MSACL 2026 Abstract

Longitudinal Clinical Metabolomic Characterization of Systemic Stress Induced by Extreme Exercise Using LC–MS/MS and ¹H NMR

Caroline Le Goff, Matthieu Schoumacher, Vincent Gillet, Lea Papiccio, Julie Nguyen, Eric Brevers, Jessica Deleersnyder, Elodie Grifnée, Pascal De Tullio, Philippe Massonnet, Etienne Cavalier
Department of Clinical Chemistry, CLIME, CIRM, University and CHU of Liège, Belgium

Caroline Le Goff, PhD (Presenter) CHU Liege

Presenter Bio: She studied pharmacology at the University of Liège. After her graduation in 2003, she followed a specialization in Clinical Laboratory Medicine. During this period, she obtained her certification in clinical pharmacy, in RIA and in Blood Draw. Starting October 1st 2008, at 28 years old, she became a clinical Biologist (European specialist in Laboratory Medicine) at the University Hospital of Liège. In 2020, she obtained a PhD in Biomedical and Pharmaceutical Sciences. From 2024, she was promoted Professor in the University of Liege in clinical Medicine. Her main interests in clinical chemistry are, in particular: cardiac, inflammatory, oxidative stress biomarkers, mass spectrometry, endocrinology (steroids, vitamin D…) and sport biology. The subject of her PhD Thesis was “Impact of intensive strenuous exercise on the release of cardiac biomarkers”. Since 2012, she has been team leader of the LC-MS/MS clinical chemistry laboratory. She has also significantly invested in the development of lipidomics, contributing to the implementation of advanced analytical strategies for the characterization of lipid biomarkers in clinical practice. She is full member in the IFCC Committee on Clinical Applications of Cardiac Bio-markers. She is a member of various scientific societies such as the Royal Belgian Society of Laboratory Medicine (board), the European Society of Cardiology, the French Society of Cardiology, and the Belgian Bone club. Her activities have resulted in around 90 peer-reviewed scientific articles as first or last author and 100 as co-author, as well as numerous presentations at various congresses.

Relevant Financial Disclosures (within past 24 months, reported on Apr 21, 2026) No relevant financial relationship(s) to disclose.

INTRODUCTION:
Ultra-endurance exercise imposes extreme physiological demands that challenge the body’s metabolic homeostasis. Understanding how systemic metabolism responds to such prolonged stress remains a key issue in sports and clinical physiology, particularly in the context of injury prevention and cardiovascular risk management. Recent advances in metabolomics provide powerful tools to capture global metabolic alterations in vivo and to identify early biomarkers of physiological strain. Such insights may support more personalized approaches to athlete monitoring, training adaptation, and recovery optimization.

OBJECTIVES:
The objective of this study was to investigate the impact of ultra endurance exercise on the circulating metabolome using a longitudinal clinical metabolomics approach combining liquid chromatography–tandem mass spectrometry (LC–MS/MS) and proton nuclear magnetic resonance (¹H NMR), with the aim of characterizing systemic metabolic responses during exercise and short term recovery.

METHODS:
Longitudinal cohort studies were conducted in athletes participating in an extreme mountain ultramarathon as a representative model of ultra endurance stress. Serum samples were collected at multiple time points encompassing pre exercise baseline, exercise progression, race completion, and post exercise recovery. Complementary metabolomic analyses were performed using validated LC–MS/MS and ¹H NMR platforms to quantify a broad panel of metabolites involved in energy metabolism, amino acid turnover, lipid metabolism, and intermediary pathways. Metabolomic data were analyzed in conjunction with functional clinical biomarkers reflecting muscular injury, cardiac stress, inflammation, and renal function. Multivariate statistical models adapted to longitudinal study designs were applied to identify time dependent metabolic trajectories and their associations with clinical markers.

RESULTS:
Ultra endurance exercise induced marked and progressive alterations in the circulating metabolome, affecting pathways related to energy production, amino acid metabolism, and lipid utilization. Metabolic profiles observed at the end of the race showed substantial divergence from baseline, reflecting sustained systemic stress. Despite recovery period, several metabolomic signatures and functional biomarkers remained altered, indicating incomplete metabolic restitution. Integrative pathway level analyses revealed key biological pathways involved in exercise induced metabolic strain and delayed recovery, consistent with ongoing inflammatory responses, muscle remodeling processes, and altered organ specific metabolic function.

CONCLUSIONS:
This study demonstrates that extreme exercises constitute profound metabolic stress with persistent systemic effects detectable by clinical metabolomics. The combined use of LC–MS/MS and ¹H NMR provides a comprehensive overview of metabolic adaptations and recovery dynamics following extreme endurance exercise. These findings highlight the relevance of metabolomic approaches for health oriented athlete monitoring, improved understanding of recovery physiology, and the identification of metabolomic patterns associated with prolonged physiological stress in ultra-endurance sports.