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Gatterer H, Villafuerte FC, Ulrich S, Bhandari SS, Keyes LE, Burtscher M. Altitude illnesses. Nat Rev Dis Primers 2024; 10:43. [PMID: 38902312 DOI: 10.1038/s41572-024-00526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/22/2024]
Abstract
Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect high-altitude resident populations worldwide. The prevalence of acute HAIs varies according to acclimatization status, rate of ascent and individual susceptibility. AMS, characterized by headache, nausea, dizziness and fatigue, is usually benign and self-limiting, and has been linked to hypoxia-induced cerebral blood volume increases, inflammation and related trigeminovascular system activation. Disruption of the blood-brain barrier leads to HACE, characterized by altered mental status and ataxia, and increased pulmonary capillary pressure, and related stress failure induces HAPE, characterized by dyspnoea, cough and exercise intolerance. Both conditions are progressive and life-threatening, requiring immediate medical intervention. Treatment includes supplemental oxygen and descent with appropriate pharmacological therapy. Preventive measures include slow ascent, pre-acclimatization and, in some instances, medications. CMS is characterized by excessive erythrocytosis and related clinical symptoms. In severe CMS, temporary or permanent relocation to low altitude is recommended. Future research should focus on more objective diagnostic tools to enable prompt treatment, improved identification of individual susceptibilities and effective acclimatization and prevention options.
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Affiliation(s)
- Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT TIROL-Private University for Health Sciences and Health Technology, Hall in Tirol, Austria.
| | - Francisco C Villafuerte
- Laboratorio de Fisiología del Transporte de Oxígeno y Adaptación a la Altura - LID, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sanjeeb S Bhandari
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
- Emergency Department, UPMC Western Maryland Health, Cumberland, MD, USA
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Owens TS, Marley CJ, Calverley TA, Stacey BS, Fall L, Tsukamoto H, Iannetelli A, Filipponi T, Davies B, Jones GL, Hirtz C, Lehmann S, Tuaillon E, Marchi N, Bailey DM. Lower systemic nitric oxide bioactivity, cerebral hypoperfusion and accelerated cognitive decline in formerly concussed retired rugby union players. Exp Physiol 2023; 108:1029-1046. [PMID: 37423736 PMCID: PMC10988504 DOI: 10.1113/ep091195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023]
Abstract
NEW FINDINGS What is the central question of this study? What are the molecular, cerebrovascular and cognitive biomarkers of retired rugby union players with concussion history? What is the main finding and its importance? Retired rugby players compared with matched controls exhibited lower systemic nitric oxide bioavailability accompanied by lower middle cerebral artery velocity and mild cognitive impairment. Retired rugby players are more susceptible to accelerated cognitive decline. ABSTRACT Following retirement from sport, the chronic consequences of prior-recurrent contact are evident and retired rugby union players may be especially prone to accelerated cognitive decline. The present study sought to integrate molecular, cerebrovascular and cognitive biomarkers in retired rugby players with concussion history. Twenty retired rugby players aged 64 ± 5 years with three (interquartile range (IQR), 3) concussions incurred over 22 (IQR, 6) years were compared to 21 sex-, age-, cardiorespiratory fitness- and education-matched controls with no prior concussion history. Concussion symptoms and severity were assessed using the Sport Concussion Assessment Tool. Plasma/serum nitric oxide (NO) metabolites (reductive ozone-based chemiluminescence), neuron specific enolase, glial fibrillary acidic protein and neurofilament light-chain (ELISA and single molecule array) were assessed. Middle cerebral artery blood velocity (MCAv, doppler ultrasound) and reactivity to hyper/hypocapnia (CVR CO 2 hyper ${\mathrm{CVR}}_{{\mathrm{CO}}_{\mathrm{2}}{\mathrm{hyper}}}$ /CVR CO 2 hypo ${\mathrm{CVR}}_{{\mathrm{CO}}_{\mathrm{2}}{\mathrm{hypo}}}$ ) were assessed. Cognition was determined using the Grooved Pegboard Test and Montreal Cognitive Assessment. Players exhibited persistent neurological symptoms of concussion (U = 109(41) , P = 0.007), with increased severity compared to controls (U = 77(41) , P < 0.001). Lower total NO bioactivity (U = 135(41) , P = 0.049) and lower basal MCAv were apparent in players (F2,39 = 9.344, P = 0.004). This was accompanied by mild cognitive impairment (P = 0.020, 95% CI, -3.95 to -0.34), including impaired fine-motor coordination (U = 141(41) , P = 0.021). Retired rugby union players with history of multiple concussions may be characterised by impaired molecular, cerebral haemodynamic and cognitive function compared to non-concussed, non-contact controls.
