Effects of high altitude exposure on the lungs of young rats

Parabronchial remodeling in chicks in response to embryonic hypoxia

The embryonic development of parabronchi occurs mainly during the second half of incubation in precocious birds, which makes this phase sensitive to possible morphological modifications induced by O₂ supply limitation. Thus, we hypothesized that hypoxia during the embryonic phase of parabronchial development induces morphological changes that remain after hatching. To test this hypothesis, chicken embryos were incubated entirely (21 days) under normoxia or partially under hypoxia (15% O₂ during days 12 to 18). Lung structures, including air capillaries, blood capillaries, infundibula, atria, parabronchial lumen, bronchi, blood vessels larger than capillaries and interparabronchial tissue, in 1- and 10-day-old chicks were analyzed using light microscopy-assisted stereology. Tissue barrier and surface area of air capillaries were measured using electron microscopy-assisted stereology, allowing for calculation of the anatomical diffusion factor. Hypoxia increased the relative volumes of air and blood capillaries, structures directly involved in gas exchange, but decreased the relative volumes of atria in both groups of chicks, and the parabronchial lumen in older chicks. Accordingly, the surface area of the air capillaries and the anatomical diffusion factor were increased under hypoxic incubation. Treatment did not alter total lung volume, relative volumes of infundibula, bronchi, blood vessels larger than capillaries, interparabronchial tissue or the tissue barrier of any group. We conclude that hypoxia during the embryonic phase of parabronchial development leads to a morphological remodeling, characterized by increased volume density and respiratory surface area of structures involved in gas exchange at the expense of structures responsible for air conduction in chicks up to 10 days old.

Lung Structure and the Intrinsic Challenges of Gas Exchange

Structural and functional complexities of the mammalian lung evolved to meet a unique set of challenges, namely, the provision of efficient delivery of inspired air to all lung units within a confined thoracic space, to build a large gas exchange surface associated with minimal barrier thickness and a microvascular network to accommodate the entire right ventricular cardiac output while withstanding cyclic mechanical stresses that increase several folds from rest to exercise. Intricate regulatory mechanisms at every level ensure that the dynamic capacities of ventilation, perfusion, diffusion, and chemical binding to hemoglobin are commensurate with usual metabolic demands and periodic extreme needs for activity and survival. This article reviews the structural design of mammalian and human lung, its functional challenges, limitations, and potential for adaptation. We discuss (i) the evolutionary origin of alveolar lungs and its advantages and compromises, (ii) structural determinants of alveolar gas exchange, including architecture of conducting bronchovascular trees that converge in gas exchange units, (iii) the challenges of matching ventilation, perfusion, and diffusion and tissue-erythrocyte and thoracopulmonary interactions. The notion of erythrocytes as an integral component of the gas exchanger is emphasized. We further discuss the signals, sources, and limits of structural plasticity of the lung in alveolar hypoxia and following a loss of lung units, and the promise and caveats of interventions aimed at augmenting endogenous adaptive responses. Our objective is to understand how individual components are matched at multiple levels to optimize organ function in the face of physiological demands or pathological constraints.

Why Are High Altitude Natives So Strong at High Altitude? Nature vs. Nurture: Genetic Factors vs. Growth and Development

Among high-altitude natives there is evidence of a general hypoxia tolerance leading to enhanced performance and/or increased capacity in several important domains. These domains likely include an enhanced physical work capacity, an enhanced reproductive capacity, and an ability to resist several common pathologies of chronic high-altitude exposure. The "strength" of the high-altitude native in this regard may have both a developmental and a genetic basis, although there is better evidence for the former (developmental effects) than for the latter. For example, early-life hypoxia exposure clearly results in lung growth and remodeling leading to an increased O2 diffusing capacity in adulthood. Genetic research has yet to reveal a population genetic basis for enhanced capacity in high-altitude natives, but several traits are clearly under genetic control in Andean and Tibetan populations e.g., resting and exercise arterial O2 saturation (SaO2). This chapter reviews the effects of nature and nurture on traits that are relevant to the process of gas exchange, including pulmonary volumes and diffusion capacity, the maximal oxygen consumption (VO2max), the SaO2, and the alveolar-arterial oxygen partial pressure difference (A-aDO2) during exercise.

Evolution, Development, and Function of the Pulmonary Surfactant System in Normal and Perturbed Environments

Surfactant lipids and proteins form a surface active film at the air-liquid interface of internal gas exchange organs, including swim bladders and lungs. The system is uniquely positioned to meet both the physical challenges associated with a dynamically changing internal air-liquid interface, and the environmental challenges associated with the foreign pathogens and particles to which the internal surface is exposed. Lungs range from simple, transparent, bag-like units to complex, multilobed, compartmentalized structures. Despite this anatomical variability, the surfactant system is remarkably conserved. Here, we discuss the evolutionary origin of the surfactant system, which likely predates lungs. We describe the evolution of surfactant structure and function in invertebrates and vertebrates. We focus on changes in lipid and protein composition and surfactant function from its antiadhesive and innate immune to its alveolar stability and structural integrity functions. We discuss the biochemical, hormonal, autonomic, and mechanical factors that regulate normal surfactant secretion in mature animals. We present an analysis of the ontogeny of surfactant development among the vertebrates and the contribution of different regulatory mechanisms that control this development. We also discuss environmental (oxygen), hormonal and biochemical (glucocorticoids and glucose) and pollutant (maternal smoking, alcohol, and common "recreational" drugs) effects that impact surfactant development. On the adult surfactant system, we focus on environmental variables including temperature, pressure, and hypoxia that have shaped its evolution and we discuss the resultant biochemical, biophysical, and cellular adaptations. Finally, we discuss the effect of major modern gaseous and particulate pollutants on the lung and surfactant system.

Persistent structural adaptation in the lungs of guinea pigs raised at high altitude

Laboratory guinea pigs raised at high altitude (HA, 3800 m) for up to 6 mo exhibit enhanced alveolar growth and remodeling (Hsia et al., 2005. Resp. Physiol. Neurobiol. 147, 105-115). To determine whether initial HA-induced structural enhancement persists following return to intermediate altitude (IA), we raised weanling guinea pigs at (a) HA for 11-12 mo, (b) IA (1200 m) for 11-12 mo, and (c) HA for 4 mo followed by IA for 7-8 mo (HA-to-IA). Morphometric analysis was performed under light and electron microscopy. Body weight and lung volume were similar among groups. Prolonged HA residence increased alveolar epithelium and interstitium volumes while reducing alveolar-capillary blood volume. The HA-induced gains in type-1 epithelium volume and alveolar surface area were no longer present following return to IA whereas volume increases in type-2 epithelium and interstitium and the reduction in alveolar duct volume persisted. Results demonstrate persistent augmentation of some but not all aspects of lung structure throughout prolonged HA residence, with partial reversibility following re-acclimatization to IA.

