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Ke J, Yang J, Liu C, Qin Z, Zhang J, Jin J, Yu S, Tan H, Yang Y, Zhang C, Li J, Yu J, Bian S, Ding X, He C, Yuan F, Tian J, Li C, Rao R, Huang L. A novel echocardiographic parameter to identify individuals susceptible to acute mountain sickness. Travel Med Infect Dis 2021; 44:102166. [PMID: 34555515 DOI: 10.1016/j.tmaid.2021.102166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute mountain sickness (AMS) may cause life-threatening conditions. This study aimed to screen echocardiographic parameters at sea level (SL) to identify predictors of AMS development. METHODS Overall, 106 healthy men were recruited at SL and ascended to 4100 m within 7 days by bus. Basic characteristics, physiological data, and echocardiographic parameters were collected both at SL and 4100 m above SL. AMS was identified by 2018 Lake Louise Questionnaire Score. RESULTS After acute high altitude exposure (AHAE), 33 subjects were diagnosed with AMS and exhibited lower lateral mitral valve tissue motion annular displacement (MV TMADlateral) at SL than AMS-free subjects (13.09 vs. 13.89 mm, p = 0.022). MV TMADlateral at SL was significantly correlated with AMS occurrence (OR = 0.717, 95% CI: 0.534-0.964, p = 0.028). The MV TMADlateral<13.30-mm group showed over 4-fold risk for AMS development versus the MV TMADlateral≥13.30-mm group. After AHAE, the MV TMADlateral<13.30-mm group had increased HR (64 vs. 74 bpm, p = 0.001) and right-ventricular myocardial performance index (0.54 vs. 0.69, p = 0.009) and decreased left ventricular global longitudinal strain (-21.50 vs. -20.23%, p = 0.002), tricuspid valve E/A ratio (2.11 vs. 1.89, p = 0.019), and MV E-wave deceleration time (169.60 vs. 156.90 ms, p = 0.035). CONCLUSION MV TMADlateral at SL was a potential predictor of AMS occurrence and might be associated with differential alterations of ventricular systolic and diastolic functions in subjects with different MV TMADlateral levels at SL after AHAE.
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Affiliation(s)
- Jingbin Ke
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Jie Yang
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Chuan Liu
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Zhexue Qin
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Jihang Zhang
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Jun Jin
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Shiyong Yu
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Hu Tan
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Yuanqi Yang
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Chen Zhang
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Jiabei Li
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Jie Yu
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Shizhu Bian
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Xiaohan Ding
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Chunyan He
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Fangzhengyuan Yuan
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Jingdu Tian
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Chun Li
- Department of Medical Ultrasonics, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Rongsheng Rao
- Department of Medical Ultrasonics, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Lan Huang
- Institute of Cardiovascular Disease of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China; Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.
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Hypoxic Exercise Exacerbates Hypoxemia and Acute Mountain Sickness in Obesity: A Case Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179078. [PMID: 34501667 PMCID: PMC8430682 DOI: 10.3390/ijerph18179078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 12/21/2022]
Abstract
Acute mountain sickness (AMS) is a common syndrome characterized by headache, dizziness, loss of appetite, weakness, and nausea. As a major public health issue, obesity has increased in high altitude urban residents and intermittent commuters to high altitudes. The present study investigated acute hypoxic exposure and hypoxic exercise on hypoxemia severity and AMS symptoms in a physically active obese man. In this case analysis, peripheral oxygen saturation (SpO2) was used to evaluate hypoxemia, heart rate (HR) and blood pressure (BP) were used to reflect the function of autonomic nervous system (ANS), and Lake Louise scoring (LLS) was used to assess AMS. The results showed that acute hypoxic exposure led to severe hypoxemia (SpO2 = 72%) and tachycardia (HRrest = 97 bpm), and acute hypoxic exercise exacerbated severe hypoxemia (SpO2 = 59%) and ANS dysfunction (HRpeak = 167 bpm, SBP/DBP = 210/97 mmHg). At the end of the 6-h acute hypoxic exposure, the case developed severe AMS (LLS = 10) symptoms of headache, gastrointestinal distress, cyanosis, vomiting, poor appetite, and fatigue. The findings of the case study suggest that high physical activity level appears did not show a reliable protective effect against severe hypoxemia, ANS dysfunction, and severe AMS symptoms in acute hypoxia exposure and hypoxia exercise.
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103
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Miglani M, Rain M, Pasha Q, Raj VS, Thinlas T, Mohammad G, Gupta A, Pandey RP, Vibhuti A. Shorter telomere length, higher telomerase activity in association with tankyrase gene polymorphism contribute to high-altitude pulmonary edema. Hum Mol Genet 2021; 29:3094-3106. [PMID: 32916703 DOI: 10.1093/hmg/ddaa205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
High-altitude pulmonary edema (HAPE) is a noncardiogenic form of pulmonary edema, which is induced upon exposure to hypobaric hypoxia at high altitude (HA). Hypobaric hypoxia generates reactive oxygen species that may damage telomeres and disturb normal physiological processes. Telomere complex comprises of multiple proteins, of which, tankyrase (TNKS) is actively involved in DNA damage repairs. We hence investigated the association of TNKS and telomeres with HAPE to delineate their potential role at HA. The study was performed in three groups, High-altitude pulmonary edema patients (HAPE-p, n = 200), HAPE-resistant sojourners (HAPE-r, n = 200) and highland permanent healthy residents (HLs, n = 200). Variants of TNKS were genotyped using polymerase chain reaction-restriction fragment length polymorphism. Plasma TNKS level was estimated using enzyme-linked immunosorbent assay, expression of TNKS and relative telomere length were assessed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and telomerase activity was assessed by the telomere repeat amplification protocol assay. TNKS poly-ADP ribosylates the telomere-repeat factor (TRF), which is a negative regulator of telomere length. Consequently, TRF expression was also measured by RT-qPCR. The TNKS heterozygotes rs7015700GA were prevalent in HLs compared to the HAPE-p and HAPE-r. The plasma TNKS was significantly decreased in HAPE-p than HAPE-r (P = 0.006). TNKS was upregulated 9.27 folds in HAPE-p (P = 1.01E-06) and downregulated in HLs by 3.3 folds (P = 0.02). The telomere length was shorter in HAPE-p compared to HAPE-r (P = 0.03) and HLs (P = 4.25E-4). The telomerase activity was significantly higher in HAPE-p compared to both HAPE-r (P = 0.01) and HLs (P = 0.001). HAPE-p had the lowest TNKS levels (0.186 ± 0.031 ng/μl) and the highest telomerase activity (0.0268 amoles/μl). The findings of the study indicate the association of TNKS and telomeres with HA adaptation/maladaptation.
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Affiliation(s)
- Manjula Miglani
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India.,Functional Genomics Unit, Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, Delhi, 110007, India
| | - Manjari Rain
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, Delhi, 110007, India
| | - Qadar Pasha
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, Delhi, 110007, India
| | - V Samuel Raj
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India
| | - Tashi Thinlas
- Department of Medicine, Sonam Norboo Memorial Hospital, Leh-Ladakh 194101, India
| | - Ghulam Mohammad
- Department of Medicine, Sonam Norboo Memorial Hospital, Leh-Ladakh 194101, India
| | - Archana Gupta
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India
| | - Ramendra Pati Pandey
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India
| | - Arpana Vibhuti
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India
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104
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Cai J, Ruan J, Shao X, Ding Y, Xie K, Tang C, Yan Z, Luo E, Jing D. Oxygen Enrichment Mitigates High-Altitude Hypoxia-Induced Hippocampal Neurodegeneration and Memory Dysfunction Associated with Attenuated Tau Phosphorylation. High Alt Med Biol 2021; 22:274-284. [PMID: 34348049 DOI: 10.1089/ham.2020.0218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Cai, Jing, Junyong Ruan, Xi Shao, Yuanjun Ding, Kangning Xie, Chi Tang, Zedong Yan, Erping Luo, and Da Jing. Oxygen enrichment mitigates high-altitude hypoxia-induced hippocampal neurodegeneration and memory dysfunction associated with attenuated tau phosphorylation. High Alt Med Biol 00:000-000, 2021. Background: Brain is predominantly vulnerable to high-altitude hypoxia (HAH), resulting in neurodegeneration and cognitive impairment. The technology of oxygen enrichment has proven effective to decrease the heart rate and improve the arterial oxygen saturation by reducing the equivalent altitude. However, the efficacy of oxygen enrichment on HAH-induced cognitive impairments remains controversial based on the results of neuropsychological tests, and its role in HAH-induced hippocampal morphological and molecular changes remains unknown. Therefore, this study aims to systematically investigate the effects of oxygen enrichment on the memory dysfunction and hippocampal neurodegeneration caused by HAH. Materials and Methods: Fifty-one male Sprague-Dawley rats were equally assigned to three groups: normal control, HAH, and HAH with oxygen enrichment (HAHO). Rats in the HAH and HAHO groups were exposed to hypoxia for 3 days in a hypobaric hypoxia chamber at a simulated altitude of 6,000 m. Rats in the HAHO group were supplemented with oxygen-enriched air, with 12 hours/day in the hypobaric hypoxia chamber. Results: Our results showed that oxygen enrichment improved the locomotor activity of HAH-exposed rats. The Morris water maze test revealed that oxygen enrichment significantly ameliorated HAH-induced spatial memory deficits. Oxygen enrichment also improved morphological alterations of pyramidal cells and the ultrastructure of neurons in the hippocampal CA1 region in rats exposed to acute HAH. Tau hyperphosphorylation at Ser396, Ser262, Thr231, and Thr181 was also significantly attenuated by oxygen enrichment in HAH-exposed rats. Conclusions: Together, our study reveals that oxygen enrichment can ameliorate HAH-induced cognitive impairments associated with improved hippocampal morphology and molecular expression, and highlights that oxygen enrichment may become a promising alternative treatment against neurodegeneration for humans ascending to the plateau.
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Affiliation(s)
- Jing Cai
- Department of Clinical Diagnostics, College of Basic Medicine, Shaanxi University of Chinese Medicine, Xianyang, China.,Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Junyong Ruan
- Medical Engineering Department, Qingdao Special Servicemen Recuperation Center of PLA Navy, Qingdao, China
| | - Xi Shao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Yuanjun Ding
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Kangning Xie
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Chi Tang
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Zedong Yan
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Erping Luo
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Da Jing
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
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105
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Miglani M, Pasha Q, Gupta A, Priyadarshini A, Pati Pandey R, Vibhuti A. Seeding drug discovery: Telomeric tankyrase as a pharmacological target for the pathophysiology of high-altitude hypoxia. Drug Discov Today 2021; 26:2774-2781. [PMID: 34302973 DOI: 10.1016/j.drudis.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 12/26/2022]
Abstract
Cellular exposure to extreme environments leads to the expression of multiple proteins that participate in pathophysiological manifestations. Hypobaric hypoxia at high altitude (HA) generates reactive oxygen species (ROS) that can damage telomeres. Tankyrase (TNKS) belongs to multiple telomeric protein complexes and is actively involved in DNA damage repair. Although published research on TNKS indicates its possible role in cancer and other hypoxic diseases, its role in HA sicknesses remains elusive. Understanding the roles of telomeres, telomerase, and TNKS could ameliorate physiological issues experienced at HA. In addition, telomeric TNKS could be a potential biomarker in hypoxia-induced sicknesses or acclimatization. Thus, a new research avenue on TNKS linked to HA sickness might lead to the discovery of drugs for hypobaric hypoxia.
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Affiliation(s)
- Manjula Miglani
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India; Functional Genomics Unit, Institute of Genomics and Integrative Biology, CSIR, Delhi 110007, India
| | - Qadar Pasha
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, CSIR, Delhi 110007, India
| | - Archana Gupta
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India
| | - Anjali Priyadarshini
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India
| | - Ramendra Pati Pandey
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India
| | - Arpana Vibhuti
- Department of Biotechnology, SRM University, Delhi-NCR, Sonepat, Haryana 131029, India.
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106
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Sethi KK, Mishra KMA, Verma SM, Vullo D, Carta F, Supuran CT. Synthesis and Human Carbonic Anhydrase I, II, IX, and XII Inhibition Studies of Sulphonamides Incorporating Mono-, Bi- and Tricyclic Imide Moieties. Pharmaceuticals (Basel) 2021; 14:ph14070693. [PMID: 34358123 PMCID: PMC8308639 DOI: 10.3390/ph14070693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 01/18/2023] Open
Abstract
New derivatives were synthesised by reaction of amino-containing aromatic sulphonamides with mono-, bi-, and tricyclic anhydrides. These sulphonamides were investigated as human carbonic anhydrases (hCAs, EC 4.2.1.1) I, II, IX, and XII inhibitors. hCA I was inhibited with inhibition constants (Kis) ranging from 49 to >10,000 nM. The physiologically dominant hCA II was significantly inhibited by most of the sulphonamide with the Kis ranging between 2.4 and 4515 nM. hCA IX and hCA XII were inhibited by these sulphonamides in the range of 9.7 to 7766 nM and 14 to 316 nM, respectively. The structure-activity relationships (SAR) are rationalised with the help of molecular docking studies.
