Natural killer cell subset count and antigen-stimulated activation in response to exhaustive running following adaptation to a ketogenic diet.

NEW FINDINGS: What is the central question of this study? Does a ketogenic diet (KD) modulate circulating counts of natural killer (NK) cells, including CD56bright and CD56dim subsets, and their ability to activate (CD69 expression) following in vitro antigen stimulation in response to exhaustive moderate-intensity exercise? What is the main finding and its importance? The KD amplified the biphasic exercise-induced NK cell response due to a greater mobilisation of the cytotoxic CD56dim subset but did not alter NK cell CD69 expression. The KD appears to modulate exercise-induced circulating NK cell mobilisation and egress, but not antigen-stimulated circulating NK cell activation. ABSTRACT: We investigated the effect of a 31-day ketogenic diet (KD) compared with a habitual, carbohydrate (CHO)-based diet on total circulating natural killer (NK) CD3- CD56+ , dim and bright subset count, and antigen-stimulated CD3- CD56+ cell activation (CD69+ ) in response to exhaustive running. In a randomised, repeated-measures, cross-over study, eight trained, male endurance athletes ingested a 31-day low-CHO KD or their habitual diet (HD). On day 31, participants ran to exhaustion at 70% V ̇ O 2 max $\dot{V}_{{\rm{O}}_{2}{\rm{max}}}$ (∼3.5-4 h, ∼45-50 km). A low-CHO (<10 g) meal was ingested prior to the KD trial, with fat ingested during exercise. A high-CHO (2 g kg-1 ) meal was ingested prior to the HD trial, with CHO (∼55 g h-1 ) ingested during exercise. Venous blood samples were collected at pre-exercise, post-exercise and 1 h post-exercise. The KD amplified the classical exercise-induced biphasic CD3- CD56+ cell response by increasing the post-exercise counts (P = 0.0004), which appeared to be underpinned by the cytotoxic CD3- CD56dim subset (main effect of time point, P < 0.0001). The KD had no effect on NK cells' expression of CD69 or their geometric mean fluorescence intensity of CD69 expression, either for unstimulated or for antigen-stimulated NK cells (all P > 0.05). In conclusion, adaptation to a KD may alter the number of circulating NK cells but not their ability to activate to an antigenic challenge.

Heat acclimation does not negatively affect salivary immunoglobulin-A and self-reported illness symptoms and wellness in recreational athletes.

Heat acclimation (HA) protocols repeatedly expose individuals to heat stress. As HA is typically performed close to the pinnacle event, it is essential that the protocol does not compromise immune status, health, or wellbeing. The purpose of this study was to examine the effect of HA on resting salivary immunoglobulin-A (s-IgA) and salivary cortisol (s-cortisol), self-reported upper-respiratory tract symptoms, and self-reported wellness parameters. Seventeen participants (peak oxygen uptake 53.2 ± 9.0 mL·kg-1·min-1) completed a 10-day controlled-hyperthermia HA protocol, and a heat stress test both before (HST1) and after (HST2) HA (33°C, 65% relative humidity). Resting saliva samples were collected at HST1, day 3 and 7 of the HA protocol, HST2, and at 5 ± 1 days post-HA. Upper-respiratory tract symptom data were collected weekly from one week prior to HA until three weeks post HA, and wellness ratings were reported daily throughout HA. HA successfully induced physiological adaptations, with a lower end-exercise rectal temperature and heart rate and higher whole-body sweat rate at HST2 compared to HST1. In contrast, resting saliva flow rate, s-IgA concentration, s-cortisol concentration, and s-cortisol secretion rate remained unchanged (n = 11-14, P = 0.10-0.48). Resting s-IgA secretion rate increased by 39% from HST1 to HST2 (n = 14, P = 0.03). No changes were observed in self-reported upper respiratory tract symptoms and wellness ratings. In conclusion, controlled-hyperthermia HA did not negatively affect resting s-IgA and s-cortisol, self-reported upper-respiratory tract symptoms, and self-reported wellness parameters in recreational athletes.

Upper respiratory tract symptom risk in elite field hockey players during a dry run for the Tokyo Olympics.

