1 2708 111 EXERCISE IN NEUROMUSCULAR DISORDERS: A PROMISING INTERVENTION. ALTHOUGH PERFORMING EXERCISE STUDIES IN PATIENTS WITH NEUROMUSCULAR DISORDERS (NMD) IS DIFFICULT, THE NUMBER OF RANDOMIZED CONTROLLED TRIALS IS STEADILY INCREASING. THERE IS GROWING EVIDENCE FOR A POSITIVE EFFECT OF AEROBIC EXERCISE IN SEVERAL NMD, ON THE OTHER HAND, THE EVIDENCE FOR THE EFFECT OF STRENGTH TRAINING IS STILL SCARCE. MANY NMD PATIENTS ARE CAPTURED IN A VICIOUS CIRCLE OF PHYSICAL INACTIVITY, AND IT IS IMPORTANT TO LET PATIENTS ADHERE TO AN ACTIVE LIFESTYLE, IN ORDER TO PREVENT FURTHER CHRONIC CARDIOVASCULAR AND MUSCLE DECONDITIONING AND INCREASED CARDIOVASCULAR HEALTH RISKS. EXERCISE HAS TO BE PRESCRIBED AS IF IT IS MEDICINE, IN ORDER TO INCREASE THE ADHERENCE OF PATIENTS AND TO OPTIMIZE THE EFFICACY OF THE INTERVENTION. EXERCISE IN NMD IS SAFE, ALTHOUGH FOR SOME METABOLIC MYOPATHIES THERE IS A CONTRAINDICATION FOR STRENUOUS EXERCISE. IN NMD KNOWN TO AFFECT CARDIAC MUSCLE, IT IS USUALLY SAFE TO EXERCISE, BUT THE CONSULTATION OF A CARDIOLOGIST IS ADVISED. BASED ON RECENT RESEARCH, AN INCREASE IN PHYSICAL ACTIVITY OF MODERATE INTENSITY AND OF SUFFICIENT DURATION, I.E. A PHYSICALLY ACTIVE LIFESTYLE, COULD BE AT LEAST AS EFFECTIVE AND RELEVANT AS PHYSICAL TRAINING. UNDERLYING MECHANISMS OF EFFECT OF EXERCISE COULD BE THE INFLUENCE OF EPIGENETIC MECHANISMS AND THE ANTI-INFLAMMATORY EFFECT OF EXERCISE, BUT FURTHER STUDIES ARE NEEDED TO CONFIRM THESE HYPOTHESES. 2019 2 2711 15 EXERCISE TRAINING ALTERS THE GENOMIC RESPONSE TO ACUTE EXERCISE IN HUMAN ADIPOSE TISSUE. AIM: TO DETERMINE THE GENOMIC MECHANISMS BY WHICH ADIPOSE TISSUE RESPONDS TO ACUTE AND CHRONIC EXERCISE. METHODS: WE PROFILED THE TRANSCRIPTOMIC AND EPIGENETIC RESPONSE TO ACUTE EXERCISE IN HUMAN ADIPOSE TISSUE COLLECTED BEFORE AND AFTER ENDURANCE TRAINING. RESULTS: ALTHOUGH ACUTE EXERCISES WERE PERFORMED AT SAME RELATIVE INTENSITIES, THE MAGNITUDE OF TRANSCRIPTOMIC CHANGES AFTER ACUTE EXERCISE WAS REDUCED BY ENDURANCE TRAINING. DNA METHYLATION REMODELING INDUCED BY ACUTE EXERCISE WAS MORE PROMINENT IN TRAINED VERSUS UNTRAINED STATE. WE FOUND AN OVERLAP BETWEEN GENE EXPRESSION AND DNA METHYLATION CHANGES AFTER ACUTE EXERCISE FOR 32 GENES PRE-TRAINING AND SIX POST-TRAINING, NOTABLY AT ADIPOCYTE-SPECIFIC GENES. CONCLUSION: TRAINING STATUS DIFFERENTIALLY AFFECTS THE EPIGENETIC AND TRANSCRIPTOMIC RESPONSE TO ACUTE EXERCISE IN HUMAN ADIPOSE TISSUE. 2018 3 2408 20 EPIGENETIC REWIRING OF SKELETAL MUSCLE ENHANCERS AFTER EXERCISE TRAINING SUPPORTS A ROLE IN WHOLE-BODY FUNCTION AND HUMAN HEALTH. OBJECTIVES: REGULAR PHYSICAL EXERCISE IMPROVES HEALTH BY REDUCING THE RISK OF A PLETHORA OF CHRONIC DISORDERS. WE HYPOTHESIZED THAT ENDURANCE EXERCISE TRAINING REMODELS THE ACTIVITY OF GENE ENHANCERS IN SKELETAL MUSCLE AND THAT THIS REMODELING CONTRIBUTES TO THE BENEFICIAL EFFECTS OF EXERCISE ON HUMAN HEALTH. METHODS AND RESULTS: BY STUDYING CHANGES IN HISTONE MODIFICATIONS, WE MAPPED THE GENOME-WIDE POSITIONS AND ACTIVITIES OF ENHANCERS IN SKELETAL MUSCLE BIOPSIES COLLECTED FROM YOUNG SEDENTARY MEN BEFORE AND AFTER 6 WEEKS OF ENDURANCE EXERCISE. WE IDENTIFIED EXTENSIVE REMODELING OF ENHANCER ACTIVITIES AFTER EXERCISE TRAINING, WITH A LARGE SUBSET OF THE REMODELED ENHANCERS LOCATED IN THE PROXIMITY OF GENES TRANSCRIPTIONALLY REGULATED AFTER EXERCISE. BY OVERLAPPING THE POSITION OF ENHANCERS WITH GENETIC VARIANTS, WE IDENTIFIED AN ENRICHMENT OF DISEASE-ASSOCIATED GENETIC VARIANTS WITHIN THE EXERCISE-REMODELED ENHANCERS. CONCLUSION: OUR DATA PROVIDE EVIDENCE OF A FUNCTIONAL LINK BETWEEN EPIGENETIC REWIRING OF ENHANCERS TO CONTROL THEIR ACTIVITY AFTER EXERCISE TRAINING AND THE MODULATION OF DISEASE RISK IN HUMANS. 