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Lower Muscle and Blood Lactate Accumulation in Sickle Cell Trait Carriers in Response to Short High-Intensity Exercise. Nutrients 2022; 14:nu14030501. [PMID: 35276859 PMCID: PMC8838817 DOI: 10.3390/nu14030501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
It remains unclear whether sickle cell trait (SCT) should be considered a risk factor during intense physical activity. By triggering the polymerization-sickling-vaso-occlusion cascade, lactate accumulation-associated acidosis in response to high-intensity exercise is believed to be one of the causes of complications. However, our understanding of lactate metabolism in response to high-intensity exercise in SCT carriers is incomplete. Thirty male SCT carriers (n = 15) and healthy subjects (n = 15) with and without α-thalassemia performed a 2-min high-intensity exercise. Blood and muscle lactate concentrations were measured at exercise completion. Time courses of blood lactate and glucose concentrations were followed during the subsequent recovery. Additional biochemical analyses were performed on biopsies of the vastus lateralis muscle. SCT was associated with lower blood and muscle lactate concentrations in response to the short high-intensity exercise. Compared to controls, the muscle content among SCT carriers of lactate transporter MCT4 and β2-adrenergic receptor were higher and lower, respectively. During recovery, the lactate removal ability was higher in SCT carriers. In the present study, no effect of α-thalassemia was observed. The lower blood and muscle lactate accumulations in SCT carriers may, to some extent, act as protective mechanisms: (i) against exercise-related acidosis and subsequent sickling, that may explain the relatively rare complications observed in exercising SCT carriers; and (ii) against the deleterious effects of intracellular lactate and associated acidosis on muscle function, that might explain the elevated presence of SCT carriers among the best sprinters.
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Chatel B, Messonnier LA, Hourdé C, Vilmen C, Bernard M, Bendahan D. Moderate and intense muscular exercises induce marked intramyocellular metabolic acidosis in sickle cell disease mice. J Appl Physiol (1985) 2017; 122:1362-1369. [DOI: 10.1152/japplphysiol.01099.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 11/22/2022] Open
Abstract
Sickle cell disease (SCD) is associated with an impaired oxygen delivery to skeletal muscle that could alter ATP production processes. The present study aimed to determine the effects of sickle hemoglobin (HbS) on muscle pH homeostasis in response to exercise in homozygous (HbSS, n = 9) and heterozygous (HbAS, n = 10) SCD (Townes) mice in comparison to control (HbAA, n = 10) littermates. Magnetic resonance spectroscopy of phosphorus 31 enabled to measure intramuscular pH and phosphocreatine (PCr) concentration during rest-stimulation-recovery protocols at two different intensities. Maximal activity of some enzymes involved in muscle energetics and content of proteins involved in pH regulation were also investigated. HbSS mice presented a more pronounced exercise-induced intramuscular acidosis, whatever the intensity of exercise. Moreover, the depletion of PCr was also exacerbated in HbSS mice in response to intense exercise as compared with both HbAA and HbAS mice ( P < 0.01). While no difference was observed concerning proteins involved in muscle pH regulation, the activity of enolase (a glycolytic enzyme) was higher in both HbSS and HbAS mice as compared with controls ( P < 0.05). Interestingly, HbAS mice presented also metabolic impairments as compared with their control counterparts. This study has identified for the first time an exacerbated exercise-induced intramuscular acidosis in SCD mice.NEW & NOTEWORTHY The main finding of the present study was that the exercise-induced intramuscular acidosis was systematically more pronounced in sickle cell disease (SCD) mice as compared with their control counterparts. This result is important since it has been demonstrated in vitro that acidosis can trigger hemoglobin polymerization. From that point of view, our results tend to support the idea that high-intensity exercise may increase the risk of hemoglobin polymerization in SCD.