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Affiliation(s)
- Kalyan K. Sethi
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam 781101, India;
- Correspondence: (K.K.S.); (C.T.S.)
| | - KM Abha Mishra
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research Guwahati, Assam 781101, India;
| | - Saurabh M. Verma
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi 835215, India;
| | - Daniela Vullo
- Neurofarba Department, Università degli Studi di Firenze, Sezione di Farmaceutica e Nutraceutica, Via Ugo Schiff 6, Sesto Fiorentino, 50019 Florence, Italy; (D.V.); (F.C.)
| | - Fabrizio Carta
- Neurofarba Department, Università degli Studi di Firenze, Sezione di Farmaceutica e Nutraceutica, Via Ugo Schiff 6, Sesto Fiorentino, 50019 Florence, Italy; (D.V.); (F.C.)
| | - Claudiu T. Supuran
- Neurofarba Department, Università degli Studi di Firenze, Sezione di Farmaceutica e Nutraceutica, Via Ugo Schiff 6, Sesto Fiorentino, 50019 Florence, Italy; (D.V.); (F.C.)
- Correspondence: (K.K.S.); (C.T.S.)
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107
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Burtscher J, Mallet RT, Burtscher M, Millet GP. Hypoxia and brain aging: Neurodegeneration or neuroprotection? Ageing Res Rev 2021; 68:101343. [PMID: 33862277 DOI: 10.1016/j.arr.2021.101343] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
The absolute reliance of the mammalian brain on oxygen to generate ATP renders it acutely vulnerable to hypoxia, whether at high altitude or in clinical settings of anemia or pulmonary disease. Hypoxia is pivotal to the pathogeneses of myriad neurological disorders, including Alzheimer's, Parkinson's and other age-related neurodegenerative diseases. Conversely, reduced environmental oxygen, e.g. sojourns or residing at high altitudes, may impart favorable effects on aging and mortality. Moreover, controlled hypoxia exposure may represent a treatment strategy for age-related neurological disorders. This review discusses evidence of hypoxia's beneficial vs. detrimental impacts on the aging brain and the molecular mechanisms that mediate these divergent effects. It draws upon an extensive literature search on the effects of hypoxia/altitude on brain aging, and detailed analysis of all identified studies directly comparing brain responses to hypoxia in young vs. aged humans or rodents. Special attention is directed toward the risks vs. benefits of hypoxia exposure to the elderly, and potential therapeutic applications of hypoxia for neurodegenerative diseases. Finally, important questions for future research are discussed.
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Affiliation(s)
- Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland; Institute of Sport Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland.
| | - Robert T Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, CH-1015, Lausanne, Switzerland
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108
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Lei Y, Yang L, Zhou Y, Wang C, Lv W, Li L, He S. Hb adaptation to hypoxia in high-altitude fishes: Fresh evidence from schizothoracinae fishes in the Qinghai-Tibetan Plateau. Int J Biol Macromol 2021; 185:471-484. [PMID: 34214574 DOI: 10.1016/j.ijbiomac.2021.06.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
Uncovering the genetic basis of hypoxic adaptation is one of the most active research areas in evolutionary biology. Among air-breathing vertebrates, modifications of hemoglobin (Hb) play a pivotal role in mediating an adaptive response to high-altitude hypoxia. However, the relative contributions in water-breathing organisms are still unclear. Here, we tested the Hb concentration of fish at different altitudes. All species showed species-specific Hb concentration, which has a non-positive correlation with altitude. Moreover, we investigated the expression of Hb genes by the RNA-seq and quantitative real-time PCR (qRT-PCR), and Hb composition by two-dimensional electrophoresis (2-DE). The results showed that the multiple Hb genes and isoforms are co-expressed in schizothoracinae fishes endemic to the Qinghai-Tibetan Plateau (QTP). Phylogenetic analyses of Hb genes indicated that the evolutionary relationships are not easily reconciled with the organismal phylogeny. Furthermore, evidence of positive selection was found in the Hb genes of schizothoracinae fishes through the selection pressure analysis. We demonstrated that positively selected sites likely facilitated the functional divergence of Hb isoforms. Taken together, this study indicated that the long-term maintenance of high Hb concentration may be a disadvantage for physiologically acclimating to high altitude hypoxia. Meanwhile, the genetically based modification of Hb-O2 affinity in schizothoracinae fishes might facilitate the evolutionary adaptation to Tibetan aqueous environments.
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Affiliation(s)
- Yi Lei
- The Key Laboratory of Aquatic Biodiversity and Conservation of Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Liandong Yang
- The Key Laboratory of Aquatic Biodiversity and Conservation of Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yu Zhou
- The Key Laboratory of Aquatic Biodiversity and Conservation of Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Cheng Wang
- The Key Laboratory of Aquatic Biodiversity and Conservation of Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wenqi Lv
- The Key Laboratory of Aquatic Biodiversity and Conservation of Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lin Li
- The Key Laboratory of Aquatic Biodiversity and Conservation of Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shunping He
- The Key Laboratory of Aquatic Biodiversity and Conservation of Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China; Center for Excellence in Animal Evolution and Genetics, Chinese Academy of Sciences, Kunming 650223, China.
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109
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Nowadly CD, Kelley KM, Crane DH, Rose JS. Evaluation of High Altitude Interstitial Pulmonary Edema in Healthy Participants Using Rapid 4-View Lung Ultrasound Protocol During Staged Ascent to Everest Base Camp. Wilderness Environ Med 2021; 32:278-283. [PMID: 34175211 DOI: 10.1016/j.wem.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/29/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Prior research identified possible interstitial pulmonary fluid, concerning for early high altitude pulmonary edema (HAPE), in a large percentage of trekkers above 3000 m using a comprehensive 28-view pulmonary ultrasound protocol. These trekkers had no clinical symptoms of HAPE despite these ultrasound findings. The more common 4-view lung ultrasound protocol (LUP) is accurate in rapidly detecting interstitial edema during resource-rich care. The objective of this study was to evaluate whether the 4-view LUP detects interstitial fluid in trekkers ascending to Everest Base Camp. METHODS Serial 4-view LUP was performed on 15 healthy trekkers during a 9-d ascent from Kathmandu to Everest Base Camp. Ascent protocols complied with Wilderness Medical Society guidelines for staged ascent. A 4-view LUP was performed in accordance with the published 2012 international consensus protocols on lung ultrasound. Symptom assessment and 4-view LUP were obtained at 6 waypoints along the staged ascent. A 4-view LUP was positive for interstitial edema if ≥3 B-lines were detected in 2 ultrasound windows. RESULTS A single participant had evidence of interstitial lung fluid at 5380 m as defined by the 4-view LUP. There was no evidence of interstitial fluid in any participant below 5380 m. One participant was evacuated for acute altitude sickness at 4000 m but showed no preceding sonographic evidence of interstitial fluid. CONCLUSIONS In this small study, sonographic detection of interstitial fluid, suggestive of early HAPE, was not identified by the 4-view LUP protocol.
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Affiliation(s)
- Craig D Nowadly
- Department of Emergency Medicine, University of California at Davis, Sacramento, California.
| | - Kenneth M Kelley
- Department of Emergency Medicine, University of California at Davis, Sacramento, California
| | - Desiree H Crane
- Steele Memorial Medical Center, Salmon, Idaho; University of California, San Francisco (Fresno), Fresno, California
| | - John S Rose
- Department of Emergency Medicine, University of California at Davis, Sacramento, California
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110
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Stewart GM, Cross TJ, Joyner MJ, Chase SC, Curry T, Lehrer-Graiwer J, Dufu K, Vlahakis NE, Johnson BD. Impact of Pharmacologically Left Shifting the Oxygen-Hemoglobin Dissociation Curve on Arterial Blood Gases and Pulmonary Gas Exchange During Maximal Exercise in Hypoxia. High Alt Med Biol 2021; 22:249-262. [PMID: 34152867 DOI: 10.1089/ham.2020.0159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stewart, Glenn M., Troy J. Cross, Michael J. Joyner, Steven C. Chase, Timothy Curry, Josh Lehrer-Graiwer, Kobina Dufu, Nicholas E. Vlahakis, and Bruce D. Johnson. Impact of pharmacologically left shifting the oxygen-hemoglobin dissociation curve on arterial blood gases and pulmonary gas exchange during maximal exercise in hypoxia. High Alt Med Biol. 22:249-262, 2021. Introduction: Physiological and pathological conditions, which reduce the loading of oxygen onto hemoglobin (Hb), can impair exercise capacity and cause debilitating symptoms. Accordingly, this study examined the impact of pharmacologically left shifting the oxygen-hemoglobin dissociation curve (ODC) on arterial oxygen saturation (SaO2) and exercise capacity. Methods: Eight healthy subjects completed a maximal incremental exercise test in hypoxia (FIO2: 0.125) and normoxia (FIO2: 0.21) before (Day 1) and after (Day 15) daily ingestion of 900 mg of voxelotor (an oxygen/Hb affinity modulator). Pulmonary gas exchange and arterial blood gases were assessed throughout exercise and at peak. Data for a 1,500 mg daily drug dose are reported in a limited cohort (n = 3). Results: Fourteen days of drug administration left shifted the ODC (p50 measured under standard conditions, Day 1: 28.0 ± 2.1 mmHg vs. Day 15: 26.1 ± 1.8 mmHg, p < 0.05). Throughout incremental exercise in hypoxia, SaO2 was systematically higher after drug (peak exercise SaO2 on Day 1: 71 ± 2 vs. Day 15: 81% ± 2%, p < 0.001), whereas oxygen extraction (Ca-vO2 diff) and consumption (VO2) were similar (peak exercise Ca-vO2 diff on Day 1: 11.5 ± 1.7 vs. Day 15: 11.0 ± 1.8 ml/100 ml blood, p = 0.417; peak VO2 on Day 1: 2.59 ± 0.39 vs. Day 15: 2.47 ± 0.43 l/min, p = 0.127). Throughout incremental exercise in normoxia, SaO2 was systematically higher after drug, whereas peak VO2 was reduced (peak exercise SaO2 on Day 1: 93.9 ± 1.8 vs. Day 15: 95.8% ± 1.0%, p = 0.008; peak VO2 on Day 1: 3.62 ± 0.55 vs. Day 15: 3.26 ± 52 l/min, p = 0.001). Conclusion: Pharmacologically increasing the affinity of Hb for oxygen improved SaO2 during hypoxia without impacting exercise capacity; however, left shifting the ODC in healthy individuals appears detrimental to exercise capacity in normoxia. Left shifting the ODC to different magnitudes and under more chronic forms of hypoxia warrants further study.
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Affiliation(s)
- Glenn M Stewart
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Troy J Cross
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Michael J Joyner
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven C Chase
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy Curry
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kobina Dufu
- Global Blood Therapeutics, South San Francisco, California, USA
| | | | - Bruce D Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Mallet RT, Burtscher J, Richalet JP, Millet GP, Burtscher M. Impact of High Altitude on Cardiovascular Health: Current Perspectives. Vasc Health Risk Manag 2021; 17:317-335. [PMID: 34135590 PMCID: PMC8197622 DOI: 10.2147/vhrm.s294121] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Globally, about 400 million people reside at terrestrial altitudes above 1500 m, and more than 100 million lowlanders visit mountainous areas above 2500 m annually. The interactions between the low barometric pressure and partial pressure of O2, climate, individual genetic, lifestyle and socio-economic factors, as well as adaptation and acclimatization processes at high elevations are extremely complex. It is challenging to decipher the effects of these myriad factors on the cardiovascular health in high altitude residents, and even more so in those ascending to high altitudes with or without preexisting diseases. This review aims to interpret epidemiological observations in high-altitude populations; present and discuss cardiovascular responses to acute and subacute high-altitude exposure in general and more specifically in people with preexisting cardiovascular diseases; the relations between cardiovascular pathologies and neurodegenerative diseases at altitude; the effects of high-altitude exercise; and the putative cardioprotective mechanisms of hypobaric hypoxia.
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Affiliation(s)
- Robert T Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Jean-Paul Richalet
- Laboratoire Hypoxie & Poumon, UMR Inserm U1272, Université Sorbonne Paris Nord 13, Bobigny Cedex, F-93017, France
| | - Gregoire P Millet
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, A-6020, Austria
- Austrian Society for Alpine and High-Altitude Medicine, Mieming, Austria
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112
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Vanderhaeghen T, Beyaert R, Libert C. Bidirectional Crosstalk Between Hypoxia Inducible Factors and Glucocorticoid Signalling in Health and Disease. Front Immunol 2021; 12:684085. [PMID: 34149725 PMCID: PMC8211996 DOI: 10.3389/fimmu.2021.684085] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022] Open
Abstract
Glucocorticoid-induced (GC) and hypoxia-induced transcriptional responses play an important role in tissue homeostasis and in the regulation of cellular responses to stress and inflammation. Evidence exists that there is an important crosstalk between both GC and hypoxia effects. Hypoxia is a pathophysiological condition to which cells respond quickly in order to prevent metabolic shutdown and death. The hypoxia inducible factors (HIFs) are the master regulators of oxygen homeostasis and are responsible for the ability of cells to cope with low oxygen levels. Maladaptive responses of HIFs contribute to a variety of pathological conditions including acute mountain sickness (AMS), inflammation and neonatal hypoxia-induced brain injury. Synthetic GCs which are analogous to the naturally occurring steroid hormones (cortisol in humans, corticosterone in rodents), have been used for decades as anti-inflammatory drugs for treating pathological conditions which are linked to hypoxia (i.e. asthma, ischemic injury). In this review, we investigate the crosstalk between the glucocorticoid receptor (GR), and HIFs. We discuss possible mechanisms by which GR and HIF influence one another, in vitro and in vivo, and the therapeutic effects of GCs on HIF-mediated diseases.