2021 4 2213 36 EPIGENETIC MODIFICATIONS AS OUTCOMES OF EXERCISE INTERVENTIONS RELATED TO SPECIFIC METABOLIC ALTERATIONS: A SYSTEMATIC REVIEW. BACKGROUND: CHRONIC DISEASES ARISE AS A CONSEQUENCE OF AN UNHEALTHY LIFESTYLE PRIMARILY CHARACTERIZED BY PHYSICAL INACTIVITY AND UNBALANCED DIETS. REGULAR PHYSICAL ACTIVITY CAN IMPROVE HEALTH, AND THERE IS CONSISTENT EVIDENCE THAT THESE IMPROVEMENTS MAY BE THE RESULT OF EPIGENETIC MODIFICATIONS. OBJECTIVE: TO IDENTIFY EPIGENETIC MODIFICATIONSAS OUTCOMES OF EXERCISE INTERVENTIONS RELATED TO SPECIFIC METABOLIC ALTERATIONS. METHODS: THE PREFERRED REPORTING ITEMS FOR SYSTEMATIC REVIEWS AND META-ANALYSES PROTOCOLS (PRISMA-P) METHODOLOGY FOR MANUSCRIPT RESEARCH AND PREPARATION WAS FOLLOWED USING PUBMED AND EBSCO DATABASES FOR LITERATURE REVIEW. OUT OF 2,638 ARTICLES IDENTIFIED, ONLY 34 ARTICLES MET THE INCLUSION CRITERIA. RESULTS: THE SECTIONS OF THE REVIEW WERE ORGANIZED BY METABOLIC ALTERATIONS IN WHICH STUDIES WERE GROUPED ACCORDING TO HEALTHY, DISEASED, AND TRAINED INDIVIDUALS. RESISTANCE EXERCISE IN HUMANS INDUCED EPIGENETIC CHANGES IN PATHWAYS ASSOCIATED WITH ENERGY METABOLISM AND INSULIN SENSITIVITY, CONTRIBUTING TO HEALTHY SKELETAL MUSCLE. ENDURANCE EXERCISE ALSO CAUSED MODIFICATIONS IN BIOMARKERS ASSOCIATED TO METABOLIC ALTERATIONS THROUGH CHANGES IN DNA METHYLATION AND THE EXPRESSION OF SPECIFIC MIRNAS. HOWEVER, BOTH RESISTANCE AND ENDURANCE EXERCISE ARE NECESSARY TO OBTAIN A BETTER PHYSIOLOGICAL ADAPTATION AND A COMBINATION OF BOTH SEEMS TO BE NEEDED TO PROPERLY TACKLE THE INCREASING PREVALENCE OF NON-COMMUNICABLE PATHOLOGIES. CONCLUSION: GIVEN THE HETEROGENEITY AND COMPLEXITY OF THE EXISTING LITERATURE, IT IS CURRENTLY NOT POSSIBLE TO PROPOSE A SPECIFIC RECOMMENDATION ABOUT THE TYPE, INTENSITY, OR DURATION OF EXERCISE THAT COULD BE BENEFICIAL FOR DIFFERENT SUBSETS OF THE POPULATION (HEALTHY, DISEASED, AND/OR TRAINED). NEVERTHELESS, THIS REVIEW HIGHLIGHTS THE IMPORTANCE OF EXERCISE FOR HEALTH AND SHOWS THE NEED TO PERFORM MORE RESEARCH IN THIS EMERGING AREA TO IDENTIFY EPIGENETIC BIOMARKERS THAT COULD SERVE AS INDICATORS OF EXERCISE ADAPTATIONS. 2019 5 724 30 CAN GENETICS GUIDE EXERCISE PRESCRIPTIONS IN OSTEOARTHRITIS? OSTEOARTHRITIS (OA) IS THE MOST COMMON FORM OF ARTHRITIS AND HAS A MULTIFACTORIAL ETIOLOGY. CURRENT MANAGEMENT FOR OA FOCUSES ON MINIMIZING PAIN AND FUNCTIONAL LOSS, TYPICALLY INVOLVING PHARMACOLOGICAL, PHYSICAL, PSYCHOSOCIAL, AND MIND-BODY INTERVENTIONS. HOWEVER, THERE REMAIN CHALLENGES IN DETERMINING WHICH PATIENTS WILL BENEFIT MOST FROM WHICH INTERVENTIONS. ALTHOUGH EXERCISE-BASED INTERVENTIONS ARE RECOMMENDED AS FIRST-LINE TREATMENTS AND ARE KNOWN TO BE BENEFICIAL FOR MANAGING BOTH THE DISEASE AND ILLNESS OF OA, THE OPTIMAL EXERCISE "PRESCRIPTION" IS UNKNOWN, DUE IN PART TO OUR LIMITED UNDERSTANDING OF THE PRECISE MECHANISMS UNDERLYING ITS ACTION. HERE WE PRESENT OUR PERSPECTIVE ON THE POTENTIAL ROLE OF GENETICS IN GUIDING EXERCISE PRESCRIPTION FOR PERSONS WITH OA. WE DESCRIBE KEY PUBLICATIONS IN THE AREAS OF EXERCISE AND OA, GENETICS AND OA, AND EXERCISE AND GENETICS, AND POINT TO A PAUCITY OF KNOWLEDGE AT THE INTERSECTION OF EXERCISE, GENETICS, AND OA. WE SUGGEST THERE IS EMERGING EVIDENCE TO SUPPORT THE USE OF GENETICS AND EPIGENETICS TO EXPLAIN THE BENEFICIAL EFFECTS OF EXERCISE FOR OA. WE IDENTIFY MISSING LINKS IN THE EXISTING RESEARCH RELATING TO EXERCISE, GENETICS, AND OA, AND HIGHLIGHT EPIGENETICS AS A PROMISING MECHANISM THROUGH WHICH ENVIRONMENTAL EXPOSURES SUCH AS EXERCISE MAY IMPACT OA OUTCOMES. WE ANTICIPATE FUTURE STUDIES WILL IMPROVE OUR UNDERSTANDING OF HOW GENETIC AND EPIGENETIC FACTORS MEDIATE EXERCISE-BASED INTERVENTIONS TO SUPPORT IMPLEMENTATION AND ULTIMATELY IMPROVE OA PATIENT CARE. 2022 6 2703 34 EXERCISE ADAPTATIONS: MOLECULAR MECHANISMS AND POTENTIAL TARGETS FOR THERAPEUTIC BENEFIT. EXERCISE IS FUNDAMENTAL