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Affiliation(s)
| | - Laurent A. Messonnier
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France; and
- Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Chambéry, France
| | - Christophe Hourdé
- Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Chambéry, France
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O'Connor FG, Bergeron MF, Cantrell J, Connes P, Harmon KG, Ivy E, Kark J, Klossner D, Lisman P, Meyers BK, O'Brien K, Ohene-Frempong K, Thompson AA, Whitehead J, Deuster PA. ACSM and CHAMP summit on sickle cell trait: mitigating risks for warfighters and athletes. Med Sci Sports Exerc 2012; 44:2045-56. [PMID: 22811029 DOI: 10.1249/mss.0b013e31826851c2] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION An estimated 300 million people worldwide have sickle cell trait (SCT). Although largely benign, SCT has been associated with exertional rhabdomyolysis and exercise-related sudden death in warfighters/athletes (WA). The National Collegiate Athletic Association's policy to confirm a student athlete's SCT status during their preparticipation medical examination prompted reaction from some organizations regarding the rationale and ethical justification of the policy. METHODS On September 26 and 27, 2011, a summit, composed of military and civilian experts in sports medicine and SCT, was convened at the Uniformed Services University in Bethesda, MD. The expert panel was charged with two objectives: 1) to provide specific recommendations to further mitigate the apparent risk with strenuous exercise in WA with SCT and 2) to develop clinical guidelines to identify, treat, and return to duty/play WA suspected to have incurred nonfatal sickle cell collapse. RESULTS New terminology is introduced, areas of current controversy are explored, consensus recommendations for mitigating risk and managing the WA with SCT are reviewed, and important areas for future research are identified. CONCLUSION Further research is needed before conclusions can be drawn regarding the etiology of the increased death rate observed in WA with SCT, and the possibility exists that SCT is a surrogate for as yet another contributing factor for the unexplained deaths.
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Affiliation(s)
- Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Vincent L, Oyono-Enguéllé S, Féasson L, Banimbek V, Dohbobga M, Martin C, Thiriet P, Francina A, Dubouchaud H, Sanchez H, Chapot R, Denis C, Geyssant A, Messonnier L. Effects of regular physical activity on skeletal muscle structural, energetic, and microvascular properties in carriers of sickle cell trait. J Appl Physiol (1985) 2012; 113:549-56. [DOI: 10.1152/japplphysiol.01573.2011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To assess the effects of regular physical activity on muscle functional characteristics of carriers of sickle cell trait (SCT), 39 untrained (U) and trained (T) hemoglobin (Hb)AA (CON) and SCT subjects (U-CON, n = 12; U-SCT, n = 8; T-CON, n = 10; and T-SCT, n = 9) performed a graded exercise and a time to exhaustion (Tex) test, and were subjected to a muscle biopsy. Maximal power, total work performed during Tex, citrate synthase and cytochrome c oxidase (COX) activities, respiratory chain complexes I and IV content, and capillary density (CD), diameter (COD), and surface area (CSA) were upregulated by the same proportion in T-CON and T-SCT compared with their untrained counterparts. These proportionally similar differences imply that the observed discrepancies between U-SCT and U-CON remained in the trained subjects. Specifically, both CD and COX remained and tended to remain lower, and both COD and CSA remained and tended to remain higher in T-SCT than in T-CON. Besides, carriers of SCT displayed specific adaptations with regular physical activity: creatine kinase activity; complexes II, III, and V content; and type I fiber surface area and capillary tortuosity were lower or unchanged in T-SCT than in U-SCT. In summary, our results show that 1) carriers of SCT adapted almost similarly to CON to regular physical activity for most of the studied muscle characteristics, 2) oxidative potential remains altered in physically active carriers of SCT compared with HbAA counterparts, and 3) the specific remodeling of muscle microvascular network persists in the trained state.