Role of posterior hypothalamus in hypobaric hypoxia induced pulmonary edema

To investigate the role of posterior hypothalamus and central neurotransmitters in the pulmonary edema due to hypobaric hypoxia, rats were placed in a high altitude simulation chamber (barometric pressure-294.4 mmHg) for 24 h. Exposure to hypobaric hypoxia resulted in increases in mean arterial blood pressure, renal sympathetic nerve activity, right ventricular systolic pressure, lung wet to dry weight ratio and Evans blue dye leakage. There was a significant attenuation in these responses to hypobaric hypoxia (a) after lesioning posterior hypothalamus and (b) after chronic infusion of GABAA receptor agonist muscimol into posterior hypothalamus. No such attenuation was evident with the chronic infusion of the nitric oxide donor SNAP into the posterior hypothalamus. It is concluded that in hypobaric hypoxia, there is over-activity of posterior hypothalamic neurons probably due to a local decrease in GABA-ergic inhibition which increases the sympathetic drive causing pulmonary hypertension and edema.

Developmental functional adaptation to high altitude: review

Various approaches have been used to understand the origins of the functional traits that characterize the Andean high-altitude native. Based on the conceptual framework of developmental functional adaptation which postulates that environmental influences during the period of growth and development have long lasting effects that may be expressed during adulthood, we initiated a series of studies addressed at determining the pattern of physical growth and the contribution of growth and development to the attainment of full functional adaptation to high-altitude of low and high altitude natives living under rural and urban conditions. Current research indicate that: (a) the pattern of growth at high altitude due to limited nutritional resources, physical growth in body size is delayed but growth in lung volumes is accelerated because of hypoxic stress); (b) low-altitude male and female urban natives can attain a full functional adaptation to high altitude by exposure to high-altitude hypoxia during the period of growth and development; (c) both experimental studies on animals and comparative human studies indicate that exposure to high altitude during the period of growth and development results in the attainment of a large residual lung volume; (d) this developmentally acquired enlarged residual lung volume and its associated increase in alveolar area when combined with the increased tissue capillarization and moderate increase in red blood cells and hemoglobin concentration contributes to the successful functional adaptation of the Andean high-altitude native to hypoxia; and (e) any specific genetic traits that are related to the successful functional adaptation of Andean high-altitude natives have yet to be identified.

Developmental and genetic components explain enhanced pulmonary volumes of female Peruvian Quechua

High altitude natives have enlarged vital capacities and residual volumes (RV). Because pulmonary volumes are an indication of functionally relevant traits, such as diffusion capacity, the understanding of the factors (genetic/developmental) that influence lung volumes provides insight into the adaptive responses of highlanders. In order to test for the effect of growth and development at high altitude on lung volumes, we obtained forced vital capacities (FVC), RV, and total lung capacities (TLC) for a sample of 65 Peruvian females of mostly Quechua origins (18-34 years) who were sub-divided into two well-matched groups: 1) sea-level born and raised females (BSL, n = 34) from Lima, Peru (150 m), and 2) high-altitude born and raised females (BHA, n = 31) from Cerro de Pasco, Peru (4,338 m). To determine Quechua origins, Native American ancestry proportion (NAAP) for each individual was assessed using a panel of 70 ancestry informative markers. NAAP was similar between groups (BSL = 91.71%; BHA = 89.93%; P = 0.240), and the analysis confirmed predominantly Quechua origins. After adjusting for body size and NAAP, BHA females had significantly higher FVC (3.79 ± 0.06 l; P < 0.001), RV (0.98 ± 0.03 l; P < 0.001) and TLC (4.80 ± 0.07 l; P < 0.001) compared to BSL females (FVC = 3.33 ± 0.05 l; RV = 0.69 ± 0.03 l; TLC = 4.02 ± 0.06 l). NAAP was not associated with FVC (P = 0.352) or TLC (P = 0.506). However, NAAP was positively associated with RV (P = 0.004). In summary, results indicate that developmental exposure to high altitude in females constitutes an important factor for all lung volumes, whereas both genetic and developmental factors seem to be important for RV.

Developmental adaptation: where we go from here

The concept of developmental adaptation is a powerful framework that can be used for understanding the origin of population differences in phenotypic and genotypic biological traits. There is great deal of information describing how developmental responses can shape adult biological outcomes. Specifically, current research suggest that individuals developing in stressful environments such as high altitude will attain an adult enlarged residual lung volume that contribute to the successful cardiovascular adaptation of the high-altitude Andean native. Likewise, studies on the etiology of the metabolic syndrome indicate that development under poor nutritional environments elicit efficient physiological and metabolic responses for the utilization of nutrients and energy, which become disadvantageous when the adult environmental conditions provide abundant access to food and low energy expenditure. Epigenetic research in experimental animals and retrospective research in humans confirm that environmental influences during developmental period have profound consequences on the phenotypic expression of biological and behavioral traits during adulthood. Research on epigenetics is a productive direction for human biologists concerned with understanding the origins of human biological variability.