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Affiliation(s)
- Tineke Vanderhaeghen
- Centre for Inflammation Research, Flanders Institute for Biotechnology (VIB), Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Rudi Beyaert
- Centre for Inflammation Research, Flanders Institute for Biotechnology (VIB), Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
| | - Claude Libert
- Centre for Inflammation Research, Flanders Institute for Biotechnology (VIB), Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium
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113
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Wang Z, Lv B, Zhang L, Gao R, Zhao W, Wang L, Min Z, Mi Z, Song Y, Zhang J, Yu Y, Ji X, Li J, Wu L. Repeated remote ischaemic preconditioning can prevent acute mountain sickness after rapid ascent to a high altitude. Eur J Sport Sci 2021; 22:1304-1314. [PMID: 33977839 DOI: 10.1080/17461391.2021.1927197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of the present study was to assess the effectiveness of 4 different remote ischaemic preconditioning (RIPC) protocols varying in duration and frequency for preventing acute mountain sickness (AMS). Methods: The participants in the four RIPC groups received different RIPC treatments in the arms at a low altitude; the control group did not receive a specific sham treatment. The participants were then flown to a High Altitude (3650 m). The primary outcome was the incidence and severity of AMS evaluated by the Lake Louise score (LLS) after arrival; vital signs were collected simultaneously. We performed an intention-to-treat analysis. Results: A total of 250 participants were included with 50 participants in each group. The total AMS incidence in all participants was 26.4%. A total of 20 AMS cases (40%) occurred in the control group, whereas 15 AMS cases (30%) occurred both in the RIPC A and RIPC B groups (relative risk 1.3; 95% confidence interval 0.8 - 2.3; χ2 = 1.099; p = 0.29), and 8 AMS cases (16%) occurred both in the RIPC C and D groups (RR 2.5; 95% CI 1.2 - 5.2; χ2 = 7.143, p < 0.01), with significantly lower LLSs in the RIPC C and D groups (F = 6.51, p <0.001). Conclusion: This study demonstrated that a four-week RIPC intervention but not a one-week regimen reduced AMS incidence and severity; however, a placebo effect might have contributed to the results of this study. METHODS The participants in the four RIPC groups received different RIPC treatments in the arms at a low altitude; the control group did not receive a specific sham treatment. The participants were then flown to a High Altitude (3650 m). The primary outcome was the incidence and severity of AMS evaluated by the Lake Louise score (LLS) after arrival; vital signs were collected simultaneously. We performed an intention-to-treat analysis. RESULTS A total of 250 participants were included with 50 participants in each group. The total AMS incidence in all participants was 26.4%. A total of 20 AMS cases (40%) occurred in the control group after arrival at high altitude, whereas 15 AMS cases (30%) occurred both in the RIPC A and RIPC B groups (relative risk 1.3; 95% confidence interval 0.8 - 2.3; χ2 = 1.099; p = 0.29), and 8 AMS cases (16%) occurred both in the RIPC C and D groups (RR 2.5; 95% CI 1.2 - 5.2; χ2 = 7.143, p < 0.01), with significantly lower LLSs in the RIPC C and D groups (F = 6.51, p <0.001). CONCLUSION This study demonstrated that a four-week RIPC intervention but not a one-week regimen reduced AMS incidence and severity; however, a placebo effect might have contributed to the results of this study.
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Affiliation(s)
- Zhen Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bo Lv
- Department of Neurology, PKUCare Zibo Hospital, Zibo, People's Republic of China.,Department of Neurology, People's Hospital of Yuncheng County, Heze, People's Republic of China
| | - Lin Zhang
- Department of Emergency, People's Hospital of Rizhao, Rizhao, People's Republic of China
| | - Ran Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhaojun Min
- Department of Geriatric Medicine, People's Hospital of Lhasa, Lhasa, People's Republic of China
| | - Zhen Mi
- Department of Geriatric Medicine, People's Hospital of Lhasa, Lhasa, People's Republic of China
| | - Yang Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yabin Yu
- Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xunming Ji
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junjie Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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Shi J, Liu Z, Li M, Guo J, Chen L, Ding L, Ding X, Zhou T, Zhang J. Polysaccharide from Potentilla anserina L ameliorate pulmonary edema induced by hypobaric hypoxia in rats. Biomed Pharmacother 2021; 139:111669. [PMID: 34243609 DOI: 10.1016/j.biopha.2021.111669] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/29/2021] [Accepted: 04/24/2021] [Indexed: 02/04/2023] Open
Abstract
High-altitude pulmonary edema (HAPE) is a life-threatening disease occurs in hypobaric hypoxia (HH) environment, which could be treated by Dexamethasone, but might cause side-effects. Potentilla anserina L polysaccharide (PAP) holds promising physiological and pharmacological properties which could be beneficial for HAPE treatment. In our study, the anti-hypoxia effect of PAP was firstly investigated through anti-normobaric hypoxia test and anti-acute hypoxia test. Then we established a model of HAPE and measured the lung water content, pathological changes and MDA, NO, SOD, GSH concentrations in lung tissues. We also evaluated the protein and mRNA levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α, VEGF, NF-κB and HIF-1α) by ELISA kits, RT-PCR and Western blotting. As expected, PAP could dramatically reduce the lung water content, alleviate lung tissue injury, and inhibit MDA and NO production, it also promote SOD activity and GSH expression. In addition, it has been found that PAP blocked the NF-κB and HIF-1α signaling pathway activation, inhibited the generation of downstream pro-inflammatory cytokines. Therefore, PAP provides great potential in HAPE treatment mainly through suppression of oxidative stress and inflammatory suppression.
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Affiliation(s)
- Jipeng Shi
- College of Life Science, Northwest Normal University, Lanzhou 730070, China; Institute of New Rural Development, Northwest Normal University, Lanzhou 730070, China; Bioactive Products Engineering Research Center for Gansu Distinctive Plants, Lanzhou 730070, China; PLA Key Laboratory of the Plateau Environment Damage Control, Department of Pharmacy, The 940th Hospital of Joint Logistic Support Force of Chinese PLA, Lanzhou 730050, China
| | - Zhao Liu
- Department of Orthopaedic Surgery, Orthopaedic Institute, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Maoxing Li
- PLA Key Laboratory of the Plateau Environment Damage Control, Department of Pharmacy, The 940th Hospital of Joint Logistic Support Force of Chinese PLA, Lanzhou 730050, China
| | - Jie Guo
- College of Life Science, Northwest Normal University, Lanzhou 730070, China; Institute of New Rural Development, Northwest Normal University, Lanzhou 730070, China; Bioactive Products Engineering Research Center for Gansu Distinctive Plants, Lanzhou 730070, China
| | - Lele Chen
- College of Life Science, Northwest Normal University, Lanzhou 730070, China; Institute of New Rural Development, Northwest Normal University, Lanzhou 730070, China; Bioactive Products Engineering Research Center for Gansu Distinctive Plants, Lanzhou 730070, China
| | - Ling Ding
- College of Life Science, Northwest Normal University, Lanzhou 730070, China; Institute of New Rural Development, Northwest Normal University, Lanzhou 730070, China; Bioactive Products Engineering Research Center for Gansu Distinctive Plants, Lanzhou 730070, China
| | - Xu Ding
- College of Life Science, Northwest Normal University, Lanzhou 730070, China; Institute of New Rural Development, Northwest Normal University, Lanzhou 730070, China; Bioactive Products Engineering Research Center for Gansu Distinctive Plants, Lanzhou 730070, China
| | - Tao Zhou
- College of Life Science, Northwest Normal University, Lanzhou 730070, China; Institute of New Rural Development, Northwest Normal University, Lanzhou 730070, China; Bioactive Products Engineering Research Center for Gansu Distinctive Plants, Lanzhou 730070, China
| | - Ji Zhang
- College of Life Science, Northwest Normal University, Lanzhou 730070, China; Institute of New Rural Development, Northwest Normal University, Lanzhou 730070, China; Bioactive Products Engineering Research Center for Gansu Distinctive Plants, Lanzhou 730070, China.
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115
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van Vliet T, Casciaro F, Demaria M. To breathe or not to breathe: Understanding how oxygen sensing contributes to age-related phenotypes. Ageing Res Rev 2021; 67:101267. [PMID: 33556549 DOI: 10.1016/j.arr.2021.101267] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 02/08/2023]
Abstract
Aging is characterized by a progressive loss of tissue integrity and functionality due to disrupted homeostasis. Molecular oxygen is pivotal to maintain tissue functions, and aerobic species have evolved a sophisticated sensing system to ensure proper oxygen supply and demand. It is not surprising that aberrations in oxygen and oxygen-associated pathways subvert health and promote different aspects of aging. In this review, we discuss emerging findings on how oxygen-sensing mechanisms regulate different cellular and molecular processes during normal physiology, and how dysregulation of oxygen availability lead to disease and aging. We describe various clinical manifestations associated with deregulation of oxygen balance, and how oxygen-modulating therapies and natural oxygen oscillations influence longevity. We conclude by discussing how a better understanding of oxygen-related mechanisms that orchestrate aging processes may lead to the development of new therapeutic strategies to extend healthy aging.
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Urdampilleta A, León-Guereño P, Calleja-González J, Roche E, Mielgo-Ayuso J. Inclusion of resistance routines in a hypoxia training program does not interfere with prevention of acute mountain sickness. PHYSICIAN SPORTSMED 2021; 49:151-157. [PMID: 32578478 DOI: 10.1080/00913847.2020.1786344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Acclimatization strategies have been shown to be the best solutions to avoid acute mountain sickness. In this context, we have designed a protocol performed in hypoxia that includes resistance routines in combination with classical endurance training exercises with mountain trekking at mid altitude. METHODS Thirty-two volunteers preparing different mountain expeditions participated in the study distributed into two groups. One group trained at 2000 m, while another group trained at 4500-5800 m of simulated altitude in a hypoxic chamber. Acute mountain sickness was monitored by answering the Lake Louise Scale questionnaire during 2 sleeping sessions at 4800 m of simulated altitude at the beginning and at the end of the study. At the same time, oxygen saturation was determined in both groups to monitor physiologic adaptation. Data were also collected from the base camps in each expedition before ascension. RESULTS Acute mountain sickness incidence in the hypoxic group decreased from 100% at the beginning to 12% of individuals at the end of the training period, and it was 25% at the base camps of expeditions. On the other hand, the control group passed from 100% to 88% of individuals at the end of the intervention and 70% at the base camps. At the same time, acute mountain sickness severity was mild in the experimental group compared to moderate-severe in the control group. These data were supported by the oxygen saturation values, indicating adequate adaptation changes for altitude in the hypoxic group. CONCLUSION The inclusion of resistance workouts in combination with endurance exercises, all performed in hypoxic conditions, does not interfere with an optimal adaptation to altitude and to prevent acute mountain sickness.
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Affiliation(s)
| | | | - Julio Calleja-González
- Department of Physical Education and Sports, University of Basque Country (UPV-EHU), Vitoria, Spain
| | - Enrique Roche
- Department of Applied Biology-Nutrition, Institute of Bioengineering, University Miguel Hernandez (Elche). Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,CIBERobn (Fisiopatología De La Obesidad Y La Nutrición CB12/03/30038) Instituto De Salud Carlos III, Spain
| | - Juan Mielgo-Ayuso
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, Soria, Spain
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Cobb AB, Levett DZH, Mitchell K, Aveling W, Hurlbut D, Gilbert-Kawai E, Hennis PJ, Mythen MG, Grocott MPW, Martin DS. Physiological responses during ascent to high altitude and the incidence of acute mountain sickness. Physiol Rep 2021; 9:e14809. [PMID: 33904650 PMCID: PMC8077104 DOI: 10.14814/phy2.14809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
Acute mountain sickness (AMS) occurs when there is failure of acclimatisation to high altitude. The aim of this study was to describe the relationship between physiological variables and the incidence of AMS during ascent to 5300 m. A total of 332 lowland‐dwelling volunteers followed an identical ascent profile on staggered treks. Self‐reported symptoms of AMS were recorded daily using the Lake Louise score (mild 3–4; moderate‐severe ≥5), alongside measurements of physiological variables (heart rate, respiratory rate (RR), peripheral oxygen saturation (SpO2) and blood pressure) before and after a standardised Xtreme Everest Step‐Test (XEST). The overall occurrence of AMS among participants was 73.5% (23.2% mild, 50.3% moderate–severe). There was no difference in gender, age, previous AMS, weight or body mass index between participants who developed AMS and those who did not. Participants who had not previously ascended >5000 m were more likely to get moderate‐to‐severe AMS. Participants who suffered moderate‐to‐severe AMS had a lower resting SpO2 at 3500 m (88.5 vs. 89.6%, p = 0.02), while participants who suffered mild or moderate‐to‐severe AMS had a lower end‐exercise SpO2 at 3500 m (82.2 vs. 83.8%, p = 0.027; 81.5 vs. 83.8%, p < 0.001 respectively). Participants who experienced mild AMS had lower end‐exercise RR at 3500 m (19.2 vs. 21.3, p = 0.017). In a multi‐variable regression model, only lower end‐exercise SpO2 (OR 0.870, p < 0.001) and no previous exposure to altitude >5000 m (OR 2.740, p‐value 0.003) predicted the development of moderate‐to‐severe AMS. The Xtreme Everest Step‐Test offers a simple, reproducible field test to help predict AMS, albeit with relatively limited predictive precision.