FOR GOOD HEALTH, WHEREAS PHYSICAL INACTIVITY UNDERPINS MANY CHRONIC DISEASES OF MODERN SOCIETY. IT IS WELL APPRECIATED THAT REGULAR EXERCISE IMPROVES METABOLISM AND THE METABOLIC PHENOTYPE IN A NUMBER OF TISSUES. THE PHENOTYPIC ALTERATIONS OBSERVED IN SKELETAL MUSCLE ARE PARTLY MEDIATED BY TRANSCRIPTIONAL RESPONSES THAT OCCUR FOLLOWING EACH INDIVIDUAL BOUT OF EXERCISE. THIS ADAPTIVE RESPONSE INCREASES OXIDATIVE CAPACITY AND INFLUENCES THE FUNCTION OF MYOKINES AND EXTRACELLULAR VESICLES THAT SIGNAL TO OTHER TISSUES. OUR UNDERSTANDING OF THE EPIGENETIC AND TRANSCRIPTIONAL MECHANISMS THAT MEDIATE THE SKELETAL MUSCLE GENE EXPRESSION RESPONSE TO EXERCISE AS WELL AS OF THEIR UPSTREAM SIGNALLING PATHWAYS HAS ADVANCED SUBSTANTIALLY IN THE PAST 10 YEARS. WITH THIS KNOWLEDGE ALSO COMES THE OPPORTUNITY TO DESIGN NEW THERAPEUTIC STRATEGIES BASED ON THE BIOLOGY OF EXERCISE FOR A VARIETY OF CHRONIC CONDITIONS WHERE REGULAR EXERCISE MIGHT BE A CHALLENGE. THIS REVIEW PROVIDES AN OVERVIEW OF THE BENEFICIAL ADAPTIVE RESPONSES TO EXERCISE AND DETAILS THE MOLECULAR MECHANISMS INVOLVED. THE POSSIBILITY OF DESIGNING THERAPEUTIC INTERVENTIONS BASED ON THESE MOLECULAR MECHANISMS IS ADDRESSED, USING RELEVANT EXAMPLES THAT HAVE EXPLOITED THIS APPROACH. 2020 7 5072 26 PHYSICAL EXERCISE POSITIVELY INFLUENCES BREAST CANCER EVOLUTION. BREAST CANCER IS ONE OF THE MOST COMMONLY DIAGNOSED TYPES OF CANCER IN WOMEN. ITS PATHOGENESIS INVOLVES GENETIC, HORMONAL, AND ENVIRONMENTAL FACTORS. A LARGE BODY OF EVIDENCE INDICATES THAT PHYSICAL ACTIVITY HAS POSITIVE EFFECTS ON EVERY ASPECT OF BREAST CANCER EVOLUTION, INCLUDING PREVENTION, MEDICAL TREATMENT, AND AFTERCARE CLINICAL SETTINGS. THUS, DIFFERENT TYPES OF EXERCISE CAN INFLUENCE THE PREVENTION AND PROGRESSION OF THE DISEASE THROUGH SEVERAL COMMON MECHANISMS, SUCH AS REDUCTION OF INSULIN RESISTANCE AND IMPROVEMENT OF IMMUNITY AND CARDIOVASCULAR FUNCTION. FURTHERMORE, ACUTE AND CHRONIC SYMPTOMS OF BREAST CANCER, SUCH AS CACHEXIA, MUSCLE MASS LOSS, FATIGUE, CARDIOTOXICITY, WEIGHT GAIN, HORMONE ALTERATIONS, BONE LOSS, AND PSYCHOLOGIC ADVERSE EFFECTS, MAY ALL BE FAVORABLY INFLUENCED BY REGULAR EXERCISE. WE REVIEW THE RELATION OF INTENSITY AND DURATION OF EXERCISE WITH POTENTIAL PATHOPHYSIOLOGIC PATHWAYS, INCLUDING OBESITY-RELATED HORMONES AND SEX STEROID HORMONE PRODUCTION, OXIDATIVE STRESS, EPIGENETIC ALTERATIONS SUCH AS DNA HYPOMETHYLATION, AND CHANGES IN TELOMERE LENGTH, WITHIN THE CONTEXT OF THE BENEFICIAL EFFECTS OF EXERCISE. THE POTENTIAL ROLE OF EXERCISE IN REDUCING THE INTENSITY OF THE ADVERSE EFFECTS THAT RESULT FROM BREAST CANCER AND ANTICANCER TREATMENT IS ALSO DISCUSSED. 2017 8 3581 23 IMPACT OF PHYSICAL ACTIVITY AND EXERCISE ON THE EPIGENOME IN SKELETAL MUSCLE AND EFFECTS ON SYSTEMIC METABOLISM. EXERCISE AND PHYSICAL ACTIVITY INDUCES PHYSIOLOGICAL RESPONSES IN ORGANISMS, AND ADAPTATIONS IN SKELETAL MUSCLE, WHICH IS BENEFICIAL FOR MAINTAINING HEALTH AND PREVENTING AND/OR TREATING MOST CHRONIC DISEASES. THESE ADAPTATIONS ARE MAINLY INSTIGATED BY TRANSCRIPTIONAL RESPONSES THAT ENSUE IN REACTION TO EACH INDIVIDUAL EXERCISE, EITHER RESISTANCE OR ENDURANCE. CONSEQUENTLY, CHANGES IN KEY METABOLIC, REGULATORY, AND MYOGENIC GENES IN SKELETAL MUSCLE OCCUR AS BOTH AN EARLY AND LATE RESPONSE TO EXERCISE, AND THESE EPIGENETIC MODIFICATIONS, WHICH ARE INFLUENCED BY ENVIRONMENTAL AND GENETIC FACTORS, TRIGGER THOSE ALTERATIONS IN THE TRANSCRIPTIONAL RESPONSES. DNA METHYLATION AND HISTONE MODIFICATIONS ARE THE MOST SIGNIFICANT EPIGENETIC CHANGES DESCRIBED IN GENE TRANSCRIPTION, LINKED TO THE SKELETAL MUSCLE TRANSCRIPTIONAL RESPONSE TO EXERCISE, AND MEDIATING THE EXERCISE ADAPTATIONS. NEVERTHELESS, OTHER ALTERATIONS IN THE EPIGENETICS MARKERS, SUCH AS EPITRANSCRIPTOMICS, MODIFICATIONS MEDIATED BY MIRNAS, AND LACTYLATION AS A NOVEL EPIGENETIC MODIFICATION, ARE EMERGING AS KEY EVENTS FOR GENE TRANSCRIPTION. HERE, WE PROVIDE AN OVERVIEW AND UPDATE OF THE IMPACT OF EXERCISE ON EPIGENETIC MODIFICATIONS, INCLUDING THE WELL-DESCRIBED DNA METHYLATIONS AND HISTONE MODIFICATIONS, AND THE EMERGING MODIFICATIONS IN THE SKELETAL MUSCLE. IN ADDITION, WE DESCRIBE THE EFFECTS OF EXERCISE ON EPIGENETIC MARKERS IN OTHER METABOLIC TISSUES; ALSO, WE PROVIDE INFORMATION ABOUT HOW SYSTEMIC METABOLISM OR ITS METABOLITES INFLUENCE EPIGENETIC MODIFICATIONS IN THE SKELETAL MUSCLE. 