Atmospheric oxygen level affects growth trajectory, cardiopulmonary allometry and metabolic rate in the American alligator (Alligator mississippiensis)

Recent palaeoatmospheric models suggest large-scale fluctuations in ambient oxygen level over the past 550 million years. To better understand how global hypoxia and hyperoxia might have affected the growth and physiology of contemporary vertebrates, we incubated eggs and raised hatchlings of the American alligator. Crocodilians are one of few vertebrate taxa that survived these global changes with distinctly conservative morphology. We maintained animals at 30 degrees C under chronic hypoxia (12% O(2)), normoxia (21% O(2)) or hyperoxia (30% O(2)). At hatching, hypoxic animals were significantly smaller than their normoxic and hyperoxic siblings. Over the course of 3 months, post-hatching growth was fastest under hyperoxia and slowest under hypoxia. Hypoxia, but not hyperoxia, caused distinct scaling of major visceral organs-reduction of liver mass, enlargement of the heart and accelerated growth of lungs. When absorptive and post-absorptive metabolic rates were measured in juvenile alligators, the increase in oxygen consumption rate due to digestion/absorption of food was greatest in hyperoxic alligators and smallest in hypoxic ones. Hyperoxic alligators exhibited the lowest breathing rate and highest oxygen consumption per breath. We suggest that, despite compensatory cardiopulmonary remodelling, growth of hypoxic alligators is constrained by low atmospheric oxygen supply, which may limit their food utilisation capacity. Conversely, the combination of elevated metabolism and low cost of breathing in hyperoxic alligators allows for a greater proportion of metabolised energy to be available for growth. This suggests that growth and metabolic patterns of extinct vertebrates would have been significantly affected by changes in the atmospheric oxygen level.

Hypoxia in the central nervous system

The brain, as a very high energy consumer, is completely reliant on molecular oxygen but because oxygen is dangerous due to toxicity [1], there are mechanisms which allow the brain to exist under low oxygen conditions when 'idling' but increase oxygen delivery when activated. This situation means that the brain can respond naturally to mild hypoxia with acute and chronic adaptive mechanisms. These mechanisms involve systemic and central metabolic and vascular processes that are mediated by hypoxia-inducible factor (HIF)-1. HIF-1-mediated cerebral angiogenesis is completed within 3 weeks of exposure onset and is reversible over the same time frame if normoxia is restored. Hypoxic acclimatizing responses may be significantly impaired with aging and metabolic or vascular disease.

Residence at 3,800-m altitude for 5 mo in growing dogs enhances lung diffusing capacity for oxygen that persists at least 2.5 years

Mammals native to high altitude (HA) exhibit larger lung volumes than their lowland counterparts. To test the hypothesis that adaptation induced by HA residence during somatic maturation improves pulmonary gas exchange in adulthood, male foxhounds born at sea level (SL) were raised at HA (3,800 m) from 2.5 to 7.5 mo of age and then returned to SL prior to somatic maturity while their littermates were simultaneously raised at SL. Following return to SL, all animals were trained to run on a treadmill; gas exchange and hemodynamics were measured 2.5 years later at rest and during exercise while breathing 21% and 13% O(2). The multiple inert gas elimination technique was employed to estimate ventilation-perfusion (Va/Q) distributions and lung diffusing capacity for O(2) (Dl(O(2))). There were no significant intergroup differences during exercise breathing 21% O(2). During exercise breathing 13% O(2), peak O(2) uptake and Va/Q distributions were similar between groups but arterial pH, base excess, and O(2) saturation were higher while peak lactate concentration was lower in animals raised at HA than at SL. At a given exercise intensity, alveolar-arterial O(2) tension gradient (A-aDo(2)) attributable to diffusion limitation was lower while Dlo(2) was 12-25% higher in HA-raised animals. Mean systemic arterial blood pressure was also lower in HA-raised animals; mean pulmonary arterial pressures were similar. We conclude that 5 mo of HA residence during maturation enhances long-term gas exchange efficiency and Dl(O(2)) without impacting Va/Q inequality during hypoxic exercise at SL.

Long-term enhancement of pulmonary gas exchange after high-altitude residence during maturation

In a previous study, our laboratory showed that young dogs born at sea level (SL) and raised from 2.5 mo of age to beyond somatic maturity at a high altitude (HA) of 3,100 m show enhanced resting lung function (Johnson RL Jr, Cassidy SS, Grover RF, Schutte JE, and Epstein RH. J Appl Physiol 59: 1773-1782, 1985). To examine whether HA-induced adaptation improves pulmonary gas exchange during exercise and whether adaptation is reversible when animals return to SL before somatic maturity, we raised 2.5-mo-old foxhounds at HA (3,800 m) for 5 mo (to age 7.5 mo) before returning them to SL. Lung function was measured under anesthesia 1 mo and 2 yr after return to SL and during exercise approximately 1 yr after return. In animals exposed to HA relative to simultaneous litter-matched SL controls, resting circulating blood and erythrocyte volumes, lung volumes, septal volume estimated by a rebreathing technique, and lung tissue volume estimated by high-resolution computed tomography scan were persistently higher. Lung diffusing capacity, membrane diffusing capacity, and pulmonary capillary blood volume estimated at a given cardiac output were significantly higher in animals exposed to HA, whereas maximal oxygen uptake and hematocrit were similar between groups. We conclude that relatively short exposure to HA during somatic maturation improves long-term lung function into adulthood.

The Maximum Expiratory Flow-Volume Loop in Natives of Ladakh and Acclimatized Lowlanders

Differences in static and dynamic volumes may exist between high altitude residents of Indian Himalayas and their South American counterparts, as well as with acclimatized lowlander sojourners. Maximum expiratory flow-volume loops were recorded in healthy native highlanders of Ladakh (NH, N = 75) and in healthy acclimatized lowlanders (AL, N = 32) at an altitude of 3450 m in the western Indian Himalayas. The forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), both corrected for a height of 168 cm, were significantly higher in NH [FVC: 5.02 (0.51) vs. 3.89 (0.45) L, p < 0.0001; FEV1: 4.27 (0.47) vs. 3.44 (0.37) L, p < 0.0001]. The flow rates at larger lung volumes (PEFR, FEF25, and FEF50) were similar in the two groups. The NH showed significantly higher flow rates at low lung volumes, that is, FEF75 and FEF75-85% [FEF75: 2.03 (0.69) vs. 1.70 (0.52) L/s, p = 0.0092; FEF75-85%: 1.42 (0.54) vs. 1.06 (0.35) L/s, p = 0.0001]. The exact mechanisms allowing the higher flow rates at low lung volumes remain to be elucidated, but it is possible that these findings may indicate an inherited adaptive response in the Ladakhi highlander.

