title: Relationship between gastro-intestinal complaints and endotoxaemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men.
abstract: The aim of the present study was to establish whether gastro-intestinal (GI) complaints observed during and after ultra-endurance exercise are related to gut ischaemia-associated leakage of endotoxins [lipopolysaccharide (LPS)] into the circulation and associated cytokine production. Therefore we collected blood samples from 29 athletes before, immediately after, and 1, 2 and 16 h after a long-distance triathlon for measurement of LPS, tumour necrosis factor-alpha and interleukin-6 (IL-6). As the cytokine response would trigger an acute-phase response, characteristic variables of these responses were also measured, along with creatine kinase (CK) to obtain an indicator of muscle damage. There was a high incidence (93% of all participants) of GI symptoms; 45% reported severe complaints and 7% of the participants abandoned the race because of severe GI distress. Mild endotoxaemia (5-15 pg/ml) was evident in 68% of the athletes immediately after the race, as also indicated by a reduction in IgG anti-LPS levels. In addition, we observed production of IL-6 (27-fold increase immediately after the race), leading to an acute-phase response (20-fold increase in C-reactive protein and 12% decrease in pre-albumin 16 h after the race). The extent of endotoxaemia was not correlated with the GI complaints or the IL-6 response, but did show a correlation with the elevation in C-reactive protein (r(s) 0.389; P=0.037). Creatine kinase levels were increased significantly immediately post-race, and increased further in the follow-up period. Creatine kinase levels did not correlate with those of either IL-6 or C-reactive protein. It is therefore concluded that LPS does enter the circulation after ultra-endurance exercise and may, together with muscle damage, be responsible for the increased cytokine response and hence GI complaints in these athletes.
authors.affiliation: Department of Human Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. A.E.Jeukendrup@bham.ac.uk
authors.forename: A E
authors.initials: AE
authors.lastname: Jeukendrup
authors.forename: K
authors.initials: K
authors.lastname: Vet-Joop
authors.forename: A
authors.initials: A
authors.lastname: Sturk
authors.forename: J H
authors.initials: JH
authors.lastname: Stegen
authors.forename: J
authors.initials: J
authors.lastname: Senden
authors.forename: W H
authors.initials: WH
authors.lastname: Saris
authors.forename: A J
authors.initials: AJ
authors.lastname: Wagenmakers
mesh_terms: D000210:Acute-Phase Reaction; D000328:Adult; D000704:Analysis of Variance; D000907:Antibodies, Bacterial / Q000097:blood; D001835:Body Weight; D002097:C-Reactive Protein / Q000032:analysis; D003402:Creatine Kinase / Q000097:blood; D016207:Cytokines / Q000378:metabolism*; D019446:Endotoxemia / Q000378:metabolism*; D005260:Female; D005767:Gastrointestinal Diseases / Q000378:metabolism*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood / Q000276:immunology; D008297:Male; D010807:Physical Endurance / Q000502:physiology*; D011228:Prealbumin / Q000032:analysis; D012420:Running / Q000502:physiology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014882:Water-Electrolyte Balance
chemical_list: D000907:Antibodies, Bacterial; D016207:Cytokines; D007074:Immunoglobulin G; D015850:Interleukin-6; D008070:Lipopolysaccharides; D011228:Prealbumin; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D003402:Creatine Kinase