2022 9 3684 28 INFLAMMATION, PHYSICAL ACTIVITY, AND CHRONIC DISEASE: AN EVOLUTIONARY PERSPECTIVE. LOW-GRADE INFLAMMATION IS EMERGING AS A COMMON FEATURE OF CONTEMPORARY METABOLIC, PSYCHIATRIC, AND NEURODEGENERATIVE DISEASES. BOTH PHYSICAL INACTIVITY AND ABDOMINAL ADIPOSITY ARE ASSOCIATED WITH PERSISTENT SYSTEMIC LOW-GRADE INFLAMMATION. THUS, THE BEHAVIORAL, BIOLOGICAL, AND PHYSIOLOGICAL CHANGES THAT CAUSE A PREDISPOSITION TO OBESITY AND OTHER CO-MORBIDITIES COULD HAVE EPIGENETIC UNDERPINNINGS IN ADDITION TO VARIOUS EVOLUTIONARY SCENARIOS. A KEY ASSUMPTION INVOLVES THE POTENTIAL FOR A MISMATCH BETWEEN THE HUMAN GENOME MOLDED OVER GENERATIONS, AND THE ISSUE OF ADAPTING TO THE MODERN HIGH CALORIE DIET AND COMMON BUILT ENVIRONMENTS PROMOTING INACTIVITY. THIS BIOLOGICAL MISMATCH APPEARS TO HAVE DIRE HEALTH CONSEQUENCES. THEREFORE, THE GOAL OF THIS ARTICLE IS TO PROVIDE A BRIEF OVERVIEW ON THE IMPORTANCE OF INFLAMMATION AS PART OF HUMAN SURVIVAL AND HOW PHYSICAL ACTIVITY (PA) AND PHYSICAL INACTIVITY ARE CRITICAL REGULATORS OF SYSTEMIC INFLAMMATION. THE REVIEW WILL HIGHLIGHT ANTI-INFLAMMATORY EFFECTS OF PA AND EXERCISE TRAINING FROM A METABOLIC AND SYSTEMIC SIGNALING PERSPECTIVE, WHICH INCLUDES SKELETAL MUSCLE TO UTILIZATION OF FATTY ACIDS, TLR4 SIGNALING, AND MYOKINE/ADIPOKINE EFFECTS. THE AVAILABLE EVIDENCE SUGGESTS THAT PA, REGULAR EXERCISE, AND WEIGHT LOSS OFFER BOTH PROTECTION AGAINST AND TREATMENT FOR A WIDE VARIETY OF CHRONIC DISEASES ASSOCIATED WITH LOW-GRADE INFLAMMATION THROUGH AN IMPROVED INFLAMMATORY PROFILE. 2020 10 2717 32 EXERCISE: PUTTING ACTION INTO OUR EPIGENOME. MOST HUMAN PHENOTYPES ARE INFLUENCED BY A COMBINATION OF GENOMIC AND ENVIRONMENTAL FACTORS. ENGAGING IN REGULAR PHYSICAL EXERCISE PREVENTS MANY CHRONIC DISEASES, DECREASES MORTALITY RISK AND INCREASES LONGEVITY. HOWEVER, THE MECHANISMS INVOLVED ARE POORLY UNDERSTOOD. THE MODULATING EFFECT OF PHYSICAL (AEROBIC AND RESISTANCE) EXERCISE ON GENE EXPRESSION HAS BEEN KNOWN FOR SOME TIME NOW AND HAS PROVIDED US WITH AN UNDERSTANDING OF THE BIOLOGICAL RESPONSES TO PHYSICAL EXERCISE. EMERGING RESEARCH DATA SUGGEST THAT EPIGENETIC MODIFICATIONS ARE EXTREMELY IMPORTANT FOR BOTH DEVELOPMENT AND DISEASE IN HUMANS. IN THE CURRENT REVIEW, WE SUMMARISE FINDINGS ON THE EFFECT OF EXERCISE ON EPIGENETIC MODIFICATIONS AND THEIR EFFECTS ON GENE EXPRESSION. CURRENT RESEARCH DATA SUGGEST EPIGENETIC MODIFICATIONS (DNA METHYLATION AND HISTONE ACETYLATION) AND MICRORNAS (MIRNAS) ARE RESPONSIVE TO ACUTE AEROBIC AND RESISTANCE EXERCISE IN BRAIN, BLOOD, SKELETAL AND CARDIAC MUSCLE, ADIPOSE TISSUE AND EVEN BUCCAL CELLS. SIX MONTHS OF AEROBIC EXERCISE ALTERS WHOLE-GENOME DNA METHYLATION IN SKELETAL MUSCLE AND ADIPOSE TISSUE AND DIRECTLY INFLUENCES LIPOGENESIS. SOME MIRNAS ARE RELATED TO MAXIMAL OXYGEN CONSUMPTION (VO(2MAX)) AND VO(2MAX) TRAINABILITY, AND ARE DIFFERENTIALLY EXPRESSED AMONGST INDIVIDUALS WITH HIGH AND LOW VO(2MAX). REMARKABLY, MIRNA EXPRESSION PROFILES DISCRIMINATE BETWEEN LOW AND HIGH RESPONDERS TO RESISTANCE EXERCISE (MIR-378, -26A, -29A AND -451) AND CORRELATE TO GAINS IN LEAN BODY MASS (MIR-378). THE EMERGING FIELD OF EXERCISE EPIGENOMICS IS EXPECTED TO PROSPER AND ADDITIONAL STUDIES MAY ELUCIDATE THE CLINICAL RELEVANCE OF MIRNAS AND EPIGENETIC MODIFICATIONS, AND DELINEATE MECHANISMS BY WHICH EXERCISE CONFERS A HEALTHIER PHENOTYPE AND IMPROVES PERFORMANCE. 