Vestibular rehabilitation ameliorates chronic dizziness through the SIRT1 axis

Abstract

Dizziness is a common clinical symptom frequently referred to general neurologists and practitioners. Exercise intervention, in the form of vestibular rehabilitation, is known as an effective clinical management for dizziness. This intervention is reported to have a functional role in correcting dizziness, improving gaze stability, retraining balance and gait, and enhancing physical fitness. Dizziness is known to be highly related to inflammation and oxidative stress. SIRT1 is a major molecule for the regulation of inflammation and mitigation of oxidative stress in chronic diseases such as atherosclerosis and chronic obstructive pulmonary disease. However, the bio-molecular roles of SIRT1 involved in the pathogenesis of dizziness are still largely unclear. In this study, a total of 30 subjects were recruited (15 patients with chronic dizziness, and 15 age/gender matched non-dizzy control subjects). The dizzy subjects group received 18 sessions of 30-min vestibular training. We found that the mRNA and protein expression levels of SIRT1 in the blood samples of chronic dizzy patients were repressed compared with those of healthy controls. After vestibular training, the dizzy patients had significant symptomatic improvements. The SIRT1 expression and its downstream genes (PPAR-γ and PGC-1α) were upregulated after vestibular exercises in dizzy subjects. Notably, the catalytic activity of SIRT1, NADPH and antioxidant enzyme activities were also activated in dizzy patients after vestibular training. Furthermore, vestibular exercise training reduced oxidative events and p53 expression in patients with dizziness. This study demonstrated that vestibular exercise training improved dizziness symptoms, and mechanisms for alleviation of chronic dizziness may partly involve the activation of the SIRT1 axis and the repression of redox status.

Effects of voluntary exercise on apoptosis and cortisol after chronic restraint stress in mice

“…Higgins et al 37 have reported that exercise can increase p53 protein expression in lung cancer tumor tissue and induce apoptosis in lung cancer. However, p53 protein expression is suppressed even with exercise training 38 . In addition, in stress-induced mice, despite receiving various kinds of vitamins without considering exercise training, only a tendency of p53 reduction is observed whereas the phosphorylation of p53 is increased by exercise 39 .…”

Exercise suppresses COX-2 pro-inflammatory pathway in vestibular migraine

“…The pink-colored chromogen, which was formed by the reaction of 2-TBA with the breakdown products of lipid peroxidation, was measured. [21,35]. NO was detected at concentrations within the range of 10-13 M in the aqueous solution, and the response time was 0.5 s. The analyzer revealed that the concentration of NO was between 10 and 180 IM.…”

“…The training consisted of low-impact exercise. The training course and the clinical assessment used to evaluate dizziness severity have been previously described [4,21].…”

A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the “post-inflammatory brain syndrome” PIBS

“…For example Yangkyuk-SanhwaTang, a Chinese herbal formulation, has been shown to reduce both dizziness and levels of pro-inflammatory cytokines TNF-a and IL-6 in Soyangin cerebral infarction patients (Jeong et al, 2002). Kao et al (2014) found that levels of SIRT1, a downregulator of the NF-jB pro-inflammatory pathway, were reduced in patients with chronic dizziness and that vestibular exercise therapy both increased SIRT1 expression and improved dizziness. In addition, several traditional medications for dizziness demonstrate antiinflammatory activity (Huang et al, 2012;Kim et al, 2012;Meng et al, 2009). In summary, there is some evidence to suggest a causal relationship between peripheral inflammation and dizziness, as it appears to be a potential consequence of administration of pro-inflammatory substances.…”