https://doi.org/10.4081/monaldi.2021.1839
Suppression of tumorigenicity 2 after exercise: a systematic review
Submitted: March 9, 2021
Accepted: July 12, 2021
Published: August 10, 2021
Accepted: July 12, 2021
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Exercise is a pivotal physiological activity, associated with benefits. Whilst the importance of physical activity is consensual along different steps of the cardiovascular (CV) continuum, there has been interest in assessing the CV adaptations to vigorous exercise. Indeed, exercise can be associated with increases in cardiac biomarkers, though the scope of this observation remains elusive. Interleukin 1 receptor related protein, Suppression of tumorigenicity 2 (ST2) is a biomarker related to the pathophysiology of fibrosis, having shown promise in the study of heart failure. Knowledge of ST2 kinetics could improve understanding of the mechanistic pathways related to CV adaptations to exercise. To assess the current state-of-the-art concerning ST2 levels after exercise in healthy individuals. A systematic review was carried out on three databases (Pubmed, ISI Web of Science and Scopus), up to October 2020, using the queries “ST2” or “ST-2” + “exercise” or “running”. A total of six studies were included in the review, encompassing 349 subjects (73% male gender) in which ST2 was assessed. Most studies reported increases in ST2 levels after exercise. Three studies, encompassing a total of 219 individuals, described a cut-off level of 35 ng/dL for ST2. In these, 92.7% of subjects had ST2 levels above this cut-off after exercise (running in all studies). Most studies report increased levels of ST2 after exercise, with an important number of individuals exceeding the 35 ng/dL threshold. Given the small number of individuals represented and the lack of imaging data and long-term follow-up, further prospective larger studies should target this.
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2016;37:2315-81.
DOI: https://doi.org/10.1093/eurheartj/ehw106
Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: A Case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation 2016;134:653-99.
DOI: https://doi.org/10.1161/CIR.0000000000000461
Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J 2015;36:1445-53.
DOI: https://doi.org/10.1093/eurheartj/ehv090
Patel AV, Friedenreich CM, Moore SC, et al. American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Med Sci Sports Exerc 2019;51:2391-402.
DOI: https://doi.org/10.1249/MSS.0000000000002117
Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ 2006;174:801-9.
DOI: https://doi.org/10.1503/cmaj.051351
Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 Update: A report From the American Heart Association. Circulation 2020;141:139-596.
DOI: https://doi.org/10.1161/CIR.0000000000000757
Fontes-Carvalho R, Azevedo AI, Sampaio F, et al. The effect of exercise training on diastolic and systolic function after acute myocardial infarction: A randomized study. Medicine (Baltimore) 2015;94:1450-6.
DOI: https://doi.org/10.1097/MD.0000000000001450
Gevaert AB, Adams V, Bahls M, et al. Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020;27:1369-85.
DOI: https://doi.org/10.1177/2047487319877716
Nieman DC, Wentz LM. The compelling link between physical activity and the body's defense system. J Sport Health Sci 2019;8:201-17.
DOI: https://doi.org/10.1016/j.jshs.2018.09.009
Vilela EM, Bastos JCC, Rodrigues RP, et al. High-sensitivity troponin after running – a systematic review. Neth J Med 2014;72:5-9.
Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: Consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 2019;51:2375-90.
DOI: https://doi.org/10.1249/MSS.0000000000002116
Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021;42:17-96.
DOI: https://doi.org/10.1093/eurheartj/ehaa605
Vilela EM, Ladeiras Lopes R, Torres S, et al. Differential Impact of a cardiac rehabilitation program on functional parameters in elderly versus non-elderly myocardial infarction survivors. Cardiology 2020;145:98-105.
DOI: https://doi.org/10.1159/000504875
Vilela EM, Ladeiras-Lopes R, Ruivo C, et al. Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction. Neth Heart J 2019;27:347-53.
DOI: https://doi.org/10.1007/s12471-019-1269-7
Aengevaeren VL, Mosterd A, Sharma S, et al. Exercise and coronary atherosclerosis: Observations, explanations, relevance, and clinical management. Circulation 2020;141:1338-50.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.044467
Franklin BA, Thompson PD, Al-Zaiti SS, et al. Exercise-related acute cardiovascular events and potential deleterious adaptations following long-term exercise training: Placing the risks into perspective-an update: A Scientific statement from the American Heart Association. Circulation 2020;141:705-36.
