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This version published online on April 26, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-2346
A more recent version of this article appeared on July 1, 2005
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Submitted on December 1, 2004
Accepted on April 20, 2005

DRAMATIC ELEVATIONS OF INTERLEUKIN-6 AND ACUTE PHASE REACTANTS IN ATHLETES PARTICIPATING IN THE ULTRADISTANCE FOOT RACE "SPARTATHLON": SEVERE SYSTEMIC INFLAMMATION AND LIPID AND LIPOPROTEIN CHANGES IN PROTRACTED EXERCISE

Alexandra Margeli, Katerina Skenderi, Maria Tsironi, Eugenia Hantzi, Antonia-Leda Matalas, Christina Vrettou, Emmanuel Kanavakis, George Chrousos, and Ioannis Papassotiriou*

Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece; Laboratory of Nutrition and Clinical Dietetics, "Harokopio" University, Athens, Greece; Department of Internal Medicine, Sparta General Hospital, Sparta, Greece; Medical Genetics, Athens University, Athens Greece; First Department of Pediatrics, Athens University, Medical School, Athens, Greece

* To whom correspondence should be addressed. E-mail: biochem{at}paidon-agiasofia.gr.

Plasma interleukin-6 (IL-6), the serum inflammatory markers C-reactive protein (CRP) and serum amyloid A (SAA), and the tissue destruction marker free plasma DNA, as well as the circulating lipid profile, were examined in athletes participating in the ultradistance foot race of the 246 Km "Spartathlon". This race consists of continuous, prolonged, brisk exercise. Blood samples were obtained from 15 male athletes, who finished the race in less than 36 h, before, at the end, and 48 h after the end of the race. IL-6, CRP, SAA and free plasma DNA levels markedly increased (by 8000-, 152- 108- and 10-fold, respectively) over the baseline at the end of the race. However, IL-6 levels returned to normal by 48 h, while CRP, SAA and free plasma DNA remained elevated. The mean values of cholesterol, triglycerides, low density lipoprotein (LDL) and Apo B decreased to a minimum value at the end of the race and remained low 48 h postrace. HDL levels, on the other hand, were mildly increased at the end of the race (P < 0.015) and decreased to normal 48 h postrace. Apo AI levels decreased significantly during the time-course of the exercise and remained low 48 h postrace (P < 0.001). These observations suggest that continuous, prolonged, moderate intensity exercise is associated with markedly elevated IL-6 and acute phase reactant concentrations, peripheral tissue damage, and significant changes in serum lipid levels. The biochemical changes observed during the "Spartathlon", amount to a potent systemic inflammatory response, which might explain severe cardiovascular events that occur during prolonged exercise in compromised individuals. The elevated IL-6, a fatigue-generating pro-inflammatory and pro-healing factor, and the acute phase reactants, may participate in the healing of tissue trauma, while the lipid changes are compatible with the increased energy requirements of continuing exercise. The sustained decreases of total cholesterol, triglycerides and LDL-cholesterol are anti-atherogenic, while the slightly increased HDL-cholesterol, combined with high SAA and low Apo A1, may have diminished anti-atherogenic/anti-inflammatory effects.
Key words: Athletes • Inflammation • Lipids




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