Purpose. To utilize proteomics to discover proteins associated with significant cardiac magnetic resonance imaging (MRI) changes in marathon runners. Methods. Serum from 25 runners was analyzed by surface enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Proteomic profiles were compared in serum samples obtained prior to the race, at the finish line and within 7 hours after race to identify dynamic proteins correlated with cardiac MRI changes. Results. 693 protein/peptide clusters were identified using two ProteinChip surface chemistries and, of these, 116 were significantly different between the three time points. We identified 7 different patterns of protein expression change within the runners and 5 prerace protein peaks, 16 finish-line protein levels, and 15 postrace proteins which were correlated with significant postrace cardiac MRI changes. Conclusions. This study has identified baseline levels of proteins which may be predictive of risk of significant cardiac damage following a marathon race. Preliminary identification of the significant proteins suggested the involvement of cytokines and other proteins involved in stress and inflammatory response. 1. Introduction A central paradox of physical activity is the association of moderate exercise with decreased cardiovascular morbidity and mortality [1, 2], whereas vigorous physical exertion increases the short-term risk of sudden cardiac death [3, 4]. Due to the rising participation in endurance sports, there is much current interest in postexercise changes in cardiac function [5]. Ever since the first marathon runner, Phidippides, collapsed and died at the finish of his famous run in ancient Greece, death due to heart-related stress has been an occasional occurrence in marathon events. Sudden unexpected death during marathons and other high impact activities is usually due to underlying and often unsuspected heart disease [6–8] and such catastrophes often attract substantial public attention [9]. Identification of marathon runners at risk is difficult, and the need for medical examinations remains controversial [2, 10, 11]. The risk of sudden cardiac death associated with marathon running has been suggested to be too low to recommend routine screening for coronary artery disease [12, 13]. An alternative approach to cardiac screening is to identify biomarkers which may predispose runners to increased risk of cardiac events. Many physical and biochemical changes have been described during endurance sports including transient changes in systolic and more persistent
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