Protecting performance and extending careers: Molecular monitoring for top athletes

 Peak performance requires extreme physiological adaptations. Most of these changes are beneficial, but some are not. The challenge lies in the fact that harmful molecular alterations often go unnoticed, long before symptoms appear or imaging techniques can detect abnormalities. The consequences can include organ dysfunction and, in rare cases, serious illness or even death, as described in two articles in the New England Journal of Medicine [1, 2].

Training and competitions increase blood pressure, vascular stress, and oxygen demand. Furthermore, mechanical stress is exerted on the tissues. All of this can lead to increased systemic inflammatory activity. While the body appears to adapt, repeated stress can contribute to undetected pathological changes such as vascular stiffness, inflammation, fibrosis, and ultimately, organ stress and damage.

Routine preventive examinations typically include an ECG, echocardiography, several blood biomarkers, and, if necessary, imaging procedures. These procedures detect advanced structural or other abnormalities, but generally not early changes. They detect the consequences, not the molecular causes of pathological changes. However, these molecular changes occur even before the visible structural changes. By the time structural changes are present, organ damage has already occurred, and performance capacity is significantly impaired. This organ damage can endanger the affected individual's life, especially under extreme stress, such as during competitive sports. This is the only way to explain the results of the study evaluation ten years after the examinations of 14- to 16-year-old professional athletes and the high number of cases of serious cardiac events, including sudden cardiac death, in this age group.

 Infections increase the risk of cardiovascular disease

The body of a professional athlete is not only subjected to constant stress, but also to infections such as influenza/COVID-19, hepatitis C, shingles, cold sores, or HPV. A recent publication shows that, for example, an influenza infection increases the likelihood of suffering a heart attack sevenfold  [5].

Added to this are the burdens of air pollution and compromised food chains. All of this affects the body, and bodies under high performance, in particular, can develop organ damage over the course of a career. Not only is the period of professional activity at risk, but also the health of life afterward.

Advantages for professional athletes

Objective biological monitoring leads to personalized risk awareness. This, in turn, supports long-term professional careers and evidence-based performance.

Conclusion

Elite sports demand precision. Performance indicators measure speed, strength, and endurance. Molecular profiling adds a new dimension: biological resilience. By monitoring early signals of tissue remodeling, athletes and their teams can make informed decisions to maintain long-term performance and protect health—even after their athletic careers end.

Some examples of studies

In studies conducted jointly with Prof. Jan Staessen, Prof. Karl-Heinz Peter, Prof. Filipattos and others, biomarkers were defined that reflect cardiovascular diseases in the early phase [7-9].

In several studies conducted jointly with Prof. Rossing, Prof. Beige, Prof. Vanholder and others, it was shown in large multinational cohorts that proteomic analysis, in particular through the detection of changes in collagen degradation and the recognition of the earliest forms of fibrosis, can detect kidney disease in its early stages and predict its progression [10-13].

Together with Prof. Nawrot, Prof. Staessen and colleagues, biomarkers for biological age were identified. As also shown in the study, these biomarkers indicate an increased biological age in patients with chronic diseases [14].

Proteomic information is also used to guide therapy. In a large consortium, it was demonstrated using over 5000 patients that the response to therapeutics can be predicted in silico based on the proteome [6, 15].