 66.2%, p = 0.001; respectively). TLR4 and NF-κB were both elevated in NZBC at PRE(+ 54%, p = 0.003 and + 57%, p = 0.004; respectively). Main effects of study condition were also shown for BAX/BCL-2(p = 0.025) and Caspase 9 (p = 0.043); both were higher in NZBC. CONCLUSION 7d of NZBC extract supplementation increased eHSP32 and PBMC HSP32 content. It also increased inflammatory and apoptotic markers in PBMC, suggesting that NZBC supports the putative inflammatory response that accompanies exertional-heat stress.
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Affiliation(s)
- Nathan J Conrad
- Department of Health & Human Performance, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Emerson P Heckler
- Department of Health & Human Performance, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Ben J Lee
- Occupational and Environmental Physiology Group, Centre for Physical Activity, Sport and Exercise Science, Coventry University, Coventry, England
- Institute of Applied Sciences, University of Chichester, Chichester, UK
| | - Garrett W Hill
- Department of Health & Human Performance, High Point University, One University Parkway, High Point, NC, 27268, USA
| | - Tessa R Flood
- Institute of Sport, Manchester Metropolitan University, Manchester, UK
- Institute of Applied Sciences, University of Chichester, Chichester, UK
| | - Lucy E V Wheeler
- Institute of Applied Sciences, University of Chichester, Chichester, UK
| | - Rianne Costello
- Global Food Security Programme, Biotechnology and Biological Sciences Research Council, Swindon, UK
| | - Ella F Walker
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - Trevor L Gillum
- Department of Kinesiology, California Baptist University, Riverside, CA, USA
| | - Mark E T Willems
- Institute of Applied Sciences, University of Chichester, Chichester, UK
| | - Matthew R Kuennen
- Department of Health & Human Performance, High Point University, One University Parkway, High Point, NC, 27268, USA.
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Han JH, Karki R, Malireddi RKS, Mall R, Sarkar R, Sharma BR, Klein J, Berns H, Pisharath H, Pruett-Miller SM, Bae SJ, Kanneganti TD. NINJ1 mediates inflammatory cell death, PANoptosis, and lethality during infection conditions and heat stress. Nat Commun 2024; 15:1739. [PMID: 38409108 PMCID: PMC10897308 DOI: 10.1038/s41467-024-45466-x] [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: 05/15/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Innate immunity provides the first line of defense through multiple mechanisms, including pyrogen production and cell death. While elevated body temperature during infection is beneficial to clear pathogens, heat stress (HS) can lead to inflammation and pathology. Links between pathogen exposure, HS, cytokine release, and inflammation have been observed, but fundamental innate immune mechanisms driving pathology during pathogen exposure and HS remain unclear. Here, we use multiple genetic approaches to elucidate innate immune pathways in infection or LPS and HS models. Our results show that bacteria and LPS robustly increase inflammatory cell death during HS that is dependent on caspase-1, caspase-11, caspase-8, and RIPK3 through the PANoptosis pathway. Caspase-7 also contributes to PANoptosis in this context. Furthermore, NINJ1 is an important executioner of this cell death to release inflammatory molecules, independent of other pore-forming executioner proteins, gasdermin D, gasdermin E, and MLKL. In an in vivo HS model, mortality is reduced by deleting NINJ1 and fully rescued by deleting key PANoptosis molecules. Our findings suggest that therapeutic strategies blocking NINJ1 or its upstream regulators to prevent PANoptosis may reduce the release of inflammatory mediators and benefit patients.
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Affiliation(s)
- Joo-Hui Han
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Woosuk University, Wanju, 55338, Republic of Korea
| | - Rajendra Karki
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Department of Biological Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - R K Subbarao Malireddi
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Raghvendra Mall
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Biotechnology Research Center, Technology Innovation Institute, Abu Dhabi, P.O. Box 9639, United Arab Emirates
| | - Roman Sarkar
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Bhesh Raj Sharma
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Jonathon Klein
- Center for Advanced Genome Engineering, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Harmut Berns
- Center for Advanced Genome Engineering, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Harshan Pisharath
- Animal Resources Center, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Shondra M Pruett-Miller
- Center for Advanced Genome Engineering, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Sung-Jin Bae
- Department of Molecular Biology and Immunology, College of Medicine, Kosin University, Busan, 49267, Republic of Korea
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Liu Y, Li Y, Deng Z, Zhao Y, Yuan R, Yang M, Wang L, Fang Y, Ding D, Zhou F, Kang H. Protective and immunomodulatory effects of mesenchymal stem cells on multiorgan injury in male rats with heatstroke. J Therm Biol 2023; 118:103696. [PMID: 37871397 DOI: 10.1016/j.jtherbio.2023.103696] [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: 05/11/2022] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 10/25/2023]
Abstract
Heatstroke (HS) causes multiple organ dysfunction syndrome (MODS) with a mortality rate of 60% after hospitalization. Currently, there is no effective and targeted approach for the treatment of HS. Despite growing evidence that mesenchymal stem cells (MSCs) may reduce multiorgan damage and improve survival through immunomodulatory effects in several diseases, no one has tested whether MSCs have immunomodulatory effects in heatstroke. The present study focused on pathological changes and levels of the cytokines and immunoglobulins to investigate the mechanisms underlying the protective effect and the anti-inflammatory effects of MSCs. We found that MSCs treatment significantly reduced the 28-day mortality rate (P < 0.05), the levels of hepatic and renal function markers on day 1 (P < 0.01) and the pathological lesion scores of multiple organs in HS rats. The levels of IgG1, IgM, and IgA of the HS + MSC group was significantly higher than that in HS group on days 3 and 28(P < 0.05). In conclusion, MSCs contribute to protecting against multiorgan injury, reducing pro-inflammatory cytokines, stabilizing immunoglobulins, and reducing the mortality rate of HS rats.
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Affiliation(s)
- Yuyan Liu
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yun Li
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zihui Deng
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Basic Medicine, Graduate School, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yan Zhao
- Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Rui Yuan
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Mengmeng Yang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lu Wang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuan Fang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Dengfeng Ding
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Laboratory Animal Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Feihu Zhou
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Laboratory Animal Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, PR China
| | - Hongjun Kang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China; Department of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
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Wang Y, Li D, Wu Z, Zhong C, Tang S, Hu H, Lin P, Yang X, Liu J, He X, Zhou H, Liu F. Development and validation of a prognostic model of survival for classic heatstroke patients: a multicenter study. Sci Rep 2023; 13:19265. [PMID: 37935703 PMCID: PMC10630318 DOI: 10.1038/s41598-023-46529-7] [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: 07/22/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
Classic heatstroke (CHS) is a life-threatening illness characterized by extreme hyperthermia, dysfunction of the central nervous system and multiorgan failure. Accurate predictive models are useful in the treatment decision-making process and risk stratification. This study was to develop and externally validate a prediction model of survival for hospitalized patients with CHS. In this retrospective study, we enrolled patients with CHS who were hospitalized from June 2022 to September 2022 at 3 hospitals in Southwest Sichuan (training cohort) and 1 hospital in Central Sichuan (external validation cohort). Prognostic factors were identified utilizing least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate Cox regression analysis in the training cohort. A predictive model was developed based on identified prognostic factors, and a nomogram was built for visualization. The areas under the receiver operator characteristic (ROC) curves (AUCs) and the calibration curve were utilized to assess the prognostic performance of the model in both the training and external validation cohorts. The Kaplan‒Meier method was used to calculate survival rates. A total of 225 patients (median age, 74 [68-80] years) were included. Social isolation, self-care ability, comorbidities, body temperature, heart rate, Glasgow Coma Scale (GCS), procalcitonin (PCT), aspartate aminotransferase (AST) and diarrhea were found to have a significant or near-significant association with worse prognosis among hospitalized CHS patients. The AUCs of the model in the training and validation cohorts were 0.994 (95% [CI], 0.975-0.999) and 0.901 (95% [CI], 0.769-0.968), respectively. The model's prediction and actual observation demonstrated strong concordance on the calibration curve regarding 7-day survival probability. According to K‒M survival plots, there were significant differences in survival between the low-risk and high-risk groups in the training and external validation cohorts. We designed and externally validated a prognostic prediction model for CHS. This model has promising predictive performance and could be applied in clinical practice for managing patients with CHS.
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Affiliation(s)
- Yu Wang
- Department of Emergency Medicine, Rongxian People's Hospital, Rongxian, 643100, China
| | - Donglin Li
- Department of Thoracic Surgery, Suining Central Hospital, Suining, 629000, China
| | - Zongqian Wu
- Department of Oncology, Zhongjiang County People's Hospital, Zhongjiang, 618100, China
| | - Chuan Zhong
- Department of Thoracic Surgery, Suining Central Hospital, Suining, 629000, China
| | - Shengjie Tang
- Department of Thoracic Surgery, Suining Central Hospital, Suining, 629000, China
| | - Haiyang Hu
- Department of Thoracic Surgery, Suining Central Hospital, Suining, 629000, China
| | - Pei Lin
- Department of Emergency Medicine, Rongxian People's Hospital, Rongxian, 643100, China
| | - Xianqing Yang
- Department of Critical Care Medicine, Jiang'an County People's Hospital, Jiang'an, 644200, China
| | - Jiangming Liu
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, 629000, China
| | - Xinyi He
- Department of Rheumatology and Immunology, Nanchong Central Hospital, Nanchong, 637000, China
| | - Haining Zhou
- Department of Thoracic Surgery, Suining Central Hospital, Suining, 629000, China.
| | - Fake Liu
- Department of Critical Care Medicine, Jiang'an County People's Hospital, Jiang'an, 644200, China.
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Huang X, Luo Z, Shen T, He G, Yu X, Liu Y, Tan Y, Wang Z, Li P, Zhang B, Zhou H, Chen X, Wang Y, Yu S, Luo X, Yang X. Holistic view of heat acclimation alleviated intestinal lesion in mice with heat stroke based on microbiome-metabolomics analysis. Microb Biotechnol 2023; 16:2114-2130. [PMID: 37792264 PMCID: PMC10616642 DOI: 10.1111/1751-7915.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 08/26/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
The severity of heat stroke (HS) is associated with intestinal injury, which is generally considered an essential issue for HS. Heat acclimation (HA) is considered the best strategy to protect against HS. In addition, HA has a protective effect on intestinal injuries caused by HS. Considering the essential role of gut microbes in intestinal structure and function, we decided to investigate the potential protective mechanism of HA in reducing intestinal injury caused by HS. HA model was established by male C57BL/6J mice (5-6 weeks old, 17-19 g) were exposed at (34 ± 0.7)°C for 4 weeks to establish an animal HA model. The protective effect of HA on intestinal barrier injury in HS was investigated by 16S rRNA gene sequencing and nontargeted liquid chromatography-mass spectrometry (LC-MS) metabolomics. According to the experimental results, HA can change the composition of the gut microbiota, which increases the proportion of lactobacilli, faecal bacteria, and urinobacteria but decreases the proportion of deoxycholic acid. Moreover, HA can reduce liver and kidney injury and systemic inflammation caused by HS and reduce intestinal injury by enhancing the integrity of the intestinal barrier. In addition, HA regulates inflammation by inhibiting NF-κB signalling and increasing tight junction protein expression in HS mice. HA induces changes in the gut microbiota, which may enhance tight junction protein expression, thereby reducing intestinal inflammation, promoting bile acid metabolism, and ultimately maintaining the integrity of the intestinal barrier. In conclusion, HA induced changes in the gut microbiota. Among the gut microbiota, lactobacilli may play a key role in the potential protective mechanism of HA.
