The effect of pH and hypoxia on function and intracellular pH of the rat diaphragm

Diaphragm muscle weakness and increased UCP-3 gene expression following acute hypoxic stress in the mouse

The effects of acute hypoxia on the diaphragm are largely unknown despite the clinical relevance to respiratory conditions such as acute respiratory distress syndrome and ventilator-induced lung injury. Adult male C57BL6/J mice were exposed to 1, 4 or 8h of hypoxia (FiO2=0.10) or normoxia. Ventilation was assessed by whole-body plethysmography during gas exposures. Diaphragm isotonic contractile parameters were assessed ex vivo. Diaphragm gene expression was determined using qRT-PCR. Acute hypoxic stress resulted in significant diaphragm muscle weakness. Gene expression data revealed that hypoxia results in temporal changes in various transcriptional genes regulating mitochondrial function and a time-dependent progressive increase in the expression of the mitochondrial uncoupling protein 3 (UCP-3) with concomitant changes in genes encoding sarcoplasmic reticulum calcium release proteins. Altered gene expression and muscle weakness are likely due to direct effects of hypoxic stress per se, and not related to increased diaphragm muscle activity, as there was no persistent change in ventilation during hypoxic exposure. These findings suggest a potentially critical role for hypoxia in diaphragm muscle remodeling in acute respiratory-related disorders.

Hypoxia, not hypercapnia, induces cardiorespiratory failure in rats

Mechanical respiratory loads induce cardiorespiratory failure, presumably by increasing O2 demand concurrently with decreases in O2 availability (decreased PaO2). We tested the hypothesis that asphyxia alone can cause cardiorespiratory failure ("failure") in pentobarbital-anesthetized rats. We also tested the hypothesis that hypoxia, not hypercapnia, is responsible by supplying supplemental O2 during mechanical loading in a separate group of rats. Asphyxia (mean PaO2 and PaCO2 of 43 and 69mmHg, respectively) resulted in failure, evident as a slowing of mean respiratory frequency (133-83breaths/min) and a sudden and large drop in mean arterial pressure (71-47mmHg), after 214±66min (n=16; range 117-355min). Neither respiratory drive nor heart rate decreased, indicating that failure was peripheral, not central. Of 8 rats tested after 3h of asphyxia for the presence in blood of cardiac troponin T, all were positive. In an additional 6 rats, normocapnic hypoxia (mean PaCO2 and PaO2 were 39±2.2 and 41±3.1mmHg, respectively) caused failure after an average 205min (range 181-275min), no different from that of asphyxic rats. In the 6 rats that breathed O2 during an initially moderate inspiratory resistive load, endurances exceeded 7h (failure occurring only because we increased the load after 6h) and tracheal pressure and left ventricular dP/dt were maintained despite supercarbia (PaCO2>150mmHg). Thus, asphyxia alone can induce failure, the failure is due to hypoxia, not hypercapnia, and hypercapnia has minimal effects on cardiac and respiratory muscle function in the presence of hyperoxia.

Skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a debilitating disease characterized by inflammation-induced airflow limitation and parenchymal destruction. In addition to pulmonary manifestations, patients with COPD develop systemic problems, including skeletal muscle and other organ-specific dysfunctions, nutritional abnormalities, weight loss, and adverse psychological responses. Patients with COPD often complain of dyspnea on exertion, reduced exercise capacity, and develop a progressive decline in lung function with increasing age. These symptoms have been attributed to increases in the work of breathing and in impairments in gas exchange that result from airflow limitation and dynamic hyperinflation. However, there is mounting evidence to suggest that skeletal muscle dysfunction, independent of lung function, contributes significantly to reduced exercise capacity and poor quality of life in these patients. Limb and ventilatory skeletal muscle dysfunction in COPD patients has been attributed to a myriad of factors, including the presence of low grade systemic inflammatory processes, nutritional depletion, corticosteroid medications, chronic inactivity, age, hypoxemia, smoking, oxidative and nitrosative stresses, protein degradation and changes in vascular density. This review briefly summarizes the contribution of these factors to overall skeletal muscle dysfunction in patients with COPD, with particular attention paid to the latest advances in the field.

