Effect of extracellular hyperosmolality during normothermia and hyperthermia on the autophagic response in peripheral blood mononuclear cells from young men.

Heat-stress-induced dehydration is associated with extracellular hyperosmolality. To counteract the associated stress, cells employ cytoprotective mechanisms, including autophagy; however, the autophagic response to hyperosmotic stress has yet to be evaluated in humans. Thus, we investigated autophagy and associated cellular stress pathways [the heat shock response (HSR), apoptosis, and the acute inflammatory response] to isosmotic and hyperosmotic conditions with and without hyperthermia in 12 young men (mean [SD]; 25 [5] yr). Participants received a 90-min intravenous infusion of either isosmotic (ISO; 0.9% NaCl; serum osmolality of 293 [4] mosmol/kgH2O) or hyperosmotic (HYP; 3.0% NaCl; 300 [6] mosmol/kgH2O) saline, followed by passive whole body heating using water perfused suit to increase esophageal temperature by ∼0.8°C. Peripheral blood mononuclear cells were harvested at baseline (preinfusion), postinfusion, and after heating, and changes in protein content were analyzed via Western blotting. Post infusion, the LC3-II/I ratio was higher in HYP compared with ISO infusion (P < 0.001), although no other protein changes were observed (all P > 0.050). Following passive heating, autophagy increased in HYP, as demonstrated by an increase in LC3-II from baseline (P = 0.004) and an elevated LC3-II/I ratio compared with ISO (P = 0.035), and a decrease in p62 when compared with the ISO condition (P = 0.019). This was accompanied by an elevation in cleaved caspase-3 following heating in the HYP condition (P < 0.010); however, the HSR and acute inflammatory response did not change under any condition (all P > 0.050). Taken together, our findings indicate that serum hyperosmolality induces autophagy and apoptotic signaling during mild hyperthermia with minimal autophagic activation during normothermia.NEW & NOTEWORTHY We demonstrate that a physiologically relevant increase in serum osmolality causes minimal activation of the autophagic response. However, the combined stressors of serum hyperosmolality and mild hyperthermia causes activation of both autophagy and apoptotic signaling. Thus, changes in osmotic homeostasis appear to influence the cell's cytoprotective ability during periods of heat stress, highlighting the importance of considering osmotic status when examining autophagic responses in vivo.

Heat therapy vs. supervised exercise therapy for peripheral arterial disease: a 12-wk randomized, controlled trial.

Peripheral arterial disease (PAD) is characterized by lower limb atherosclerosis impairing blood supply and causing walking-induced leg pain or claudication. Adherence to traditional exercise training programs is poor due to these symptoms despite exercise being a mainstay of conservative treatment. Heat therapy improves many cardiovascular health outcomes, so this study tested if this was a viable alternative cardiovascular therapy for PAD patients. Volunteers with PAD were randomized to 12 wk of heat (n = 11; mean age 76 ± 8 yr, BMI 28.7 ± 3.5 kg/m2, 4 females) or exercise (n = 11; 74 ± 10 yr, 28.5 ± 6.8 kg/m2, 3 females). Heat involved spa bathing at ∼39°C, 3-5 days/wk for ≤30 min, followed by ≤30 min of callisthenics. Exercise involved ≤90 min of supervised walking and gym-based exercise, 1-2 days/wk. Following the interventions, total walking distance during a 6-min walk test increased (from ∼350 m) by 41 m (95% CI: [13, 69], P = 0.006) regardless of group, and pain-free walking distance increased (from ∼170 m) by 43 m ([22, 63], P < 0.001). Systolic blood pressure was reduced more following heat (-7 mmHg, [-4, -10], P < 0.001) than following exercise (-3 mmHg, [0, -6], P = 0.078), and diastolic and mean arterial pressure decreased by 4 mmHg in both groups (P = 0.002). There were no significant changes in blood volume, ankle-brachial index, or measures of vascular health. There were no differences in the improvement in functional or blood pressure outcomes between heat and exercise in individuals with PAD. NEW & NOTEWORTHY Heat therapy via hot-water immersion and supervised exercise both improved walking distance and resting blood pressure in peripheral arterial disease (PAD) patients over 12 wk. Adherence to heat therapy was excellent, and the heat intervention was well tolerated. The results of the current study indicate that heat therapy can improve functional ability and has potential as an effective cardiovascular conditioning tool for individuals with PAD.