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Affiliation(s)
- Xueyan Huang
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Zhen Luo
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Tingting Shen
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Genlin He
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Xueting Yu
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Yishan Liu
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Yulong Tan
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Zeze Wang
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Ping Li
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Boyi Zhang
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Huan Zhou
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Xiangyu Chen
- The Center of Emergency and Trauma, Southwest HospitalArmy Medical UniversityChongqingChina
| | - Ying Wang
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Shasha Yu
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Xue Luo
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
| | - Xuesen Yang
- Department of Tropical Medicine, College of Military Preventive MedicineArmy Medical UniversityChongqingChina
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of ChinaChongqingChina
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Luo Z, Wang Z, Li P, Tan Y, He G, Liu X, Shen T, Yang X, Luo X. Intestinal alkaline phosphatase improves intestinal permeability and alleviates multiple organ dysfunction caused by heatstroke. Heliyon 2023; 9:e21838. [PMID: 38028005 PMCID: PMC10663923 DOI: 10.1016/j.heliyon.2023.e21838] [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: 06/15/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Heatstroke (HS) is a severe acute disease related to gastrointestinal barrier dysfunction, systemic inflammation and multiple organ injury. Many of the functions of Intestinal alkaline phosphatase (IAP) have been linked to gut homeostasis, gut barrier function and inflammation. However, the protective effect of IAP on heatstroke is not fully elucidated. This study aims to explore the protective effect of IAP on heatstroke by maintaining intestinal barrier and improving permeability. Methods Male C57BL/6 mice were placed in a controlled climate chamber (ambient temperature: 40.0 ± 0.5 °C; humidity: 60 ± 5 %) until the maximum core temperature (Tc, max) reached 42.7 °C (the received criterion of HS). Then heat exposed mice (n = 195) were divided into three groups: 0.2 mL of 0.9 % physiological saline (HS) or vehicle (HS + Vehicle) or 300 IU IAP (HS + IAP) by gavage at 0, 24, and 48 h after onset. Control group mice (Con) (n = 65) were not exposed to heat and were gavaged with 0.9 % physiological saline of the same volume at the same time. Results IAP treatment significantly reduced the levels of endotoxin, FD4, and D-lactate in the blood of heatstroke mice, reduced intestinal permeability and maintained the integrity of the intestinal barrier by increasing the expression of tight junction proteins. Meanwhile, IAP treatment alleviated liver and kidney damage caused by heatstroke, reduced serum levels of inflammatory cytokines, and thus improved survival rate of mice after heatstroke. Conclusion This study indicates that IAP can improve the intestinal barrier function and intestinal permeability by increasing intestinal tight junctions, reduce systemic inflammation and multiple organ injury and improving the survival rate of heatstroke. Therefore, we consider IAP may be added to enteral nutrition formulas as a potential means for diseases characterized by intestinal permeability disorders, including heatstroke.
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Affiliation(s)
- Zhen Luo
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Zeze Wang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Ping Li
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Yulong Tan
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Genlin He
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Xiaoqian Liu
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Tingting Shen
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Xuesen Yang
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
| | - Xue Luo
- Department of Tropical Medicine, College of Military Preventive Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Chongqing, China
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Henningsen K, Mika A, Alcock R, Gaskell SK, Parr A, Rauch C, Russo I, Snipe RMJ, Costa RJS. The increase in core body temperature in response to exertional-heat stress can predict exercise-induced gastrointestinal syndrome. Temperature (Austin) 2023; 11:72-91. [PMID: 38577295 PMCID: PMC10989703 DOI: 10.1080/23328940.2023.2213625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 04/06/2024] Open
Abstract
Utilizing metadata from existing exertional and exertional-heat stress studies, the study aimed to determine if the exercise-associated increase in core body temperature can predict the change in exercise-induced gastrointestinal syndrome (EIGS) biomarkers and exercise-associated gastrointestinal symptoms (Ex-GIS). Endurance-trained individuals completed 2 h of running exercise in temperate (21.2-30.0°C) to hot (35.0-37.2°C) ambient conditions (n = 132 trials). Blood samples were collected pre- and post-exercise to determine the change in gastrointestinal integrity biomarkers and systemic inflammatory cytokines. Physiological and thermoregulatory strain variables were assessed every 10-15 min during exercise. The strength of the linear relationship between maximal (M-Tre) and change (Δ Tre) in rectal temperature and EIGS variables was determined via Spearman's rank correlation coefficients. While the strength of prediction was determined via simple and multiple linear regression analyses dependent on screened EIGS and Ex-GIS confounding factors. Significant positive correlations between Tre maximum (M-Tre) and change (Δ Tre) with I-FABP (rs = 0.434, p < 0.001; and rs = 0.305, p < 0.001; respectively), sCD14 (rs = 0.358, p < 0.001; and rs = 0.362, p < 0.001), systemic inflammatory response profile (SIR-Profile) (p < 0.001), and total Ex-GIS (p < 0.05) were observed. M-Tre and Δ Tre significantly predicted (adjusted R2) magnitude of change in I-FABP (R2(2,123)=0.164, p < 0.001; and R2(2,119)=0.058, p = 0.011; respectively), sCD14 (R2(2,81)=0.249, p < 0.001; and R2(2,77)=0.214, p < 0.001), SIR-Profile (p < 0.001), and total Ex-GIS (p < 0.05). Strong to weak correlations were observed between M-Tre and Δ Tre with plasma concentrations of I-FABP, sCD14, SIR-Profile, and Ex-GIS in response to exercise. M-Tre and Δ Tre can predict the magnitude of these EIGS variables and Ex-GIS in response to exercise.
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Affiliation(s)
- Kayla Henningsen
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Alice Mika
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Rebekah Alcock
- Department of Dietetics and Human Nutrition, La Trobe University, Bundoora, Victoria, Australia
| | - Stephanie K. Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Alexandra Parr
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Christopher Rauch
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Isabela Russo
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
| | - Rhiannon M. J. Snipe
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Victoria, Australia
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11
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Effects of high-/low-temperature and high-altitude hypoxic environments on gut microbiota of sports people: A retrospective analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2023. [DOI: 10.1016/j.smhs.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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12
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Peng M, Yi W, Murong M, Peng N, Tong H, Jiang M, Jin D, Peng S, Liang W, Quan J, Li M, Shi L, Xiao G. Akkermansia muciniphila improves heat stress-impaired intestinal barrier function by modulating HSP27 in Caco-2 cells. Microb Pathog 2023; 177:106028. [PMID: 36796737 DOI: 10.1016/j.micpath.2023.106028] [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: 12/07/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Heat stress causes an elevation of intestinal epithelial barrier permeability and leads to multiple organ dysfunction in heatstroke. Akkermansia muciniphila (A. muciniphila) plays a role in maintaining intestinal integrity and improving the inflammatory state. This study aimed to investigate whether A. muciniphila could alleviate heat stress-induced dysfunction of intestinal permeability in Caco-2 monolayers and have the preventive effects on heatstroke. METHODS Human intestinal epithelial Caco-2 cells were preincubated with live or pasteurized A. muciniphila then exposed to heat stress at 43 °C. Transepithelial electrical resistance (TEER) and the flux of horseradish peroxidase (HRP) across cell monolayers were measured to determine intestinal permeability. The levels of the tight junction proteins Occludin, ZO-1 and HSP27 were analyzed by Western blotting. These proteins were immunostained and localized by fluorescence microscopy. TJ morphology was observed using transmission electron microscopy (TEM). RESULTS Both live and pasteurized A. muciniphila effectively attenuated the decrease in TEER and impairment of intestinal permeability in HRP flux induced by heat exposure. A. muciniphila significantly elevated the expression of Occludin and ZO-1 by promoting HSP27 phosphorylation. The distortion and redistribution of tight junction proteins and disruption of morphology were also effectively prevented by pretreatment with A. muciniphila. CONCLUSION This study indicates for the first time that both live and pasteurized A. muciniphila play an important protective role against heat-induced permeability dysfunction and epithelial barrier damage.
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Affiliation(s)
- Mian Peng
- Department of Critical Care Medicine, Shenzhen Luohu Hospital Group, Shenzhen, Guangdong, 518001, China
| | - Wanhua Yi
- Department of Critical Care Medicine, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Min Murong
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Na Peng
- Emergency Department, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Huasheng Tong
- Emergency Department, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Mengliu Jiang
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Di Jin
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Suliu Peng
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Weifen Liang
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Jingwen Quan
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Muman Li
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China
| | - Linna Shi
- Department of Nutrition, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Guizhen Xiao
- Department of Nutrition, General Hospital of Southern Theater Command, Guangzhou, Guangdong, 510010, China; Huabo Post-Doctoral Research Center, Biological Pharmaceutical Research Institute, Guangzhou, Guangdong, 510010, China.
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Li F, Deng J, He Q, Zhong Y. ZBP1 and heatstroke. Front Immunol 2023; 14:1091766. [PMID: 36845119 PMCID: PMC9950778 DOI: 10.3389/fimmu.2023.1091766] [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: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Heatstroke, which is associated with circulatory failure and multiple organ dysfunction, is a heat stress-induced life-threatening condition characterized by a raised core body temperature and central nervous system dysfunction. As global warming continues to worsen, heatstroke is expected to become the leading cause of death globally. Despite the severity of this condition, the detailed mechanisms that underlie the pathogenesis of heatstroke still remain largely unknown. Z-DNA-binding protein 1 (ZBP1), also referred to as DNA-dependent activator of IFN-regulatory factors (DAI) and DLM-1, was initially identified as a tumor-associated and interferon (IFN)-inducible protein, but has recently been reported to be a Z-nucleic acid sensor that regulates cell death and inflammation; however, its biological function is not yet fully understood. In the present study, a brief review of the main regulators is presented, in which the Z-nucleic acid sensor ZBP1 was identified to be a significant factor in regulating the pathological characteristics of heatstroke through ZBP1-dependent signaling. Thus, the lethal mechanism of heatstroke is revealed, in addition to a second function of ZBP1 other than as a nucleic acid sensor.
