Prehabilitation and Inflammation.

Abstract

Background: In the perioperative setting, surgical trauma triggers an inflammatory reaction that is accompanied by an elevated risk for the development of severe immune-related complications (e.g., sepsis). The underlying pathophysiological mechanisms are partially caused by the patients' debilitated health conditions prior to the surgical procedure. As such, multimodal prehabilitation regimens (in particular preoperative exercise training and nutritional therapy) aimed at improving immune function have gained much attention. We hereby describe and highlight molecular and cellular targets for assessing the biological effects of prehabilitation and potential biomarkers for the success of these interventions.

Summary: Prehabilitation can remodel skeletal muscles at the molecular level and improve immune cell function through physical exercise and nutritional therapy. This review focuses on two emerging molecular pathways modulated by exercise-based therapies and potential biomarkers of whole-body health and of inflammation: the regulation of hypoxia inducible factors and of a class of bioactive lipids called ceramides. Additionally, we describe and highlight important cellular targets of prehabilitation which are of particular relevance for driving and sustaining the benefits of prehabilitation on the patients' immune function postoperatively.

Key messages: Dissecting the molecular mechanisms that modulate inflammation and immune cell function upon prehabilitation with beneficial effects on the patients' clinical outcomes is essential to properly diagnose the success of these interventions. And while there seems to be a multitude of organs and cells affected by physical conditioning, the key biological pathways which should be evaluated during prehabilitation interventions are yet to be uncovered and more research is needed for it. Nonetheless, some candidates are emerging as powerful regulators of inflammation and general health and deserve further investigation.