Signals and mechanisms of compensatory lung growth

Growth of the lung involves unique structure-function interactions not seen in solid organs. Mechanical feedback between the lung and thorax constitutes a major signal that sustains developmental as well as compensatory lung growth. After the loss of lung units as by pneumonectomy (PNX), increased mechanical stress and strain on the remaining units induce adaptive responses to augment oxygen transport, including 1) recruitment of alveolar-capillary reserves, 2) remodeling of existing tissue, and 3) regenerative growth of acinar tissue when strain exceeds a critical threshold. Alveolar hypoxia, hormones, and growth factors may feed into the mechanical feedback system to modify an existing growth response but are unlikely to initiate compensatory growth in the absence of sufficient mechanical signals. Whereas endogenous post-PNX alveolar growth preserves normal structure-function relationships, experimental manipulation of selected metabolic pathways can distort these relationships. Finally, PNX widens the disparity between the rapidly adapting acini and slowly adapting conducting airways and blood vessels, leading to disproportionate airflow and hemodynamic dysfunction and secondary hypertrophy of the right ventricle and respiratory muscles that limits overall organ function despite regeneration of gas exchange tissue. These are key concepts to consider when formulating approaches to stimulate or augment compensatory growth in chronic lung disease.

Upregulation of erythropoietin receptor during postnatal and postpneumonectomy lung growth

Circulating erythropoietin (EPO) stimulates erythrocytosis, whereas organ-specific local EPO receptor (EPOR) expression has been linked to angiogenesis, tissue growth, and development. On the basis of the observation of concurrent enhancement of lung growth and erythrocyte production during exposure to chronic hypoxia, we hypothesized that a paracrine EPO system is involved in mediating lung growth. We analyzed EPOR protein expression in normal dog lung tissue during postnatal maturation and during compensatory lung growth after right pneumonectomy (PNX). Membrane-bound EPOR was significantly more abundant in the immature lung compared with mature lung and in the remaining lung 3 wk after PNX compared with matched sham controls. COOH-terminal cytosolic EPOR peptides, which were even more abundant than membrane-bound EPOR, were also upregulated in immature lung but differentially processed after PNX. Apoptosis was enhanced during both types of lung growth in direct relationship to cellular proliferation and EPOR expression. We conclude that both developmental and compensatory lung growth involve paracrine EPO signaling with parallel upregulation but differential processing of EPOR.

Postnatal development in intermittent hypoxia enhances resistance to myocardial ischemia/reperfusion in male rats

To assess the tolerance of rats that developed from birth in intermittent hypoxia (IH) to myocardial ischemia and reperfusion, we set up a reproducible model in our laboratory. IH rats were raised 60 days from birth in a hypobaric chamber at 5000 m for 6 h daily, while controls were in continuous normoxic conditions. At 60 days after birth, the antioxidant capacity of the heart was determined; arterial and venous partial pressures of oxygen were measured at sea level and 5000 m altitude. In addition, isolated hearts of each group were perfused in Langendorff mode and submitted to 30 min global ischemia followed by 30 min reperfusion to compare functional recovery and lactate dehydrogenase release. For the IH rats, recovery of left ventricular developed pressure (DP), the maximum of the positive or negative first derivative of left ventricular pressure with respect to time (+/-LV d P/d t), end-diastolic pressure (EDP), and pressure-rate product (PRP) were all superior ( P<0.05) to those of control rats. The myocardial antioxidant capacity was also significantly increased in the left ventricle of IH rats. Further, at 5000 m altitude the arterio-venous oxygen gradient ( Pa-vO(2)) was significantly ( P<0.01) higher in the IH rats than in the controls. These data indicate that IH from birth enhances the tolerance of the heart to ischemia/reperfusion, elevates the myocardial antioxidant capacity, and increases oxygen extraction.

Developmental plasticity in aerobic performance in deer mice (Peromyscus maniculatus)

While several studies have examined the abiotic effects of altitude (low ambient temperatures and hypoxia) on the aerobic performance of small mammals, few have explored the effects of development and maturation at different altitudes on aerobic performance as adults. We examined the basal metabolism and aerobic performance of deer mice (Peromyscus maniculatus) under four different developmental and testing regimes: (1) reared (gestation through weaning) and tested at high altitude; (2) reared and tested at low altitude; (3) reared at low altitude and tested at high altitude after acclimation; and (4) reared at low altitude and tested in hypoxia without acclimation. We found that mice that developed and were tested at low altitudes had a higher aerobic capacity (both aerobic performance and basal metabolic rate) than those that developed, or were acclimated as adults, at high altitudes. In addition, we found that mice that developed at high altitude did not have a higher aerobic capacity than those that developed at low altitude and were acclimated to high altitude as adults. Both groups tested at high altitudes had higher hematocrits (% red blood cells) and hemoglobin than mice tested at low altitudes. Surprisingly, mice acclimated to low altitudes and given an instantaneous exposure to hypoxia did not suffer a depression in aerobic performance.

Ventilation, EELV and diaphragmatic activity in rats during chronic normobaric hypoxia

We determined the effects of chronic hypoxia on end-expiratory lung volume (EELV), end-expiratory diaphragmatic activity (DE) and ventilation (VE) in 27 intact (awake and anesthetized) and six carotid body-denervated (CBD; anesthetized) rats. Twenty-nine control animals were also studied. Recordings were made during hypoxia and normoxia before and after 2 or 3 weeks of hypoxia (+3 days of recovery from chronic hypoxia). In awake rats, 2 weeks of chronic hypoxia increased only normoxic VE, while 3 weeks of chronic hypoxia did not change VE or DE. In anesthetized intact rats, after both exposures, hypoxic and normoxic VE tended to decrease, DE did not change and hypoxic and normoxic EELV were enlarged. In CBD animals, 2 weeks of chronic hypoxia did not affect hypoxic VE but decreased normoxic ventilation and enlarged EELV similar to the intact animals. After 3 days of recovery in normoxia, all parameters except EELV were restored to prehypoxic values. Also, transition from hypoxia to normoxia induced parallel changes in EELV and DE while chronic hypoxia increased only EELV. Therefore, chronic normobaric hypoxia induced, (1) an increase in normoxic ventilation reflecting a process of acclimatization; (2) an enlargement of EELV that did not depend on changes in DE and carotid chemoreceptors.

