Gut Leakage Markers in Response to Strenuous Exercise in Patients with Suspected Coronary Artery Disease

Cells. 2021 Aug 25;10(9):2193. doi: 10.3390/cells10092193.


Elevated levels of gut leakage markers have been shown after strenuous exercise in healthy individuals. Any association between a temporary increase in these markers and the presence of coronary artery disease (CAD) is unknown. We therefore aimed to explore circulating gut leakage markers in response to a bout of strenuous exercise in patients with symptoms of CAD. Patients referred to exercise stress testing due to symptoms of CAD were included (n = 287). A maximal exercise ECG stress test was performed and venous blood samples were drawn at rest and within five minutes after, for analysis of soluble cluster of differentiation 14 (sCD14), lipopolysaccharide-binding protein (LBP), intestinal fatty-acid binding protein (I-FABP), lipopolysaccharide (LPS) and gene expression of toll-like receptor 4 (TLR4) in circulating leukocytes. Patients then underwent coronary angiography. LPS, LBP and sCD14 increased significantly after strenuous exercise in patients with symptoms of CAD, suggesting that even short bouts of vigorous exercise are associated with gut leakage. The gene expression of TLR4 decreased significantly after exercise, possibly as a negative feedback to the increase in LPS. There were no differences in exercise-induced changes between the groups of CAD, suggesting gut leakage to be independent of the presence of CAD.

Keywords: acute exercise; cardiovascular disease; gut leakage; inflammation; microbiota; strenuous exercise.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute-Phase Proteins / metabolism
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / metabolism*
  • Carrier Proteins / metabolism
  • Coronary Angiography / methods
  • Coronary Artery Disease / metabolism*
  • Coronary Artery Disease / physiopathology*
  • Digestive System / metabolism*
  • Exercise / physiology*
  • Exercise Test / methods
  • Female
  • Humans
  • Male
  • Membrane Glycoproteins / metabolism
  • Middle Aged
  • Toll-Like Receptor 4 / metabolism


  • Acute-Phase Proteins
  • Biomarkers
  • Carrier Proteins
  • Membrane Glycoproteins
  • Toll-Like Receptor 4
  • lipopolysaccharide-binding protein