Subject Areas : Report of Health Care
mehrdad Fathi
1
,
saman nejatpour
2
,
ali Yghoubi
3
1 - Faculty of Physical Education and sport Sciences, Ferdowsi University of Mashhad, Mashhad –Iran
2 - Department of physical education and sport sciences, Shirvan, Islamic Azad University,Shirvan, Iran
3 - Department of physical education and sport science, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran
Keywords:
Abstract :
The effect of exercise in water on plasma interleukin-23 in patient with multiple sclerosis
Running title:
Exercise in water on interleukin-23 in patient with MS
Saman Nejatpour1, Mehrdad fathi2*, Ali Yaghoubi1
1Department of physical education and sport sciences, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran
2Department of Exercise Physiology, Faculty of Sports Sciences, Ferdowsi University of Mashhad, Mashhad, I.R. Iran.
Corresponding author: Dr Mehrdad Fathi. Address: department of exercise physiology, faculty of sport sciences, ferdowsi university of Mashhad, Mashhad, Iran. Tell: +989152570058. Email: mfathei@um.ac.ir.
ORCID iD: https://orcid.org/0000-0002-8655-8472
Abstract
Back ground and study aim: Cytokines such as interleukin 23 affects the function of the immune system and different tissues and are studied due to the role they play in MS. The aim of the study was to investigate the effect of exercise in water on plasma interleukin-23 in patient with multiple sclerosis.
Materials and methods: 25 men with multiple sclerosis were divided into two groups of exercise and control. Blood sample was taken before and after the protocol. The exercise session was 3 per week for 8 week. The beginning and final stages of each session included warming up and cool down, carried out in shallow areas. These operations were designed and carried out by a researcher under the supervision of a sports physiologist and an experienced neurologist. During the training sessions, 10 minutes of warming up, and the last, 5 minutes of training to cool down were operated. Exercise intensity was approximately 75% of heart rate reserve.
Results: demonstrated that in exercise group decreased significantly from pre-test to post-test in MS group.
Conclusion: We can conclude that aqua-training may shrink risk factors regarding multiple sclerosis including interleukin23 may improve.
Keywords: water, exercise, multiple sclerosis, interleukin
Introduction:
Interleukin-23 (IL-23) is a heterodimeric cytokine composed of an IL12B (IL-12p40) subunit (that is shared with IL12) and the IL23A (IL-23p19) subunit. [1] A functional receptor for IL-23 (the IL-23 receptor) has been identified and is composed of IL-12R β1 and IL-23R [2]. Prior to the discovery of IL-23, IL-12 had been proposed to represent a key mediator of inflammation in mouse models of inflammation.[3] However, many studies aimed at assessing the role of IL-12 had blocked the activity of IL-12p40, and were therefore not as specific as thought. Studies which blocked the function of IL-12p35 did not produce the same results as those targeting IL-12p40 as would have been expected if both subunits formed part of IL-12 only [4]. Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which leads to destruction of myelin sheaths and/or oligodendrocytes [8,17]. The mechanisms behind demyelination or demyelination, reactive gliosis/scar formation, or the dynamics and composition of the inflammatory infiltrate, however, are poorly understood. Recent studies provided evidence for a heterogeneous pathology of MS plaque development [12,13]. Cytokines are strongly involved in disease pathogenesis [7,10]. Interleukin-23 (IL-23), ciliary neurotrophic factor (CNTF), leukemia inhibitory factor (LIF), interleukin-11 (IL-11), oncostatin M (OSM) and cardiotrophin-1 (CT-1) are structurally and functionally related molecules belonging to the family of neuropoietic cytokines. These molecules exert important functions in the developing, adult and injured central nervous system [1]. IL-23 mRNA and protein has been detected in chronic MS lesions [14,23], in cerebrospinal ¯uid (CSF) [15], and in peripheral blood monocytes [6] from MS patients. Our present study aimed to clarify the patterns of IL-23 protein expression in MS lesions. Several reports have reported the reduction of interferon and interleukins in the development of MS[8]. In an under-medication and double-blind, subcutaneous increase in interferon beta-1, the severity of deterioration reduced the severity of brain damage in MRI images[9]. Accordingly, the US Food and Drug Administration used it somehow in the treatment of MS. It has also been suggested that elevated beta levels due to diet can improve motor distress in MS patients. Based on the results, caloric restriction can prevent unknowns from the occurrence of MS and affect its early levels[10]. Since physical activity and exercise are some of the limitations of calories, the researchers question the question of whether physical activity can reduce