Effects of Altitude and Temperature on Organ Phenotypic Plasticity Along an Altitudinal Gradient

Small mammals living in high-altitude environments must endure decreased ambient temperatures and hypoxic conditions relative to sea-level environments. Previously, it was noted that heart, lung and digestive tract masses and blood hematocrit increase along an altitudinal gradient in small mammals. Increases in digestive organ mass were attributed to lower ambient temperatures and greater food intake, and increases in lung mass and hematocrit were attributed to hypoxia, but these assumptions were not explicitly tested. In addition, it was not clear whether changes in heart and lung mass were a function of an increase in organ blood content or of an increase in organ tissue mass. We used captive deer mice (Peromyscus maniculatus sonoriensis) to determine the relative effects of ambient temperature and oxygen concentration (PO2) on organ mass and blood hematocrit along an altitudinal gradient. We also exsanguinated hearts and lungs to determine whether changes in mass were associated with the blood content or with increases in tissue mass. We found that small intestine mass was, as expected, correlated positively with energy intake and negatively with ambient temperature. Heart mass was also negatively correlated with temperature. Lung mass and hematocrit were, as expected, positively correlated with altitude (and PO2). Interestingly, the masses of both small intestine and kidney were negatively correlated with altitude. For kidney mass, this correlation was apparent in cold-exposed mice but not in warm-exposed mice. We also found that changes in both heart and lung mass were mainly a function of changes in tissue mass rather than blood content. These data show that different abiotic variables have different effects on organ masses at high altitude, but also that phenotypic plasticity in response to cold temperatures and low oxygen pressures at altitude is widespread across several different organ systems, suggesting a general elevated whole-body response.

Inhaled nitric oxide improves survival in the rat model of high-altitude pulmonary edema

OBJECTIVES

High-altitude pulmonary edema (HAPE) afflicts certain individuals after a rapid gain in elevation. Those susceptible demonstrate an exaggerated hypoxic pulmonary vasoconstrictive response. This causes pulmonary hypertension, which may disrupt vascular integrity. This experiment was designed to test whether inhaled nitric oxide would affect development of HAPE in a rat model.

METHODS

Subjects were exposed in a hypobaric chamber to a simulated altitude of 6200 m (barometric pressure = 380 mm Hg, fraction of inspired oxygen = 0.19) for 24 hours. Control animals (n = 48) spontaneously breathed a mixture of 90% room air and 10% nitrogen, whereas the nitric oxide group (n = 48) received a similar mixture containing 83 ppm nitric oxide. Postmortem examination of lungs was performed for light microscopy, total hemoglobin, and gravimetric estimates of water content.

RESULTS

Mortality was 39.5% (n = 19) in control animals and 6.2% (n = 3) in the nitric oxide group (P < .001). Both groups significantly increased their lung weight-body weight ratio. Percentage of lung water was similar in both groups despite increases in lung weight, which is consistent with the protein-rich edema characteristic of HAPE. Light microscopic examination of survivors' lungs in both groups revealed scattered alveolar hemorrhage. No significant cellular inflammatory response was present.

CONCLUSIONS

We conclude that inhaled nitric oxide improves survival in the rat model of HAPE.

Viral respiratory infection increases susceptibility of young rats to hypoxia-induced pulmonary edema

Recent clinical observations of a high incidence of preexisting respiratory infections in pediatric cases of high-altitude pulmonary edema prompted us to ask whether such infections would increase the susceptibility to hypoxia-induced pulmonary edema in young rats. We infected weanling rats with Sendai virus, thus causing a mild respiratory infection. Within 7 days of infection, Sendai virus was essentially undetectable by using viral culture and immunohistochemical techniques. Animals at day 7 of Sendai virus infection were then exposed to normobaric hypoxia (fraction of inspired O2 = 0.1) for 24 h and examined for increases in gravimetric lung water and in vascular permeability, as well as for histological evidence of increased lung water. Bronchoalveolar lavage was performed on a separate series of animals. Compared with control groups, infected hypoxic animals showed significant increases in perivascular cuffing, gravimetric lung water, and lung protein leak. In addition, infected hypoxic animals had increases in lavage fluid cell counts and protein content compared with controls. We conclude that young rats, exposed to moderate hypoxia while recovering from a mild viral respiratory infection, may demonstrate evidence of early pulmonary edema formation, a finding of potential relevance to human high-altitude pulmonary edema.

Exercise performance of Tibetan and Han adolescents at altitudes of 3,417 and 4,300 m

The difference was studied between O2 transport in lifelong Tibetan adolescents and in newcomer Han adolescents acclimatized to high altitude. We measured minute ventilation, maximal O2 uptake, maximal cardiac output, and arterial O2 saturation during maximal exercise, using the incremental exercise technique, at altitudes of 3,417 and 4,300 m. The groups were well matched for age, height, and nutritional status. The Tibetans had been living at the altitudes for a longer period than the Hans (14.5 +/- 0.2 vs. 7.8 +/- 0.8 yr at 3,417 m, P < 0.01; and 14.7 +/- 0.3 vs. 5.3 +/- 0.7 yr at 4,300 m, P < 0.01, respectively). At rest, Tibetans had significantly greater vital capacity and maximal voluntary ventilation than the Hans at both altitudes. At maximal exercise, Tibetans compared with Hans had higher maximal O2 uptake (42.2 +/- 1.7 vs. 36.7 +/- 1.2 ml . min-1 . kg-1 at 3,417 m, P < 0.01; and 36.8 +/- 1.9 vs. 30.0 +/- 1. 4 ml . min-1 . kg-1 at 4,300 m, P < 0.01, respectively) and greater maximal cardiac output (12.8 +/- 0.3 vs. 11.4 +/- 0.2 l/min at 3,417 m, P < 0.01; 11.5 +/- 0.5 vs. 10.0 +/- 0.5 l/min at 4,300 m, P < 0. 05, respectively). Although the differences in arterial O2 saturation between Tibetans and Hans were not significant at rest and during mild exercise, the differences became greater with increases in exercise workload at both altitudes. We concluded that exposure to high altitude from birth to adolescence resulted in an efficient O2 transport and a greater aerobic exercise performance that may reflect a successful adaptation to life at high altitude.