2014 11 2093 27 EPIGENETIC EFFECTS FOLLOWING ACUTE AND CHRONIC EXERCISE IN CARDIOVASCULAR DISEASE: A SYSTEMATIC REVIEW. INTRODUCTION: ACUTE EXERCISE AND EXERCISE TRAINING MAY CONFER EPIGENETIC MODIFICATIONS IN HEALTHY SUBJECTS. EPIGENETIC EFFECTS AFTER EXERCISE HAVE BEEN SHOWED IN PATIENTS WITH CARDIOVASCULAR DISEASE. THE AIM OF THIS SYSTEMATIC REVIEW WAS TO SUMMARIZE THE EVIDENCE FROM AVAILABLE CLINICAL TRIALS THAT STUDY EPIGENETIC ADAPTATIONS AFTER EXERCISE IN PATIENTS WITH CARDIOVASCULAR DISEASE. METHODS: THE SEARCH STRATEGY WAS PERFORMED IN PUBMED AND CENTRAL DATABASES ON ARTICLES PUBLISHED UNTIL SEPTEMBER 2020. STUDIES WITH TITLES AND ABSTRACTS RELEVANT TO EXERCISE EPIGENETIC MODIFICATION APPLIED TO CARDIOVASCULAR PATIENTS WERE FULLY EXAMINED. INCLUSION AND EXCLUSION CRITERIA WERE UTILIZED FOR STUDIES SCREENING. QUALITY ASSESSMENT WITH PEDRO SCALE AND EVALUATION BY TWO INDEPENDENT REVIEWERS WAS PERFORMED. RESULTS: OF THE 1714 ARTICLES RETRIEVED, 88 ARTICLES WERE ASSESSED FOR ELIGIBILITY CRITERIA AND 8 ARTICLES MATCHED OUR SEARCH CRITERIA AND FINALLY INCLUDED IN THE SYSTEMATIC ANALYSIS. THE ACUTE EXERCISE EPIGENETIC (MIRNAS) EFFECTS WERE ASSESSED IN THREE STUDIES AND THE CHRONIC EXERCISE TRAINING EFFECTS (MIRNAS AND DNA METHYLATION) IN SIX STUDIES. THE RESULTS HAVE SHOWN THAT THERE IS POSSIBLY AN ACUTE SIGNIFICANT EXERCISE EFFECT ON EPIGENETIC TARGETS WHICH IS MORE EVIDENT AFTER CHRONIC EXERCISE TRAINING. CONCLUSIONS: BY THE PRESENT SYSTEMATIC REVIEW, WE PROVIDE PRELIMINARY EVIDENCE OF BENEFICIAL EPIGENETIC ADAPTATIONS FOLLOWING ACUTE AND CHRONIC EXERCISE IN PATIENTS WITH CARDIOVASCULAR DISEASE. MORE CONTROLLED STUDIES ARE NEEDED TO CONFIRM SUCH EVIDENCE. 2021 12 6211 27 THE INTERPLAY BETWEEN OXIDATIVE STRESS, EXERCISE, AND PAIN IN HEALTH AND DISEASE: POTENTIAL ROLE OF AUTONOMIC REGULATION AND EPIGENETIC MECHANISMS. OXIDATIVE STRESS CAN BE INDUCED BY VARIOUS STIMULI AND ALTERED IN CERTAIN CONDITIONS, INCLUDING EXERCISE AND PAIN. ALTHOUGH MANY STUDIES HAVE INVESTIGATED OXIDATIVE STRESS IN RELATION TO EITHER EXERCISE OR PAIN, THE LITERATURE PRESENTS CONFLICTING RESULTS. THEREFORE, THIS REVIEW CRITICALLY DISCUSSES EXISTING LITERATURE ABOUT THIS TOPIC, AIMING TO PROVIDE A CLEAR OVERVIEW OF KNOWN INTERACTIONS BETWEEN OXIDATIVE STRESS, EXERCISE, AND PAIN IN HEALTHY PEOPLE AS WELL AS IN PEOPLE WITH CHRONIC PAIN, AND TO HIGHLIGHT POSSIBLE CONFOUNDING FACTORS TO KEEP IN MIND WHEN REFLECTING ON THESE INTERACTIONS. IN ADDITION, AUTONOMIC REGULATION AND EPIGENETIC MECHANISMS ARE PROPOSED AS POTENTIAL MECHANISMS OF ACTION UNDERLYING THE INTERPLAY BETWEEN OXIDATIVE STRESS, EXERCISE, AND PAIN. THIS REVIEW HIGHLIGHTS THAT THE RELATION BETWEEN OXIDATIVE STRESS, EXERCISE, AND PAIN IS POORLY UNDERSTOOD AND NOT STRAIGHTFORWARD, AS IT IS DEPENDENT ON THE CHARACTERISTICS OF EXERCISE, BUT ALSO ON WHICH POPULATION IS INVESTIGATED. TO BE ABLE TO COMPARE STUDIES ON THIS TOPIC, STRICT GUIDELINES SHOULD BE DEVELOPED TO LIMIT THE EFFECT OF SEVERAL CONFOUNDING FACTORS. THIS WAY, THE TRUE INTERPLAY BETWEEN OXIDATIVE STRESS, EXERCISE, AND PAIN, AND THE UNDERLYING MECHANISMS OF ACTION CAN BE REVEALED AND VALIDATED VIA INDEPENDENT STUDIES. 