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Affiliation(s)
- Alexandra B Cobb
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Denny Z H Levett
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Perioperative and Critical Care Research Theme, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kay Mitchell
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Perioperative and Critical Care Research Theme, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Wynne Aveling
- Anaesthetic Department, University College London Hospital, London, UK
| | - Daniel Hurlbut
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Edward Gilbert-Kawai
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Philip J Hennis
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Monty G Mythen
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK
| | - Michael P W Grocott
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Perioperative and Critical Care Research Theme, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Daniel S Martin
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Intensive Care Unit, University Hospitals Plymouth, Plymouth, UK.,Peninsula Medical School, University of Plymouth, Plymouth, UK
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Turner REF, Gatterer H, Falla M, Lawley JS. High-altitude cerebral edema: its own entity or end-stage acute mountain sickness? J Appl Physiol (1985) 2021; 131:313-325. [PMID: 33856254 DOI: 10.1152/japplphysiol.00861.2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
High-altitude cerebral edema (HACE) and acute mountain sickness (AMS) are neuropathologies associated with rapid exposure to hypoxia. However, speculation remains regarding the exact etiology of both HACE and AMS and whether they share a common mechanistic pathology. This review outlines the basic principles of HACE development, highlighting how edema could develop from 1) a progression from cytotoxic swelling to ionic edema or 2) permeation of the blood brain barrier (BBB) with or without ionic edema. Thereafter, discussion turns to the available neuroimaging literature in the context of cytotoxic, ionic, or vasogenic edema in both HACE and AMS. Although HACE is clearly caused by an increase in brain water of ionic and/or vasogenic origin, there is very little evidence that this type of edema is present when AMS develops. However, cerebral vasodilation, increased intracranial blood volume, and concomitant intracranial fluid shifts from the extracellular to the intracellular space, as interpreted from changes in diffusion indices within white matter, are observed consistently in persons acutely exposed to hypoxia and with AMS. Therefore, herein we explore the idea that intracellular swelling occurs alongside AMS, and is a critical precursor to extracellular ionic edema formation. We propose that this process produces a subtle modulation of the BBB, which either together with or independent of vasogenic edema provides a transvascular segue from the end-stage of AMS to HACE. Ultimately, this review seeks to shed light on the possible processes underlying HACE pathophysiology, and thus highlights potential avenues for future prevention and treatment.
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Affiliation(s)
- Rachel E F Turner
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Marika Falla
- Center for Mind/Brain Sciences and Centre for Neurocognitive Rehabilitation, University of Trento, Rovereto, Italy
| | - Justin S Lawley
- Division of Performance Physiology & Prevention, Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Venkat D, Dhillon K, Rowley JA. Effects of High Altitude on Sleep and Respiratory System. CURRENT PULMONOLOGY REPORTS 2021. [DOI: 10.1007/s13665-021-00276-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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120
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High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 3:59-69. [PMID: 35782163 PMCID: PMC9219347 DOI: 10.1016/j.smhs.2021.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 01/19/2023] Open
Abstract
Areas at high-altitude, annually attract millions of tourists, skiers, trekkers, and climbers. If not adequately prepared and not considering certain ascent rules, a considerable proportion of those people will suffer from acute mountain sickness (AMS) or even from life-threatening high-altitude cerebral (HACE) or/and pulmonary edema (HAPE). Reduced inspired oxygen partial pressure with gain in altitude and consequently reduced oxygen availability is primarily responsible for getting sick in this setting. Appropriate acclimatization by slowly raising the hypoxic stimulus (e.g., slow ascent to high altitude) and/or repeated exposures to altitude or artificial, normobaric hypoxia will largely prevent those illnesses. Understanding physiological mechanisms of acclimatization and pathophysiological mechanisms of high-altitude diseases, knowledge of symptoms and signs, treatment and prevention strategies will largely contribute to the risk reduction and increased safety, success and enjoyment at high altitude. Thus, this review is intended to provide a sound basis for both physicians counseling high-altitude visitors and high-altitude visitors themselves.
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Acute Hypobaric and Hypoxic Preconditioning Reduces Myocardial Ischemia-Reperfusion Injury in Rats. Cardiol Res Pract 2021; 2021:6617374. [PMID: 33815836 PMCID: PMC7990552 DOI: 10.1155/2021/6617374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 03/03/2021] [Indexed: 12/30/2022] Open
Abstract
Background Chronic and/or intermittent exposure to hypobaric hypoxia reportedly exerts cardioprotective effects against ischemia-reperfusion injury. However, few studies have focused on the cardioprotective effects of acute and/or short-term hypobaric and hypoxic exposures. This study investigated the effects of acute hypobaric hypoxia on myocardial ischemia-reperfusion injury. Materials and Methods Rats were assigned to groups receiving normobaric normoxia (NN group), hypobaric hypoxia (HH group), or normobaric hypoxia (NH group). HH group rats were exposed to 60.8 kPa and 12.6% fraction of inspired oxygen in a hypobaric chamber for 6 h. NH group rats were exposed to hypoxic conditions under normal pressure. After each exposure, 30 min of myocardial ischemia was followed by 60 min of reperfusion. Cardiac function and infarct size were determined after reperfusion. Expression of hypoxia-inducible factor 1 alpha (HIF1α) was also measured. Results Cardiac function was better preserved in the HH and NH groups than in the NN group (p < 0.01 each). Median infarct size/area at risk was significantly lower in the HH group (50%, interquartile range [IQR] 48–54%; p < 0.01 vs. NN group) and NH group (45%, IQR 36–50%; p < 0.01 vs. NN group) than in the NN group (72%, IQR 69–75%). HIF1α expression was significantly higher in the HH group (p < 0.05 vs. NN group) and NH group (p < 0.01 vs. NN group) than in the NN group. Conclusions Exposure to acute and/or short-term hypobaric and hypoxic conditions might exert cardioprotective effects against myocardial ischemia-reperfusion injury via HIF1α modulation.
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Speidel V, Purrucker JC, Klobučníková K. Manifestation of Intracranial Lesions at High Altitude: Case Report and Review of the Literature. High Alt Med Biol 2021; 22:87-89. [PMID: 33709803 DOI: 10.1089/ham.2020.0223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Speidel, Victor, Jan Christoph Purrucker, and Katarína Klobučníková. Manifestation of intracranial lesions at high altitude: case report and review of the literature. High Alt Med Biol. 22:87-89, 2021.-A 32-year-old man trekked to the South Everest Base Camp (5,364 m) in Nepal. On the last day of the ascent, he noticed some dysesthesia in his right leg and descended by helicopter. He suffered a generalized seizure shortly after his descent, followed by right-sided hemiparesis and speech arrest. Without the possibility of cerebral imaging, the patient was given dexamethasone intravenously who showed a marked improvement and regained the ability to speak. Magnetic resonance imaging later revealed a lesion in the left frontotemporal region with compression of brain parenchyma and minimal paralesional edema. A meningioma was later surgically resected. Although seizures are a common first manifestation of meningioma, we argue that the exposure to high altitude may have contributed to his symptoms, either by increasing the peritumoral edema by pathophysiology similar to high-altitude cerebral edema (HACE) or lowering the seizure threshold otherwise. This case shows a before unknown pre-existing condition becoming symptomatic at high altitude and illustrates the necessity for careful and immediate evaluation of every patient with new onset of unexplained focal neurological deficits or seizures at high altitude in addition to unspecific neurological symptoms commonly associated with HACE such as headaches, dizziness, lightheadedness, or ataxia.
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Affiliation(s)
- Victor Speidel
- Department of Emergency Medicine, Oberaargau Regional Hospital, Langenthal, Switzerland.,Department of Emergency Medicine, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland.,Pasang Lhamu Nicole Niquille Hospital, Lukla, Nepal
| | | | - Katarína Klobučníková
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
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123
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Habashi NM, Camporota L, Gatto LA, Nieman G. Functional pathophysiology of SARS-CoV-2-induced acute lung injury and clinical implications. J Appl Physiol (1985) 2021; 130:877-891. [PMID: 33444117 PMCID: PMC7984238 DOI: 10.1152/japplphysiol.00742.2020] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 02/08/2023] Open
Abstract
The worldwide pandemic caused by the SARS-CoV-2 virus has resulted in over 84,407,000 cases, with over 1,800,000 deaths when this paper was submitted, with comorbidities such as gender, race, age, body mass, diabetes, and hypertension greatly exacerbating mortality. This review will analyze the rapidly increasing knowledge of COVID-19-induced lung pathophysiology. Although controversial, the acute respiratory distress syndrome (ARDS) associated with COVID-19 (CARDS) seems to present as two distinct phenotypes: type L and type H. The "L" refers to low elastance, ventilation/perfusion ratio, lung weight, and recruitability, and the "H" refers to high pulmonary elastance, shunt, edema, and recruitability. However, the LUNG-SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) and ESICM (European Society of Intensive Care Medicine) Trials Groups have shown that ∼13% of the mechanically ventilated non-COVID-19 ARDS patients have the type-L phenotype. Other studies have shown that CARDS and ARDS respiratory mechanics overlap and that standard ventilation strategies apply to these patients. The mechanisms causing alterations in pulmonary perfusion could be caused by some combination of 1) renin-angiotensin system dysregulation, 2) thrombosis caused by loss of endothelial barrier, 3) endothelial dysfunction causing loss of hypoxic pulmonary vasoconstriction perfusion control, and 4) hyperperfusion of collapsed lung tissue that has been directly measured and supported by a computational model. A flowchart has been constructed highlighting the need for personalized and adaptive ventilation strategies, such as the time-controlled adaptive ventilation method, to set and adjust the airway pressure release ventilation mode, which recently was shown to be effective at improving oxygenation and reducing inspiratory fraction of oxygen, vasopressors, and sedation in patients with COVID-19.
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Affiliation(s)
- Nader M Habashi
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, St Thomas' Hospital, London, United Kingdom
| | - Louis A Gatto
- Department of Surgery, Upstate Medical University, Syracuse, New York
| | - Gary Nieman
- Department of Surgery, Upstate Medical University, Syracuse, New York
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Dünnwald T, Kienast R, Niederseer D, Burtscher M. The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude. SENSORS 2021; 21:s21041263. [PMID: 33578839 PMCID: PMC7916608 DOI: 10.3390/s21041263] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy.
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Affiliation(s)
- Tobias Dünnwald
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT—Private University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria;
| | - Roland Kienast
- Department of Biomedical and Health Technology, Federal Higher Technical Institute for Education and Experimentation—HTL Anichstraße, 6020 Innsbruck, Austria;
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
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Janigro D, Bailey DM, Lehmann S, Badaut J, O'Flynn R, Hirtz C, Marchi N. Peripheral Blood and Salivary Biomarkers of Blood-Brain Barrier Permeability and Neuronal Damage: Clinical and Applied Concepts. Front Neurol 2021; 11:577312. [PMID: 33613412 PMCID: PMC7890078 DOI: 10.3389/fneur.2020.577312] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
Within the neurovascular unit (NVU), the blood–brain barrier (BBB) operates as a key cerebrovascular interface, dynamically insulating the brain parenchyma from peripheral blood and compartments. Increased BBB permeability is clinically relevant for at least two reasons: it actively participates to the etiology of central nervous system (CNS) diseases, and it enables the diagnosis of neurological disorders based on the detection of CNS molecules in peripheral body fluids. In pathological conditions, a suite of glial, neuronal, and pericyte biomarkers can exit the brain reaching the peripheral blood and, after a process of filtration, may also appear in saliva or urine according to varying temporal trajectories. Here, we specifically examine the evidence in favor of or against the use of protein biomarkers of NVU damage and BBB permeability in traumatic head injury, including sport (sub)concussive impacts, seizure disorders, and neurodegenerative processes such as Alzheimer's disease. We further extend this analysis by focusing on the correlates of human extreme physiology applied to the NVU and its biomarkers. To this end, we report NVU changes after prolonged exercise, freediving, and gravitational stress, focusing on the presence of peripheral biomarkers in these conditions. The development of a biomarker toolkit will enable minimally invasive routines for the assessment of brain health in a broad spectrum of clinical, emergency, and sport settings.
