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Changes in gastrointestinal cell integrity after marathon running and exercise-associated collapse

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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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Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

DBP:

Diastolic blood pressure

EAC:

Exercise-associated collapse

EHI:

Exertional heat illness

EHS:

Exertional heat stroke

GI:

Gastro-intestinal

HR:

Heart rate

I-FABP:

Intestinal fatty acid-binding protein

MAP:

Mean arterial pressure

SBP:

Systolic blood pressure

SpO2 :

Peripheral oxygen saturation

TTYM :

Tympanic temperature

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Acknowledgements

The authors declare that the results of the study are presented clearly, honestly, and without fabrication, falsification or inappropriate data manipulation. The authors acknowledge the following with grateful thanks: the statistical advice of Dr Louise Lloyd, the assistance of the Brighton Marathon medical management team (Dr Rob Galloway, Dr Rachel Grimaldi and Ms Carrie Weller) in facilitating the research, Prof Steve Brett (Imperial College, London) for his invaluable assistance with the planning of the study. Ms Tracy Neal (Affinity laboratory director) for her advice and facilitating the sample analysis.

Funding

The authors acknowledge with grateful thanks the financial assistance of the Surgeon General, Defence Medical Services.

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Authors and Affiliations

  1. Intensive Care Unit, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK

    Edward Walter

  2. Centre for Human Performance, Exercise and Rehabilitation (CHPER), Division of Sport, Health and Exercise Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK

    Oliver R. Gibson

  3. Department of Surgery and Cancer, Imperial College London, London, UK

    Michael Stacey

  4. Department of Endocrinology and Diabetes, Imperial College Healthcare NHS Trust, London, UK

    Neil Hill

  5. Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK

    Michael Stacey, Iain T. Parsons & David Woods

  6. School of Cardiovascular Medicine and Life Sciences, King’s College London, London, UK

    Iain T. Parsons

  7. Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK

    David Woods

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  1. Edward Walter
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  2. Oliver R. Gibson
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Contributions

All authors contributed to the design of the work, and the acquisition and analysis of the data. All authors were involved with the writing of the paper, and all have seen and approved the final version. OG provided further statistical analysis of the data.

Corresponding author

Correspondence to Edward Walter.

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No authors declare any competing interests.

Ethics approval

Ethical approval was obtained from the London-South East Research Ethics Committee.

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Informed consent was obtained from all individual participants included in the study.

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Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Fabio Fischetti.

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Walter, E., Gibson, O.R., Stacey, M. et al. Changes in gastrointestinal cell integrity after marathon running and exercise-associated collapse. Eur J Appl Physiol 121, 1179–1187 (2021). https://doi.org/10.1007/s00421-021-04603-w

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  • DOI: https://doi.org/10.1007/s00421-021-04603-w

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