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Affiliation(s)
- Fanglin Li
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,Department of Critical Care Medicine and Hematology, The 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Jiayi Deng
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiuli He
- Department of Nephrology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China,*Correspondence: Qiuli He, ; Yanjun Zhong,
| | - Yanjun Zhong
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Qiuli He, ; Yanjun Zhong,
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An Overview of Exertional Heat Illness in Thoroughbred Racehorses: Pathophysiology, Diagnosis, and Treatment Rationale. Animals (Basel) 2023; 13:ani13040610. [PMID: 36830397 PMCID: PMC9951674 DOI: 10.3390/ani13040610] [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: 01/05/2023] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Exertional heat illness (EHI) is a complex medical disease. The thoroughbred (TB) racehorse is at considerable risk because of the intensity of its exercise activity and its high rate of metabolic heat production. The pathophysiology of EHI can combine aspects of both the heat toxicity pathway and the heat sepsis or endotoxemic pathway. Treatment regimes depend upon the detection of earliest clinical signs, rapid assessment, aggressive cooling and judicious use of ancillary medications. Ice-cold water provides the most rapid cooling, consistent with the need to lower core body temperature before tissue damage occurs. Research into EHI/HS by inducing the condition experimentally is ethically unjustifiable. Consequently, leading researchers in the human field have conceded that "most of our knowledge has been gained from anecdotal incidents, gathered from military personnel and athletes who have collapsed during or following physical activity, and that retrospective and case studies have provided important evidence regarding recognition and treatment of EHI". The authors' review into EHI shares that perspective, and the recommendations made herein are based on observations of heat-affected racehorses at the racetrack and their response, or lack of response, to treatment. From 2014 to 2018, 73 race meetings were attended, and of the 4809 individual starters, signs of EHI were recorded in 457. That observational study formed the basis for a series of articles which have been published under the title, 'EHI in Thoroughbred racehorses in eastern Australia', and forms the background for this review.
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15
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Wu J, Yang S, Wang T, Wu Q, Liao X, Yao R, Du L. Comparison of immune cell profiles associated with heatstroke, sepsis, or cardiopulmonary bypass: Study protocol for an exploratory, case-control study trial. Front Med (Lausanne) 2023; 10:1165786. [PMID: 37138748 PMCID: PMC10149687 DOI: 10.3389/fmed.2023.1165786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Heatstroke is a life-threatening illness involving extreme hyperthermia and multi-organ failure, and it is associated with high mortality. The immune profiles of heatstroke have not been fully elucidated, and diagnostic and prognostic biomarkers of heatstroke are lacking. This study will analyze immune profiles in heatstroke patients as they differ from profiles in patients with sepsis or aseptic inflammation patients in order to identify diagnostic and prognostic biomarkers. Methods This exploratory, case-control study will recruit patients with heatstroke, patients with sepsis, patients undergoing cardiopulmonary bypass as well as healthy controls at West China Hospital of Sichuan University from 1 January 2023 to 31 October 2023. The four cohorts will be profiled at one time point in terms of lymphocytes, monocytes, natural killer cells, and granulocytes using flow cytometry, and cell populations will be visualized in two dimensions using t-SNE and UMAP, then clustered using PhenoGraph and FlowSOM. Gene expression in the specific immune cell populations will also be compared across the four cohorts, as will levels of plasma cytokines using enzyme-linked immunosorbent assays. Outcomes in the cohorts will be monitored during 30-day follow-up. Discussion This trial is, to our knowledge, the first attempt to improve the diagnosis of heatstroke and prediction of prognosis based on immune cell profiles. The study is also likely to generate new insights into immune responses during heatstroke, which may help clarify the disease process and lay the foundation for immunotherapies.
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Affiliation(s)
- Juan Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sha Yang
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Tingting Wang
- Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qinjuan Wu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyi Liao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Yao
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
- Rong Yao,
| | - Lei Du
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Lei Du,
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16
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Brownlow MA, Mizzi JX. Pathophysiology of exertional heat illness in the Thoroughbred racehorse: Broadening perspective to include an exercise‐induced gastrointestinal syndrome in which endotoxaemia and systemic inflammation may contribute to the condition. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - James Xavier Mizzi
- Department of Regulation, Welfare and Biosecurity Policy The Hong Kong Jockey Club, Sha Tin Racecourse Sha Tin Hong Kong
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Lee JKW, Tan B, Ogden HB, Chapman S, Sawka MN. Exertional heat stroke: nutritional considerations. Exp Physiol 2022; 107:1122-1135. [PMID: 35521757 PMCID: PMC9790308 DOI: 10.1113/ep090149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/02/2022] [Indexed: 12/30/2022]
Abstract
NEW FINDINGS What is the topic of this review? The potential role of nutrition in exertional heat stroke. What advances does it highlight? Certain nutritional and dietary strategies used by athletes and workers may exert a protective effect the pathophysiological processes of exertional heat stroke, whereas others may be detrimental. While current evidence suggests that some of these practices may be leveraged as a potential countermeasure to exertional heat stroke, further research on injury-related outcomes in humans is required. ABSTRACT Exertional heat stroke (EHS) is a life-threatening illness and an enduring problem among athletes, military servicemen and -women, and occupational labourers who regularly perform strenuous activity, often under hot and humid conditions or when wearing personal protective equipment. Risk factors for EHS and mitigation strategies have generally focused on the environment, health status, clothing, heat acclimatization and aerobic conditioning, but the potential role of nutrition is largely underexplored. Various nutritional and dietary strategies have shown beneficial effects on exercise performance and health and are widely used by athletes and other physically active populations. There is also evidence that some of these practices may dampen the pathophysiological features of EHS, suggesting possible protection or abatement of injury severity. Promising candidates include carbohydrate ingestion, appropriate fluid intake and glutamine supplementation. Conversely, some nutritional factors and low energy availability may facilitate the development of EHS, and individuals should be cognizant of these. Therefore, the aims of this review are to present an overview of EHS along with its mechanisms and pathophysiology, discuss how selected nutritional considerations may influence EHS risk focusing on their impact on the key pathophysiological processes of EHS, and provide recommendations for future research. With climate change expected to increase EHS risk and incidence in the coming years, further investigation on how diet and nutrition may be optimized to protect against EHS would be highly beneficial.
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Affiliation(s)
- Jason K. W. Lee
- Human Potential Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Heat Resilience and Performance Centre, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Department of Physiology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,N.1 Institute for HealthNational University of SingaporeSingapore,Global Asia InstituteNational University of SingaporeSingapore,Institute for Digital MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore,Singapore Institute for Clinical SciencesAgency for Science, Technology and Research (A*STAR)Singapore,Campus for Research Excellence and Technological Enterprise (CREATE)SingaporeSingapore
| | - Beverly Tan
- Human Potential Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Campus for Research Excellence and Technological Enterprise (CREATE)SingaporeSingapore
| | - Henry B. Ogden
- Army Recruit Health and Performance ResearchHeadquarters of Army Recruiting and Initial Training Command, UpavonPewseyUK,Department of Sport, Health and WellbeingPlymouth Marjon UniversityPlymouthUK
| | - Shaun Chapman
- Army Recruit Health and Performance ResearchHeadquarters of Army Recruiting and Initial Training Command, UpavonPewseyUK,Cambridge Centre for Sport and Exercise SciencesSchool of Psychology and Sport ScienceAnglia Ruskin UniversityCambridgeUK
| | - Michael N. Sawka
- School of Biological SciencesGeorgia Institute of TechnologyAtlantaGAUSA
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Zhang Y, Deng X, Zhang J, Zhang L, Akram Z, Zhang B, Sun S. A Potential Driver of Disseminated Intravascular Coagulation in Heat Stroke Mice: Neutrophil Extracellular Traps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12448. [PMID: 36231751 PMCID: PMC9566744 DOI: 10.3390/ijerph191912448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
AIMS Disseminated intravascular coagulation (DIC) is a common complication of heat stroke (HS) patients, and it is one of the important reasons leading to multiple organ failure and even death. The association between neutrophil extracellular traps (NETs) and DIC is unclear in HS mice. METHODS AND RESULTS Here, HS was induced by the combination of hyperthermia (HT) and lipopolysaccharide (LPS). The DIC was evaluated by measuring prothrombin time (PT), D-dimer, thrombomodulin (TM), fibrinogen (FIB), and platelet (PLT). The expression of citrullinated-histone (CitH3) was analyzed by Western blotting. The formation of NETs was observed by immunofluorescence microscopy. The risk of HS-induced DIC was increased when HT was combined with LPS. The markers of NETs were significantly higher than those in the control group, and the NETs derived from HS promoted the development of DIC. DNase I improved coagulation dysfunction via the clearance of NETs caused by neutrophil aggregation. CONCLUSIONS Degradation of NETs reduced the risk of developing DIC, and thus the survival rate of mice was improved. These results indicate that NETs may hold potential alternative therapeutic strategies for the treatment of DIC in HS patients.
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Affiliation(s)
- Yuling Zhang
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi University, Shihezi 832000, China
- Key Laboratory for Green Processing of Chemical Engineering of Xinjiang Bingtuan, School of Chemistry and Chemical Engineering, Shihezi University, Shihezi 832000, China
| | - Xiling Deng
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi University, Shihezi 832000, China
| | - Jing Zhang
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi University, Shihezi 832000, China
- Key Laboratory for Green Processing of Chemical Engineering of Xinjiang Bingtuan, School of Chemistry and Chemical Engineering, Shihezi University, Shihezi 832000, China
| | - Liang Zhang
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi University, Shihezi 832000, China
| | - Zubair Akram
- Key Laboratory for Green Processing of Chemical Engineering of Xinjiang Bingtuan, School of Chemistry and Chemical Engineering, Shihezi University, Shihezi 832000, China
| | - Bo Zhang
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi University, Shihezi 832000, China
| | - Shiguo Sun
- Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi University, Shihezi 832000, China
- College of Chemistry and Pharmaceutical Engineering, Hebei University of Science and Technology, Shijiazhuang 050000, China
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Anthocyanin-Rich Blackcurrant Extract Preserves Gastrointestinal Barrier Permeability and Reduces Enterocyte Damage but Has No Effect on Microbial Translocation and Inflammation After Exertional Heat Stress. Int J Sport Nutr Exerc Metab 2022; 32:265-274. [PMID: 35287112 DOI: 10.1123/ijsnem.2021-0330] [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: 11/26/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
Abstract
This study investigated the effects of 7 days of 600 mg/day anthocyanin-rich blackcurrant extract intake on small intestinal permeability, enterocyte damage, microbial translocation, and inflammation following exertional heat stress. Twelve recreationally active men (maximal aerobic capacity = 55.6 ± 6.0 ml·kg-1·min-1) ran (70% VO2max) for 60 min in an environmental chamber (34 °C, 40% relative humidity) on two occasions (placebo/blackcurrant, randomized double-blind crossover). Permeability was assessed from a 4-hr urinary excretion of lactulose and rhamnose and expressed as a ratio of lactulose/rhamnose. Venous blood samples were taken at rest and 20, 60, and 240 min after exercise to measure enterocyte damage (intestinal fatty acid-binding protein); microbial translocation (soluble CD14, lipopolysaccharide-binding protein); and interleukins 6, interleukins 10, and interleukins 1 receptor antagonist. Exercise increased rectal temperature (by ∼2.8 °C) and heart rate (by ∼123 beats/min) in each condition. Blackcurrant supplementation led to a ∼12% reduction in lactulose/rhamnose ratio (p < .0034) and enterocyte damage (∼40% reduction in intestinal fatty acid-binding protein area under the curve; p < .0001) relative to placebo. No between-condition differences were observed immediately after exercise for lipopolysaccharide-binding protein (mean, 95% confidence interval [CI]; +80%, 95% CI [+61%, +99%]); soluble CD14 (+37%, 95% CI [+22%, +51%]); interleukins 6 (+494%, 95% CI [+394%, +690%]); interleukins 10 (+288%, 95% CI [+105%, +470%]); or interleukins 1 receptor antagonist (+47%, 95% CI [+13%, +80%]; all time main effects). No between-condition differences for these markers were observed after 60 or 240 min of recovery. Blackcurrant extract preserves the GI barrier; however, at subclinical levels, this had no effect on microbial translocation and downstream inflammatory processes.