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Affiliation(s)
- Damir Janigro
- Department of Physiology Case Western Reserve University, Cleveland, OH, United States.,FloTBI Inc., Cleveland, OH, United States
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, United Kingdom
| | - Sylvain Lehmann
- IRMB, INM, UFR Odontology, University Montpellier, INSERM, CHU Montpellier, CNRS, Montpellier, France
| | - Jerome Badaut
- Brain Molecular Imaging Lab, CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France
| | - Robin O'Flynn
- IRMB, INM, UFR Odontology, University Montpellier, INSERM, CHU Montpellier, CNRS, Montpellier, France
| | - Christophe Hirtz
- IRMB, INM, UFR Odontology, University Montpellier, INSERM, CHU Montpellier, CNRS, Montpellier, France
| | - Nicola Marchi
- Cerebrovascular and Glia Research, Department of Neuroscience, Institute of Functional Genomics (UMR 5203 CNRS-U 1191 INSERM, University of Montpellier), Montpellier, France
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126
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Shao X, Dong X, Cai J, Tang C, Xie K, Yan Z, Luo E, Jing D. Oxygen Enrichment Ameliorates Cardiorespiratory Alterations Induced by Chronic High-Altitude Hypoxia in Rats. Front Physiol 2021; 11:616145. [PMID: 33488404 PMCID: PMC7817980 DOI: 10.3389/fphys.2020.616145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022] Open
Abstract
Chronic high-altitude hypoxia (HAH) results in compensatory pathological adaptations, especially in the cardiorespiratory system. The oxygen enrichment technology can provide long-lasting oxygen supply and minimize oxygen toxicity, which has proven to be effective to increase oxygen saturation, decrease heart rate, and improve human exercise performance after ascending to high altitudes. Nevertheless, it remains unknown whether oxygen enrichment can resist chronic HAH-induced cardiorespiratory alterations. Thirty-six male rats were equally assigned to the normal control (NC), HAH, and HAH with oxygen enrichment (HAHO) groups. The HAH and HAHO rats were housed in a hypobaric hypoxia chamber equivalent to 5,000 m for 4 weeks. The HAHO rats were exposed to oxygen-enriched air for 8 h/day. We found that oxygen enrichment mitigated the augmented skin blood flow and improved the locomotor activity of HAH-exposed rats. Oxygen enrichment inhibited HAH-induced increase in the production of red blood cells (RBCs). The hemodynamic results showed that oxygen enrichment decreased right ventricular systolic pressure (RVSP) and mean pulmonary artery pressure (mPAP) in HAH-exposed rats. HAH-associated right ventricular hypertrophy and cardiomyocyte enlargement were ameliorated by oxygen enrichment. Oxygen enrichment inhibited HAH-induced excessive expression of cytokines associated with cardiac hypertrophy and myocardial fibrosis [angiotensin-converting enzyme (ACE)/angiotensin-converting enzyme 2 (ACE2), angiotensin II (Ang II), collagen type I alpha 1 (Col1α1), collagen type III alpha 1 (Col3α1), and hydroxyproline] in the right ventricle (RV). Oxygen enrichment inhibited medial thickening, stenosis and fibrosis of pulmonary arterioles, and cytokine expression related with fibrosis (Col1α1, Col3α1, and hydroxyproline) and pulmonary vasoconstriction [endothelin-1(ET-1)] in HAH-exposed rats. This study represents the first effort testing the efficacy of the oxygen enrichment technique on cardiopulmonary structure and function in chronic HAH animals, and we found oxygen enrichment has the capability of ameliorating chronic HAH-induced cardiopulmonary alterations.
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Affiliation(s)
- Xi Shao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Xu Dong
- Recuperation Management Office, Department of Medical Management and Training, Qingdao Special Service Recuperation Center of PLA Navy, Qingdao, China
| | - Jing Cai
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.,College of Basic Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Chi Tang
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Kangning Xie
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Zedong Yan
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Erping Luo
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Da Jing
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
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127
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Integrative analysis of miRNA-mRNA network in high altitude retinopathy by bioinformatics analysis. Biosci Rep 2021; 41:227459. [PMID: 33393628 PMCID: PMC7809558 DOI: 10.1042/bsr20200776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/27/2020] [Accepted: 12/24/2020] [Indexed: 01/08/2023] Open
Abstract
High-altitude retinopathy (HAR) is an ocular manifestation of acute oxygen deficiency at high altitudes. Although the pathophysiology of HAR has been revealed by many studies in recent years, the molecular mechanism is not yet clear. Our study aimed to systematically identify the genes and microRNA (miRNA) and explore the potential biomarkers associated with HAR by integrated bioinformatics analysis. The mRNA and miRNA expression profiles were obtained from the Gene Expression Omnibus database. We performed Gene Ontology functional annotations and Kyoto Encyclopedia of Genes and Genomes pathway analysis. Potential target gene analysis and miRNA-mRNA network analysis were also conducted. Quantitative RT-PCR (qRT-PCR) was used to validate the results of the bioinformatics analysis. Through a series of bioinformatics analyses and experiments, we selected 16 differentially expressed miRNAs (DE-miRNAs) and 157 differentially expressed genes related to acute mountain sickness (AMS) and constructed a miRNA-mRNA network containing 240 relationship pairs. The hub genes were filtered from the protein-protein interaction network: IL7R, FOS, IL10, FCGR2A, DDX3X, CDK1, BCL11B and HNRNPH1, which were all down-regulated in the AMS group. Then, nine up-regulated DE-miRNAs and eight hub genes were verified by qRT-PCR in our hypoxia-induced HAR cell model. The expression of miR-3177-3p, miR-369-3p, miR-603, miR-495, miR-4791, miR-424-5p, FOS, IL10 and IL7R was consistent with our bioinformatics results. In conclusion, FOS, IL10, IL-7R and 7 DE-miRNAs may participate in the development of HAR. Our findings will contribute to the identification of biomarkers and promote the effective prevention and treatment of HAR in the future.
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128
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Lucas SJE, Malein WL, Thomas OD, Ashdown KM, Rue CA, Joyce KE, Newman C, Cadigan P, Johnson B, Myers SD, Myers FA, Wright AD, Delamere J, Imray CHE, Bradwell AR, Edsell M. Effect of losartan on performance and physiological responses to exercise at high altitude (5035 m). BMJ Open Sport Exerc Med 2021; 7:e000982. [PMID: 33489310 PMCID: PMC7797254 DOI: 10.1136/bmjsem-2020-000982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Altitude-related and exercise-related elevations in blood pressure (BP) increase the likelihood of developing pulmonary hypertension and high-altitude illness during high-altitude sojourn. This study examined the antihypertensive effect and potential exercise benefit of the angiotensin II receptor antagonist losartan when taken at altitude. Methods Twenty participants, paired for age and ACE genotype status, completed a double-blinded, randomised study, where participants took either losartan (100 mg/day) or placebo for 21 days prior to arrival at 5035 m (Whymper Hut, Mt Chimborazo, Ecuador). Participants completed a maximal exercise test on a supine cycle ergometer at sea level (4 weeks prior) and within 48 hours of arrival to 5035 m (10-day ascent). Power output, beat-to-beat BP, oxygen saturation (SpO2) and heart rate (HR) were recorded during exercise, with resting BP collected from daily medicals during ascent. Before and immediately following exercise at 5035 m, extravascular lung water prevalence was assessed with ultrasound (quantified via B-line count). Results At altitude, peak power was reduced relative to sea level (p<0.01) in both groups (losartan vs placebo: down 100±29 vs 91±28 W, p=0.55), while SpO2 (70±6 vs 70±5%, p=0.96) and HR (146±21 vs 149±24 bpm, p=0.78) were similar between groups at peak power, as was the increase in systolic BP from rest to peak power (up 80±37 vs 69±33 mm Hg, p=0.56). Exercise increased B-line count (p<0.05), but not differently between groups (up 5±5 vs 8±10, p=0.44). Conclusion Losartan had no observable effect on resting or exercising BP, exercise-induced symptomology of pulmonary hypertension or performance at 5035 m.
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Affiliation(s)
- Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Owen D Thomas
- Department of Anaesthesia, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Kimberly M Ashdown
- Occupational Performance Research Group, University of Chichester, Chichester, West Sussex, UK
| | - Carla A Rue
- Occupational Performance Research Group, University of Chichester, Chichester, West Sussex, UK
| | - Kelsey E Joyce
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Charles Newman
- Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Patrick Cadigan
- Birmingham Medical Research Expeditionary Society, Birmingham, UK
| | - Brian Johnson
- Birmingham Medical Research Expeditionary Society, Birmingham, UK
| | - Stephen D Myers
- Occupational Performance Research Group, University of Chichester, Chichester, West Sussex, UK
| | - Fiona A Myers
- School of Biological Sciences, University of Portsmouth, Portsmouth, Hampshire, UK
| | | | - John Delamere
- School of Medicine, University of Birmingham, Birmingham, UK
| | - Chris H E Imray
- Department of Vascular Surgery, University Hospitals of Coventry and Warwickshire, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Mark Edsell
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK
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Millet GP, Debevec T, Brocherie F, Burtscher M, Burtscher J. Altitude and COVID-19: Friend or foe? A narrative review. Physiol Rep 2021; 8:e14615. [PMID: 33340275 PMCID: PMC7749581 DOI: 10.14814/phy2.14615] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
Recent reports suggest that high-altitude residence may be beneficial in the novel coronavirus disease (COVID-19) implicating that traveling to high places or using hypoxic conditioning thus could be favorable as well. Physiological high-altitude characteristics and symptoms of altitude illnesses furthermore seem similar to several pathologies associated with COVID-19. As a consequence, high altitude and hypoxia research and related clinical practices are discussed for potential applications in COVID-19 prevention and treatment. We summarize the currently available evidence on the relationship between altitude/hypoxia conditions and COVID-19 epidemiology and pathophysiology. The potential for treatment strategies used for altitude illnesses is evaluated. Symptomatic overlaps in the pathophysiology of COVID-19 induced ARDS and high altitude illnesses (i.e., hypoxemia, dyspnea…) have been reported but are also common to other pathologies (i.e., heart failure, pulmonary embolism, COPD…). Most treatments of altitude illnesses have limited value and may even be detrimental in COVID-19. Some may be efficient, potentially the corticosteroid dexamethasone. Physiological adaptations to altitude/hypoxia can exert diverse effects, depending on the constitution of the target individual and the hypoxic dose. In healthy individuals, they may optimize oxygen supply and increase mitochondrial, antioxidant, and immune system function. It is highly debated if these physiological responses to hypoxia overlap in many instances with SARS-CoV-2 infection and may exert preventive effects under very specific conditions. The temporal overlap of SARS-CoV-2 infection and exposure to altitude/hypoxia may be detrimental. No evidence-based knowledge is presently available on whether and how altitude/hypoxia may prevent, treat or aggravate COVID-19. The reported lower incidence and mortality of COVID-19 in high-altitude places remain to be confirmed. High-altitude illnesses and COVID-19 pathologies exhibit clear pathophysiological differences. While potentially effective as a prophylactic measure, altitude/hypoxia is likely associated with elevated risks for patients with COVID-19. Altogether, the different points discussed in this review are of possibly some relevance for individuals who aim to reach high-altitude areas. However, due to the ever-changing state of understanding of COVID-19, all points discussed in this review may be out of date at the time of its publication.
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Affiliation(s)
| | - Tadej Debevec
- Faculty of SportUniversity of LjubljanaLjubljanaSlovenia
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Barclay H, Mukerji S, Kayser B, O'Donnell T, Tzeng YC, Hill S, Knapp K, Legg S, Frei D, Fan JL. Respiratory alkalinization and posterior cerebral artery dilatation predict acute mountain sickness severity during 10 h normobaric hypoxia. Exp Physiol 2020; 106:175-190. [PMID: 33347666 DOI: 10.1113/ep088938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Abstract
NEW FINDINGS What is the central question of this study? The pathophysiology of acute mountain sickness (AMS), involving the respiratory, renal and cerebrovascular systems, remains poorly understood. How do the early adaptations in these systems during a simulated altitude of 5000 m relate to AMS risk? What is the main finding and its importance? The rate of blood alkalosis and cerebral artery dilatation predict AMS severity during the first 10 h of exposure to a simulated altitude of 5000 m. Slow metabolic compensation by the kidneys of respiratory alkalosis attributable to a brisk breathing response together with excessive brain blood vessel dilatation might be involved in early development of AMS. ABSTRACT The complex pathophysiology of acute mountain sickness (AMS) remains poorly understood and is likely to involve maladaptive responses of the respiratory, renal and cerebrovascular systems to hypoxia. Using stepwise linear regression, we tested the hypothesis that exacerbated respiratory alkalosis, as a result of a brisk ventilatory response, sluggish renal compensation in acute hypoxia and dysregulation of cerebral perfusion predict AMS severity. We assessed the Lake Louise score (LLS, an index of AMS severity), fluid balance, ventilation, venous pH, bicarbonate, sodium and creatinine concentrations, body weight, urinary pH and cerebral blood flow [internal carotid artery (ICA) and vertebral artery (VA) blood flow and diameter], in 27 healthy individuals (13 women) throughout 10 h exposures to normobaric normoxia (fraction of inspired O2 = 0.21) and normobaric hypoxia (fraction of inspired O2 = 0.117, simulated 5000 m) in a randomized, single-blinded manner. In comparison to normoxia, hypoxia increased the LLS, ventilation, venous and urinary pH, and blood flow and diameter in the ICA and VA, while venous concentrations of both bicarbonate and creatinine were decreased (P < 0.001 for all). There were significant correlations between AMS severity and the rates of change in blood pH, sodium concentration and VA diameter and more positive fluid balance (P < 0.05). Stepwise regression found increased blood pH [beta coefficient (β) = 0.589, P < 0.001] and VA diameter (β = 0.418, P = 0.008) to be significant predictors of AMS severity in our cohort [F(2, 20) = 16.1, R2 = 0.617, P < 0.001, n = 24], accounting for 62% of the variance in peak LLS. Using classic regression variable selection, our data implicate the degree of respiratory alkalosis and cerebrovascular dilatation in the early stages of AMS development.