2020 13 5069 24 PHYSICAL ACTIVITY IN THE PREVENTION OF HUMAN DISEASES: ROLE OF EPIGENETIC MODIFICATIONS. EPIGENETIC MODIFICATION REFERS TO HERITABLE CHANGES IN GENE FUNCTION THAT CANNOT BE EXPLAINED BY ALTERATIONS IN THE DNA SEQUENCE. THE CURRENT LITERATURE CLEARLY DEMONSTRATES THAT THE EPIGENETIC RESPONSE IS HIGHLY DYNAMIC AND INFLUENCED BY DIFFERENT BIOLOGICAL AND ENVIRONMENTAL FACTORS SUCH AS AGING, NUTRIENT AVAILABILITY AND PHYSICAL EXERCISE. AS SUCH, IT IS WELL ACCEPTED THAT PHYSICAL ACTIVITY AND EXERCISE CAN MODULATE GENE EXPRESSION THROUGH EPIGENETIC ALTERNATIONS ALTHOUGH THE TYPE AND DURATION OF EXERCISE ELICITING SPECIFIC EPIGENETIC EFFECTS THAT CAN RESULT IN HEALTH BENEFITS AND PREVENT CHRONIC DISEASES REMAINS TO BE DETERMINED. THIS REVIEW HIGHLIGHTS THE MOST SIGNIFICANT FINDINGS FROM EPIGENETIC STUDIES INVOLVING PHYSICAL ACTIVITY/EXERCISE INTERVENTIONS KNOWN TO BENEFIT CHRONIC DISEASES SUCH AS METABOLIC SYNDROME, DIABETES, CANCER, CARDIOVASCULAR AND NEURODEGENERATIVE DISEASES. 2017 14 2713 30 EXERCISE TRAINING AND EPIGENETIC REGULATION: MULTILEVEL MODIFICATION AND REGULATION OF GENE EXPRESSION. EXERCISE TRAINING ELICITS ACUTE AND ADAPTIVE LONG TERM CHANGES IN HUMAN PHYSIOLOGY THAT MEDIATE THE IMPROVEMENT OF PERFORMANCE AND HEALTH STATE. THE RESPONSES ARE INTEGRATIVE AND ORCHESTRATED BY SEVERAL MECHANISMS, AS GENE EXPRESSION. GENE EXPRESSION IS ESSENTIAL TO CONSTRUCT THE ADAPTATION OF THE BIOLOGICAL SYSTEM TO EXERCISE TRAINING, SINCE THERE ARE MOLECULAR PROCESSES MEDIATING OXIDATIVE AND NON-OXIDATIVE METABOLISM, ANGIOGENESIS, CARDIAC AND SKELETAL MYOFIBER HYPERTROPHY, AND OTHER PROCESSES THAT LEADS TO A GREATER PHYSIOLOGICAL STATUS. EPIGENETIC IS THE FIELD THAT STUDIES ABOUT GENE EXPRESSION CHANGES HERITABLE BY MEIOSIS AND MITOSIS, BY CHANGES IN CHROMATIN AND DNA CONFORMATION, BUT NOT IN DNA SEQUENCE, THAT STUDIES THE REGULATION ON GENE EXPRESSION THAT IS INDEPENDENT OF GENOTYPE. THE FIELD APPROACHES MECHANISMS OF DNA AND CHROMATIN CONFORMATIONAL CHANGES THAT INHIBIT OR INCREASE GENE EXPRESSION AND DETERMINE TISSUE SPECIFIC PATTERN. THE THREE MAJOR STUDIED EPIGENETIC MECHANISMS ARE DNA METHYLATION, HISTONE MODIFICATION, AND REGULATION OF NONCODING RNA-ASSOCIATED GENES. THIS REVIEW ELUCIDATES THESE MECHANISMS, FOCUSING ON THE RELATIONSHIP BETWEEN THEM AND THEIR RELATIONSHIP WITH EXERCISE TRAINING, PHYSICAL PERFORMANCE AND THE ENHANCEMENT OF HEALTH STATUS. ON THIS CHAPTER, WE CLARIFIED THE RELATIONSHIP OF EPIGENETIC MODULATIONS AND THEIR INTIMAL RELATIONSHIP WITH ACUTE AND CHRONIC EFFECT OF EXERCISE TRAINING, CONCENTRATING OUR EFFORT ON SKELETAL MUSCLE, HEART AND VASCULAR RESPONSES, THAT ARE THE MOST RESPONSIVE SYSTEMS AGAINST TO EXERCISE TRAINING AND PLAY CRUCIAL ROLE ON PHYSICAL PERFORMANCE AND IMPROVEMENT OF HEALTH STATE. 2017 15 2521 25 EPIGENETICS AND THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH MODEL: BRIDGING NATURE, NURTURE, AND PATIENT-CENTERED POPULATION HEALTH. EPIGENETIC PROCESSES ENABLE ENVIRONMENTAL INPUTS SUCH AS DIET, EXERCISE, AND HEALTH BEHAVIORS TO REVERSIBLY TAG DNA WITH CHEMICAL "MARKS" THAT INCREASE OR DECREASE THE EXPRESSION OF AN INDIVIDUAL'S GENETIC TEMPLATE. OVER TIME, EPIGENETIC ADAPTATIONS ENABLE THE EFFECTS OF HEALTHY OR UNHEALTHY STRESSES TO BECOME STABLY EXPRESSED IN THE TISSUE OF AN ORGANISM, WITH IMPORTANT CONSEQUENCES FOR HEALTH AND DISEASE. NEW RESEARCH INDICATES THAT SEEMINGLY NON-BIOLOGICAL FACTORS SUCH AS SOCIAL STRESS, POVERTY, AND CHILDHOOD HARDSHIP INITIATE EPIGENETIC ADAPTATIONS IN GENE PATHWAYS THAT GOVERN INFLAMMATION AND IMMUNITY, TWO OF THE GREATEST CONTRIBUTORS TO CHRONIC DISEASES SUCH AS DIABETES AND OBESITY. EPIGENETIC PROCESSES THEREFORE PROVIDE A BIOLOGICAL BRIDGE BETWEEN THE GENOME-AN INDIVIDUAL'S GENETIC INHERITANCE-AND THE SOCIAL DETERMINANTS OF HEALTH-THE CONDITIONS IN WHICH THEY ARE BORN, GROW, LIVE, WORK, AND AGE. THIS PERSPECTIVE PAPER ARGUES THAT PHYSICAL THERAPY CLINICIANS, RESEARCHERS, AND EDUCATORS CAN USE THE THEORETICAL FRAMEWORK PROVIDED BY THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY, AND HEALTH (ICF MODEL) TO HARMONIZE NEW DISCOVERIES FROM BOTH PUBLIC HEALTH RESEARCH AND MEDICALLY FOCUSED GENOMIC RESEARCH. THE ICF MODEL LIKEWISE CAPTURES THE ESSENTIAL ROLE