Lactate Distribution in the Blood Compartments of Sickle Cell Trait Carriers during Incremental Exercise and Recovery

Abstract

Whether or not whole blood lactate concentration is the same during a ramp exercise test in subjects with sickle cell trait (AS) as in normal subjects remains a point of controversy in the literature. Some studies have shown that the ability to produce or clear circulating lactate might differ between AS and subjects with normal haemoglobin (AA). If this is indeed so, the lactate distribution in the blood compartments should also differ. To test this hypothesis, lactate concentrations in the whole blood, plasma and red blood cells of AS and AA were compared at rest and in response to exercise. Eight AS and 8 AA performed an incremental exercise test. Whole blood, plasma and red blood cell lactate concentrations, the red blood cell : plasma lactate concentration ratio, the plasma-to-red blood cell lactate gradient, haematocrit and cardiorespiratory variables were analysed at rest and during an incremental exercise test and active recovery. Maximal oxygen uptake and ventilatory thresholds were similar in the two groups. No significant difference in whole blood, plasma or red blood cell lactate concentrations was observed between the two groups at rest, during exercise, or during the immediate recovery. Neither the red blood cell : plasma lactate concentration ratio nor the plasma-to-red blood cell lactate gradient differed between groups. Lactate distribution in the blood compartments did not differ between the two groups and this finding suggests that lactate production and/or clearance is quite similar during exercise in AS and AA.