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Burhans W, Rossiter Burhans C, Baumgard L. Invited review: Lethal heat stress: The putative pathophysiology of a deadly disorder in dairy cattle. J Dairy Sci 2022; 105:3716-3735. [DOI: 10.3168/jds.2021-21080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/11/2022] [Indexed: 01/13/2023]
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21
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Ogden HB, Fallowfield JL, Child RB, Davison G, Fleming SC, Delves SK, Millyard A, Westwood CS, Layden JD. No protective benefits of low dose acute L-glutamine supplementation on small intestinal permeability, epithelial injury and bacterial translocation biomarkers in response to subclinical exertional-heat stress: A randomized cross-over trial. Temperature (Austin) 2022; 9:196-210. [PMID: 36106146 PMCID: PMC9467553 DOI: 10.1080/23328940.2021.2015227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Exertional heat stress disrupts gastrointestinal permeability and, through subsequent bacterial translocation, can result in potentially fatal exertional heat stroke. Glutamine supplementation is a potential countermeasure although previously validated doses are not universally well tolerated. Ten males completed two 80-minute subclinical exertional heat stress tests (EHSTs) following either glutamine (0.3 g kg FFM-1) or placebo supplementation. Small intestinal permeability was assessed using the lactulose/rhamnose dual sugar absorption test and small intestinal epithelial injury using Intestinal Fatty-Acid Binding Protein (I-FABP). Bacterial translocation was assessed using the total 16S bacterial DNA and Bacteroides/total 16S DNA ratio. The glutamine bolus was well tolerated, with no participants reporting symptoms of gastrointestinal intolerance. Small intestinal permeability was not influenced by glutamine supplementation (p = 0.06) although a medium effect size favoring the placebo trial was observed (d = 0.73). Both small intestinal epithelial injury (p < 0.01) and Bacteroides/total 16S DNA (p = 0.04) increased following exertional heat stress, but were uninfluenced by glutamine supplementation. Low-dose acute oral glutamine supplementation does not protect gastrointestinal injury, permeability, or bacterial translocation in response to subclinical exertional heat stress.
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Affiliation(s)
- Henry B. Ogden
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, UK,CONTACT Henry B. Ogden
| | - Joanne L. Fallowfield
- Environmental Medicine and Science Division, Institute of Naval Medicine, Alverstoke, UK
| | - Robert B. Child
- School of Chemical Engineering, University of Birmingham, Birmingham, UK
| | - Glen Davison
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
| | - Simon C. Fleming
- Department of Clinical Chemistry, Royal Cornwall NHS Trust, Truro, UK
| | - Simon K. Delves
- Environmental Medicine and Science Division, Institute of Naval Medicine, Alverstoke, UK
| | - Alison Millyard
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, UK
| | | | - Joseph D. Layden
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, UK
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22
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Stanculescu D, Sepúlveda N, Lim CL, Bergquist J. Lessons From Heat Stroke for Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Neurol 2021; 12:789784. [PMID: 34966354 PMCID: PMC8710546 DOI: 10.3389/fneur.2021.789784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/11/2021] [Indexed: 01/01/2023] Open
Abstract
We here provide an overview of the pathophysiological mechanisms during heat stroke and describe similar mechanisms found in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Both conditions are characterized by disturbed homeostasis in which inflammatory pathways play a central role. Splanchnic vasoconstriction, increased gut permeability, gut-related endotoxemia, systemic inflammatory response, central nervous system dysfunction, blood coagulation disorder, endothelial-cell injury, and mitochondrial dysfunction underlie heat stroke. These mechanisms have also been documented in ME/CFS. Moreover, initial transcriptomic studies suggest that similar gene expressions are altered in both heat stroke and ME/CFS. Finally, some predisposing factors for heat stroke, such as pre-existing inflammation or infection, overlap with those for ME/CFS. Notwithstanding important differences - and despite heat stroke being an acute condition - the overlaps between heat stroke and ME/CFS suggest common pathways in the physiological responses to very different forms of stressors, which are manifested in different clinical outcomes. The human studies and animal models of heat stroke provide an explanation for the self-perpetuation of homeostatic imbalance centered around intestinal wall injury, which could also inform the understanding of ME/CFS. Moreover, the studies of novel therapeutics for heat stroke might provide new avenues for the treatment of ME/CFS. Future research should be conducted to investigate the similarities between heat stroke and ME/CFS to help identify the potential treatments for ME/CFS.
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Affiliation(s)
| | - Nuno Sepúlveda
- CEAUL-Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal.,Department of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Chin Leong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jonas Bergquist
- Analytical Chemistry and Neurochemistry, Department of Chemistry-BMC, Uppsala University, Uppsala, Sweden.,The ME/CFS Collaborative Research Center at Uppsala University, Uppsala, Sweden
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23
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Ogden HB, Fallowfield JL, Child RB, Davison G, Fleming SC, Delves SK, Millyard A, Westwood CS, Layden JD. Acute L-Glutamine Supplementation does not improve Gastrointestinal Permeability, Injury or Microbial Translocation in Response to Exhaustive High Intensity Exertional-Heat Stress. Eur J Sport Sci 2021; 22:1865-1876. [PMID: 34726114 DOI: 10.1080/17461391.2021.2001575] [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: 12/13/2022]
Abstract
PurposeExertional-heat stress adversely distrupts (GI) barrier integrity and, through subsequent microbial translocation (MT), can result in potentially fatal exertional-heat stroke. Acute glutamine (GLN) supplementation is a potential nutritional countermeasure, although the practical value of current supplementation regimens is questionable. Method: Ten males completed two high-intensity exertional-heat stress tests (EHST) involving running in the heat (40°C and 40% relative humidity) at lactate threshold to volitional exhaustion. Participants ingested GLN (0.3 g·kg·FFM-1) or a non-calorific placebo (PLA) one hour prior to the EHST. Venous blood was drawn pre-, post- and one-hour post-EHST. GI permeability was assessed using a serum dual-sugar absorption test (DSAT) and small intestinal epithelial injury using plasma Intestinal Fatty-Acid Binding Protein (I-FABP). MT was assessed using the Bacteroides/total 16S DNA ratio. Results: Volitional exhaustion occurred after 22:19 ± 2:22 (minutes: seconds) in both conditions, during which whole-body physiological responses and GI symptoms were not different (p ˃ 0.05). GI permeability (serum DSAT) was greater following GLN (0.043 ± 0.020) than PLA (0.034 ± 0.019) (p = 0.02; d = 0.47), but small intestine epithelial injury (I-FABP) increased comparably (p = 0.22; η2p = 0.16) following the EHST in both trials (GLN Δ = 1.25 ± 0.63 ng·ml-1; PLA Δ= 0.92 ± 0.44 ng·ml-1). GI MT (Bacteroides/total 16S DNA ratio) was unchanged in either condition following the EHST (p = 0.43). Conclusion: Acute low-dose (0.3 g·kg-1 fat free mass) GLN supplementation ingested one hour before high-intesity exertional-heat stress worsened GI permeability, but did not influence either small intestinal epithilial injury or microbial translocation.Highlights: The pathophysiology of exertional-heat stroke is widely hypothesised to be at least in part attributable to a systemic inflammatory response caused by the leak of gastrointestinal microbes into the circulating blood.Acute high-dose (0.9 g·kg·FFM-1) L-glutamine supplementation is widely promoted as a practical strategy to protect gastrointestinal barrier integrity during exertional-heat stress. However, previously validated doses are often poorly tolerated and cannot be recommended for widespread implementation.This study examined the efficacy of low-dose (0.30 g·kg·FFM-1; ∼20 grams) acute L-glutamine supplementation on small intestinal injury, permeability, and microbial translocation in response a high-intensity exertional-heat stress test to exhaustion (20 - 30 minutes). This type of exercise accounts for the majority of exertional-heat stroke cases in the military.Despite being universally well-tolerated across all participants, acute low-dose L-glutamine supplementation worsened gastrointestinal permeability, without influencing either small intestinal injury or microbial translocation. These findings do not support the application of low-dose L-glutamine supplementation to help prevent exertional-heat stroke.
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Affiliation(s)
- Henry B Ogden
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
| | | | - Robert B Child
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Glen Davison
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, United Kingdom
| | | | | | - Alison Millyard
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
| | - Caroline S Westwood
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
| | - Joseph D Layden
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
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24
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Gaskell SK, Rauch CE, Costa RJS. Gastrointestinal Assessment and Therapeutic Intervention for the Management of Exercise-Associated Gastrointestinal Symptoms: A Case Series Translational and Professional Practice Approach. Front Physiol 2021; 12:719142. [PMID: 34557109 PMCID: PMC8452991 DOI: 10.3389/fphys.2021.719142] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/05/2021] [Indexed: 12/31/2022] Open
Abstract
This translational research case series describes the implementation of a gastrointestinal assessment protocol during exercise (GastroAxEx) to inform individualised therapeutic intervention of endurance athletes affected by exercise-induced gastrointestinal syndrome (EIGS) and associated gastrointestinal symptoms (GIS). A four-phase approach was applied. Phase 1: Clinical assessment and exploring background history of exercise-associated gastrointestinal symptoms. Phase 2: Individual tailored GastroAxEx laboratory simulation designed to mirror exercise stress, highlighted in phase 1, that promotes EIGS and GIS during exercise. Phase 3: Individually programmed therapeutic intervention, based on the outcomes of Phase 2. Phase 4: Monitoring and readjustment of intervention based on outcomes from field testing under training and race conditions. Nine endurance athletes presenting with EIGS, and two control athletes not presenting with EIGS, completed Phase 2. Two athletes experienced significant thermoregulatory strain (peak core temperature attained > 40°C) during the GastroAxEx. Plasma cortisol increased substantially pre- to post-exercise in n = 6/7 (Δ > 500 nmol/L). Plasma I-FABP concentration increased substantially pre- to post-exercise in n = 2/8 (Δ > 1,000 pg/ml). No substantial change was observed in pre- to post-exercise for systemic endotoxin and inflammatory profiles in all athletes. Breath H2 responses showed that orocecal transit time (OCTT) was delayed in n = 5/9 (90-150 min post-exercise) athletes, with the remaining athletes (n = 4/9) showing no H2 turning point by 180 min post-exercise. Severe GIS during exercise was experienced in n = 5/9 athletes, of which n = 2/9 had to dramatically reduce work output or cease exercise. Based on each athlete's identified proposed causal factors of EIGS and GIS during exercise (i.e., n = 9/9 neuroendocrine-gastrointestinal pathway of EIGS), an individualised gastrointestinal therapeutic intervention was programmed and advised, adjusted from a standard EIGS prevention and management template that included established strategies with evidence of attenuating EIGS primary causal pathways, exacerbation factors, and GIS during exercise. All participants reported qualitative data on their progress, which included their previously presenting GIS during exercise, such as nausea and vomiting, either being eliminated or diminished resulting in work output improving (i.e., completing competition and/or not slowing down during training or competition as a result of GIS during exercise). These outcomes suggest GIS during exercise in endurance athletes are predominantly related to gastrointestinal functional and feeding tolerance issues, and not necessarily gastrointestinal integrity and/or systemic issues. GastroAxEx allows for informed identification of potential causal pathway(s) and exacerbation factor(s) of EIGS and GIS during exercise at an individual level, providing a valuable informed individualised therapeutic intervention approach.