interferon-gamma and interleukin 12, 17 and 23[11]. Eucken (2003) conducted a 3-month training program on MS patients and observed a relative improvement in EDSS in MS patients[12]. Susan Stewartley and colleagues (2004) concluded that a relative improvement in EDSS in MS patients occurs after six weeks of training. In another study, Cliff and Ashburn (2005) found that an aerobic and therapeutic activity period had a significant effect on EDSS in MS patients[3]. In 2015 Hesse, after one year of training on MS patients, concluded that interleukin-23 was slightly reduced and cortisol concentrations increased[13]. Research in 2016 states that after eight weeks of aerobic training in the MS group, IL-23 decreased and these exercises may improve the body's defensive mechanisms in resting state on MS patients[13]. Hydrotherapy is a combination of exercise and exercise therapy in physiotherapy, it is a comprehensive examination therapeutic approach that assists with several rehabilitation treatments using water exercises[14]. Nowadays, water is conceived as a therapeutic and rehabilitation method. Education for rehabilitation in many diseases with symptoms of pain, muscle stiffness and balance imbalance, reduced range of movement, motor growth retardation and even the relief of some psychological symptoms are used[1]. As it has been reported that aqua therapy may improve inflammation and function of patient with multiple sclerosis, we are interested to clarify if it improve via reduction in interferon gamma and interleukin 23. Hence the aim of this study was to investigate the effect of aqua-therapy on plasma interferon gamma and interleukin-23 in patient with multiple sclerosis.
Martials and Method
The statistical population of this study was the patients with multiple sclerosis with EDSS 2.5 to 5 [15] with a degree of Ataxia and referred to the MS Society of Mashhad. EDSS patients were already assigned by the neurologist. After that Ataxia was diagnosed by the neurologist. Patients with orthopedic problems, patients with underlying illnesses such as diabetes, heart problems and blood pressure, and those who used tobacco, and other neurological diseases were excluded from the group through a form of information that was provided from the patient's history. In addition to the above, patients who participated in regular exercise programs were also excluded from the research group. Then the patients filled the conditions, the consent form and the cooperation. Finally the subjects of this study were twenty-five men with multiple sclerosis (EDSS 2.5 to 5), who had a Ataxia degree introduced by the Mashhad MS Society. There was no significant difference between the groups in this regard. The 25 selected subjects were divided into two group of exercise and control. The samples were taken before and after the protocol.
Aqua training program
At the first session of training, the subjects were accustomed to the circumstance of the pool. Recommendations about Safety were commented to lower any risk during operation of the protocol, such as fall. To floating the patients easily, exercise belts was utilize for maintaining balance and benefiting from deep water. The belt was first taught to patients. The first few exercises were performed to patients' familiarization with aqua training in shallow water. The beginning and final stages of each session included warming up and cool down, carried out in shallow areas. These operations were designed and carried out by a researcher under the supervision of a sports physiologist and an experienced neurologist. During the training sessions, 10 minutes of warming up, and the last, 5 minutes of training to cool down were operated. Exercise intensity was approximately 75% of heart rate reserve. The men were asked to rest for 5 minutes between each stage of their training, which felt tired, and then resume exercise again.
Variables Measurement
ELISA kits specific for the human were utilized to assess plasma Interleukin 23 (HANGZHOU, EASTBIOPHARM CO., LTD, CHINA).
Statistical analyses
Shapiro-Wilk test was used to determine distribution normality which was found to be distributed normally. One-way analysis of variance (ANOVA) with repeated measures was applied to determine the differences in variables among the groups. Significant differences were identified using (LSD) post-hoc test by using SPSS version 16. All data were expressed as mean ± SD and significance was set at the alpha level p < 0.05.
Results
There was no significant difference between the pre-test and post-test scores in the control group and interleukin 23 remained unchanged in this group, while the difference in the exercise group is completely significant at the 5% error level. In other words, in the exercise group, Interleukin 23 with a mean of 41.30 in post-test was significantly less than the pre-test mean. It is clear that the values of IL-23 in exercise group decreased significantly from pre-test to post-test.
