Background: Atherosclerosis is the leading cause of death worldwide. The disease development is by and large driven by old age and lifestyle factors, such as diet, physical activity, and smoking. In the present study, we have investigated the effect of exercise and diet on the development of atherosclerosis in young and aged mice. Objective: This study aimed at comparing multiple age-dependent factors that may influence atherosclerosis in a transgenic mouse model. Methods: Young (14 weeks) and aged (49–52 weeks) C57BL/6 wild-type (WT) and atherosclerosis-prone ApoE–/– mice were subjected to physical endurance exercise on a treadmill, with or without a high-fat diet. Five weeks later, the frequencies of regulatory T cells (TREGs) in lymph nodes were assessed by flow cytometry, plasmatic cytokines (interleukin [IL]-1β, IL-6, IL-10, IL-17, interferon-γ, tumor necrosis factor-α, and transforming growth factor [TGF]-β1) levels were determined by Luminex assay. Lipids (cholesterol and triglycerides) and anti-heat shock protein 60 (HSP60) autoantibodies were measured by ELISA. Aortic lesion sizes were assessed by en face imaging. Microarray analysis and qPCR of skeletal muscle gene expression were also performed. Results: Exercise leads to a reduction of aortic lesions in young ApoE–/– and aged WT mice independent of diet. In most groups, this reduction was followed by an increased proportion of TREGs and TGF-β1 levels. Moreover, gene expression analysis showed that exercise seems to affect the AMPK signaling pathway. In particular, PGC-1α1 mRNA was induced in aged WT mice, whereas it was reduced in young ApoE–/– mice. In addition, GSEA analysis showed a marked reduction in the insulin signaling pathway in aged ApoE–/– mice. Conclusion: Practicing endurance exercise seems to be enough for reducing early aortic lesion formation, independent of diet. However, this was only true in mice with smaller aortic lesions, since mice with large, advanced, complicated atherosclerotic plaques did not show any reduction in lesion size with exercise training.

1.
Ross R: Atherosclerosis – an inflammatory disease. New Engl J Med 1999; 340: 115–126.
2.
Hansson GK, Libby P: The immune response in atherosclerosis: a double-edged sword. Nat Rev Immunol 2006; 6: 508–519.
3.
Wick G, Schett G, Amberger A, Kleindienst R, Xu Q: Is atherosclerosis an immunologically mediated disease? Immunol Today 1995; 16: 27–33.
4.
Wick G, Jakic B, Buszko M, Wick MC, Grundtman C: The role of heat shock proteins in atherosclerosis. Nat Rev Cardiol 2014; 11: 516–529.
5.
Spitz C, Winkels H, Burger C, Weber C, Lutgens E, Hansson GK, Gerdes N: Regulatory T cells in atherosclerosis: critical immune regulatory function and therapeutic potential. Cell Mol Life Sci 2016; 73: 901–922.
6.
Yeh SH, Chuang H, Lin LW, Hsiao CY, Eng HL: Regular tai chi chuan exercise enhances functional mobility and CD4CD25 regulatory T cells. Br J Sports Med 2006; 40: 239–243.
7.
Petersen AM, Pedersen BK: The anti-inflammatory effect of exercise. J Appl Physiol 2005; 98: 1154–1162.
8.
Wensveen FM, Valentic S, Sestan M, Turk Wensveen T, Polic B: The “Big Bang” in obese fat: events initiating obesity-induced adipose tissue inflammation. Eur J Immunol 2015; 45: 2446–2456.
9.
Bernecker C, Scherr J, Schinner S, Braun S, Scherbaum WA, Halle M: Evidence for an exercise induced increase of TNF-α and IL-6 in marathon runners. Scand J Med Sci Sports 2013; 23: 207–214.
10.
Misic MM, Valentine RJ, Rosengren KS, Woods JA, Evans EM: Impact of training modality on strength and physical function in older adults. Gerontology 2009; 55: 411–416.
11.
Wang J, Song H, Tang X, Yang Y, Vieira VJ, Niu Y, Ma Y: Effect of exercise training intensity on murine T-regulatory cells and vaccination response. Scand J Med Sci Sports 2012; 22: 643–652.
12.
Werner C, Furster T, Widmann T, Poss J, Roggia C, Hanhoun M, Scharhag J, Buchner N, Meyer T, Kindermann W, Haendeler J, Bohm M, Laufs U: Physical exercise prevents cellular senescence in circulating leukocytes and in the vessel wall. Circulation 2009; 120: 2438–2447.
13.
Okabe TA, Shimada K, Hattori M, Murayama T, Yokode M, Kita T, Kishimoto C: Swimming reduces the severity of atherosclerosis in apolipoprotein E deficient mice by antioxidant effects. Cardiovasc Res 2007; 74: 537–545.
