Damage-associated molecular pattern and innate cytokine release in the airways of competitive swimmers

Allergy. 2015 Feb;70(2):187-94. doi: 10.1111/all.12540.


Background: Daily intensive exercise by elite athletes can result in exercise-induced asthma especially in elite swimmers and this may be linked to epithelial damage.

Objective: To study airway epithelial damage and release of damage-associated molecular patterns (DAMPs) after intensive exercise in elite athletes and controls.

Methods: We recruited competitive swimmers (n = 26), competitive indoor athletes (n = 13) and controls (n = 15) without any history of asthma. Lung function was measured before, immediately after and 24 h after a 90-min intensive exercise protocol. Sputum induction was performed at baseline and 24 h after exercise. Exercise-induced bronchoconstriction (EIB) was assessed by the eucapnic voluntary hyperventilation test.

Results: Baseline sputum uric acid, high mobility group box-1, CXCL8 mRNA, sputum neutrophils and serum Clara cell protein-16 (CC-16) were significantly higher in competitive swimmers compared with controls. Intensive swimming for 90 min resulted in an increase of sputum IL-1β, IL-6 and TNF mRNA in competitive swimmers, and of sputum IL-6 mRNA and sputum neutrophils in controls. Although all participants were asymptomatic, seven competitive swimmers, one indoor athlete and one control met the criteria for EIB.

Conclusion: Our findings show that the intensive training combined with exposure to by-products of chlorination induces airway epithelial damage in competitive swimmers. This is associated with increased damage-associated molecular patterns, innate cytokine release and neutrophilic airway inflammation.

Keywords: Clara cell protein-16; elite athlete; eucapnic voluntary hyperventilation; exercise-induced bronchoconstriction; uric acid.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Asthma, Exercise-Induced / immunology
  • Asthma, Exercise-Induced / metabolism*
  • Asthma, Exercise-Induced / pathology*
  • Asthma, Exercise-Induced / physiopathology
  • Athletes*
  • Biomarkers
  • Case-Control Studies
  • Cytokines / metabolism*
  • Female
  • Humans
  • Immunity, Innate
  • Male
  • Respiratory Function Tests
  • Respiratory Mucosa / immunology
  • Respiratory Mucosa / metabolism*
  • Respiratory Mucosa / pathology*
  • Sputum / cytology
  • Sputum / metabolism
  • Swimming*
  • Young Adult


  • Biomarkers
  • Cytokines