DOI: https://doi.org/10.1161/CIR.0000000000000749
O’Keefe JH, Lavie CJ. Run for your life...at a comfortable speed and not too far. Heart Month 2013;99:516-9.
DOI: https://doi.org/10.1136/heartjnl-2012-302886
Biscaglia S, Campo G, Sorbets E, et al. Relationship between physical activity and long-term outcomes in patients with stable coronary artery disease. Eur J Prev Cardiol 2020;27:426-36.
DOI: https://doi.org/10.1177/2047487319871217
Lechner K, Spanier B, Lechner B, et al. Your athlete-patient has a high coronary artery calcification score-'Heart of Stone'. What should you advise? Is exercise safe? Br J Sports Med 2020;bjsports-2019-100769. Online ahead of print.
Malek LA, Bucciarelli-Ducci C. Myocardial fibrosis in athletes - Current perspective. Clin Cardiol 2020;43:882-8.
DOI: https://doi.org/10.1002/clc.23360
van de Schoor FR, Aengevaeren VL, Hopman MT, et al. Myocardial fibrosis in athletes. Mayo Clin Proc 2016;91:1617-31.
DOI: https://doi.org/10.1016/j.mayocp.2016.07.012
Dhingra R, Vasan RS. Biomarkers in cardiovascular disease: Statistical assessment and section on key novel heart failure biomarkers. Trends Cardiovasc Med 2017;27:123-33.
DOI: https://doi.org/10.1016/j.tcm.2016.07.005
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018;72:2231-64.
DOI: https://doi.org/10.1016/j.jacc.2018.08.1038
Roca E, Nescolarde L, Lupon J, et al. The dynamics of cardiovascular biomarkers in non-elite marathon runners. J Cardiovasc Transl Res 2017;10:206-8.
DOI: https://doi.org/10.1007/s12265-017-9744-2
Eijsvogels TM, Fernandez AB, Thompson PD. Are There deleterious cardiac effects of acute and chronic endurance exercise? Physiol Rev 2016;96:99-125.
Tulloh L, Robinson D, Patel A, et al. Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercise--the Australian Ironman Triathlon. Br J Sports Med 2006;40:605-9.
DOI: https://doi.org/10.1136/bjsm.2005.022319
Vilela EM, Bettencourt-Silva R, Nunes JP, et al. BNP and NT-proBNP elevation after running--a systematic review. Acta Cardiol 2015;70:501-9.
DOI: https://doi.org/10.1080/AC.70.5.3110509
Knechtle B, Nikolaidis PT. Physiology and pathophysiology in ultra-marathon running. Front Physiol 2018;9:1-33.
DOI: https://doi.org/10.3389/fphys.2018.00634
Aengevaeren VL, RRJ VAN Kimmenade, Hopman MTE, et al. Exercise-induced changes in soluble ST2 concentrations in marathon runners. Med Sci Sports Exerc 2019;51:405-10.
DOI: https://doi.org/10.1249/MSS.0000000000001806
Griesenauer B, Paczesny S. The ST2/IL-33 axis in immune cells during inflammatory diseases. Front Immunol 2017;8:475.
DOI: https://doi.org/10.3389/fimmu.2017.00475
Nah EH, Cho S, Kim S, et al. Reference interval and the role of soluble suppression of tumorigenicity 2 (sST2) in subclinical cardiac dysfunction at health checkups. J Clin Lab Anal 2020;34:e23461.
Pascual-Figal DA, Januzzi JL. The biology of ST2: the international ST2 consensus panel. Am J Cardiol 2015;115:3B-7B.
van Vark LC, Lesman-Leegte I, Baart SJ, et al. Prognostic value of serial ST2 measurements in patients with acute heart failure. J Am Coll Cardiol 2017;70:2378-88.
DOI: https://doi.org/10.1016/j.jacc.2017.09.026
Homsak E, Gruson D. Soluble ST2: A complex and diverse role in several diseases. Clin Chim Acta 2020;507:75-87.
DOI: https://doi.org/10.1016/j.cca.2020.04.011
Bartunek J, Delrue L, Van Durme F, et al. Nonmyocardial production of ST2 protein in human hypertrophy and failure is related to diastolic load. J Am Coll Cardiol 2008;52:2166-74.
DOI: https://doi.org/10.1016/j.jacc.2008.09.027
Suthahar N, Meems LMG, Ho JE, et al. Sex-related differences in contemporary biomarkers for heart failure: a review. Eur J Heart Fail 2020;22:775-88.