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Affiliation(s)
- Holly Barclay
- Wellington Medical Technology Group, Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand.,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Saptarshi Mukerji
- Emergency Department, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Terrence O'Donnell
- Wellington Medical Technology Group, Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand.,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Yu-Chieh Tzeng
- Wellington Medical Technology Group, Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand.,Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Stephen Hill
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Katie Knapp
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Stephen Legg
- Centre for Ergonomics, Occupational Health and Safety, Massey University, Palmerston North, New Zealand
| | - Dan Frei
- Department of Anaesthesia and Pain Medicine, Wellington Regional Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - Jui-Lin Fan
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Sareban M, Schiefer LM, Macholz F, Schäfer L, Zangl Q, Inama F, Reich B, Mayr B, Schmidt P, Hartl A, Bärtsch P, Niebauer J, Treff G, Berger MM. Endurance Athletes Are at Increased Risk for Early Acute Mountain Sickness at 3450 m. Med Sci Sports Exerc 2020; 52:1109-1115. [PMID: 31876668 DOI: 10.1249/mss.0000000000002232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Acute mountain sickness (AMS) may develop in nonacclimatized individuals after exposure to altitudes ≥2500 m. Anecdotal reports suggest that endurance-trained (ET) athletes with a high maximal oxygen uptake (V˙O2max) may be at increased risk for AMS. Possible underlying mechanisms include a training-induced increase in resting parasympathetic activity, higher resting metabolic rate (RMR), and lower hypoxic ventilatory response (HVR). METHODS In 38 healthy, nonacclimatized men (19 ET and 19 untrained controls [UT], V˙O2max 66 ± 6 mL·min·kg vs 45 ± 7 mL·min·kg; P < 0.001) peripheral oxygen saturation (SpO2), heart rate variability, RMR, and poikilocapnic HVR were assessed at 424 m and during 48 h at 3450 m after passive ascent by train (~2 h). Acute mountain sickness was evaluated by AMS cerebral (AMS-C) score. RESULTS On day 1 at altitude, ET presented with a higher AMS incidence (42% vs 11%; P < 0.05) and severity (AMS-C score: ET, 0.48 ± 0.5 vs UT, 0.21 ± 0.2; P = 0.03), but no group difference was found on days 2 and 3. SpO2 decreased upon arrival at altitude (ET: 82% ± 6% vs UT: 83% ± 4%; ptime <0.001) with a significantly different time course between ET and UT (ptime × group = 0.045). Parasympathetic activity decreased at altitude (P < 0.001) but was always higher in ET (P < 0.05). At altitude RMR increased (P < 0.001) and was higher in ET (P < 0.001). Hypoxic ventilatory response increased only in ET (P < 0.05) and was greater than in UT after 24 and 48 h (P < 0.05). CONCLUSIONS Endurance-trained athletes are at higher risk for developing AMS on the first day after passive and rapid ascent to 3450 m, possibly due to an increased parasympathetic activity and an increased RMR, while HVR appeared to be of minor importance. Differences in AMS time course and physiological responses should be taken into consideration when ET are planning high-altitude sojourns.
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Affiliation(s)
- Mahdi Sareban
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Lisa M Schiefer
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Franziska Macholz
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Larissa Schäfer
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Quirin Zangl
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Franciscus Inama
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Bernhard Reich
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Barbara Mayr
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Peter Schmidt
- Department of Anesthesiology, Perioperative and General Critical Care Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Arnulf Hartl
- Institute of Ecomedicine, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Peter Bärtsch
- Department of Internal Medicine, University of Heidelberg, Heidelberg, GERMANY
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, AUSTRIA
| | - Gunnar Treff
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, GERMANY
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Nowadly CD, Solomon AJ, Burke SM, Rose JS. Evaluation of Serial Chest Radiographs of High-Altitude Pulmonary Edema Requiring Medical Evacuation from South Pole Station, Antarctica: From Diagnosis to Recovery. Mil Med 2020; 186:e1135-e1139. [DOI: 10.1093/milmed/usaa490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Introduction
Chest radiography is a diagnostic tool commonly used by medical providers to assess high-altitude pulmonary edema (HAPE). Although HAPE often causes a pattern of pulmonary edema with right lower lung predominance, previous research has shown that there is no single radiographic finding associated with the condition. The majority of research involves a retrospective analysis of chest radiographs taken at the time of HAPE diagnosis. Little is known about the radiographic progression of HAPE during treatment or medical evacuation.
Materials and Methods
Three sequential chest radiographs were obtained from two patients diagnosed with HAPE at the Amundsen-Scott South Pole Station, Antarctica, who required treatment and medical evacuation. Deidentified and temporally randomized images were reviewed in a blinded fashion by two radiologists. A score of 0 (normal lung) to 4 (alveolar disease) was assigned for each of the four lung quadrants for an aggregate possible score ranging from 0 to 16 for each radiograph.
Results
Patient 1’s initial radiograph showed severe HAPE with an initial score of 13. Despite a rapid clinical improvement after medical evacuation, he continued to show multifocal radiographic evidence of disease in all the lung quadrants on day 1 (score of 11) and day 2 (score of 5). Patient 2’s radiographs showed less severe disease at presentation (score of 6). Despite the need for continued treatment, his radiographs showed a rapid improvement, with radiographic score decreasing to 3 on day 1 and 1 on day 3.
Conclusion
The chest radiographs showed serial improvement after medical evacuation in both patients. There was not a strong correlation between clinical symptoms and radiographic severity in subsequent images.
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Affiliation(s)
- Craig D Nowadly
- Department of Emergency Medicine, University of California at Davis, Sacramento, CA 95817, USA
| | - Alex J Solomon
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sean M Burke
- Department of Radiology, The University of Texas Health Science Center, Houston, TX 77030, USA
| | - John S Rose
- Department of Emergency Medicine, University of California at Davis, Sacramento, CA 95817, USA
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Dalby T, Wohl E, Dinsmore M, Unger Z, Chowdhury T, Venkatraghavan L. Pathophysiology of Cerebral Edema—A Comprehensive Review. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1721165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
AbstractCerebral edema is a condition where an excess of cerebral water accumulates due to primary neurological or non-neurological causes. Cerebral edema complicates many brain pathologies causing additional injury often in excess of the original neurological insult. Classic descriptions divide cerebral edema into cytotoxic, vasogenic, interstitial, and osmotic subtypes. The interplay of different mechanisms is important in the clinical manifestations. Recent research has advanced our understanding of the molecular pathophysiology of cerebral edema, exposing the central role of aquaporins and specific ion channels. The aim of this review is to provide a comprehensive overview of the molecular pathophysiology of cerebral edema including unique disease specific mechanisms.
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Affiliation(s)
- Tara Dalby
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Elyana Wohl
- Department of Anesthesia, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Michael Dinsmore
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Zoe Unger
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Tumul Chowdhury
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Lakshmikumar Venkatraghavan
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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134
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Bazilio DS, Rodrigues KL, Moraes DJA, Machado BH. Distinct cardiovascular and respiratory responses to short-term sustained hypoxia in juvenile Sprague Dawley and Wistar Hannover rats. Auton Neurosci 2020; 230:102746. [PMID: 33260056 DOI: 10.1016/j.autneu.2020.102746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022]
Abstract
Short-term sustained hypoxia (SH) elicits active expiration, augmented late-expiratory (late-E) sympathetic activity, increased arterial pressure and ventilation, and amplified sympathetic and abdominal expiratory responses to chemoreflex activation in rats of the Wistar-Ribeirão Preto (WRP) strain. Herein, we investigated whether SH can differentially affect the cardiovascular and respiratory outcomes of Sprague-Dawley (SD) and Wistar Hannover (WH) rats and compared the results with previous data using WRP rats. For this, we exposed SD and WH rats to SH (FiO2 = 0.1) for 24 h and evaluated arterial pressure, sympathetic activity, and respiratory pattern. SD rats presented increased arterial pressure, respiratory rate and tidal volume, as well as augmented late-E expiratory motor output and increased sympathetic outflow due to post-inspiratory and late-E sympathetic overactivity. WH rats presented reduced changes, suggesting lower responsiveness of this strain to this SH protocol. The magnitudes of changes in sympathetic and abdominal expiratory motor activities to chemoreflex activation in SD rats were reduced by SH. Pressor responses to chemoreflex activation were shown to be blunted in SD and WH rats after SH. The data are showing that SD, WH, and WRP rat strains exhibit marked differences in their cardiovascular, autonomic and respiratory responses to 24-h SH and draw attention to the importance of rat strain for studies exploring the underlying mechanisms involved in the neuronal changes induced by the experimental model of SH.
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Affiliation(s)
- Darlan S Bazilio
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Karla L Rodrigues
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Davi J A Moraes
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
| | - Benedito H Machado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil.
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135
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Hamm W, Kassem S, von Stülpnagel L, Maier F, Klemm M, Schüttler D, Grabher F, Weckbach LT, Huber BC, Bauer A, Rizas KD, Brunner S. Deceleration Capacity and Periodic Repolarization Dynamics As Predictors of Acute Mountain Sickness. High Alt Med Biol 2020; 21:417-422. [DOI: 10.1089/ham.2020.0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wolfgang Hamm
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Sari Kassem
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Lukas von Stülpnagel
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Medicine III, University Hospital, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Maier
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Mathias Klemm
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Dominik Schüttler
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Felix Grabher
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Ludwig T. Weckbach
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Bruno C. Huber
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Axel Bauer
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Medicine III, University Hospital, Medical University of Innsbruck, Innsbruck, Austria
| | - Konstantinos D. Rizas
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Stefan Brunner
- Department of Medicine I, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
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Wang Y, Duo D, Yan Y, He R, Wang S, Wang A, Wu X. Bioactive constituents of Salvia przewalskii and the molecular mechanism of its antihypoxia effects determined using quantitative proteomics. PHARMACEUTICAL BIOLOGY 2020; 58:469-477. [PMID: 32476549 PMCID: PMC7336993 DOI: 10.1080/13880209.2020.1762668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/27/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
Context: Environmental hypobaric hypoxia induces several physiological or pathological responses in individuals in high-altitude regions. Salvia przewalskii Maxim (Labiatae) (SPM) is a traditional Chinese herbal medicine and has known antibacterial, antiviral, antioxidant, anti-thrombotic, and anti-depressant activities.Objective: This study examined the antihypoxia effects of SPM in vivo.Materials and methods: The dried and pulverised of SPM was extracted from root crude drug with 70% ethanol with ultrasound. Male Sprague-Dawley rats were divided into three groups (n = 10): normal group, hypoxia group (altitude of 4260 m), and hypoxia + SPM group (altitude of 4260 m, SPM of 1.0 g/kg/day). The experiment persisted for 4 weeks. The mean pulmonary arterial pressure (mPAP), hypoxia-inducible factor-1α (HIF-1α) mRNA, and lung pathology were analysed using pulmonary artery pressure recorder, quantitative polymerase chain reaction, and histopathological analysis. Moreover, the effects of SPM on lung proteomes during hypoxia were observed by a TMT-based proteomic approach.Results: Pre-treatment with SPM decreased mPAP (24.86%) and HIF-1α (31.24%), and attenuated the pathological changes in lung tissues. In addition, a total of 28 proteins were differentially expressed in lung of hypoxia + SPM group (fold change > ± 1.2 and p < 0.05). The differentially altered proteins were primarily associated with antioxidative stress, as evidenced by the downregulated expression of Adh7, Cyp2d1, Plod2, Selenow, ND3, and Fabp1, and fructose metabolism, as evidenced by the downregulated expression of Khk and Aldob.Discussion and conclusions: These results suggested that SPM is a promising drug for antihypoxia. The mechanism of action might be related to increasing antioxidant capacity and inhibiting fructose metabolism.
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Affiliation(s)
- Yafeng Wang
- People’s Hospital of Qinghai Province, Xining, China
| | - Delong Duo
- People’s Hospital of Qinghai Province, Xining, China
| | - Yingjun Yan
- People’s Hospital of Qinghai Province, Xining, China
| | - Rongyue He
- People’s Hospital of Qinghai Province, Xining, China
| | | | - Aixia Wang
- People’s Hospital of Qinghai Province, Xining, China
| | - Xinan Wu
- Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou, China
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137
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Sánchez K, Ballaz SJ. Might a high hemoglobin mass be involved in non-cardiogenic pulmonary edema? The case of the chronic maladaptation to high-altitude in the Andes. Med Hypotheses 2020; 146:110418. [PMID: 33268002 DOI: 10.1016/j.mehy.2020.110418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
Exposure to hypoxic environments when ascending at high altitudes may cause life-threatening pulmonary edema (HAPE) due to a rapid accumulation of extracellular fluid flooding in the pulmonary alveoli. In Andeans, high-altitude adaptation occurs at the expense of being more prone to chronic mountain sickness: relative hypoventilation, excess pulmonary hypertension, and secondary polycythemia. Because HAPE prevalence is high in the Andes, we posit the hypothesis that a high hemoglobine mass may increase HAPE risk. In support of it, high intrapulmonary hypertension along with hyperviscosity produced by polycytemia may enhance sear forces and intravascular hemolysis, thus leading to increased acellular hemoglobin and the subsequent damage of the alveolar and endothelial barrier. It is proposed to investigate the relationship between the vaso-endothelial homeostasis and erythropoiesis in the maladaptation to high altitude and HAPE. This research is especially important when reentry HAPE, since rheologic properties of blood changes with rapid ascent to high altitudes.
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Affiliation(s)
- Karen Sánchez
- School of Biological Sciences & Engineering. Yachay Tech University, San Miguel de Urcuquí, Ecuador
| | - Santiago J Ballaz
- School of Biological Sciences & Engineering. Yachay Tech University, San Miguel de Urcuquí, Ecuador.