ABSTRACTThe primary aim of this study was to examine if biomarker and/or self-reported data could predict upper respiratory tract symptom (URTS) risk in elite field hockey players. The secondary aim was to investigate the effect of the additional stressor 'repeated heat exposure' on measures of thermoregulation and immunity. A prospective cohort repeated measures study design was used to collect URTS, household illness, self-reported wellness, biomarker and thermoregulatory data from elite male field hockey players (n = 19), during an 8-week training and competition period that simulated the preparatory and competition phases of the 2020 Tokyo Olympics. Heat response testing (HRT) was performed at the beginning of the study period, following heat acclimation (HA) and following an intensified competition period (ICP) played in hot and humid conditions (27-37°C and 53-80% relative humidity). Univariate frailty analysis demonstrated that illness in players' households (Hazard ratio (HR: 4.90; p < 0.001)) and self-reported stress (HR: 0.63; p = 0.043) predicted players' risk for URTS. Additionally, low baseline resting salivary secretory immunoglobulin A (SIgA) concentration predicted players' "potential" URTS risk (p = 0.021). The additional stressor "repeated heat exposure" was found to facilitate partial thermoregulatory adaptation without attenuating resting immune functions. In conclusion, lifestyle and behavioural factors (i.e. household illness and stress) influenced players risk for URTS more so than sport-related stressors. Furthermore, repeated heat exposure did not appear to compromise players resting immunity. To assess athletes' risk for URTS, baseline screening of SIgA concentration and regular monitoring of self-reported lifestyle and behavioural data are recommended.Highlights Self-reported illness in players' households and higher self-reported stress significantly predicted increased upper respiratory tract symptom risk.Low baseline salivary secretory immunoglobulin A concentration predicted players "potential" URTS risk.Repeated heat exposures facilitated partial thermoregulatory adaptation without altering resting immunity.

Predictors of upper respiratory tract symptom risk: Differences between elite rugby union and league players.

This study examined possible predictors of upper respiratory tract symptom (URTS) episodes in elite rugby union and league players (n = 51) during intensive pre-season training. Baseline saliva and blood samples were collected in the first week of pre-season training for analysis of salivary secretory immunoglobulin A (SIgA) and cytomegalovirus. Thereafter, SIgA, URTS, internal training load and self-reported wellness data were repeatedly measured throughout a 10-week pre-season training period. Univariate frailty model analysis, which included 502 observations, was performed for each rugby code for the following independent predictor variables: SIgA concentration, internal training load, total wellness, sleep quantity, sleep quality and stress. Rugby union and league players experienced a similar number of URTS episodes; however, predictors of URTS episodes differed between the codes. No biomarkers or self-reported measures significantly predicted URTS risk in rugby union players, while reductions in self-reported total wellness (HR: 0.731, p = 0.004) and sleep quality (HR: 0.345, p = 0.001) predicted increased URTS risk in rugby league players. The findings from this study highlight that factors influencing URTS risk are perhaps sport specific and this may be attributed to different sporting demands and/or different management of players by team-practitioners.

Household illness is the strongest predictor of upper respiratory tract symptom risk in elite rugby union players.

OBJECTIVES: To identify periods of increased risk for upper respiratory tract symptom (URTS) episodes, and examine whether biomarkers and/or self-reported lifestyle and wellness data can predict URTS risk in elite rugby union players. DESIGN: Prospective, longitudinal and repeated-measures study. METHODS: Salivary secretory immunoglobulin A (SIgA), salivary cortisol, URTS, internal training load and self-reported lifestyle and wellness data including household illness, stress, mood, fatigue, muscle soreness and sleep quality were repeatedly measured in elite Southern hemisphere rugby union players (n=28) throughout a season. Univariate frailty model analysis, which included 495 observations, was used to determine predictors of URTS risk. RESULTS: Surprisingly, the highest incidence of URTS occurred after rest weeks, namely the Christmas break and bye weeks (i.e., no scheduled trainings or matches); whereas URTS risk was reduced during weeks involving international travel (Hazard ratio (HR): 0.43, p<0.001)). Household illness was the strongest predictor of URTS risk; players were almost three-fold more at risk for an URTS episode when illness in the household was present (HR: 2.90, p=0.002). A non-significant, but potentially important trend for an inverse association between SIgA concentration and URTS incidence was also observed (HR: 0.99, p=0.070). CONCLUSIONS: Rest weeks were identified as periods of increased risk for URTS; while international travel did not appear to increase players risk for URTS. Incidence of household illness and SIgA concentration independently predicted URTS risk, with household illness being the strongest predictor. These findings can assist practitioners monitoring and management of athletes to potentially reduce URTS risk.

Adaptation to a ketogenic diet modulates adaptive and mucosal immune markers in trained male endurance athletes.

This study examined the effect of short-term adaptation to a ketogenic diet (KD) on resting and post-exercise immune markers. Using a randomized, repeated-measures, crossover design, eight trained, male, endurance athletes ingested a 31-day low carbohydrate (CHO), KD (energy intake: 4% CHO; 78% fat) or their habitual diet (HD) (energy intake: 43% CHO; 38% fat). On days 0 and 31, participants ran to exhaustion at 70% VO2max . A high-CHO (2 g·kg-1 ) meal was ingested prior to the pre-HD, post-HD, and pre-KD trials, with CHO (~55 g·h-1 ) ingested during exercise, whereas a low-CHO (<10 g) meal was ingested prior to the post-KD trial, with fat ingested during exercise. Blood and saliva samples were collected at pre-exercise, exhaustion, and 1 hour post-exhaustion. T-cell-related cytokine gene expression within peripheral blood mononuclear cells (PBMCs) and whole-blood inflammatory cytokine production were determined using 24-hour multi-antigen-stimulated whole-blood cultures. Multi-antigen-stimulated PBMC IFN-γ mRNA expression and the IFN-γ/IL-4 mRNA expression ratio were higher at exhaustion in the post-KD compared with pre-KD trial (P = 0.003 and P = 0.004); however, IL-4 and IL-10 mRNA expression were unaltered (P > 0.05). Multi-antigen-stimulated whole-blood IL-10 production was higher in the post-KD compared with pre-KD trial (P = 0.028), whereas IL-1ß, IL-2, IL-8, and IFN-γ production was lower in the post-HD compared with pre-HD trial (P < 0.01). Salivary immunoglobulin A (SIgA) secretion rate was higher in the post-KD compared with pre-KD trial (P < 0.001). In conclusion, short-term adaptation to a KD in endurance athletes may alter the pro- and anti-inflammatory immune cell cytokine response to a multi-antigen in vitro and SIgA secretion rate.