14.
Shimada K, Kishimoto C, Okabe TA, Hattori M, Murayama T, Yokode M, Kita T: Exercise training reduces severity of atherosclerosis in apolipoprotein E knockout mice via nitric oxide. Circ J 2007; 71: 1147–1151.
15.
Pereira SS, Teixeira LG, Aguilar EC, Matoso RO, Soares FL, Ferreira AV, Alvarez-Leite JI: Differences in adipose tissue inflammation and oxidative status in C57BL/6 and ApoE–/– mice fed high fat diet. Anim Sci J 2012; 83: 549–555.
16.
Getz GS, Reardon CA: Diet and murine atherosclerosis. Arterioscler Thromb Vasc Biol 2006; 26: 242–249.
17.
Kollias HD, McDermott JC: Transforming growth factor-beta and myostatin signaling in skeletal muscle. J Appl Physiol 2008; 104: 579–587.
18.
Tedgui A, Mallat Z: Cytokines in atherosclerosis: pathogenic and regulatory pathways. Physiol Rev 2006; 86: 515–581.
19.
Lira VA, Benton CR, Yan Z, Bonen A: PGC-1α regulation by exercise training and its influences on muscle function and insulin sensitivity. Am J Physiol Endocrinol Metab 2010; 299:E145–E161.
20.
Ruas JL, White JP, Rao RR, Kleiner S, Brannan KT, Harrison BC, Greene NP, Wu J, Estall JL, Irving BA, Lanza IR, Rasbach KA, Okutsu M, Nair KS, Yan Z, Leinwand LA, Spiegelman BM: A PGC-1α isoform induced by resistance training regulates skeletal muscle hypertrophy. Cell 2012; 151: 1319–1331.
21.
Barone R, Macaluso F, Sangiorgi C, Campanella C, Marino Gammazza A, Moresi V, Coletti D, Conway de Macario E, Macario AJ, Cappello F, Adamo S, Farina F, Zummo G, Di Felice V: Skeletal muscle heat shock protein 60 increases after endurance training and induces peroxisome proliferator-activated receptor gamma coactivator 1 α1 expression. Sci Rep 2016; 6: 19781.
22.
Salo DC, Donovan CM, Davies KJ: HSP70 and other possible heat shock or oxidative stress proteins are induced in skeletal muscle, heart, and liver during exercise. Free Radic Biol Med 1991; 11: 239–246.
23.
Paigen B, Morrow A, Brandon C, Mitchell D, Holmes P: Variation in susceptibility to atherosclerosis among inbred strains of mice. Atherosclerosis 1985; 57: 65–73.
24.
Mahley RW, Weisgraber KH, Huang Y: Apolipoprotein E: structure determines function, from atherosclerosis to Alzheimer’s disease to AIDS. J Lipid Res 2009; 50(suppl):S183–S188.
25.
Ishibashi S, Goldstein JL, Brown MS, Herz J, Burns DK: Massive xanthomatosis and atherosclerosis in cholesterol-fed low density lipoprotein receptor-negative mice. J Clin Invest 1994; 93: 1885–1893.
26.
Chiba T, Nakazawa T, Yui K, Kaneko E, Shimokado K: VLDL induces adipocyte differentiation in ApoE-dependent manner. Arterioscler Thromb Vasc Biol 2003; 23: 1423–1429.
27.
Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB: The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2006; 61: 1059–1064.
28.
Kadoglou NP, Kostomitsopoulos N, Kapelouzou A, Moustardas P, Katsimpoulas M, Giagini A, Dede E, Boudoulas H, Konstantinides S, Karayannacos PE, Liapis CD: Effects of exercise training on the severity and composition of atherosclerotic plaque in apoE-deficient mice. J Vasc Res 2011; 48: 347–356.
29.
Di Cataldo V, Geloen A, Langlois JB, Chauveau F, Theze B, Hubert V, Wiart M, Chirico EN, Rieusset J, Vidal H, Pialoux V, Canet-Soulas E: Exercise does not protect against peripheral and central effects of a high cholesterol diet given ad libitum in old apoe–/– mice. Front Physiol 2016; 7: 453.
30.
Cesar L, Suarez SV, Adi J, Adi N, Vazquez-Padron R, Yu H, Ma Q, Goldschmidt-Clermont PJ, Agatston A, Kurlansky P, Webster KA: An essential role for diet in exercise-mediated protection against dyslipidemia, inflammation and atherosclerosis in ApoE–/– mice. PLoS One 2011; 6:e17263.
31.
Kanoski SE, Davidson TL: Western diet consumption and cognitive impairment: links to hippocampal dysfunction and obesity. Physiol Behav 2011; 103: 59–68.