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138
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Chanana N, Palmo T, Newman JH, Pasha MAQ. Vascular homeostasis at high-altitude: role of genetic variants and transcription factors. Pulm Circ 2020; 10:2045894020913475. [PMID: 33282179 PMCID: PMC7682230 DOI: 10.1177/2045894020913475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/14/2020] [Indexed: 12/24/2022] Open
Abstract
High-altitude pulmonary edema occurs most frequently in non-acclimatized low landers on exposure to altitude ≥2500 m. High-altitude pulmonary edema is a complex condition that involves perturbation of signaling pathways in vasoconstrictors, vasodilators, anti-diuretics, and vascular growth factors. Genetic variations are instrumental in regulating these pathways and evidence is accumulating for a role of epigenetic modification in hypoxic responses. This review focuses on the crosstalk between high-altitude pulmonary edema-associated genetic variants and transcription factors, comparing high-altitude adapted and high-altitude pulmonary edema-afflicted subjects. This approach might ultimately yield biomarker information both to understand and to design therapies for high-altitude adaptation.
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Affiliation(s)
- Neha Chanana
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - Tsering Palmo
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi, India
| | - John H Newman
- Pulmonary Circulation Center, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M A Qadar Pasha
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Delhi, India.,Indian Council of Medical Research, New Delhi, India
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139
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Biollaz J, Buclin T, Hildebrandt W, Décosterd LA, Nussberger J, Swenson ER, Bärtsch P. No renal dysfunction or salt and water retention in acute mountain sickness at 4,559 m among young resting males after passive ascent. J Appl Physiol (1985) 2020; 130:226-236. [PMID: 33180647 DOI: 10.1152/japplphysiol.00382.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined the role and function of the kidney at high altitude in relation to fluid balance and the development of acute mountain sickness (AMS), avoiding confounders that have contributed to conflicting results in previous studies. We examined 18 healthy male resting volunteers (18-40 yr) not acclimatized to high altitude while on a controlled diet for 24 h at Lausanne (altitude: 560 m) followed by a period of 44 h after reaching the Regina Margherita hut (4,559 m) by helicopter. AMS scores peaked after 20 h at 4,559 m. AMS was defined as functional Lake Louise score ≥ 2. There were no significant differences between 10 subjects with and 8 subjects without AMS for urinary flow, fluid balance, and weight change. Sodium excretion rate was lower in those with AMS after 24 h at altitude. Microalbuminuria increased at altitude but was not different between the groups. Creatinine clearance was not affected by altitude or AMS, whereas clearances of sinistrin and p-aminohippuric acid decreased slightly, somewhat more in those without AMS. Plasma concentrations of epinephrine, norepinephrine, atrial natriuretic factor, and vasopressin increased whereas renin activity, angiotensin, and aldosterone decreased at altitude. Circulating hormone concentrations did not differ between those with and without AMS. Summarizing, in healthy resting young men flown by helicopter to 4,559 m, renal function was not affected by hypoxia except for minor microalbuminuria, high altitude diuresis did not occur, and AMS was not associated with salt and water retention or renal dysfunction.NEW & NOTEWORTHY Kidney function remained essentially unaffected and acute mountain sickness (AMS) was not associated with salt and water retention in healthy young men flown to and resting at the Margherita hut (4,559 m) under strictly controlled conditions maintaining water, salt, and food intake at pre-exposure levels. Thus, renal dysfunction and fluid retention are not essential factors contributing to the pathophysiology of AMS.
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Affiliation(s)
- Jérôme Biollaz
- Service of Clinical Pharmacology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Wulf Hildebrandt
- Institute of Anatomy and Cell Biology, Philipps-University of Marburg, Marburg, Germany.,Department of Internal Medicine, University Clinic, Heidelberg, Germany
| | - Laurent A Décosterd
- Service of Clinical Pharmacology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jürg Nussberger
- Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Erik R Swenson
- Department of Internal Medicine, University Clinic, Heidelberg, Germany.,Pulmonary and Critical Care Medicine, Medical Service, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington
| | - Peter Bärtsch
- Department of Internal Medicine, University Clinic, Heidelberg, Germany
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140
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Tian X, Ma J, Wu Y, Zhang P, Li Q, Zhang H, Wu C. Functional analysis of the brain natriuretic peptide gene for high-altitude adaptation in Tibetan pigs. Gene 2020; 768:145305. [PMID: 33186614 DOI: 10.1016/j.gene.2020.145305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/22/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Abstract
High-altitude adaptation in Tibetan pigs (TP) is associated with positively-selected genes. The brain natriuretic peptide (BNP) gene is critical in the regulation of cardiovascular homeostasis and energy metabolism. The present study was conducted to identify the function of BNP for high-altitude adaptations in TP. RT-qPCR and western blotting results indicated that BNP expression could be upregulated when the pigs (especially for the Tibetan pigs) were raised to high altitude. In the 5' flanking region, three polymorphic sites, A-1964G, C-1780G, and T-940C were detected, and the genotype distribution of C-1780G was significantly different between the highland (TP) and lowland (Diannan small-eared pig; Yorkshire pig) breeds. The site of C-1780G was in active promoter regions identified using the luciferase reporter gene system, and the fragment with allele G had higher transcriptional activity than that with allele C. The TP population had a higher frequency of allele G than the two lowland breeds. Our results collectively demonstrated that the G allele of C-1780G in the BNP gene may be advantageous for high-altitude adaptation in pigs through upregulating BNP expression. Our findings provide information that helps toward a comprehensive understanding of the mechanism underlying the involvement of the BNP gene in high-altitude adaptation.
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Affiliation(s)
- Xiaolong Tian
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, China Agricultural University, Beijing 100193, China
| | - Jun Ma
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, China Agricultural University, Beijing 100193, China
| | - Yijing Wu
- Institute of Animal Science and Veterinary Medicine, Anhui Academy of Agriculture Science, Hefei 230031, China
| | - Pan Zhang
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, China Agricultural University, Beijing 100193, China
| | - Qinggang Li
- Institute of Animal Science and Veterinary Medicine, Anhui Academy of Agriculture Science, Hefei 230031, China
| | - Hao Zhang
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, China Agricultural University, Beijing 100193, China.
| | - Changxin Wu
- National Engineering Laboratory for Animal Breeding, Beijing Key Laboratory for Animal Genetic Improvement, China Agricultural University, Beijing 100193, China
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141
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Shen Y, Yang YQ, Liu C, Yang J, Zhang JH, Jin J, Tan H, Yuan FZY, Ke JB, He CY, Zhang LP, Zhang C, Yu J, Huang L. Association between physiological responses after exercise at low altitude and acute mountain sickness upon ascent is sex-dependent. Mil Med Res 2020; 7:53. [PMID: 33148321 PMCID: PMC7643355 DOI: 10.1186/s40779-020-00283-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 10/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Acute mountain sickness (AMS) is the mildest form of acute altitude illnesses, and consists of non-specific symptoms when unacclimatized persons ascend to elevation of ≥2500 m. Risk factors of AMS include: the altitude, individual susceptibility, ascending rate and degree of pre-acclimatization. In the current study, we examined whether physiological response at low altitude could predict the development of AMS. METHODS A total of 111 healthy adult healthy volunteers participated in this trial; and 99 (67 men and 32 women) completed the entire study protocol. Subjects were asked to complete a 9-min exercise program using a mechanically braked bicycle ergometer at low altitude (500 m). Heart rate, blood pressure (BP) and pulse oxygen saturation (SpO2) were recorded prior to and during the last minute of exercise. The ascent from 500 m to 4100 m was completed in 2 days. AMS was defined as ≥3 points in a 4-item Lake Louise Score, with at least one point from headache wat 6-8 h after the ascent. RESULTS Among the 99 assessable subjects, 47 (23 men and 24 women) developed AMS at 4100 m. In comparison to the subjects without AMS, those who developed AMS had lower proportion of men (48.9% vs. 84.6%, P < 0.001), height (168.4 ± 5.9 vs. 171.3 ± 6.1 cm, P = 0.019), weight (62.0 ± 10.0 vs. 66.7 ± 8.6 kg, P = 0.014) and proportion of smokers (23.4% vs. 51.9%, P = 0.004). Multivariate regression analysis revealed the following independent risks for AMS: female sex (odds ratio (OR) =6.32, P < 0.001), SpO2 change upon exercise at low altitude (OR = 0.63, P = 0.002) and systolic BP change after the ascent (OR = 0.96, P = 0.029). Women had larger reduction in SpO2 after the ascent, higher AMS percentage and absolute AMS score. Larger reduction of SpO2 after exercise was associated with both AMS incidence (P = 0.001) and AMS score (P < 0.001) in men but not in women. CONCLUSIONS Larger SpO2 reduction after exercise at low altitude was an independent risk for AMS upon ascent. Such an association was more robust in men than in women. TRIAL REGISTRATION Chinese Clinical Trial Registration, ChiCTR1900025728 . Registered 6 September 2019.
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Affiliation(s)
- Yang Shen
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Yuan-Qi Yang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Ji-Hang Zhang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jun Jin
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Hu Tan
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Fang-Zheng-Yuan Yuan
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jing-Bin Ke
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Chun-Yan He
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Lai-Ping Zhang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Chen Zhang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Jie Yu
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China. .,Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing, 400037, China.
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142
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Ma J, Wang C, Sun Y, Pang L, Zhu S, Liu Y, Zhu L, Zhang S, Wang L, Du L. Comparative study of oral and intranasal puerarin for prevention of brain injury induced by acute high-altitude hypoxia. Int J Pharm 2020; 591:120002. [PMID: 33141084 DOI: 10.1016/j.ijpharm.2020.120002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
Human activities in the areas of high altitude have increased significantly recently. Brain is highly sensitive to changing of oxygen pressure due to high altitude, and this physiological response may lead to serious brain injury, such as learning and memory disabilities. Puerarin is a phytoestrogen with many pharmacological activities, such as treatment of neurological disorders. However, most of current drugs can not easily enter brain through the blood-brain barrier (BBB). The nose-to-brain route can bypass BBB for brain-targeting. Here, thermosensitive in situ hydrogels (TISGs) of puerarin were prepared with poloxamers 407, poloxamers 188 and propylene glycol to improve bioavailability and brain targeting. In vitro drug release in simulated nasal fluids, rheological properties and cilia toxicity of puerarin TISGs were explored. The pharmacodynamics and pharmacokinetics of puerarin by intranasal (i.n.) and oral (p.o.) administrations were also evaluated. The viscosity of puerarin TISGs tended to increase obviously with increased temperature. The puerarin release profile and transmucosal process of puerarin TISGs could be described with the first-order kinetics equation, depending on drug diffusion. The cilia toxicity of puerarin TISGs was not obvious. Rat models of hypobarism/hypoxia-induced brain injury were established with a hypobaric simulation chamber. Morris water maze and open filed tests indicated that puerarin TISGs improved the spatial memory and spontaneous exploratory behavior of the rats suffering from hypoxia-induced brain injury. Furthermore, puerarin TISGs decreased the level of oxidative stress cytokines (malondialdehyde (MDA) and glutathione (GSH)) in the peripheral circulation, alleviated the cerebral histological lesions, and relieved the expression of hypoxia-inducible factor-1α (HIF-1α). Intranasal puerarin TISGs were absorbed quickly with a shorter Tmax (10.0 ± 5.7 min) compared to that of oral puerarin (36 ± 13.4 min). In addition, the relative bioavailability of i.n. puerarin TISGs was high to 300% compared to oral administration of puerarin. The area under the curve (AUC) of brain after i.n. administration of puerarin TISGs was 954.5 ± 335.1 h.ng/mL, while no puerarin was detected in the brain after oral administration. Therefore, i.n. puerarin TISGs led to excellent brain targeting effect. Puerarin TISGs are an effective neuroprotector formulation for prevention of brain injury induced by acute high-altitude hypoxia.
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Affiliation(s)
- Jinqiu Ma
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Chenyun Wang
- Chinese PLA General Hospital, Beijing 100853, China
| | - Yunbo Sun
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Lulu Pang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Siqing Zhu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Yijing Liu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Lin Zhu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Shouguo Zhang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Lin Wang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Lina Du
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; School of Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China.
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143
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Dzhalilova D, Makarova O. Differences in Tolerance to Hypoxia: Physiological, Biochemical, and Molecular-Biological Characteristics. Biomedicines 2020; 8:E428. [PMID: 33080959 PMCID: PMC7603118 DOI: 10.3390/biomedicines8100428] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Hypoxia plays an important role in the development of many infectious, inflammatory, and tumor diseases. The predisposition to such disorders is mostly provided by differences in basic tolerance to oxygen deficiency, which we discuss in this review. Except the direct exposure of different-severity hypoxia in decompression chambers or in highland conditions, there are no alternative methods for determining organism tolerance. Due to the variability of the detection methods, differences in many parameters between tolerant and susceptible organisms are still not well-characterized, but some of them can serve as biomarkers of susceptibility to hypoxia. At the moment, several potential biomarkers in conditions after hypoxic exposure have been identified both in experimental animals and humans. The main potential biomarkers are Hypoxia-Inducible Factor (HIF)-1, Heat-Shock Protein 70 (HSP70), and NO. Due to the different mechanisms of various high-altitude diseases, biomarkers may not be highly specific and universal. Therefore, it is extremely important to conduct research on hypoxia susceptibility biomarkers. Moreover, it is important to develop a method for the evaluation of organisms' basic hypoxia tolerance without the necessity of any oxygen deficiency exposure. This can contribute to new personalized medicine approaches' development for diagnostics and the treatment of inflammatory and tumor diseases, taking into account hypoxia tolerance differences.