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Affiliation(s)
| | | | - Ricardo J. S. Costa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
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25
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Walter E, W Watt P, Gibson OR, Wilmott AGB, Mitchell D, Moreton R, Maxwell NS. Exercise hyperthermia induces greater changes in gastrointestinal permeability than equivalent passive hyperthermia. Physiol Rep 2021; 9:e14945. [PMID: 34409760 PMCID: PMC8374382 DOI: 10.14814/phy2.14945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 01/09/2023] Open
Abstract
Hyperthermia and exertional heat illness increase gastrointestinal (GI) permeability, although whether the latter is only via hyperthermia is unclear. The aim of this pilot study was to determine whether different changes in GI permeability, characterized by an increased plasma lactulose:rhamnose concentration ratio ([L:R]), occurred in exercise hyperthermia in comparison to equivalent passive hyperthermia. Six healthy adult male participants (age 25 ± 5 years, mass 77.0 ± 6.7 kg, height 181 ± 6 cm, peak oxygen uptake [ V · O 2 peak ] 48 ± 8 ml.kg-1 .min-1 ) underwent exercise under hot conditions (Ex-Heat) and passive heating during hot water immersion (HWI). Heart rate (HR), rectal temperature (TCORE ), rating of perceived exertion (RPE), and whole-body sweat loss (WBSL) were recorded throughout the trials. The L:R ratio, peak HR, change in HR, and change in RPE were higher in Ex-Heat than HWI, despite no differences in trial duration, peak core temperature or WBSL. L:R was strongly correlated (p < 0.05) with HR peak (r = 0.626) and change in HR (r = 0.615) but no other variable. The greater L:R in Ex-Heat, despite equal TCORE responses to HWI, indicates that increased cardiovascular strain occurred during exercise, and exacerbates hyperthermia-induced GI permeability at the same absolute temperature.
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Affiliation(s)
- Edward Walter
- Department of Intensive CareRoyal Surrey County HospitalGuildfordUK
- Environmental Extremes Lab, Sport and Exercise Science and Medicine Research and Enterprise GroupUniversity of BrightonEastbourneEast SussexUK
| | - Peter W Watt
- Environmental Extremes Lab, Sport and Exercise Science and Medicine Research and Enterprise GroupUniversity of BrightonEastbourneEast SussexUK
| | - Oliver R. Gibson
- Centre for Human Performance, Exercise and Rehabilitation (CHPER)Division of Sport, Health and Exercise SciencesCollege of Health, Medicine, and Life SciencesBrunel University LondonUxbridgeUK
| | - Ashley G. B. Wilmott
- Environmental Extremes Lab, Sport and Exercise Science and Medicine Research and Enterprise GroupUniversity of BrightonEastbourneEast SussexUK
- Cambridge Centre for Sport and Exercise Sciences (CCSES)School of Psychology and Sport ScienceAnglia Ruskin UniversityCambridgeUK
| | - Dominic Mitchell
- Environmental Extremes Lab, Sport and Exercise Science and Medicine Research and Enterprise GroupUniversity of BrightonEastbourneEast SussexUK
| | - Robert Moreton
- Environmental Extremes Lab, Sport and Exercise Science and Medicine Research and Enterprise GroupUniversity of BrightonEastbourneEast SussexUK
| | - Neil S. Maxwell
- Environmental Extremes Lab, Sport and Exercise Science and Medicine Research and Enterprise GroupUniversity of BrightonEastbourneEast SussexUK
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26
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Yoshiyama N, Uzu H, Ito T, Ogura S. Acute pyelonephritis after recovery from heat stroke. BMJ Case Rep 2021; 14:14/7/e244515. [PMID: 34257136 DOI: 10.1136/bcr-2021-244515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Naomasa Yoshiyama
- Department of Emergency Medicine, Fukuoka-ken Saiseikai Futsukaichi Byoin, Chikushino, Fukuoka, Japan
| | - Hideaki Uzu
- Department of Emergency Medicine, Omuta City General Hospital, Omuta, Fukuoka, Japan
| | - Takahiko Ito
- Department of Emergency Medicine, Omuta City General Hospital, Omuta, Fukuoka, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Hospital, Gifu, Gifu, Japan
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27
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Hu JM, Hsu CH, Lin YC, Kung CW, Chen SY, Lin WT, Cheng PY, Shen HH, Lee YM. Ethyl pyruvate ameliorates heat stroke-induced multiple organ dysfunction and inflammatory responses by induction of stress proteins and activation of autophagy in rats. Int J Hyperthermia 2021; 38:862-874. [PMID: 34078225 DOI: 10.1080/02656736.2021.1931479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective: Heat stroke (HS) elicits the systemic inflammatory responses that result in multiple organ dysfunction (MOD). Heat shock response and autophagy are activated during heat stress for removal of damaged organelles and proteins, emerging as a major regulator of cellular homeostasis. Ethyl pyruvate (EP) is a derivative of pyruvic acid and possesses antioxidant and anti-inflammatory effects. This study aims to investigate the effects of EP on MOD in HS rats and explore the possible mechanisms.Method: Anesthetized rats were placed in a heating chamber (42 °C) to elevate the core body temperature attaining to 42.9 °C. Rats were then moved to room temperature and monitored for 6 h. EP (60 mg/kg, i.v.) was administered 30 min prior to heat exposure.Results: Results showed that EP significantly reduced HS-induced increases in plasma levels of LDH, CPK, GPT and CK-MB, reversed the decrease of platelet counts, and alleviated intestinal mucosal and pulmonary damage. Moreover, EP reduced pro-inflammatory protein, including TNF-α, IL-6, IL-1β, HMGB1 and iNOS, and induced stress proteins, heme oxygenase-1 (HO-1), heat shock protein (HSP) 70 and HSP90 in the liver of HS rats. The levels of HS-activated autophagy-regulatory proteins were affected by EP, in which the phosphorylated mTOR and AKT were reduced, and the phosphorylated AMPK increased, accompanied with upregulation in ULK1, Atg7, Atg12 and LC3II, and downregulation of p62.Conclusion: In conclusion, EP ameliorated HS-induced inflammatory responses and MOD, and the underlying mechanism is associated with the induction of the stress proteins HO-1 and HSP70 as well as restorage of autophagy.
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Affiliation(s)
- Je-Ming Hu
- Department of Surgery, Division of Colorectal Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hsueng Hsu
- Department of Internal Medicine, Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chun Lin
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Wen Kung
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Shu-Ying Chen
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
| | - Wen-Ting Lin
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
| | - Pao-Yun Cheng
- Department of Physiology & Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hsueh Shen
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
| | - Yen-Mei Lee
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
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28
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Zhang ZT, Gu XL, Zhao X, He X, Shi HW, Zhang K, Zhang YM, Su YN, Zhu JB, Li ZW, Li GB. NLRP3 ablation enhances tolerance in heat stroke pathology by inhibiting IL-1β-mediated neuroinflammation. J Neuroinflammation 2021; 18:128. [PMID: 34092247 PMCID: PMC8182902 DOI: 10.1186/s12974-021-02179-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with prior illness are more vulnerable to heat stroke-induced injury, but the underlying mechanism is unknown. Recent studies suggested that NLRP3 inflammasome played an important role in the pathophysiology of heat stroke. Methods In this study, we used a classic animal heat stroke model. Prior infection was mimicked by using lipopolysaccharide (LPS) or lipoteichoic acid (LTA) injection before heat stroke (LPS/LTA 1 mg/kg). Mice survival analysis curve and core temperature (TC) elevation curve were produced. NLRP3 inflammasome activation was measured by using real-time PCR and Western blot. Mice hypothalamus was dissected and neuroinflammation level was measured. To further demonstrate the role of NLRP3 inflammasome, Nlrp3 knockout mice were used. In addition, IL-1β neutralizing antibody was injected to test potential therapeutic effect on heat stroke. Results Prior infection simulated by LPS/LTA injection resulted in latent inflammation status presented by high levels of cytokines in peripheral serum. However, LPS/LTA failed to cause any change in animal survival rate or body temperature. In the absence of LPS/LTA, heat treatment induced heat stroke and animal death without significant systemic or neuroinflammation. Despite a decreased level of IL-1β in hypothalamus, Nlrp3 knockout mice demonstrated no survival advantage under mere heat exposure. In animals with prior infection, their heat tolerance was severely impaired and NLRP3 inflammasome induced neuroinflammation was detected. The use of Nlrp3 knockout mice enhanced heat tolerance and alleviated heat stroke-induced death by reducing mice hypothalamus IL-1β production with prior infection condition. Furthermore, IL-1β neutralizing antibody injection significantly extended endotoxemic mice survival under heat stroke. Conclusions Based on the above results, NLRP3/IL-1β induced neuroinflammation might be an important mechanistic factor in heat stroke pathology, especially with prior infection. IL-1β may serve as a biomarker for heat stroke severity and potential therapeutic method.