PLAYED BY PHYSICAL ACTIVITY AND EXERCISE, WHICH INITIATE POWERFUL AND WIDESPREAD EPIGENETIC ADAPTATIONS THAT PROMOTE HEALTH AND FUNCTIONING. IN THIS PROPOSED FRAMEWORK, EPIGENETIC PROCESSES TRANSDUCE THE EFFECTS OF THE SOCIAL DETERMINANTS OF HEALTH AND BEHAVIORS SUCH AS EXERCISE INTO STABLE BIOLOGICAL ADAPTATIONS THAT AFFECT AN INDIVIDUAL'S DAILY ACTIVITIES AND THEIR PARTICIPATION IN SOCIAL ROLES. BY HARMONIZING "NATURE" AND "NURTURE," PHYSICAL THERAPISTS CAN APPROACH PATIENT CARE WITH A MORE INTEGRATED PERSPECTIVE, CAPITALIZING ON NOVEL DISCOVERIES IN PRECISION MEDICINE, REHABILITATION SCIENCE, AND IN POPULATION-LEVEL RESEARCH. AS THE EXPERTS IN PHYSICAL ACTIVITY AND EXERCISE, PHYSICAL THERAPISTS ARE IDEALLY POSITIONED TO DRIVE PROGRESS IN THE NEW ERA OF PATIENT-CENTERED POPULATION HEALTH CARE. 2022 16 4080 25 MATERNAL LIFESTYLE INTERVENTIONS: TARGETING PRECONCEPTION HEALTH. ABOUT ONE-THIRD OF WOMEN OF REPRODUCTIVE AGE ARE OBESE, PREDISPOSING BOTH MOTHER AND BABY TO UNFAVOURABLE PREGNANCY OUTCOMES AND INITIATING AN INTERGENERATIONAL CYCLE OF CHRONIC METABOLIC DISORDERS. HERE WE SUMMARISE RECENT RESEARCH ON THE INFLUENCE OF MATERNAL METABOLIC HEALTH ON OFFSPRING SUSCEPTIBILITY TO FUTURE CARDIOMETABOLIC DISEASES. CURRENT PRIMARY LIFESTYLE APPROACHES (I.E., DIET AND EXERCISE INTERVENTIONS) TO HALT THE SUCCESSION OF INHERITED AND EPIGENETIC METABOLIC ABNORMALITIES HAVE MET WITH LIMITED SUCCESS DUE TO LATE IMPLEMENTATION, POOR ADHERENCE, AND/OR GENERIC GUIDELINES. IN OUR OPINION, SUCH INTERVENTIONS MUST COMMENCE PRIOR TO CONCEPTION TO IMPROVE BOTH MATERNAL AND CHILD HEALTH OUTCOMES, WITH NEW APPROACHES URGENTLY NEEDED TO INCREASE ADHERENCE TO PRIMARY LIFESTYLE CHANGES AMONG REPRODUCTIVE-AGE WOMEN. 2020 17 5073 20 PHYSICAL EXERCISE PREVENTED STRESS-INDUCED ANXIETY VIA IMPROVING BRAIN RNA METHYLATION. PHYSICAL EXERCISE IS EFFECTIVE IN ALLEVIATING MENTAL DISORDERS BY IMPROVING SYNAPTIC TRANSMISSION; HOWEVER, THE LINK BETWEEN BODY ENDURANCE TRAINING AND NEURAL ADAPTATION HAS NOT YET BEEN COMPLETELY RESOLVED. IN THIS STUDY, THE AUTHORS INVESTIGATED THE ROLE OF RNA N(6) -METHYLADENOSINE (M6A), AN EMERGING EPIGENETIC MECHANISM, IN IMPROVED RESILIENCE AGAINST CHRONIC RESTRAINT STRESS. A COMBINATION OF MOLECULAR, BEHAVIORAL, AND IN VIVO RECORDING DATA DEMONSTRATES EXERCISE-MEDIATED RESTORATION OF M6A IN THE MOUSE MEDIAL PREFRONTAL CORTEX, WHOSE ACTIVITY IS POTENTIATED TO EXERT ANXIOLYTIC EFFECTS. FURTHERMORE, IT IS REVEALED THAT HEPATIC BIOSYNTHESIS OF ONE METHYL DONOR IS NECESSARY FOR EXERCISE TO IMPROVE BRAIN RNA M6A TO COUNTERACT ENVIRONMENTAL STRESS. THIS NOVEL LIVER-BRAIN AXIS PROVIDES AN EXPLANATION FOR BRAIN NETWORK CHANGES UPON EXERCISE TRAINING AND PROVIDES NEW INSIGHTS INTO THE DIAGNOSIS AND TREATMENT OF ANXIETY DISORDERS. 2022 18 5605 31 ROUTINE ASSESSMENT AND PROMOTION OF PHYSICAL ACTIVITY IN HEALTHCARE SETTINGS: A SCIENTIFIC STATEMENT FROM THE AMERICAN HEART ASSOCIATION. PHYSICAL INACTIVITY IS ONE OF THE MOST PREVALENT MAJOR HEALTH RISK FACTORS, WITH 8 IN 10 US ADULTS NOT MEETING AEROBIC AND MUSCLE-STRENGTHENING GUIDELINES, AND IS ASSOCIATED WITH A HIGH BURDEN OF CARDIOVASCULAR DISEASE. IMPROVING AND MAINTAINING RECOMMENDED LEVELS OF PHYSICAL ACTIVITY LEADS TO REDUCTIONS IN METABOLIC, HEMODYNAMIC, FUNCTIONAL, BODY COMPOSITION, AND EPIGENETIC RISK FACTORS FOR NONCOMMUNICABLE CHRONIC DISEASES. PHYSICAL ACTIVITY ALSO HAS A SIGNIFICANT ROLE, IN MANY CASES COMPARABLE OR SUPERIOR TO DRUG INTERVENTIONS, IN THE PREVENTION AND MANAGEMENT OF >40 CONDITIONS SUCH AS DIABETES MELLITUS, CANCER, CARDIOVASCULAR DISEASE, OBESITY, DEPRESSION, ALZHEIMER DISEASE, AND ARTHRITIS. WHEREAS MOST OF THE MODIFIABLE CARDIOVASCULAR DISEASE RISK FACTORS INCLUDED IN THE AMERICAN HEART ASSOCIATION'S MY LIFE CHECK - LIFE'S SIMPLE 7 ARE EVALUATED