Acute hyperketonaemia alters T-cell-related cytokine gene expression within stimulated peripheral blood mononuclear cells following prolonged exercise.

PURPOSE: We investigated the effect of the racemic ß-hydroxybutyrate precursor, R,S-1,3-butanediol (BD), on T-cell-related cytokine gene expression within stimulated peripheral blood mononuclear cells (PBMC) following prolonged, strenuous exercise. METHODS: A repeated-measures, randomised, crossover study was conducted in nine healthy, trained male cyclists (age, 26.7 ± 5.2 years; VO2peak, 63.9 ± 2.5 mL kg-1 min-1). Participants ingested 0.35 g kg-1 of BD or placebo 30 min before and 60 min during 85 min of steady-state (SS) exercise, which preceded a ~ 30 min time-trial (TT) (7 kJ kg-1). Blood samples were collected at pre-supplement, pre-exercise, post-SS, post-TT and 1-h post-TT. Whole blood cultures were stimulated with Staphylococcal enterotoxin B (SEB) for 24 h to determine T-cell-related interleukin (IL)-4, IL-10 and interferon (IFN)-γ mRNA expression within isolated PBMCs in vitro. RESULTS: Serum cortisol, total circulating leukocyte and lymphocyte, and T-cell subset concentrations were similar between trials during exercise and recovery (all p > 0.05). BD ingestion increased T-cell-related IFN-γ mRNA expression compared with placebo throughout exercise and recovery (p = 0.011); however, IL-4 and IL-10 mRNA expression and the IFN-γ/IL-4 mRNA expression ratio were unaltered (all p > 0.05). CONCLUSION: Acute hyperketonaemia appears to transiently amplify the initiation of the pro-inflammatory T-cell-related IFN-γ response to an immune challenge in vitro during and following prolonged, strenuous exercise; suggesting enhanced type-1 T-cell immunity at the gene level.

Keeping Athletes Healthy at the 2020 Tokyo Summer Games: Considerations and Illness Prevention Strategies.

Keeping athletes healthy will be important for optimal athletic performance at the 2020 Tokyo Summer Olympic and Paralympic Games. Athletes will be exposed to several stressors during the preparatory and competition phases of the Summer Games that have the potential to depress immunity and increase illness risk. This mini-review provides an overview on effective and practical stressor-specific illness prevention strategies that can be implemented to maintain and protect the health of Olympic and Paralympic athletes.

The impact of sport related stressors on immunity and illness risk in team-sport athletes.

OBJECTIVES: Elite team-sport athletes are frequently exposed to stressors that have the potential to depress immunity and increase infection risk. Therefore, the purpose of this review is to describe how team-sport stressors impact upon immune responses, along with exploring whether alterations in these markers have the potential to predict upper respiratory tract illness symptoms. DESIGN: Narrative review. METHODS: Salivary secretory immunoglobulin A (SIgA) and T-cell markers have been shown to predict infection risk in individual endurance athletes. Papers discussing the impact of team-sport stressors on SIgA and T-cells were discussed in the review, studies discussing other aspects of immunity were excluded. Journal articles were sourced from PubMed, Web of science and Scopus. Key search terms included team-sport athletes, stressors, immunity, T-cells, cytokines, SIgA and upper respiratory illness. RESULTS: Most team-sport stressors appear to increase risk for illness. An association between reduced SIgA and increased illness incidence has been demonstrated. Intensive training and competition periods have been shown to reduce SIgA, however, it is less clear how additional stressors including extreme environmental conditions, travel, psychological stress, sleep disturbance and poor nutrition affect immune responses. CONCLUSIONS: Monitoring SIgA may provide an assessment of a team-sport athletes risk status for developing upper respiratory tract symptoms, however there is currently not enough evidence to suggest SIgA alone can predict illness. Team-sport stressors challenge immunity and it is possible that the combination of stressors could have a compounding effect on immunodepression and infection risk. Given that illness can disrupt training and performance, further research is required to better elucidate how stressors individually and collectively influence immunity and illness.