Lung morphometric changes after exposure to hypobaria and/or hypoxia and undernutrition

Lung morphometry was studied in rats between 4 and 7 weeks of age. The animals were divided into 5 groups: general controls (fed ad libitum), hypobaric normoxic, normobaric hypoxic, hypobaric hypoxic, and weight-matched controls (weight matched to the hypobaric hypoxic group). In both hypobaric and normobaric hypoxia, lung volume, alveolar surface area and total alveolar number increased compared to weight-matched controls. In normobaric hypoxia, mean linear intercept, mean chord length of alveoli increased and number of alveoli/unit volume decreased compared to weight-matched animals. In hypobaric hypoxia, only mean chord length increased. Dysanaptic index decreased in both. In hypobaric normoxia, alveolar size and lung volume diminished compared to general controls. Lung growth was impaired in weight-matched controls without affecting airspace dimensions. Hypobaric and normobaric hypoxia increase lung growth overcoming nutritional effects but is dysanaptic. Lung growth in hypobaric hypoxia is mainly determined by low oxygen but low pressure may also produce subtle structural alterations.

Time course of lung growth following exposure to hypobaria and/or hypoxia in rats

Four-week-old rats were divided into five groups: general controls, weight-matched controls (weight matched to hypobaric hypoxia), hypobaric hypoxia, normobaric hypoxia, and hypobaric normoxia. Lung growth impairment in weight-matched animals occurred by reduction in cell number and size. In both hypoxic groups, lung weight, RNA and protein were significantly higher on day 3, and DNA on day 5 and remained higher thereafter. Maximum 3H-TdR incorporation occurred on day 3 in both hypoxic groups. Hypoxia increased RNA/DNA ratio on day 1 and protein/DNA on day 3. Following 3 days of recovery, DNA synthesis and RNA/DNA ratio of hypoxic groups and controls were identical. DNA synthesis also doubled on day 5 in hypobaric normoxia compared to general controls. Hypoxia up regulates lung growth despite down regulation by undernutrition. Maximum lung growth stimulation occurs during early exposure by cellular hypertrophy followed by hyperplasia. Low pressure by itself also stimulates lung growth. Cellular activity returns immediately to normal levels after removal of hypoxic stimulus.

Water balance and lung fluids in rats at high altitude

A disturbed water and electrolyte homeostasis is not generally held to be a primary mechanism in the pathogenesis of acute mountain sickness (AMS) and high altitude pulmonary edema (HAPE), but the association of oliguria and weight gain with AMS and HAPE has led to the hypothesis that water retention may be a facilitative mechanism, possibly caused by an effect of hypoxia to release antidiuretic hormone (ADH). To examine the problem, normal Long-Evans rats (N) and the strain with congenital diabetes insipidus (DI) were exposed to hypobaric hypoxia (0.5 atm) for 4 days, and fluid balance in the whole animals and in their lungs was studied. Both strains reduced water intake and were oliguric on acute exposure, but the N rats gained body weight and increased lung water, while the DI rats increased neither body weight nor lung water. Neither strain increased lung blood at high altitude. The oliguria in the DI rats could not have been due to a release of antidiuretic hormone, and was attributed to the diminished water intake in both strains. The protection against HAPE in the DI rats was probably due to their more severe dehydration that exists already in normoxia, and its further increase in hypoxia, compared with N rats.

Chronic hypoxia increases beta-adrenergic receptor density in the lungs of young and old rats

To test the hypothesis that the ability to regulate beta-adrenergic receptor (BAR) density in response to chronic hypoxic stress is impaired by aging, we measured BAR density in the lungs of young (age 3 months) and aged (age 20 months) rats exposed to hypobaric hypoxia (1/2 atm) for 3 weeks. BAR density increased by 63% in the lungs of both young and aged rats exposed to chronic hypoxia. Lung BAR density was unaffected by aging, independent of hypoxic conditions. We conclude that the ability to respond to chronic hypoxic stress with increased lung BAR density is unaffected by aging in rats.

Perinatal hypoxia increases hypoxic pulmonary vasoconstriction in adult rats recovering from chronic exposure to hypoxia

The possibility that perinatal exposure to hypoxia influences the pulmonary vasculature in adults was tested. Rats born in a hypoxic environment were kept in hypoxia for an additional week after birth. The rats were then raised in atmospheric air, and when adult, they were compared with the rats born and raised in air. Rats (10 wk old) of both groups were exposed to 10% O2 for 2 wk. They were then studied immediately after the exposure and after 2 wk of recovery from the sojourn in the hypoxic environment. The experience of perinatal hypoxia did not affect mean pulmonary arterial blood pressure, right ventricle weight, or the number of muscularized peripheral pulmonary vessels. During exposure to chronic hypoxia in adulthood, both groups developed pulmonary hypertension, which was not affected by previous perinatal hypoxia. The pulmonary vascular responses to acute hypoxic challenges were studied in the preparation of isolated perfused lungs. In both groups of rats, perinatally hypoxic and normoxic, the acute hypoxic vasoconstriction was attenuated immediately after the exposure of adult animals to chronic hypoxia. However, during the recovery from this hypoxic sojourn, the rats born in hypoxia were significantly more reactive to acute lung hypoxia than all other groups of rats studied. It is concluded that the experience of a short period of perinatal hypoxia did not affect the development of hypoxic pulmonary hypertension induced in adulthood. It increased, however, the pulmonary vascular reactivity to acute hypoxic stimuli during the period of recovery from a sojourn in the hypoxic environment in adulthood.

Role of hyperventilation in hypoxia on lung growth in rats

This study was conducted in an attempt to differentiate the contribution of hyperventilation, if any, from that of low PO2 on adaptive lung growth in response to hypoxia. Male albino rats were exposed to one of the following: (1) Room air for 7 days, as control; (2) 10% O2 in N2 for 7 days; (3) 10% O2 for 6 h, 1 day or 2 days and air for the remaining of 7 days; (4) 10% O2 for 2 days and 7% CO2 in air for 5 days; (5) air for 2 days and 7% CO2 for 5 days; or (6) 7% CO2 in air for 7 days. Lung growth was assessed by measuring the lung weight, lung air volume, lung DNA content and rate of DNA synthesis in lung explants. Hypoxia stimulated lung DNA synthesis even when administered for only 6 h, and the effects persisted for a few days after discontinuation of hypoxia. Hypercapnia did not stimulate DNA synthesis in lung. In 2 day hypoxic 5 day air rats the lung weight and lung DNA content increased, in 2 day air 5 day hypercapnic rats only the lung volume increased, and in 2 day hypoxic 5 day hypercapnic rats all parameters of lung growth, i.e., lung weight, DNA content and air volume increased as in 7 day hypoxic rats. The results suggest that adaptive or compensatory lung growth in hypoxia is brought about on one hand by the direct effect of low PO2 on lung cells, resulting in lung hyperplasia, and on the other hand by the mechanical stimulation of lung tissue by hyperventilation, causing lung distension.