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Affiliation(s)
- Lucile Vincent
- Université de Savoie, Laboratoire de Physiologie de l'Exercice EA4338, Chambéry, France
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Samuel Oyono-Enguéllé
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Léonard Féasson
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
- Université de Lyon, Université Jean Monnet Saint-Etienne, Laboratoire de Physiologie de l'Exercice EA4338, Saint Etienne, France
| | - Viviane Banimbek
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Macias Dohbobga
- Institut National de la Jeunesse et des Sports, Yaoundé, Cameroun
| | - Cyril Martin
- Centre de Recherche et d'Innovation sur le Sport EA647, Université Claude Bernard Lyon 1, Université de Lyon, France
| | - Patrice Thiriet
- Centre de Recherche et d'Innovation sur le Sport EA647, Université Claude Bernard Lyon 1, Université de Lyon, France
| | - Alain Francina
- Unité Pathologie Moléculaire de l'Hémoglobine, Hospices Civils de Lyon, Lyon, France
| | - Hervé Dubouchaud
- Université Joseph Fourier, Laboratoire de Bioénergétique Fondamentale et Appliquée, Grenoble, France
- Institut National de la Santé et de la Recherche Médicale U1055, Grenoble, France; and
| | - Hervé Sanchez
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Activités Physiques Militaires, La Tronche, France
| | - Rachel Chapot
- Institut de Recherche Biomédicale des Armées, Unité de Physiologie des Activités Physiques Militaires, La Tronche, France
| | - Christian Denis
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
- Université de Lyon, Université Jean Monnet Saint-Etienne, Laboratoire de Physiologie de l'Exercice EA4338, Saint Etienne, France
| | - André Geyssant
- Unité de Myologie, Centre Hospitalier Universitaire de Saint Etienne, France
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
- Université de Lyon, Université Jean Monnet Saint-Etienne, Laboratoire de Physiologie de l'Exercice EA4338, Saint Etienne, France
| | - Laurent Messonnier
- Université de Savoie, Laboratoire de Physiologie de l'Exercice EA4338, Chambéry, France
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Tarini BA, Brooks MA, Bundy DG. A policy impact analysis of the mandatory NCAA sickle cell trait screening program. Health Serv Res 2011; 47:446-61. [PMID: 22150647 DOI: 10.1111/j.1475-6773.2011.01357.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate the impact of the mandatory National Collegiate Athletic Association (NCAA) sickle cell trait (SCT) screening policy on the identification of sickle cell carriers and prevention of sudden death. DATA SOURCE We used NCAA reports, population-based SCT prevalence estimates, and published risks for exercise-related sudden death attributable to SCT. STUDY DESIGN We estimated the number of sickle cell carriers identified and the number of potentially preventable sudden deaths with mandatory SCT screening of NCAA Division I athletes. We calculated the number of student-athletes with SCT using a conditional probability based upon SCT prevalence data and self-identified race/ethnicity status. We estimated sudden deaths over 10 years based on published attributable risk of exercise-related sudden death due to SCT. PRINCIPAL FINDINGS We estimate that over 2,000 NCAA Division I student-athletes with SCT will be identified under this screening policy and that, without intervention, about seven NCAA Division I student-athletes would die suddenly as a complication of SCT over a 10-year period. CONCLUSION Universal sickle cell screening of NCAA Division I student-athletes will identify a substantial number of sickle cell carriers. A successful intervention could prevent about seven deaths over a decade.
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Affiliation(s)
- Beth A Tarini
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, 300 N. Ingalls Street, Ann Arbor, MI 48109-0456, USA.
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Vincent L, Féasson L, Oyono-Enguéllé S, Banimbek V, Monchanin G, Dohbobga M, Wouassi D, Martin C, Gozal D, Geyssant A, Thiriet P, Denis C, Messonnier L. Skeletal muscle structural and energetic characteristics in subjects with sickle cell trait, α-thalassemia, or dual hemoglobinopathy. J Appl Physiol (1985) 2010; 109:728-34. [DOI: 10.1152/japplphysiol.00349.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Previous studies have shown that subjects with sickle cell trait (SCT), α-thalassemia (α-t), and the dual hemoglobinopathy (SCT/α-t) manifest subtle, albeit significant, differences during exercise. To better understand such differences, we assessed skeletal muscle histomorphological and energetic characteristics in 10 control HbAA subjects (C), 5 subjects with α-t (α-t), 6 SCT carriers (SCT) and 9 SCT carriers with α-t (SCT/α-t). Subjects underwent a muscle biopsy and also performed an incremental maximal exercise and a time to exhaustion test. There were no observable differences in daily energy expenditure, maximal power output (Pmax), or time to exhaustion at 110% Pmax ( Tex) among the groups. Blood lactate concentrations measured at the end of the Tex, muscle fiber type distribution, and mean phosphofructokinase (PFK), lactate dehydrogenase (LDH), β-hydroxyacyl-CoA-dehydrogenase (HAD), and citrate synthase (CS) activities were all similar among the four groups. However, SCT was associated with a lower cytochrome- c oxidase (COx) activity in type IIa fibers ( P < 0.05), and similar trends were observed in fiber types I and IIx. Trends toward lower creatine kinase (CK) activity ( P = 0.0702) and higher surface area of type IIx fibers were observed in SCT ( P = 0.0925). In summary, these findings support most of the previous observations in SCT, such as 1) similar maximal power output and associated maximal oxygen consumption (V̇o2max) values and 2) lower exercise performances during prolonged submaximal exercise. Furthermore, performances during short supramaximal exercise were not different in SCT. Finally, the dual hemoglobinopathy condition does not seem to affect muscle characteristics.