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Affiliation(s)
- Zi-Teng Zhang
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, No.29 Bulan Road, Longgang District, Shenzhen, 518055, China
| | - Xiao-Lei Gu
- Department of Pharmacy, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, 450008, China
| | - Xin Zhao
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, No.29 Bulan Road, Longgang District, Shenzhen, 518055, China
| | - Xian He
- School of Pharmacy, Dali University, Dali, 671000, China.,Fifth Medical Center of PLA General Hospital, Beijing, 100000, China
| | - Hao-Wei Shi
- Department of Neurosurgery, Hebei Provincial People's Hospital, Shijiazhuang, 050051, China
| | - Kun Zhang
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, No.29 Bulan Road, Longgang District, Shenzhen, 518055, China
| | - Yi-Ming Zhang
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, No.29 Bulan Road, Longgang District, Shenzhen, 518055, China
| | - Yi-Nan Su
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, No.29 Bulan Road, Longgang District, Shenzhen, 518055, China
| | - Jiang-Bo Zhu
- Department of Health Toxicology, Faculty of Navy Medicine, Navy Medical University, Shanghai, 200433, China
| | - Zhi-Wei Li
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, No.29 Bulan Road, Longgang District, Shenzhen, 518055, China.
| | - Guo-Bao Li
- Department of Lung Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, No.29 Bulan Road, Longgang District, Shenzhen, 518055, China.
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29
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Gaskell SK, Rauch CE, Parr A, Costa RJS. Diurnal versus Nocturnal Exercise-Effect on the Gastrointestinal Tract. Med Sci Sports Exerc 2021; 53:1056-1067. [PMID: 33065594 DOI: 10.1249/mss.0000000000002546] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The study aimed to determine the effect of diurnal versus nocturnal exercise on gastrointestinal integrity and functional responses, plasma lipopolysaccharide binding protein (LBP) and soluble CD14 (sCD14) concentrations (as indirect indicators of endotoxin responses), systemic inflammatory cytokine profile, gastrointestinal symptoms, and feeding tolerance. METHODS Endurance runners (n = 16) completed 3 h of 60% V˙O2max (22.7°C, 45% relative humidity) running, on one occasion performed at 0900 h (400 lx; DAY) and on another occasion at 2100 h (2 lx; NIGHT). Blood samples were collected pre- and postexercise and during recovery to determine plasma concentrations of cortisol, catecholamines, claudin-3, I-FABP, LBP, and sCD14 and inflammatory cytokine profiles by ELISA. Orocecal transit time (OCTT) was determined by lactulose challenge test given at 150 min, with concomitant breath hydrogen (H2) and gastrointestinal symptom determination. RESULTS Cortisol increased substantially pre- to postexercise on NIGHT (+182%) versus DAY (+4%) (trial-time, P = 0.046), with no epinephrine (+41%) and norepinephrine (+102%) trial differences. I-FABP, but not claudin-3, increased pre- to postexercise on both trials (mean = 2269 pg·mL-1, 95% confidence interval = 1351-3187, +143%) (main effect of time [MEOT], P < 0.001). sCD14 increased pre- to postexercise (trial-time, P = 0.045, +5.6%) and was greater on DAY, but LBP decreased (MEOT, P = 0.019, -11.2%) on both trials. No trial difference was observed for systemic cytokine profile (MEOT, P = 0.004). Breath H2 responses (P = 0.019) showed that OCTT was significantly delayed on NIGHT (>84 min, with n = 3 showing no breath H2 turning point by 180 min postexercise) compared with DAY (mean = 54 min, 95% confidence interval = 29-79). NIGHT resulted in greater total gastrointestinal symptoms (P = 0.009) compared with DAY. No difference in feeding tolerance markers was observed between trials. CONCLUSION Nocturnal exercise instigates greater gastrointestinal functional perturbations and symptoms compared with diurnal exercise. However, there are no circadian differences to gastrointestinal integrity and systemic perturbations in response to the same exertional stress and controlled procedures.
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Affiliation(s)
- Stephanie K Gaskell
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, AUSTRALIA
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30
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Qiang W, Xuan H, Yu S, Hailun P, Yueli Z, Zhiguo P, Lei S. Impact of the gut microbiota on heat stroke rat mediated by Xuebijing metabolism. Microb Pathog 2021; 155:104861. [PMID: 33864878 DOI: 10.1016/j.micpath.2021.104861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/17/2022]
Abstract
The goal of the present study was to evaluate the fecal microbiome and serum metabolites in Xuebijing (XBJ)-injected rats after heat stroke using 16S rRNA gene sequencing and gas chromatography-mass spectrometry (GC-MS) metabolomics. Eighteen rats were divided into the control group (CON), heat stroke group (HS), and XBJ group. The 16S rRNA gene sequencing results revealed that the abundance of Bacteroidetes was overrepresented in the XBJ group compared to the HS group, while Actinobacteria was underrepresented. Metabolomic profiling showed that the pyrimidine metabolism pathway, pentose phosphate pathway, and glycerophospholipid metabolism pathway were upregulated in the XBJ group compared to the HS group. Taken together, these results demonstrated that heat stroke not only altered the gut microbiome community structure of rats but also greatly affected metabolic functions, leading to gut microbiome toxicity.
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Affiliation(s)
- Wen Qiang
- The First Clinical Medical College, Southern Medical University, Guangzhou, China; Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China
| | - He Xuan
- Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Shao Yu
- Second Department of Internal Medicine for Cadres, General Hospital of Guangzhou Military Command, China
| | - Peng Hailun
- The First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Zhao Yueli
- Graduate School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Pan Zhiguo
- The First Clinical Medical College, Southern Medical University, Guangzhou, China; Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China.
| | - Su Lei
- The First Clinical Medical College, Southern Medical University, Guangzhou, China; Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangzhou, China.
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31
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Changes in gastrointestinal cell integrity after marathon running and exercise-associated collapse. Eur J Appl Physiol 2021; 121:1179-1187. [PMID: 33512586 DOI: 10.1007/s00421-021-04603-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/10/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Endurance exercise and hyperthermia are associated with compromised intestinal permeability and endotoxaemia. The presence of intestinal fatty acid-binding protein (I-FABP) in the systemic circulation suggests intestinal wall damage, but this marker has not previously been used to investigate intestinal integrity after marathon running. METHODS Twenty-four runners were recruited as controls prior to completing a standard marathon and had sequential I-FABP measurements before and on completion of the marathon, then at four and 24 h later. Eight runners incapacitated with exercise-associated collapse (EAC) with hyperthermia had I-FABP measured at the time of collapse and 1 hour later. RESULTS I-FABP was increased immediately on completing the marathon (T0; 2593 ± 1373 ng·l-1) compared with baseline (1129 ± 493 ng·l-1; p < 0.01) in the controls, but there was no significant difference between baseline and the levels at four hours (1419 ± 1124 ng·l-1; p = 0.7), or at 24 h (1086 ± 302 ng·l-1; p = 0.5). At T0, EAC cases had a significantly higher I-FABP concentration (15,389 ± 8547 ng.l-1) compared with controls at T0 (p < 0.01), and remained higher at 1 hour after collapse (13,951 ± 10,476 ng.l-1) than the pre-race control baseline (p < 0.05). CONCLUSION I-FABP is a recently described biomarker whose presence in the circulation is associated with intestinal wall damage. I-FABP levels increase after marathon running and increase further if the endurance exercise is associated with EAC and hyperthermia. After EAC, I-FABP remains high in the circulation for an extended period, suggesting ongoing intestinal wall stress.
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Ogden HB, Fallowfield JL, Child RB, Davison G, Fleming SC, Edinburgh RM, Delves SK, Millyard A, Westwood CS, Layden JD. Reliability of gastrointestinal barrier integrity and microbial translocation biomarkers at rest and following exertional heat stress. Physiol Rep 2021; 8:e14374. [PMID: 32170836 PMCID: PMC7070100 DOI: 10.14814/phy2.14374] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Exertional heat stress adversely distrupts (GI) barrier integrity and, through subsequent microbial translocation (MT), negativly impacts health. Despite widespread application, the temporal reliability of popular GI barrier integity and MT biomarkers is poorly characterised. METHOD Fourteen males completed two 80-min exertional heat stress tests (EHST) separated by 7-14 days. Venous blood was drawn pre, immediately- and 1-hr post both EHSTs. GI barrier integrity was assessed using the serum Dual-Sugar Absorption Test (DSAT), Intestinal Fatty-Acid-Binding Protein (I-FABP) and Claudin-3 (CLDN-3). MT was assessed using plasma Lipopolysaccharide Binding Protein (LBP), total 16S bacterial DNA and Bacteroides DNA. RESULTS No GI barrier integrity or MT biomarker, except absolute Bacteroides DNA, displayed systematic trial order bias (p ≥ .05). I-FABP (trial 1 = Δ 0.834 ± 0.445 ng ml-1 ; trial 2 = Δ 0.776 ± 0.489 ng ml-1 ) and CLDN-3 (trial 1 = Δ 0.317 ± 0.586 ng ml-1 ; trial 2 = Δ 0.371 ± 0.508 ng ml-1 ) were increased post-EHST (p ≤ .01). All MT biomarkers were unchanged post-EHST. Coefficient of variation and typical error of measurement post-EHST were: 11.5% and 0.004 (ratio) for the DSAT 90-min postprobe ingestion; 12.2% and 0.004 (ratio) at 150-min postprobe ingestion; 12.1% and 0.376 ng ml-1 for I-FABP; 4.9% and 0.342 ng ml-1 for CLDN-3; 9.2% and 0.420 µg ml-1 for LBP; 9.5% and 0.15 pg µl-1 for total 16S DNA; and 54.7% and 0.032 for Bacteroides/total 16S DNA ratio. CONCLUSION Each GI barrier integrity and MT translocation biomarker, except Bacteroides/total 16S ratio, had acceptable reliability at rest and postexertional heat stress.
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Affiliation(s)
- Henry B Ogden
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
| | | | - Robert B Child
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Glen Davison
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, United Kingdom
| | | | | | | | - Alison Millyard
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
| | - Caroline S Westwood
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
| | - Joseph D Layden
- School of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth, United Kingdom
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Woods SE. Immunosuppression is associated with epigenetic remodelling in a murine model of exertional heat stroke. J Physiol 2020; 599:1373-1374. [PMID: 33210295 DOI: 10.1113/jp280949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Siobhan E Woods
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
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Shahzad A, Khan AA, Arif MA, Yousaf Z. Acute Myocarditis in a Patient with Exertional Heat Illness: A Rare Association. Eur J Case Rep Intern Med 2020; 7:002027. [PMID: 33457364 DOI: 10.12890/2020_002027] [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: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Exertional heat illness (EHI) is common in hot weather among young athletes, outdoor manual workers and military personnel. EHI can involve multiple organs of the body, including the muscles, kidneys and brain; however, myocardium involvement is infrequent. Materials and methods We present the case of a 26-year-old male construction worker who worked outdoors in a hot arid environment. He presented with acute kidney injury and rhabdomyolysis and was diagnosed with EHI. During his hospital stay, he developed complete heart block, and cardiac MRI showed features of myocarditis. Work-up to identify other aetiologies of myocarditis was normal. This case highlights the effects of EHI on the myocardium. Conclusion It is important to keep in mind the various effects of EHI on the myocardium. Myocarditis due to EHI is rare, and conduction defects resulting from it might persist, necessitating specialist intervention. LEARNING POINTS Exertional heat illness (EHI) can cause end-organ damage and it is imperative to keep in mind the various effects of EHI on the myocardium.Myocarditis due to EHI is rare, and conduction defects resulting from it might persist, requiring specialist intervention.