Minimizing perioperative hypoxemia does not affect postpneumonectomy lung growth

The effects of preventing the acute hypoxemia common during lung resection on postpneumonectomy lung growth were investigated. Rats that had undergone translaryngeal tracheal intubation and were supported with intermittent positive-pressure ventilation during pneumonectomy (IPPV) were compared with those allowed to breathe room air spontaneously via the natural airway (SV). A pulse oximeter was used to document intraoperative and postoperative oxygen saturation (SaO2). Almost all SV animals became acutely hypoxemic during thoracotomy [SaO2 less than 50% for 2.5 +/- 0.5 min (8/9), less than 30% for 1.7 +/- 0.4 (8/9)], whereas IPPV animals largely maintained oxygenation [SaO2 less than 50% for 0.3 +/- 0.2 min (8/13), less than 30% for 0.05 +/- 0.05 min (1/13)]. Direct measurements of oxygen saturation correlated well with the pulse oximeter (slope of regression line = 0.90, correlation 0.91), and arterial blood gases showed the SV group to be hypercapneic and acidotic as well as hypoxemic during lung removal. These abnormalities resolved soon after chest closure. Intubated animals had mild postextubation hypoxemia that normalized within 3 h of surgery. Two weeks postoperative, there were no differences in lung mass or content of water, RNA, DNA, and protein between the two groups.

Compensatory growth of the lung following partial pneumonectomy

In a variety of species, partial resection of the lung initiates rapid compensatory growth of the remaining tissue adequate to restore normal total lung mass. Increases in tissue content of protein, RNA, and DNA in proportion to dry lung weight suggest hyperplastic growth of the tissue, rather than cellular hypertrophy. A general acceleration of cell division is supported further by the results of quantitative morphometric studies, which indicate that both cellular and functional characteristics of the peripheral lung, including alveolar and capillary volumes and thickness and surface area of the blood-gas barrier, are maintained when compensatory growth is complete. The rate and nature of the growth response are subject to hormonal modulation, particularly by adrenal steroids and growth hormone. Little is known, however, regarding the specific actions of these agents or of additional factors that may be primary regulators of the initiation and cessation of accelerated compensatory growth. Definition of such regulatory mechanisms is of critical importance in understanding normal growth and development of the lung and the response of the lung to injury, as well as in future efforts to manipulate growth and/or repair of the tissue.

The thickness of the alveolar capillary wall in guinea-pigs at high and low altitude

The thickness of the alveolar-capillary wall was measured in the lungs of seven guinea-pigs born and living at La Raya, in the Peruvian Andes, at an altitude of 4200 m and in seven sea-level representatives of the same species. This was achieved by carrying out morphometric studies on electron micrographs to obtain the so-called arithmetic and harmonic mean thicknesses. The arithmetic mean thickness was always the larger, this being due to the greater emphasis which the technique employed places on the copious amounts of connective tissue in the interstitial space of the alveolar capillary wall in this species. These thicker portions of the alveolar wall are not concerned with gaseous diffusion. The harmonic mean thickness probably gives a more physiologically realistic estimate of the magnitude of the diffusion barrier to oxygen. This proved to be smaller in the animals from high altitude and may facilitate diffusion of oxygen from alveolar spaces to blood, thus making less steep the "oxygen cascade" from inspired air to mitochondria.

Hypoxic pulmonary vasoconstriction in chronically hypoxic rats

Reactivity of lung vessels to acute hypoxia was found increased or decreased in chronically hypoxic (CH) rats by different authors. We examined severity and duration of hypoxia and age as possible explanations. Isolated blood-perfused lungs of CH rats ventilated with low-O2 mixtures were compared with control (C) rats. Juvenile CH rats (10 or 12% O2, 3 weeks) showed increased reactivity; reactivity of mature CH rats (10% O2, 3 weeks) was not significantly different from controls. Reactivity declined with age in CH but not C rats. Juvenile and mature rats exposed to 10% O2 for 48 h showed reduced reactivity; after 3 weeks but not 48 h hypoxia, pulmonary arterioles are narrowed by new muscle. The pressure/flow relationship differed in CH from C rats in that resistance and critical closing pressure (CCP) were greater during normoxia. Hypoxia caused increased resistance and CCP in C rats but mainly an increase in CCP in CH rats. The difference may be attributable to muscularisation of collapsible alveolar vessels in chronic hypoxia.

The effect of chronic hypoxia on pulmonary arteries in young rats

The effect of hypoxia on the postnatal development of rat lung from 8 days of life and continuing for 3, 7, 14, 21 and 28 days is described, with particular emphasis on the pulmonary arterial circulation. In hypoxic rats, absolute lung volume and body weight increases more slowly than in age-matched controls but lung volume relative to body weight is greater. After three days hypoxia intra-acinar arterial concentration is reduced and medial thickness of small arteries increased but by Day 7, both features return to "normal" values. By Day 14, right ventricular hypertrophy is apparent as is reduction in lumen diameter of preacinar arteries. From Day 21, muscle is seen in smaller and more peripheral arteries than normal: By Day 28 arteries of all sizes show increased medial thickness, and arterial and alveolar concentration is reduced. Compared with adult rats the growing lung seems to be somewhat "protected" in that the hypoxia-induced changes occur slowly although ultimately their severity is similar. At the end of the exposure period, however, the young lung is small for age suggesting that the changes are more severe than in the adult.

Design of the mammalian respiratory system. IX. Functional and structural limits for oxygen flow

This paper presents the synthesis and interpretation of a series of correlated studies of the mammalian respiratory system--measurements of maximal rate of O2 consumption, the lung's diffusing capacity, the mitochondrial volume, and the capillary number and length in skeletal muscle. It discusses the results with respect to the principle of symmorphosis, i.e. of morphogenesis adapted to functional needs. We find that the accumulated evidence supports this principle at all organizational levels considered, although the models used for structure-function correlation need further refinement.