Responses to hypoxia during early development

Sustained hypoxia evokes a predictable cascade of ventilatory, neurochemical, and metabolic responses. Responses in immature animals are characterized by earlier and more marked depression of ventilation than fully mature animals. Ventilation during hypoxia reflects a collective system output, incorporating a number of compensatory mechanisms (stimulation or depression) from multiple systems. The time course of these responses is clearly developmentally regulated. When hypercapnia interacts with hypoxia, the ventilatory responses are enhanced but other responses are apparently unchanged. We propose a model in which responses to intermittent stimuli vary according to the point within the sequence of a single response where the stimulus interruption occurs. An intermittent stimulus may be seen as 'continuous' if the recurrence frequency exceeds a certain threshold, whereas application of slower cycles below such threshold may elicit discordant recruitment of the compensatory responses. Indeed, experimental observations on intermittent (hypercapnic or poikylocapnic) hypoxia show excitatory or depressant effects that are dictated by the cycle duration. Subject to further testing, this model may help explain how detrimental effects of hypoxic events in infancy only affect selected groups.

The effect of hypoxia on shortening contractions in rat diaphragm muscle

Hypoxia is known to reduce isometric contractile properties of isolated rat diaphragm bundles. Its effect on isotonic contractile properties (i.e. force-velocity relationship and power output) has not been studied. We hypothesized that hypoxia reduces velocity of shortening and consequently power output of the unfatigued muscle, and shortens endurance time during isotonic contractions. Force-velocity relationship, power output, and fatigue resistance of rat diaphragm muscle bundles were measured during hypoxia (PO2: 6.6 +/- 0.2 kPa) and compared with hyperoxia (PO2: 91.8 +/- 0.7 kPa). Force was clamped from 1 to 100% of maximal tetanic force (Po). Fatigue during isotonic contractions was induced by repeated stimulation every 2 s at a clamp level of 33% of Po. Hypoxia did not affect isometric force generation compared with hyperoxia, nor contraction or relaxation time. In contrast, maximum shortening velocity decreased significantly (hypoxia: 4.2 +/- 0.3, hyperoxia: 6.0 +/- 0.2 Lo/s, P < 0.05). The force-velocity curve shifted downwards (P < 0.05). Hypoxia lowered power output at each load compared with hyperoxia (P < 0.05). The isotonic endurance time was shorter during hypoxia compared with hyperoxia (80 +/- 2 vs. 130 +/- 3 s, P < 0.05). These data show that hypoxia depresses isotonic contractile properties and power output, and reduces endurance time during repeated isotonic contractions.

beta2-adrenoceptor agonists reduce the decline of rat diaphragm twitch force during severe hypoxia

The aim of the present study was to investigate the in vitro effects of the short-acting beta2-adrenoceptor agonist salbutamol and the long-acting beta2-adrenoceptor agonist salmeterol on hypoxia-induced rat diaphragm force reduction. In vitro diaphragm twitch force (Pt) and maximal tetanic force (Po) of isolated diaphragm muscle strips were measured for 90 min during hyperoxia (tissue bath PO2 83.8 +/- 0.9 kPa and PCO2 3.9 +/- 0.1 kPa) or severe hypoxia (PO2 7.1 +/- 0.3 kPa and PCO2 3.9 +/- 0.1 kPa) in the presence and absence of 1 microM salbutamol or 1 microM salmeterol. During hyperoxia, salbutamol and salmeterol did not significantly alter the time-related decreases in Pt and Po (to approximately 50% of initial values). Salbutamol had no effects on Po or the Pt-to-Po ratio. Salmeterol treatment significantly reduced Po and increased the Pt-to-Po ratio during hyperoxia (P < 0.05 compared with control value). Hypoxia resulted in a severe decrease in Pt (to approximately 30% of initial value) and Po after 90 min. Both salbutamol and salmeterol significantly reduced the decline in Pt during hypoxia (P < 0.05). The reduction in Po was not prevented. Salbutamol increased Pt rapidly but transiently. Salmeterol had a delayed onset of effect and a longer duration of action. Addition of 1 microM propranolol (a nonselective beta-adrenoceptor antagonist) did not alter Pt, Po, or the Pt-to-Po ratio during hypoxia but completely blocked the inotropic effects of salbutamol and salmeterol, indicating that these effects are dependent on beta2-adrenoceptor agonist-related processes.