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Affiliation(s)
- Lucile Vincent
- Laboratoire de Physiologie de l'Exercice EA4338, Université de Savoie, Chambéry and
| | - Léonard Féasson
- Laboratoire de Physiologie de l'Exercice EA4338, Université Jean Monnet and
- Unité de Myologie, Centre Hospitalier Universitaire (CHU) de Saint-Etienne, Saint-Etienne, France
| | - Samuel Oyono-Enguéllé
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Viviane Banimbek
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Géraldine Monchanin
- Centre de Recherche et d'Innovation sur le Sport (CRIS) EA647, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Macias Dohbobga
- Institut National de la Jeunesse et des Sports, Yaoundé, Cameroon; and
| | - Dieudonné Wouassi
- Institut National de la Jeunesse et des Sports, Yaoundé, Cameroon; and
| | - Cyril Martin
- Centre de Recherche et d'Innovation sur le Sport (CRIS) EA647, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - André Geyssant
- Laboratoire de Physiologie de l'Exercice EA4338, Université Jean Monnet and
| | - Patrice Thiriet
- Centre de Recherche et d'Innovation sur le Sport (CRIS) EA647, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Christian Denis
- Laboratoire de Physiologie de l'Exercice EA4338, Université Jean Monnet and
- Unité de Myologie, Centre Hospitalier Universitaire (CHU) de Saint-Etienne, Saint-Etienne, France
| | - Laurent Messonnier
- Laboratoire de Physiologie de l'Exercice EA4338, Université de Savoie, Chambéry and
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ANZALONE MARYL, GREEN VALERIES, BUJA MAXIMILLIAN, SANCHEZ LUISA, HARRYKISSOON RAJESHI, EICHNER ERANDY. Sickle Cell Trait and Fatal Rhabdomyolysis in Football Training. Med Sci Sports Exerc 2010; 42:3-7. [DOI: 10.1249/mss.0b013e3181ae0700] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Touhami I, Fattoum S, Bibi A, Siala H, Messaoud T, Koubaa D, Mankai R, Bartagi Z, Le Gallais D. The epidemiology of abnormal hemoglobins in Mediterranean high-level athletes. Eur J Appl Physiol 2009; 108:1075-81. [PMID: 20013288 DOI: 10.1007/s00421-009-1314-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2009] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the prevalence and nature of hemoglobin (Hb) defects in a Mediterranean high-level (HL) athlete population. Five hundred and ninety-four HL male and female athletes were recruited during the annual follow-up of the members of Tunisian national teams. Hematological data, Hb electrophoresis, and DNA analysis were assessed using conventional techniques. Sporting discipline, type of sport, and performance levels were assessed using a questionnaire. The results showed that 32 HL athletes had abnormal Hb (5.4%): beta-thalassemia (2.2%), alpha-thalassemia (0.5%), HbAS (1.5%), HbAC (0.5%), and rare Hb variants (0.7%). Of the 32 defect carriers, all but one (a alpha-thalassemia) were heterozygous. All the detected hemoglobinopathies but one (an Hb Hope) had already been reported in the country. The prevalence of Hb defect in the HL athletes was similar to that described in the general Tunisian population (P > 0.05). The percentage of Hb defect in the athletes was not dependent on gender, or performance level (P > 0.05). Within each type of sport the percentages of athletes with normal and abnormal Hb were similar (P > 0.05). The hematological data revealed the diversity of anemia, microcytosis, and hypochromia in thalassemic HL athletes. We concluded that HL athletes in Tunisia were a representative sample of the general Tunisian population regarding the prevalence and nature of benign abnormal Hb. The hematological data of the thalassemia carriers exhibited high variability and raised the question of genetic and sporting counseling, as well as biological follow-up for these carriers.
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Affiliation(s)
- Imed Touhami
- Dynamics of Cardiovascular Incoherencies, Montpellier 1 University, Montpellier, France
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Hue O, Connes P, Romana M, Etienne-Julan M, Hardy-Dessources MD. A medical consideration for sickle cell trait carriers in sports: example of Guadeloupe. Scand J Med Sci Sports 2009; 19:603-5. [DOI: 10.1111/j.1600-0838.2009.00944.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Connes P, Reid H, Hardy-Dessources MD, Morrison E, Hue O. Physiological Responses of Sickle Cell Trait Carriers during Exercise. Sports Med 2008; 38:931-46. [DOI: 10.2165/00007256-200838110-00004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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