Design of the mammalian respiratory system. V. Scaling morphometric pulmonary diffusing capacity to body mass: wild and domestic mammals

This paper utilizes a comparative approach to establish the relationship between morphometric diffusing capacity for oxygen (DLo2) and maximal oxygen consumption (Vo2max). DLo2 and Vo2max were determined on the same 21 individuals in African mammals spanning a range in body mass from 0.4 to 240kg. We confirmed earlier findings that Dlo2 was proportional to Mb0.99 while Vo2max was proportional to Mb0.79. Thus, the ratio of Dlo2/Vo2 is approximately proportional to Mb0.20. We conclude that large animals require a larger pulmonary diffusing capacity to transfer oxygen at the same rate from air to blood.

Lung morphometry in guinea pigs acclimated to hypoxia during growth

The effect of chronic hypoxic exposure on lung development has been assessed in growing guinea pigs (Cavia porcellus). Weanling males of initial W = 229 g were acclimated to a PO2 of 80 Torr for 2-14 weeks before sacrifice (range of W = 244-965 g). Growth was the same in hypoxic animals as in controls maintained at a PO2 of 133 Torr (range of W in controls = 89-1274 g). Lungs were fixed by tracheal instillation of glutaraldehyde and examined morphometrically with the electron microscope. Within 3 weeks of exposure, lung volume (VL) and alveolar surface area (Sa) were significantly increased by 32% and 27% respectively in the hypoxia acclimated animals compared to controls of similar W. However, these differences were progressively reduced with increasing time of exposure, and mean values of VL and Sa were not different between groups when W greater than 900 g. Chronic hypoxia accelerated lung development towards normal adult dimensions to a degree remarkably similar to that reported in cold acclimated guinea pigs. These findings are compatable with the theory of adaptive lung growth mediated by increased pulmonary blood flow, and suggest anatomical limitations to such growth related to an animal's age.

Lung growth in response to altered metabolic demand in hamsters: influence of thyroid function and cold exposure

This study examines the relation between whole body O2 requirements and lung growth. 6-week-old hamsters were exposed to cold (5 degrees C) or injected with thyroid hormone. These treatments elevated O2 consumption by 26% over a 28-day period. Both alveolar surface area and total lung air volume were increased by approximately 25% in each group. Morphometric data suggest that lung enlargement was due to an increase in the number or complexity, rather than size of individual alveolar units. Further elevating O2 demand by increasing thyroid dosage did not enhance lung size beyond the level observed with the lowest dose used. Depressing metabolic rate with an antithyroid drug for four weeks had no effect on lung structure (in this animal model). Results indicate that in hamsters, increased physiologic O2 demand may be met to a certain extent by augmentation of the pulmonary diffusing surface.

The scaling of maximal oxygen consumption and pulmonary dimensions in small mammals

This report has reexamined the relationship between standard and maximal rates of oxygen consumption (VO2std and VO2max) and pulmonary surface area in mammals whose weights extend over the lower half of the total log weight range in mammals. For combined groups of wild and laboratory animals with body weights of 2--3700 g, the following equations pertain: VO2std (ml . min-1) = 0.0602 . W0.727; VO2std, or the factorial aerobic scope, is nearly constant over this weight range at approximately 6.6 (range 5.8--7.1). In view of this finding, earlier studies relating SA or pulmonary diffusion capacity to VO2std are still appropriate models for pulmonary constraints on metabolic rate. The data summarized here suggest that, at least for wild species of mammals, pulmonary diffusion capacity may limit VO2max.

The effect of acute and chronic hypoxia on thoracic gas volume in anaesthetized rats

1. Thoracic gas volume at end expiration (functional residual capacity, FRC) was measured in chronically and acutely hypoxic anaesthetized rats by a plethysmograph method. 2. FRC, measured during air breathing, was 34-62% larger in rats which had been kept in an environmental chamber in 8, 10 or 12% O2 for 3 weeks than in littermate controls. FRC returned to normal after the rats had returned to air for 9 days. There was no constant difference in the pattern of breathing between control and chronically hypoxic rats. 3. Pressure-volume curves measured post mortem showed no difference in the volume of the lung at 25 cm H2O pressure or in the compliance of the lung between chronically hypoxic and control rats. Thus there was no gross mechanical change in the lung to account for the increase in FRC. 4. Acute hypoxia caused by breathing 12% O2 increased FRC in control but not in chronically hypoxic rats. The increase in FRC in control rats was abolished by combined blockade of the vagus nerves and carotid bodies (with procaine) but not by vagal blockade alone. 5. The combined vagal and carotid body blockade reduced FRC significantly in rats which had been in 10% O2 for 3 days but not in those which had been in 10% O2 for 21 days. 6. Lung area measured from radiographs was not reduced by a muscle relaxant in chronically hypoxic rats. Electromyograms from anterior intercostal muscles and the diaphragm showed no electrical activity in expiration in chronically hypoxic rats which might indicate an active muscular basis for their increased FRC. However when FRC was raised by acute hypoxia in control animals there was also no increase in electrical activity in expiration which could have explained their increase in lung volume. 7. We concluded that the increase in FRC during acute hypoxia in control rats was probably due to a reflex from the carotid body. The increase in FRC in chronically hypoxic rats, which was present while they breathed air, may have had an active muscular component in the early stages but later on there was possibly a structural factor in the chest wall.

Adaptation of the growing lung to increased Vo2: III. The effect of exposure to cold environment in rats

This study was undertaken to further test the hypothesis that increased Vo2 operates as a stimulus for enhanced lung growth leading to a pulmonary diffusing capacity adapted to the body's O2 requirements. Vo2 was augmented by raising 4-week-old rats for 3 weeks at 11 degrees C ambient temperature, with controls kept at 24 degrees C; this led to an increase in Vo2 averaged over 24 h by 64%. In contrast to previous experiments with waltzing mice this regime did not affect body growth, as the final body weights were identical in both groups. In the cold-exposed rats the lung volume was larger by 24%, due to an increase by 26% in air volume (at about TLC), 13% in capillary blood volume and 19% in tissue volume. The alveolar and capillary surface areas were increased by 18%, and Dm and Dl by 17% and 21% respectively. It is concluded that the hypothesis of adaptation of pulmonary gas exchange capacity to increased Vo2 cannot be rejected. Whilst in previous experiments some doubts had to be retained as to the specificity of the stimulus, because of its rather marked effect on body weight, this reservation does not hold in this case. The structural modifications which lead to increased Dl in the various experimental models are discussed.