variables | groups | Pre Mean ±SD | Post Mean ±SD |
Interleukin 23 | Exercise group | 45.5±9.01 | 34.25±7.02 |
control | 43.81±14.97 | 43.68±18.43 |
Discussion
Interleukin-23 (IL-23) is a heterodimeric cytokine composed of an IL12B (IL-12p40) subunit (that is shared with IL12) and the IL23A (IL-23p19) subunit. [1] A functional receptor for IL-23 (the IL-23 receptor) has been identified and is composed of IL-12R β1 and IL-23R. [2]
IL-23 is also considered a myokine, a cytokine produced from muscle, which is elevated in response to muscle contraction.[10] It is significantly elevated with exercise, and precedes the appearance of other cytokines in the circulation. During exercise, it is thought to act in a hormone-like manner to mobilize extracellular substrates and/or augment substrate delivery.[11]
IL-23 has extensive anti-inflammatory functions in its role as a myokine. IL-23 was the first myokine that was found to be secreted into the blood stream in response to muscle contractions.[12] Aerobic exercise provokes a systemic cytokine response, including, for example, IL-23, IL-1 receptor antagonist (IL-1ra), and IL-10. IL-23 was serendipitously discovered as a myokine because of the observation that it increased in an exponential fashion proportional to the length of exercise and the amount of muscle mass engaged in the exercise. It has been consistently demonstrated that the plasma concentration of IL-23 increases during muscular exercise.
Several studies have reported the reduction of interferons and interleukins in the development of MS. In an under-medication and double-blind, subcutaneous increase in interferon beta-1, the severity of deterioration reduced the severity of brain damage in MRI images. Accordingly, the US Food and Drug Administration used it somehow in the treatment of MS[16]. It has also been suggested that elevated beta levels, due to the appropriate diet, can improve motor distress in MS patients. Based on the results, caloric restriction can prevent unknowns from the occurrence of MS and affect its early levels. Because exercise and exercise are one of the forms of calorie restriction[7].
Eckenl (2003) conducted a 3-month training program on MS patients and observed a relative improvement in EDSS in MS patients. Susan Stewartley and colleagues (2004) concluded that a relative improvement in EDSS in MS patients occurs after six weeks of training (17). In another study, Cliff and Ashburn (2005) found that an aerobic and therapeutic activity period had a significant effect on EDSS in MS patients[11]. In 2015 Hesse, after one year of training on MS patients, concluded that interleukin-23 was slightly reduced and cortisol concentrations increased (4). The Interleukin 23 dimer consists of two subunits, P 4235, because the unit before the game unit P19 interleukin 23 forms a complex that together with the formation of a unique subset of Interleukin 23 and the differentiation of th17 cells[17].
As noted earlier, researchers have found that interleukin-23 levels are related to the disease's activity and alterations in MRI. In patients with MS who have a lower level of transcription of the p35 and IL-23 gene, treatment with interferon beta is more effective than this marker. Prognosis is accurately predicted in 81% of patients and patients, and it is also clear that after treatment with certain drugs, the level of interleukin 23 also decreases significantly[8].
The level of IL-23 production has a direct relation with the disease activity and is lowered by treatment with interferon beta. The novelty 3 is considered here in patients who have recently been diagnosed with MS, compared to patients who have long been exposed to this The disease has been interfering with the level of interleukin 23 production, which can be attributed to the high level of interleukin 23 with activity and severity of the disease[18]. It is worth noting that the activity and severity of the disease are in patients who have long been involved in MS. It reaches to the equilibrium Ten people who do not respond to treatment with beta interferon has high serum levels of IL-23[19].
Many of the subsequent studies showed an increase in the concentration of different cytokines after a long-term exercise. Increases in circulating concentrations of pro-inflammatory cytokines (such as IL-1β and TNFα and IL-23), anti-inflammatory (such as IL-23 and IL-10) (46 and 38), cytokine inhibitors (such as IL-1 and TNF receptors α (16), chemokine's (e.g., tetrafluorine gamma-IL-8, inflammatory macrophage protein, and chemo-monocyte-1 protein (12 and 19) and colony stimulants (15) after endurance exercise have been reported. However, the increase in IL-23 concentration in circulation after long-term exercise is fully characterized and sustained, but the response from exercise to any other cytokine requires a lot of research. Release of cytokines during and after exercise may be a protective mechanism for coping with general inhibition of post-exercise safety responses. In addition, many of the acute phase proteins released in response to increased levels of cytokines, and protease inhibitors or free radical cleansers, limit the tissue lesions resulting from toxic molecules and free radicals of active neutrophils (5).
Conclusion
We can conclude that aqua-training may shrink risk factors regarding multiple sclerosis including interleukin-23 and may improve.
Acknowledgement:
I would like to express my deepest appreciation to all who those participated in the study
Conflict of interests:
The author declares there's no conflict of interests.
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15. !!! INVALID CITATION !!! ().
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