ROUTINELY IN CLINICAL PRACTICE (GLUCOSE AND LIPID PROFILES, BLOOD PRESSURE, OBESITY, AND SMOKING), PHYSICAL ACTIVITY IS TYPICALLY NOT ASSESSED. THE PURPOSE OF THIS STATEMENT IS TO PROVIDE A COMPREHENSIVE REVIEW OF THE EVIDENCE ON THE FEASIBILITY, VALIDITY, AND EFFECTIVENESS OF ASSESSING AND PROMOTING PHYSICAL ACTIVITY IN HEALTHCARE SETTINGS FOR ADULT PATIENTS. IT ALSO ADDS CONCRETE RECOMMENDATIONS FOR HEALTHCARE SYSTEMS, CLINICAL AND COMMUNITY CARE PROVIDERS, FITNESS PROFESSIONALS, THE TECHNOLOGY INDUSTRY, AND OTHER STAKEHOLDERS IN ORDER TO CATALYZE INCREASED ADOPTION OF PHYSICAL ACTIVITY ASSESSMENT AND PROMOTION IN HEALTHCARE SETTINGS AND TO CONTRIBUTE TO MEETING THE AMERICAN HEART ASSOCIATION'S 2020 IMPACT GOALS. 2018 19 2712 26 EXERCISE TRAINING AND DNA METHYLATION IN HUMANS. THE RESPONSE TO EXERCISE TRAINING (TRAINABILITY) HAS BEEN SHOWN TO HAVE A STRONG HERITABLE COMPONENT. THERE IS GROWING EVIDENCE SUGGESTING THAT TRAITS SUCH AS TRAINABILITY DO NOT ONLY DEPEND ON THE GENETIC CODE, BUT ALSO ON EPIGENETIC SIGNALS. EPIGENETIC SIGNALS PLAY AN IMPORTANT ROLE IN THE MODULATION OF GENE EXPRESSION, THROUGH MECHANISMS SUCH AS DNA METHYLATION AND HISTONE MODIFICATIONS. THERE IS AN EMERGING EVIDENCE TO SHOW THAT PHYSICAL ACTIVITY INFLUENCES DNA METHYLATION IN HUMANS. THE PRESENT REVIEW AIMS TO SUMMARIZE CURRENT KNOWLEDGE ON THE LINK BETWEEN DNA METHYLATION AND PHYSICAL ACTIVITY IN HUMANS. WE HAVE CRITICALLY REVIEWED THE LITERATURE AND ONLY PAPERS FOCUSED ON PHYSICAL ACTIVITY AND ITS INFLUENCE ON DNA METHYLATION STATUS WERE INCLUDED; A TOTAL OF 25 PAPERS WERE SELECTED. WE CONCLUDED THAT BOTH ACUTE AND CHRONIC EXERCISES SIGNIFICANTLY IMPACT DNA METHYLATION, IN A HIGHLY TISSUE- AND GENE-SPECIFIC MANNER. THIS REVIEW ALSO PROVIDES INSIGHTS INTO THE MOLECULAR MECHANISMS OF EXERCISE-INDUCED DNA METHYLATION CHANGES, AND RECOMMENDATIONS FOR FUTURE RESEARCH. 2015 20 6467 28 TISSUE-SPECIFIC EFFECTS OF EXERCISE AS NAD(+) -BOOSTING STRATEGY: CURRENT KNOWLEDGE AND FUTURE PERSPECTIVES. NICOTINAMIDE ADENINE DINUCLEOTIDE (NAD(+) ) IS AN EVOLUTIONARILY HIGHLY CONSERVED COENZYME WITH MULTI-FACETED CELL FUNCTIONS, INCLUDING ENERGY METABOLISM, MOLECULAR SIGNALING PROCESSES, EPIGENETIC REGULATION, AND DNA REPAIR. SINCE THE DISCOVERY THAT LOWER NAD(+) LEVELS ARE A SHARED CHARACTERISTIC OF VARIOUS DISEASES AND AGING PER SE, SEVERAL NAD(+) -BOOSTING STRATEGIES HAVE EMERGED. OTHER THAN PHARMACOLOGICAL AND NUTRITIONAL APPROACHES, EXERCISE IS THOUGHT TO RESTORE NAD(+) HOMEOSTASIS THROUGH METABOLIC ADAPTION TO CHRONICALLY RECURRING STATES OF INCREASED ENERGY DEMAND. IN THIS REVIEW WE DISCUSS THE IMPACT OF ACUTE EXERCISE AND EXERCISE TRAINING ON TISSUE-SPECIFIC NAD(+) METABOLISM OF RODENTS AND HUMANS TO HIGHLIGHT THE POTENTIAL VALUE AS NAD(+) -BOOSTING STRATEGY. BY INTERCONNECTING RESULTS FROM DIFFERENT INVESTIGATIONS, WE AIM TO DRAW ATTENTION TO TISSUE-SPECIFIC ALTERATIONS IN NAD(+) METABOLISM AND THE ASSOCIATED IMPLICATIONS FOR WHOLE-BODY NAD(+) HOMEOSTASIS. ACUTE EXERCISE LED TO PROFOUND ALTERATIONS OF INTRACELLULAR NAD(+) METABOLISM IN VARIOUS INVESTIGATIONS, WITH THE MAGNITUDE AND DIRECTION OF CHANGES BEING STRONGLY DEPENDENT ON THE APPLIED EXERCISE MODALITY, CELL TYPE, AND INVESTIGATED ANIMAL MODEL OR HUMAN POPULATION. EXERCISE TRAINING ELEVATED NAD(+) LEVELS AND NAD(+) METABOLISM ENZYMES IN VARIOUS TISSUES. BASED ON THESE RESULTS, WE DISCUSS MOLECULAR MECHANISMS THAT MIGHT CONNECT ACUTE EXERCISE-INDUCED DISRUPTIONS OF NAD(+) /NADH HOMEOSTASIS TO CHRONIC EXERCISE ADAPTIONS IN NAD(+) METABOLISM. TAKING THIS HYPOTHESIS-DRIVEN APPROACH, WE HOPE TO INSPIRE FUTURE RESEARCH ON THE MOLECULAR MECHANISMS OF EXERCISE AS NAD(+) -MODIFYING LIFESTYLE INTERVENTION, THEREBY ELUCIDATING THE POTENTIAL THERAPEUTIC VALUE IN NAD(+) -RELATED PATHOLOGIES. 2023