DOI: https://doi.org/10.1002/ejhf.1771
Aimo A, Januzzi JL, Jr., Bayes-Genis A, et al. Clinical and prognostic significance of sST2 in heart failure: JACC review topic of the week. J Am Coll Cardio. 2019;74:2193-203.
DOI: https://doi.org/10.1016/j.jacc.2019.08.1039
Aimo A, Vergaro G, Passino C, et al. Prognostic value of soluble suppression of tumorigenicity-2 in chronic heart failure: A meta-analysis. JACC Heart Fail 2017;5:280-6.
DOI: https://doi.org/10.1016/j.jchf.2016.09.010
Bayes-Genis A, de Antonio M, Vila J, et al. Head-to-head comparison of 2 myocardial fibrosis biomarkers for long-term heart failure risk stratification: ST2 versus galectin-3. J Am Coll Cardiol 2014;63:158-66.
DOI: https://doi.org/10.1016/j.jacc.2013.07.087
Pearson MJ, King N, Smart NA. Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis. Open Heart 2018;5:e000819.
Le Goff C, Farre Segura J, Dufour P, et al. Intense sport practices and cardiac biomarkers. Clin Biochem 2020;79:1-8.
DOI: https://doi.org/10.1016/j.clinbiochem.2020.02.008
Bekos C, Zimmermann M, Unger L, et al. Non-professional marathon running: RAGE axis and ST2 family changes in relation to open-window effect, inflammation and renal function. Sci Rep 2016;6:32315.
DOI: https://doi.org/10.1038/srep32315
Galliera E, Lombardi G, Marazzi MG, et al. Acute exercise in elite rugby players increases the circulating level of the cardiovascular biomarker GDF-15. Scand J Clin Lab Invest 2014;74:492-9.
DOI: https://doi.org/10.3109/00365513.2014.905697
Le Goff C, Kaux JF, Farre Segura J, et al. Evolution of the slopes of ST2 and galectin-3 during marathon and ultratrail running compared to a control group. Clin Chem Lab Med 2020;58:314-21.
DOI: https://doi.org/10.1515/cclm-2019-0555
Sponder M, Lichtenauer M, Wernly B, et al. Serum heart-type fatty acid-binding protein decreases and soluble isoform of suppression of tumorigenicity 2 increases significantly by long-term physical activity. J Investig Med 2019;67:833-40.
DOI: https://doi.org/10.1136/jim-2018-000913
Agoston-Coldea L, Lupu S, Hicea S, et al. Serum levels of the soluble IL-1 receptor family member ST2 and right ventricular dysfunction. Biomarkers Medicine 2014;8:95-106.
DOI: https://doi.org/10.2217/bmm.13.116
Ho JE, Shi L, Day SM, et al. Biomarkers of cardiovascular stress and fibrosis in preclinical hypertrophic cardiomyopathy. Open Heart 2017;4:615-23.
Sanz-de la Garza M, Iannino N, Finnerty V, et al. Cardiopulmonary, biomarkers, and vascular responses to acute hypoxia following cardiac transplantation. Clin Transplant 2018;32:e13352.
Zheng YG, Yang T, He JG, et al. Plasma soluble ST2 levels correlate with disease severity and predict clinical worsening in patients with pulmonary arterial hypertension. Clin Cardio. 2014;37:365-70.
DOI: https://doi.org/10.1002/clc.22262
Shave R, Baggish A, George K, et al. Exercise-induced cardiac troponin elevation: evidence, mechanisms, and implications. J Am Coll Cardiol 2010;56:169-76.
DOI: https://doi.org/10.1016/j.jacc.2010.03.037
Airaksinen KEJ. Cardiac troponin release after endurance exercise: Still much to learn. J Am Heart Assoc 2020;9:1-3.
DOI: https://doi.org/10.1161/JAHA.120.015912
Aengevaeren VL, Hopman MTE, Thompson PD, et al. Exercise-induced cardiac troponin I increase and incident mortality and cardiovascular events. Circulation 2019;140:804-14.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.041627
Gresslien T, Agewall S. Troponin and exercise. Int J Cardiol 2016;221:609-21.
DOI: https://doi.org/10.1016/j.ijcard.2016.06.243
La Gerche A, Burns AT, Mooney DJ, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J 2012;33:998-1006.