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Affiliation(s)
- Dzhuliia Dzhalilova
- Department of Immunomorphology of Inflammation, Federal State Budgetary Institution ‘Research Institute of Human Morphology’, Moscow 117418, Russia;
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144
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Siques P, Brito J, Ordenes S, Pena E. Involvement of overweight and lipid metabolism in the development of pulmonary hypertension under conditions of chronic intermittent hypoxia. Pulm Circ 2020; 10:42-49. [PMID: 33110496 PMCID: PMC7557786 DOI: 10.1177/2045894020930626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022] Open
Abstract
There is growing evidence that exposure to hypoxia, regardless of the source,
elicits several metabolic responses in individuals. These responses are
constitutive and are usually observed under hypoxia but vary according to the
type of exposure. The aim of this review was to describe the involvement of
obesity and lipid metabolism in the development of high-altitude pulmonary
hypertension and in the development of acute mountain sickness under chronic
intermittent hypoxia. Overweight or obesity, which are common in individuals
with long-term chronic intermittent hypoxia exposure (high-altitude miners,
shift workers, and soldiers), are thought to play a major role in the
development of acute mountain sickness and high-altitude pulmonary hypertension.
This association may be rooted in the interactions between obesity-related
metabolic and physical alterations, such as increased waist circumference and
neck circumference, among others, which lead to critical ventilation
impairments; these impairments aggravate hypoxemia at high altitude, thereby
triggering high-altitude diseases. Overweight and obesity are strongly
associated with higher mean pulmonary artery pressure in the context of
long-term chronic intermittent hypoxia. Remarkably, de novo synthesis of
triglycerides by the sterol regulatory element-binding protein-1c pathway has
been demonstrated, mainly due to the upregulation of stearoyl-CoA desaturase-1,
which is also associated with the same outcomes. Therefore, overweight, obesity,
and other metabolic conditions may hinder proper acclimatization. The involved
mechanisms include respiratory impairment, alteration of the nitric oxide
pathways, inflammatory status, reactive oxygen species imbalance, and other
metabolic changes; however, further studies are required.
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Affiliation(s)
- Patricia Siques
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile.,Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Iquique (Chile)
| | - Julio Brito
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile.,Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Iquique (Chile)
| | - Stefany Ordenes
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile.,Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Iquique (Chile)
| | - Eduardo Pena
- Institute of Health Studies, Universidad Arturo Prat, Iquique, Chile.,Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Iquique (Chile)
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145
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Benveniste H, Elkin R, Heerdt PM, Koundal S, Xue Y, Lee H, Wardlaw J, Tannenbaum A. The glymphatic system and its role in cerebral homeostasis. J Appl Physiol (1985) 2020; 129:1330-1340. [PMID: 33002383 DOI: 10.1152/japplphysiol.00852.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The brain's high bioenergetic state is paralleled by high metabolic waste production. Authentic lymphatic vasculature is lacking in brain parenchyma. Cerebrospinal fluid (CSF) flow has long been thought to facilitate central nervous system detoxification in place of lymphatics, but the exact processes involved in toxic waste clearance from the brain remain incompletely understood. Over the past 8 yr, novel data in animals and humans have begun to shed new light on these processes in the form of the "glymphatic system," a brain-wide perivascular transit passageway dedicated to CSF transport and interstitial fluid exchange that facilitates metabolic waste drainage from the brain. Here we will discuss glymphatic system anatomy and methods to visualize and quantify glymphatic system (GS) transport in the brain and also discuss physiological drivers of its function in normal brain and in neurodegeneration.
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Affiliation(s)
- Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Rena Elkin
- Departments of Computer Science and Applied Mathematics & Statistics, Stony Brook University, Stony Brook, New York
| | - Paul M Heerdt
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Sunil Koundal
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Yuechuan Xue
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Hedok Lee
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Joanna Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
| | - Allen Tannenbaum
- Departments of Computer Science and Applied Mathematics & Statistics, Stony Brook University, Stony Brook, New York
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146
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Shlim DR. The use of acetazolamide for the prevention of high-altitude illness. J Travel Med 2020; 27:5693888. [PMID: 31897486 DOI: 10.1093/jtm/taz106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Modern travel means that many travellers can arrive abruptly to high-altitude destinations without doing any trekking or climbing. Airports in high-altitude cities mean that travellers can go from sea level to over 3350-3960 m (11 000-13 000 feet) in a matter of hours, putting themselves at risk for high-altitude illness (HAI). METHODS Acetazolamide has been shown to be an effective way to help prevent HAI on such itineraries. The risk of HAI on rapid arrival to altitudes over 3350 m (11 000 feet) has been shown to range from 35% to nearly 50%. The risk can be higher for high-altitude trekking. This risk is far higher than most travel medicine risks and is on a par with the risk of travellers' diarrhea in high risk destinations. RESULT The use of prophylactic acetazolamide in a dosage of 125 mg every 12 h is highly effective at diminishing the risk of HAI. CONCLUSION Travel medicine practitioners should become comfortable with assessing the risk of HAI and determining when it is appropriate to offer acetazolamide prophylaxis to prevent HAI.
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Affiliation(s)
- David R Shlim
- Jackson Hole Travel and Tropical Medicine, Jackson Hole, WY, USA
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147
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Tannheimer M, Lechner R. Rapid ascents of Mt Everest: normobaric hypoxic preacclimatization. J Travel Med 2020; 27:5861564. [PMID: 32577764 DOI: 10.1093/jtm/taaa099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/22/2020] [Accepted: 06/11/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Acclimatization to high altitude is time consuming. An expedition to Mt Everest (8848 m) requires roughly 8 weeks. Therefore it seems very attractive to reach the summit within 3 weeks from home, which is currently promised by some expedition tour operators. These rapid ascent expeditions are based on two main components, normobaric hypoxic training (NHT) prior to the expedition and the use of high flow supplemental oxygen (HFSO2). We attempted to assess the relative importance of these two elements. METHODS We evaluated the effect of NHT on the basis of the available information of these rapid ascent expeditions and our experiences made during an expedition to Manaslu (8163 m) where we used NHT for preacclimatization. To evaluate the effect of an increased O2 flow rate we calculated its effect at various activity levels at altitudes of 8000 m and above. RESULTS So far rapid ascents to Mt Everest have been successful. The participants carried out 8 weeks of NHT, reaching sleeping altitudes = 7100 m and spent at least 300 h in NH. At rest a flow rate of 2 l O2/min is sufficient to keep the partial pressure of inspired oxygen (PIO2) close to 50 mm Hg even at the summit. For ativities of ~80% of the maximum rate of oxygen consumption (VO2max) at the summit 6 l O2/min are required to maintain a PIO2 above 50 mm Hg. DISCUSSION NHT for preacclimatization seems to be the decisive element of the offered rapid ascent expeditions. An increased O2 flow rate of 8 l/min is not mandatory for climbing Mt Everest. CONCLUSIONS Preacclimatization using normobaric hypoxica (NH) is far more important than the use of HFSO2. We think that NHT will be widely used in the future. The most effective regimen of preacclimatization in NH, the duration of each session and the optimal FIO2 are still unclear and require further study.
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Affiliation(s)
- Markus Tannheimer
- University of Ulm, Department of Sport and Rehabilitation Medicine, Leimgrubenweg 14, 89089075 Ulm/75 Ulm, Germany
| | - Raimund Lechner
- Department of Anaesthesiology and Intensive Care, Bundeswehr Hospital Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
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148
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Toussaint CM, Kenefick RW, Petrassi FA, Muza SR, Charkoudian N. Altitude, Acute Mountain Sickness, and Acetazolamide: Recommendations for Rapid Ascent. High Alt Med Biol 2020; 22:5-13. [PMID: 32975448 DOI: 10.1089/ham.2019.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Toussaint, Claudia M., Robert W. Kenefick, Frank A. Petrassi, Stephen R. Muza, and Nisha Charkoudian. Altitude, acute mountain sickness, and acetazolamide: recommendations for rapid ascent. High Alt Med Biol. 22:5-13, 2021. Background: Sea level natives ascending rapidly to altitudes above 1,500 m often develop acute mountain sickness (AMS), including nausea, headaches, fatigue, and lightheadedness. Acetazolamide (AZ), a carbonic anhydrase inhibitor, is a commonly used medication for the prevention and treatment of AMS. However, there is continued debate about appropriate dosing, particularly when considering rapid and physically demanding ascents to elevations above 3,500 m by emergency medical and military personnel. Aims: Our goal in the present analysis was to evaluate and synthesize the current literature regarding the use of AZ to determine the most effective dosing for prophylaxis and treatment of AMS for rapid ascents to elevations >3,500 m. These circumstances are specifically relevant to military and emergency medical personnel who often need to ascend rapidly and perform physically demanding tasks upon arrival at altitude. Methods: We conducted a literature search from April 2018 to February 2020 using PubMed, Google Scholar, and Web of Science to identify randomized controlled trials that compared AZ with placebo or other treatment with the primary endpoint of AMS incidence and severity. We included only research articles/studies that focused on evaluation of AZ use during rapid ascent. Results: Four doses of AZ (125, 250, 500, and 750 mg daily) were identified as efficacious in decreasing the incidence and/or severity of AMS during rapid ascents, with evidence of enhanced effectiveness with higher doses. Conclusions: For military, emergency medical, or other activities involving rapid ascent to altitudes >3,500 m, doses 500-750 mg/day within 24 hours of altitude exposure appear to be the most effective for minimizing symptoms of AMS.
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Affiliation(s)
- Claudia M Toussaint
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA.,Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Robert W Kenefick
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Frank A Petrassi
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Stephen R Muza
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Nisha Charkoudian
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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149
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Berger MM, Hackett PH, Bärtsch P. No Relevant Analogy Between COVID-19 and Acute Mountain Sickness. High Alt Med Biol 2020; 21:315-318. [PMID: 32970479 DOI: 10.1089/ham.2020.0147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Berger, Marc Moritz, Peter H. Hackett, and Peter Bärtsch. No relevant analogy between COVID-19 and acute mountain sickness. High Alt Med Biol. 21:315-318, 2020.-Clinicians and scientists have suggested therapies for coronavirus disease-19 (COVID-19) that are known to be effective for other medical conditions. A recent publication suggests that pathophysiological mechanisms underlying acute mountain sickness (a syndrome of nonspecific neurological symptoms typically experienced by nonacclimatized individuals at altitudes >2500 m) may overlap with the mechanisms causing COVID-19. In this short review, we briefly evaluate this mistaken analogy and demonstrate that this concept is not supported by scientific evidence.
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Affiliation(s)
- Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Peter H Hackett
- Altitude Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter Bärtsch
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
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150
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Nimje MA, Patir H, Tirpude RK, Reddy PK, Kumar B. Physiological and oxidative stress responses to intermittent hypoxia training in Sprague Dawley rats. Exp Lung Res 2020; 46:376-392. [PMID: 32930002 DOI: 10.1080/01902148.2020.1821263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Rapid ascent to high altitude and inability to acclimatize lead to high-altitude illnesses. Intermittent hypoxia (IH) conditioning has been hypothesized as a non-pharmacological strategy aiming to improve adaptive responses during high altitude ascent. In the recent years, IH training (IHT) has become increasingly popular among recreational and professional athletes owing to its ability to mitigate high altitude related problems. This study aimed at exploring the role of IHT in altitude acclimatization. METHODS Male Sprague Dawley rats were subjected to IHT for 4 h consecutively for 5 days at 12% FiO2 under normobaric conditions. To assess the effect of IHT in hypoxic acclimatization, animals were further exposed to extreme hypoxia (EH) at 8% FiO2. Oxygen saturation (SpO2), respiratory rate and heart rate were recorded during the exposure. Oxidative stress (ROS, MDA, and 4-HNE) and histopathological examinations were studied in the lung tissue sections. Hypoxia biomarkers, HIF-1α, EPO, VEGF, and BPGM were evaluated through western blotting in the lung tissue. RESULTS Assessment of the IHT showed that SpO2 levels were found to be higher in the IH trained rats with a statistical difference of p < 0.01 in the first hour of hypoxia exposure as compared to the untrained rats. There was a significantly higher (p < 0.001) generation of ROS and MDA in the untrained rats as compared to the trained rats. Lipid peroxidation markers and systemic inflammatory marker were found to be expressed at much higher level in the untrained rats. There was a higher expression of HIF-1α (1.24-fold ↑), VEGF (1.14-fold ↑) and decrease in EPO (1.43-fold ↓) in the untrained rats as compared to trained rats. CONCLUSIONS Preconditioning with IHT resulted in the reduction in hypoxia induced oxidative stress during extreme hypoxia exposure and thus, maintaining redox balance as well as adjustment in the physiological changes in rats.
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Affiliation(s)
- Megha A Nimje
- Defence Institute of Physiology and Allied Sciences (DIPAS), (DRDO), Timarpur, Delhi, India
| | - Himadri Patir
- Defence Institute of Physiology and Allied Sciences (DIPAS), (DRDO), Timarpur, Delhi, India
| | - Rajesh Kumar Tirpude
- Defence Institute of Physiology and Allied Sciences (DIPAS), (DRDO), Timarpur, Delhi, India
| | - Prasanna K Reddy
- Defence Institute of Physiology and Allied Sciences (DIPAS), (DRDO), Timarpur, Delhi, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences (DIPAS), (DRDO), Timarpur, Delhi, India
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