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Affiliation(s)
- Aamir Shahzad
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Adeel Ahmad Khan
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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Fundamental Concepts of Human Thermoregulation and Adaptation to Heat: A Review in the Context of Global Warming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217795. [PMID: 33114437 PMCID: PMC7662600 DOI: 10.3390/ijerph17217795] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022]
Abstract
The international community has recognized global warming as an impending catastrophe that poses significant threat to life on earth. In response, the signatories of the Paris Agreement (2015) have committed to limit the increase in global mean temperature to <1.5 °C from pre-industry period, which is defined as 1850–1890. Considering that the protection of human life is a central focus in the Paris Agreement, the naturally endowed properties of the human body to protect itself from environmental extremes should form the core of an integrated and multifaceted solution against global warming. Scholars believe that heat and thermoregulation played important roles in the evolution of life and continue to be a central mechanism that allows humans to explore, labor and live in extreme conditions. However, the international effort against global warming has focused primarily on protecting the environment and on the reduction of greenhouse gases by changing human behavior, industrial practices and government policies, with limited consideration given to the nature and design of the human thermoregulatory system. Global warming is projected to challenge the limits of human thermoregulation, which can be enhanced by complementing innate human thermo-plasticity with the appropriate behavioral changes and technological innovations. Therefore, the primary aim of this review is to discuss the fundamental concepts and physiology of human thermoregulation as the underlying bases for human adaptation to global warming. Potential strategies to extend human tolerance against environmental heat through behavioral adaptations and technological innovations will also be discussed. An important behavioral adaptation postulated by this review is that sleep/wake cycles would gravitate towards a sub-nocturnal pattern, especially for outdoor activities, to avoid the heat in the day. Technologically, the current concept of air conditioning the space in the room would likely steer towards the concept of targeted body surface cooling. The current review was conducted using materials that were derived from PubMed search engine and the personal library of the author. The PubMed search was conducted using combinations of keywords that are related to the theme and topics in the respective sections of the review. The final set of articles selected were considered “state of the art,” based on their contributions to the strength of scientific evidence and novelty in the domain knowledge on human thermoregulation and global warming.
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Wilkins D, O'Sullivan O, Sayer J, Penny L, Roiz de Sa D, Ellis H, Dharm-Datta S. Neurological rehabilitation following heat illness in the UK Armed Forces. BMJ Mil Health 2020; 168:320-323. [DOI: 10.1136/bmjmilitary-2020-001602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/04/2022]
Abstract
Heat illness remains a significant threat to health in the UK Armed Forces despite recent improvements in the prevention of cases. A small number of heat illness survivors develop long-term neurological sequelae. Here we briefly review the background literature and present our experience of treating UK Armed Forces patients with neurological consequences of heat illness. In our cohort of patients, we observed significant improvements in subjective symptoms and objective assessments following a period of neurological rehabilitation at the Defence Medical Rehabilitation Centre. We conclude with recommendations for further research and for the incorporation of screening for neurological disability following heat illness into service policy.
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Influence of aerobic fitness on gastrointestinal barrier integrity and microbial translocation following a fixed-intensity military exertional heat stress test. Eur J Appl Physiol 2020; 120:2325-2337. [PMID: 32794058 DOI: 10.1007/s00421-020-04455-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Exertional-heat stress adversely disrupts gastrointestinal (GI) barrier integrity, whereby subsequent microbial translocation (MT) can result in potentially serious health consequences. To date, the influence of aerobic fitness on GI barrier integrity and MT following exertional-heat stress is poorly characterised. METHOD Ten untrained (UT; VO2max = 45 ± 3 ml·kg-1·min-1) and ten highly trained (HT; VO2max = 64 ± 4 ml·kg-1·min-1) males completed an ecologically valid (military) 80-min fixed-intensity exertional-heat stress test (EHST). Venous blood was drawn immediately pre- and post-EHST. GI barrier integrity was assessed using the serum dual-sugar absorption test (DSAT) and plasma Intestinal Fatty-Acid Binding Protein (I-FABP). MT was assessed using plasma Bacteroides/total 16S DNA. RESULTS UT experienced greater thermoregulatory, cardiovascular and perceptual strain (p < 0.05) than HT during the EHST. Serum DSAT responses were similar between the two groups (p = 0.59), although Δ I-FABP was greater (p = 0.04) in the UT (1.14 ± 1.36 ng·ml-1) versus HT (0.20 ± 0.29 ng·ml-1) group. Bacteroides/Total 16S DNA ratio was unchanged (Δ; -0.04 ± 0.18) following the EHST in the HT group, but increased (Δ; 0.19 ± 0.25) in the UT group (p = 0.05). Weekly aerobic training hours had a weak, negative correlation with Δ I-FABP and Bacteroides/total 16S DNA responses. CONCLUSION When exercising at the same absolute workload, UT individuals are more susceptible to small intestinal epithelial injury and MT than HT individuals. These responses appear partially attributable to greater thermoregulatory, cardiovascular, and perceptual strain.
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Bennett CJ, Henry R, Snipe RMJ, Costa RJS. Is the gut microbiota bacterial abundance and composition associated with intestinal epithelial injury, systemic inflammatory profile, and gastrointestinal symptoms in response to exertional-heat stress? J Sci Med Sport 2020; 23:1141-1153. [PMID: 32620352 DOI: 10.1016/j.jsams.2020.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/24/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The study aimed to examine if the α-diversity and relative abundance of the gastrointestinal bacterial taxa is associated with the response magnitude of markers characteristic of exercise-induced gastrointestinal syndrome in response to exertional-heat stress. DESIGN Cross-sectional. METHODS Twenty-two endurance-trained athletes completed 2h running at 60% V.O2max in hot ambient conditions (35.2°C, 25% relative humidity). Faecal samples were collected pre-exercise to determine bacterial taxonomy by 16S rRNA amplicon sequencing (Illumina MiSeq platform). Data were processed using the QIIME2 pipeline (v2019.1) establishing taxonomic classification with >95% confidence using SILVA. Pre- and post-exercise blood samples were used to determine plasma I-FABP and cortisol concentrations, and systemic inflammatory response profile. Markers of physiological and thermoregulatory strain, and gastrointestinal symptoms were measured every 10min during exercise. Associations were determined by partial correlation controlled for body mass variables. RESULTS Positive associations between Tenericutes (r(18)=0.446, p=0.049) and Verrucomicrobia (r(18)=0.450, p=0.046) phylum, Akkermansiaceae (r(18)=0.486, p=0.030) and Ruminococcaceae (r(18)=0.449, p=0.047) family and aligned genus groups with I-FABP were observed. Whilst, associations between Faecalibacterium (r(12)=0.668, p=0.009) and Ruminoclostridium-9 (r(12)=-0.577, p=0.031) genus with systemic inflammatory profile were observed. Association between bacterial phyla, family, and genus groups were also observed for gastrointestinal symptoms and markers of thermoregulatory strain (r(18) >0.400, p<0.05). CONCLUSIONS The relative abundance of several commensal bacterial groups showed modest favourable (i.e., low perturbations) or detrimental associations with the magnitude of gastrointestinal integrity perturbations and symptoms, and potentially influences body temperature change, in response to exertional-heat stress.
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Affiliation(s)
| | - Rebekah Henry
- Monash University, Department of Civil Engineering, Australia
| | | | - Ricardo J S Costa
- Monash University, Department of Nutrition Dietetics & Food, Australia.
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Abstract
BACKGROUND Severe heat stroke is a clinical syndrome caused by host stress dysfunction due to heat stress and subsequent life-threatening organ dysfunction. We aimed to explore the early risk factors affecting the 90-day prognosis of severe heat stroke patients. METHODS A case-control study was used to retrospectively analyze the clinical data of 117 severe heat stroke patients admitted to the intensive care unit of the General Hospital of Southern Theater Command from April 2014 to May 2019. The risk factors affecting the 90-day mortality of the patients were analyzed, and subgroup analysis was performed comparing the complete recovery and the sequelae subgroups of survivors. RESULTS Thirteen patients (11.1%) died within 90 days. The multivariate Cox risk regression model showed that cooling time (HR 4.87; 95% CI: 1.94-12.18; P = 0.001), heart rate (HR 1.04; 95% CI: 1.01-1.09; P = 0.027), and Sequential Organ Failure (SOFA) score (HR 1.41; 95% CI: 1.21-1.65; P < 0.001) were independent risk factors affecting the survival of patients. The area under the Receiver Operating Characteristic (ROC) curve of the combination of cooling time, heart rate, and SOFA score for the prediction of mortality due to severe heat stroke was 98.1% (95% CI 0.957-1.000, P < 0.001), the sensitivity was 96.2%, and the specificity was 92.3%. CONCLUSIONS The longer the cooling duration, the faster the heart rate at admission, and the higher the SOFA score, the lower the 90-day survival rate was. These three indicators can be used in combination to predict 90-day mortality and poor prognosis in patients with severe heat stroke.
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40
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Hansson E, Glaser J, Jakobsson K, Weiss I, Wesseling C, Lucas RAI, Wei JLK, Ekström U, Wijkström J, Bodin T, Johnson RJ, Wegman DH. Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers. Nutrients 2020; 12:E1639. [PMID: 32498242 PMCID: PMC7352879 DOI: 10.3390/nu12061639] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. METHODS Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. RESULTS Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. DISCUSSION Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Jason Glaser
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 405 30 Gothenburg, Sweden
| | - Ilana Weiss
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Catarina Wesseling
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Rebekah A. I. Lucas
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, 142 Edgbaston Park Rd, Birmingham B15 2TT, UK
| | - Jason Lee Kai Wei
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 2 Medical Drive, MD9, National University of Singapore, Singapore 117593, Singapore;
- Global Asia Institute, National University of Singapore, 10 Lower Kent Ridge Rd, Singapore 119076, Singapore
- N.1 Institute for Health, National University of Singapore, 28 Medical Dr, Singapore 117456, Singapore
| | - Ulf Ekström
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, 221 85 Lund, Sweden
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science Intervention and Technology, Karolinska Institutet, 141 86 Stockholm, Sweden;
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA;
| | - David H. Wegman
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA 01845, USA
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McKechnie AE, Wolf BO. The Physiology of Heat Tolerance in Small Endotherms. Physiology (Bethesda) 2020; 34:302-313. [PMID: 31389778 DOI: 10.1152/physiol.00011.2019] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Understanding the heat tolerances of small mammals and birds has taken on new urgency with the advent of climate change. Here, we review heat tolerance limits, pathways of evaporative heat dissipation that permit the defense of body temperature during heat exposure, and mechanisms operating at tissue, cellular, and molecular levels.