DOI: https://doi.org/10.1093/eurheartj/ehr397
Breuckmann F, Mohlenkamp S, Nassenstein K, et al. Myocardial late gadolinium enhancement: Prevalence, pattern, and prognostic relevance in marathon runners. Radiology 2009;251:50-7.
DOI: https://doi.org/10.1148/radiol.2511081118
Hanssen H, Keithahn A, Hertel G, et al. Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running. Clin Sci (Lond) 2011;120:143-52.
DOI: https://doi.org/10.1042/CS20100206
Trivax JE, Franklin BA, Goldstein JA, et al. Acute cardiac effects of marathon running. J Appl Physiol (1985) 2010;108:1148-53.
DOI: https://doi.org/10.1152/japplphysiol.01151.2009
Hattasch R, Spethmann S, de Boer RA, et al. Galectin-3 increase in endurance athletes. Eur J Prev Cardiol 2014;21:1192-9.
DOI: https://doi.org/10.1177/2047487313492069
Ramakrishnan R, Doherty A, Smith-Byrne K, et al. Accelerometer measured physical activity and the incidence of cardiovascular disease: Evidence from the UK Biobank cohort study. PLoS Med 2021;18:e1003487.
Elliott AD, Linz D, Mishima R, et al. Association between physical activity and risk of incident arrhythmias in 402 406 individuals: evidence from the UK Biobank cohort. Eur Heart J 2020;41:1479-86.
DOI: https://doi.org/10.1093/eurheartj/ehz897
Sharim J, Daniels LB. Soluble ST2 and soluble markers of fibrosis: Emerging roles for prognosis and guiding therapy. Curr Cardiol Rep 2020;22:41.
DOI: https://doi.org/10.1007/s11886-020-01288-z
Wu AH, Wians F, Jaffe A. Biological variation of galectin-3 and soluble ST2 for chronic heart failure: implication on interpretation of test results. Am Heart J 2013;165:995-9.
DOI: https://doi.org/10.1016/j.ahj.2013.02.029
Mueller T, Dieplinger B. Soluble ST2 and galectin-3: what we know and don’t know analytically. eJIFCC 2016;3:224-37.
Nishimura M, Brann A, Chang KW, et al. The confounding effects of non-cardiac pathologies on the interpretation of cardiac biomarkers. Curr Heart Fail Rep 2018;15:239-49.
DOI: https://doi.org/10.1007/s11897-018-0398-4
Watson CJ, Tea I, O'Connell E, et al. Comparison of longitudinal change in sST2 vs BNP to predict major adverse cardiovascular events in asymptomatic patients in the community. J Cell Mol Med 2020;24:6495-9.
DOI: https://doi.org/10.1111/jcmm.15004
Mirna M, Lichtenauer M, Wernly B, et al. Novel cardiovascular biomarkers in patients with cardiovascular diseases undergoing intensive physical exercise. Panminerva Med 2020;62:135-42.
DOI: https://doi.org/10.23736/S0031-0808.20.03838-0
Magini A, Farina S, Riggio D, et al. ST2 and B-type natriuretic peptide kinetics during exercise in severe heart failure. Eur J Heart Fail 2018;20:1494-5.
DOI: https://doi.org/10.1002/ejhf.1246
Maisel AS, Richards AM, Pascual-Figal D, et al. Serial ST2 testing in hospitalized patients with acute heart failure. Am J Cardiol 2015;115:32B-7.
Billebeau G, Vodovar N, Sadoune M, et al. Effects of a cardiac rehabilitation programme on plasma cardiac biomarkers in patients with chronic heart failure. Eur J Prev Cardiol 2017;241127-35.
Witvrouwen I, Van Craenenbroeck EM, Abreu A, et al. Exercise training in women with cardiovascular disease: Differential response and barriers - review and perspective. Eur J Prev Cardiol 2021;28:779-90.
DOI: https://doi.org/10.1177/2047487319838221
How to Cite
Martins da Costa, Ana, Rafael Teixeira, Eduardo M. Vilela, Ana Tavares, Susana Torres, Francisco Sampaio, Madalena Teixeira, Ricardo Fontes-Carvalho, and José Pedro Nunes. 2021. “Suppression of Tumorigenicity 2 After Exercise: A Systematic Review”. Monaldi Archives for Chest Disease 92 (1). https://doi.org/10.4081/monaldi.2021.1839.
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