32.
Xu Q, Willeit J, Marosi M, Kleindienst R, Oberhollenzer F, Kiechl S, Stulnig T, Luef G, Wick G: Association of serum antibodies to heat-shock protein 65 with carotid atherosclerosis. Lancet 1993; 341: 255–259.
33.
Schett G, Xu Q, Amberger A, Van der Zee R, Recheis H, Willeit J, Wick G: Autoantibodies against heat shock protein 60 mediate endothelial cytotoxicity. J Clin Invest 1995; 96: 2569–2577.
34.
Lewis EJ, Ramsook AH, Locke M, Amara CE: Mild eccentric exercise increases Hsp72 content in skeletal muscles from adult and late middle-aged rats. Cell Stress Chaperones 2013; 18: 667–673.
35.
Whelton SP, Chin A, Xin X, He J: Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002; 136: 493–503.
36.
von Boehmer H: Mechanisms of suppression by suppressor T cells. Nat Immunol 2005; 6: 338–344.
37.
Mallat Z, Ait-Oufella H, Tedgui A: Regulatory T-cell immunity in atherosclerosis. Trends Cardiovasc Med 2007; 17: 113–118.
38.
Harats D, Yacov N, Gilburd B, Shoenfeld Y, George J: Oral tolerance with heat shock protein 65 attenuates Mycobacterium tuberculosis-induced and high-fat-diet-driven atherosclerotic lesions. J Am Coll Cardiol 2002; 40: 1333–1338.
39.
Weiskopf D, Weinberger B, Grubeck-Loebenstein B: The aging of the immune system. Transpl Int 2009; 22: 1041–1050.
40.
Gielen S, Adams V, Mobius-Winkler S, Linke A, Erbs S, Yu J, Kempf W, Schubert A, Schuler G, Hambrecht R: Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure. J Am Coll Cardiol 2003; 42: 861–868.
41.
Cokorinos EC, Delmore J, Reyes AR, Albuquerque B, Kjobsted R, Jorgensen NO, Tran JL, Jatkar A, Cialdea K, Esquejo RM, Meissen J, Calabrese MF, Cordes J, Moccia R, Tess D, Salatto CT, Coskran TM, Opsahl AC, Flynn D, Blatnik M, Li W, Kindt E, Foretz M, Viollet B, Ward J, Kurumbail RG, Kalgutkar AS, Wojtaszewski JFP, Cameron KO, Miller RA: Activation of skeletal muscle AMPK promotes glucose disposal and glucose lowering in non-human primates and mice. Cell Metab 2017; 25: 1147–1159 e10.
42.
Stein S, Lohmann C, Handschin C, Stenfeldt E, Boren J, Luscher TF, Matter CM: ApoE–/– PGC-1α–/– mice display reduced IL-18 levels and do not develop enhanced atherosclerosis. PLoS One 2010; 5:e13539.
43.
Xiong S, Salazar G, Patrushev N, Ma M, Forouzandeh F, Hilenski L, Alexander RW: Peroxisome proliferator-activated receptor γ coactivator-1alpha is a central negative regulator of vascular senescence. Arterioscler Thromb Vasc Biol 2013; 33: 988–998.
44.
Kojda G, Hambrecht R: Molecular mechanisms of vascular adaptations to exercise. Physical activity as an effective antioxidant therapy? Cardiovasc Res 2005; 67: 187–197.
45.
Vega RB, Konhilas JP, Kelly DP, Leinwand LA: Molecular mechanisms underlying cardiac adaptation to exercise. Cell Metab 2017; 25: 1012–1026.
46.
Hambrecht R, Adams V, Erbs S, Linke A, Krankel N, Shu Y, Baither Y, Gielen S, Thiele H, Gummert JF, Mohr FW, Schuler G: Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 2003; 107: 3152–3158.
47.
Green DJ, Maiorana A, O’Driscoll G, Taylor R: Effect of exercise training on endothelium-derived nitric oxide function in humans. J Physiol 2004; 561: 1–25.
48.
Lauschke J, Maisch B: Athlete’s heart or hypertrophic cardiomyopathy? Clin Res Cardiol 2009; 98: 80–88.
49.
Janssen CI, Jansen D, Mutsaers MP, Dederen PJ, Geenen B, Mulder MT, Kiliaan AJ: The effect of a high-fat diet on brain plasticity, inflammation and cognition in female ApoE4-knockin and ApoE-knockout mice. PLoS One 2016; 11:e0155307.
50.
Gomez-Pinilla F: Brain foods: the effects of nutrients on brain function. Nat Rev Neuro sci 2008; 9: 568–578.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.