Key words

Sickle cell trait - lactate - red blood cell - plasma and exercise

References

• 1 Bangsbo J, Juel C, Hellsten Y, Saltin B. Dissociation between lactate and proton exchange in muscle during intense exercise in man.  J Physiol. 1997;  504 489-499
• 2 Beaver W L, Wasserman K, Whipp B J. A new method for detecting anaerobic threshold by gas exchange.  J Appl Physiol. 1986;  60 2020-2027
• 3 Bile A, Le Gallais D, Mercier B, Martinez P, Ahmaidi S, Prefaut C, Mercier J. Blood lactate concentrations during incremental exercise in subjects with sickle cell trait.  Med Sci Sports Exerc. 1998;  30 649-654
• 4 Brooks G A. The lactate shuttle during exercise and recovery.  Med Sci Sports Exerc. 1986;  18 360-368
• 5 Buono M J, Yeager J E. Intraerythrocyte and plasma lactate concentrations during exercise in humans.  Eur J Appl Physiol. 1986;  55 326-329
• 6 Daniel S S, Morishima H O, James L S, Adamsons Jr K. Lactate and pyruvate gradients between red blood cells and plasma during acute asphyxia.  J Appl Physiol. 1964;  19 1100-1104
• 7 Deuticke B, Beyer E, Forst B. Discrimination of three parallel pathways of lactate transport in the human erythrocyte membrane by inhibitors and kinetic properties.  Biochim Biophys Acta. 1982;  684 96-110
• 8 Donovan C M, Brooks G A. Endurance training affects lactate clearance, not lactate production.  Am J Physiol. 1983;  244 E83-92
• 9 Embury S H, Dozy A M. The alpha-globin genotype as a determinant of hematologic parameters in sickle cell trait. Sigler E The Molecular Basis of Mutant Hemoglobin Dysfunction. North Holland; Elsevier 1981: 63-67
• 10 Foxdal P, Sjodin B, Rudstam H, Ostman C, Ostman B, Hedenstierna G C. Lactate concentration differences in plasma, whole blood, capillary finger blood and erythrocytes during submaximal graded exercise in humans.  Eur J Appl Physiol. 1990;  61 218-222
• 11 Franklin Q J, Compeggie M. Splenic syndrome in sickle cell trait: four case presentations and a review of the literature.  Mil Med. 1999;  164 230-233
• 12 Freund H, Lonsdorfer J, Oyono-Enguelle S, Lonsdorfer A, Bogui P. Lactate exchange and removal abilities in sickle cell patients and in untrained and trained healthy humans.  J Appl Physiol. 1992;  73 2580-2587
• 13 Freund H, Lonsdorfer J, Oyono-Enguelle S, Lonsdorfer A, Dah C, Bogui P. Lactate exchange and removal abilities in sickle cell trait carriers during and after incremental exercise.  Int J Sports Med. 1995;  16 428-434
• 14 Gozal D, Thiriet P, Mbala E, Wouassi D, Gelas H, Geyssant A, Lacour J R. Effect of different modalities of exercise and recovery on exercise performance in subjects with sickle cell trait.  Med Sci Sports Exerc. 1992;  24 1325-1331
• 15 Hildebrand A, Lormes W, Emmert J, Liu Y, Lehmann M, Steinacker J M. Lactate concentration in plasma and red blood cells during incremental exercise.  Int J Sports Med. 2000;  21 463-468
• 16 Huisman T H. Trimodality in the percentages of beta chain variants in heterozygotes: the effect of the number of active Hbalpha structural loci.  Hemoglobin. 1977;  1 349-382
• 17 Jones S R, Binder R A, Donowho Jr E M. Sudden death in sickle-cell trait.  N Engl J Med. 1970;  282 323-325
• 18 Juel C, Bangsbo J, Graham T, Saltin B. Lactate and potassium fluxes from human skeletal muscle during and after intense, dynamic, knee extensor exercise.  Acta Physiol Scand. 1990;  140 147-159
• 19 Kark J A, Posey D M, Schumacher H R, Ruehle C J. Sickle-cell trait as a risk factor for sudden death in physical training.  N Engl J Med. 1987;  317 781-787
• 20 Kark J A, Ward F T. Exercise and hemoglobin S.  Semin Hematol. 1994;  31 181-225
• 21 Keclard L, Romana M, Lavocat E, Saint-Martin C, Berchel C, Merault G. Sickle cell disorder, beta-globin gene cluster haplotypes and alpha-thalassemia in neonates and adults from Guadeloupe.  Am J Hematol. 1997;  55 24-27
• 22 MacRae H S, Dennis S C, Bosch A N, Noakes T D. Effects of training on lactate production and removal during progressive exercise in humans.  J Appl Physiol. 1992;  72 1649-1656
• 23 Monplaisir N, Saint-Martin C, Seytors S, Cassius de Linval J, Ouka M, Mérault G, Rosa J. Etude épidémiologique des hémoglobinopathies aux Antilles. Doin Maladies héréditaires du globule rouge. Progrès en hématologie. 1984 6: 219-223
• 24 Oyono-Enguelle S, Freund H. Ability to remove lactate in endurance-trained and -untrained humans.  J Appl Physiol. 1992;  72 396-399
• 25 Perez-Martin A, Dumortier M, Raynaud E, Brun J F, Fedou C, Bringer J, Mercier J. Balance of substrate oxidation during submaximal exercise in lean and obese people.  Diabetes Metab. 2001;  27 466-474
• 26 Poole R C, Halestrap A P. Transport of lactate and other monocarboxylates across mammalian plasma membranes.  Am J Physiol. 1993;  264 C761-782
• 27 Sara F, Hardy-Dessources M D, Voltaire B, Etienne-Julan M, Hue O. Lactic response in sickle cell trait carriers in comparison with subjects with normal hemoglobin.  Clin J Sport Med. 2003;  13 96-101
• 28 Sears D A. The morbidity of sickle cell trait: a review of the literature.  Am J Med. 1978;  64 1021-1036
• 29 Sears D A. Sickle cell trait. Embury SH HR, Mohandas N, Steinberg MH Sickle Cell Disease: Basic Principles and Clinical Practice. New York; Raven Press Ltd 1994: 381-394
• 30 Senay L CJ, Rogers G, Jooste P. Changes in blood plasma during progressive treadmill and cycle exercise.  J Appl Physiol. 1980;  49 59-65
• 31 Serjeant G R. Sickle cell trait disease. Oxford; Oxford medical publications 1985
• 32 Smith E W, Skelton M S, Kremer D E, Pascoe D D, Gladden L B. Lactate distribution in the blood during progressive exercise.  Med Sci Sports Exerc. 1997;  29 654-660
• 33 Smith E W, Skelton M S, Kremer D E, Pascoe D D, Gladden L B. Lactate distribution in the blood during steady-state exercise.  Med Sci Sports Exerc. 1998;  30 1424-1429
• 34 Sullivan L W. The risks of sickle-cell trait: caution and common sense.  N Engl J Med. 1987;  317 830-831
• 35 Wasserman K, McIlroy M B. Detecting the threshold of anaerobic metabolism in cardiac patients during exercise.  Am J Cardiol. 1964;  14 844-852
• 36 Wasserman K, Whipp B J, Koyl S N, Beaver W L. Anaerobic threshold and respiratory gas exchange during exercise.  J Appl Physiol. 1973;  35 236-243
• 37 Weisman I M, Zeballos R J, Johnson B D. Cardiopulmonary and gas exchange responses to acute strenuous exercise at 1270 meters in sickle cell trait.  Am J Med. 1988;  84 377-383
• 38 Weisman I M, Zeballos R J, Johnson B D. Effect of moderate inspiratory hypoxia on exercise performance in sickle cell trait.  Am J Med. 1988;  84 1033-1040
• 39 Westerman M P, Green D, Gilman-Sachs A, Beaman K, Freels S, Boggio L, Allen S, Schlegel R, Williamson P. Coagulation changes in individuals with sickle cell trait.  Am J Hematol. 2002;  69 89-94
• 40 Wirthwein D P, Spotswood S D, Barnard J J, Prahlow J A. Death due to microvascular occlusion in sickle-cell trait following physical exertion.  J Forens Sci. 2001;  46 399-401
• 41 Yoshida T, Suda Y, Takeuchi N. Endurance training regimen based upon arterial blood lactate: effects on anaerobic threshold.  Eur J Appl Physiol. 1982;  49 223-230