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Affiliation(s)
- Andrew E McKechnie
- South African Research Chair in Conservation Physiology, National Zoological Garden, South African National Biodiversity Institute, Pretoria, South Africa.,DST-NRF Centre of Excellence at the FitzPatrick Institute, Department of Zoology and Entomology, University of Pretoria, Hatfield, South Africa
| | - Blair O Wolf
- UNM Biology Department, University of New Mexico, Albuquerque, New Mexico
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Ogden HB, Child RB, Fallowfield JL, Delves SK, Westwood CS, Layden JD. The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures. Nutrients 2020; 12:E537. [PMID: 32093001 PMCID: PMC7071449 DOI: 10.3390/nu12020537] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 12/12/2022] Open
Abstract
Exertional heat stroke (EHS) is a life-threatening medical condition involving thermoregulatory failure and is the most severe condition along a continuum of heat-related illnesses. Current EHS policy guidance principally advocates a thermoregulatory management approach, despite growing recognition that gastrointestinal (GI) microbial translocation contributes to disease pathophysiology. Contemporary research has focused to understand the relevance of GI barrier integrity and strategies to maintain it during periods of exertional-heat stress. GI barrier integrity can be assessed non-invasively using a variety of in vivo techniques, including active inert mixed-weight molecular probe recovery tests and passive biomarkers indicative of GI structural integrity loss or microbial translocation. Strenuous exercise is strongly characterised to disrupt GI barrier integrity, and aspects of this response correlate with the corresponding magnitude of thermal strain. The aetiology of GI barrier integrity loss following exertional-heat stress is poorly understood, though may directly relate to localised hyperthermia, splanchnic hypoperfusion-mediated ischemic injury, and neuroendocrine-immune alterations. Nutritional countermeasures to maintain GI barrier integrity following exertional-heat stress provide a promising approach to mitigate EHS. The focus of this review is to evaluate: (1) the GI paradigm of exertional heat stroke; (2) techniques to assess GI barrier integrity; (3) typical GI barrier integrity responses to exertional-heat stress; (4) the aetiology of GI barrier integrity loss following exertional-heat stress; and (5) nutritional countermeasures to maintain GI barrier integrity in response to exertional-heat stress.
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Affiliation(s)
- Henry B. Ogden
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Derriford Rd, Plymouth PL6 8BH, UK; (C.S.W.); (J.D.L.)
| | - Robert B. Child
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2QU, UK;
| | | | - Simon K. Delves
- Institute of Naval Medicine, Alverstoke PO12 2DW, UK; (J.L.F.); (S.K.D.)
| | - Caroline S. Westwood
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Derriford Rd, Plymouth PL6 8BH, UK; (C.S.W.); (J.D.L.)
| | - Joseph D. Layden
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Derriford Rd, Plymouth PL6 8BH, UK; (C.S.W.); (J.D.L.)
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Li Y, Zhu X, Zhang M, Tong H, Su L. Heatstroke-induced hepatocyte exosomes promote liver injury by activating the NOD-like receptor signaling pathway in mice. PeerJ 2019; 7:e8216. [PMID: 31875151 PMCID: PMC6925953 DOI: 10.7717/peerj.8216] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Liver injury is a common and important clinical issue of severe heat stress (HS), which has toxic effects and promotes subsequent multiple organ failure. The pathogenesis of HS-induced liver injury has not been fully elucidated. Passively injured hepatocytes also drive liver injury. Exosomes, extracellular vesicles secreted by hepatocytes as “danger signals,” mediate the intercellular transportation of diverse functional protein cargoes and modulate the biological processes of target cells. However, whether hepatocyte exosomes are involved in HS-induced liver injury has not been reported. The purpose of the current study was to clarify the release of hepatocyte exosomes under HS conditions and to explore their role in mediating HS-induced liver injury. Methods HS was induced in hepatocytes or mice by hyperthermic treatment at 43.0 °C for 1 h. Exosomes from control and HS-exposed hepatocytes were isolated by standard differential ultracentrifugation. The hepatocyte exosomes were characterized, and the differentially expressed proteins of the control and HS exosomes were identified by isobaric tags for relative and absolute quantitation (iTRAQ) mass spectrometry and subjected to Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis. Recipient hepatocytes were treated with control or HS exosomes, whereas in vivo, the exosomes were infused into mice. The internalization of HS hepatocyte exosomes by hepatocytes or the liver was tracked. The effect of HS exosomes on the activation of the NOD-like receptor signaling pathway and liver injury was demonstrated in vitro and in vivo. Results HS induced an increase in the release of exosomes from hepatocytes, which were internalized by recipient liver cells in vitro and taken up by the liver in vivo. HS significantly changed the proteomic profiles of hepatocyte exosomes based on the iTRAQ analysis. The KEGG pathway analysis revealed the enrichment of proteins associated with injury and inflammatory signaling pathways, especially the NOD-like receptor signaling pathway, the activity of which was upregulated. Subsequently, the capacity of HS hepatocyte exosomes to activate the NOD-like receptor signaling pathway was verified and found to aggrevate liver damage and inflammation in vitro and in vivo. Conclusions This study is the first preliminary study to demonstrate the induction of acute liver injury by hepatic exosomes in the setting of severe HS and reveals potentially related pathways. These results provide a basis for future research and the identification of new targets for clinical intervention.
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Affiliation(s)
- Yue Li
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xintao Zhu
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Ming Zhang
- Department of Intensive Care Unit, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Huasheng Tong
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Lei Su
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Key Laboratory of Hot Zone Trauma Care and Tissue Repair of PLA, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
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Parsons IT, Stacey MJ, Woods DR. Heat Adaptation in Military Personnel: Mitigating Risk, Maximizing Performance. Front Physiol 2019; 10:1485. [PMID: 31920694 PMCID: PMC6928107 DOI: 10.3389/fphys.2019.01485] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/21/2019] [Indexed: 12/22/2022] Open
Abstract
The study of heat adaptation in military personnel offers generalizable insights into a variety of sporting, recreational and occupational populations. Conversely, certain characteristics of military employment have few parallels in civilian life, such as the imperative to achieve mission objectives during deployed operations, the opportunity to undergo training and selection for elite units or the requirement to fulfill essential duties under prolonged thermal stress. In such settings, achieving peak individual performance can be critical to organizational success. Short-notice deployment to a hot operational or training environment, exposure to high intensity exercise and undertaking ceremonial duties during extreme weather may challenge the ability to protect personnel from excessive thermal strain, especially where heat adaptation is incomplete. Graded and progressive acclimatization can reduce morbidity substantially and impact on mortality rates, yet individual variation in adaptation has the potential to undermine empirical approaches. Incapacity under heat stress can present the military with medical, occupational and logistic challenges requiring dynamic risk stratification during initial and subsequent heat stress. Using data from large studies of military personnel observing traditional and more contemporary acclimatization practices, this review article (1) characterizes the physical challenges that military training and deployed operations present (2) considers how heat adaptation has been used to augment military performance under thermal stress and (3) identifies potential solutions to optimize the risk-performance paradigm, including those with broader relevance to other populations exposed to heat stress.
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Affiliation(s)
- Iain T. Parsons
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Michael J. Stacey
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David R. Woods
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Department of Sport and Exercise Endocrinology, Carnegie Research Institute, Leeds Beckett University, Leeds, United Kingdom
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Affiliation(s)
- Yoram Epstein
- From the Heller Institute of Medical Research, Sheba Medical Center (Y.E., R.Y.), and Sackler Faculty of Medicine, Tel Aviv University (Y.E.) - both in Tel Aviv, Israel; and Wingate College for Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel (R.Y.)
| | - Ran Yanovich
- From the Heller Institute of Medical Research, Sheba Medical Center (Y.E., R.Y.), and Sackler Faculty of Medicine, Tel Aviv University (Y.E.) - both in Tel Aviv, Israel; and Wingate College for Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel (R.Y.)
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46
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Roberts L, Suzuki K. Exercise and Inflammation. Antioxidants (Basel) 2019; 8:antiox8060155. [PMID: 31159470 PMCID: PMC6617227 DOI: 10.3390/antiox8060155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Llion Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast 4215, Australia.
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama 359-1192, Japan.
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Costa RJS, Gaskell SK, McCubbin AJ, Snipe RMJ. Exertional-heat stress-associated gastrointestinal perturbations during Olympic sports: Management strategies for athletes preparing and competing in the 2020 Tokyo Olympic Games. Temperature (Austin) 2019; 7:58-88. [PMID: 32166105 PMCID: PMC7053925 DOI: 10.1080/23328940.2019.1597676] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/05/2019] [Accepted: 03/14/2019] [Indexed: 12/15/2022] Open
Abstract
Exercise-induced gastrointestinal syndrome (EIGS) is a common characteristic of exercise. The causes appear to be multifactorial in origin, but stem primarily from splanchnic hypoperfusion and increased sympathetic drive. These primary causes can lead to secondary outcomes that include increased intestinal epithelial injury and gastrointestinal hyperpermeability, systemic endotoxemia, and responsive cytokinemia, and impaired gastrointestinal function (i.e. transit, digestion, and absorption). Impaired gastrointestinal integrity and functional responses may predispose individuals, engaged in strenuous exercise, to gastrointestinal symptoms (GIS), and health complications of clinical significance, both of which may have exercise performance implications. There is a growing body of evidence indicating heat exposure during exercise (i.e. exertional-heat stress) can substantially exacerbate these gastrointestinal perturbations, proportionally to the magnitude of exertional-heat stress, which is of major concern for athletes preparing for and competing in the upcoming 2020 Tokyo Olympic Games. To date, various hydration and nutritional strategies have been explored to prevent or ameliorate exertional-heat stress associated gastrointestinal perturbations. The aims of the current review are to comprehensively explore the impact of exertional-heat stress on markers of EIGS, examine the evidence for the prevention and (or) management of EIGS in relation to exertional-heat stress, and establish best-practice nutritional recommendations for counteracting EIGS and associated GIS in athletes preparing for and competing in Tokyo 2020.
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Affiliation(s)
- Ricardo J S Costa
- Monash University, Department of Nutrition Dietetics and Food, Notting Hill, Victoria, Australia
| | - Stephanie K Gaskell
- Monash University, Department of Nutrition Dietetics and Food, Notting Hill, Victoria, Australia
| | - Alan J McCubbin
- Monash University, Department of Nutrition Dietetics and Food, Notting Hill, Victoria, Australia
| | - Rhiannon M J Snipe
- Deakin University, Centre for Sport Research, School of Exercise and Nutrition Science, Burwood, Victoria, Australia
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Ye G, Cheng L, Klomparens E, Liu D, Wang M, Yin X, Liu W, Liu Y, Zhang Q. Effects of low-molecular-weight heparin and unfractionated heparin on patients with exertional heat stroke with thrombocytopenia: A prospective study. ENVIRONMENTAL DISEASE 2019. [DOI: 10.4103/ed.ed_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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