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Affiliation(s)
- Thomas S. Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Christopher J. Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Thomas A. Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Benjamin S. Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Lewis Fall
- Faculty of Computing, Engineering and ScienceUniversity of South WalesUK
| | | | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Teresa Filipponi
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Bruce Davies
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Gareth L. Jones
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
| | - Christophe Hirtz
- LBPC‐PPCUniversity of Montpellier, Institute of Regenerative Medicine‐Biotherapy IRMB, Centre Hospitalier Universitaire de Montpellier, INSERMMontpellierFrance
| | - Sylvain Lehmann
- LBPC‐PPCUniversity of Montpellier, Institute of Regenerative Medicine‐Biotherapy IRMB, Centre Hospitalier Universitaire de Montpellier, INSERMMontpellierFrance
| | - Edouard Tuaillon
- CHU Montpellier, Department of Bacteriology‐VirologyCentre University ofMontpellierFrance
| | - Nicola Marchi
- Cerebrovascular and Glia Research, Department of NeuroscienceInstitute of Functional Genomics (University of Montpellier, CNRS, INSERM)MontpellierFrance
| | - Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesUK
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Hartmann JP, Bailey DM, Berg RMG. A song of iron and oxygen: Hypoxic pulmonary vasoconstriction and gas exchange in chronic obstructive pulmonary disease. Exp Physiol 2023; 108:535-538. [PMID: 36744659 PMCID: PMC10103854 DOI: 10.1113/ep091078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Jacob P. Hartmann
- Centre for Physical Activity ResearchCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Ronan M. G. Berg
- Centre for Physical Activity ResearchCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Department of Biomedical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenDenmark
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Stacey BS, Hoiland RL, Caldwell HG, Howe CA, Vermeulen T, Tymko MM, Vizcardo‐Galindo GA, Bermudez D, Figueroa‐Mujíica RJ, Gasho C, Tuaillon E, Hirtz C, Lehmann S, Marchi N, Tsukamoto H, Villafuerte FC, Ainslie PN, Bailey DM. Lifelong exposure to high-altitude hypoxia in humans is associated with improved redox homeostasis and structural-functional adaptations of the neurovascular unit. J Physiol 2023; 601:1095-1120. [PMID: 36633375 PMCID: PMC10952731 DOI: 10.1113/jp283362] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
High-altitude (HA) hypoxia may alter the structural-functional integrity of the neurovascular unit (NVU). Herein, we compared male lowlanders (n = 9) at sea level (SL) and after 14 days acclimatization to 4300 m (chronic HA) in Cerro de Pasco (CdP), Péru (HA), against sex-, age- and body mass index-matched healthy highlanders (n = 9) native to CdP (lifelong HA). Venous blood was assayed for serum proteins reflecting NVU integrity, in addition to free radicals and nitric oxide (NO). Regional cerebral blood flow (CBF) was examined in conjunction with cerebral substrate delivery, dynamic cerebral autoregulation (dCA), cerebrovascular reactivity to carbon dioxide (CVRCO2 ) and neurovascular coupling (NVC). Psychomotor tests were employed to examine cognitive function. Compared to lowlanders at SL, highlanders exhibited elevated basal plasma and red blood cell NO bioavailability, improved anterior and posterior dCA, elevated anterior CVRCO2 and preserved cerebral substrate delivery, NVC and cognition. In highlanders, S100B, neurofilament light-chain (NF-L) and T-tau were consistently lower and cognition comparable to lowlanders following chronic-HA. These findings highlight novel integrated adaptations towards regulation of the NVU in highlanders that may represent a neuroprotective phenotype underpinning successful adaptation to the lifelong stress of HA hypoxia. KEY POINTS: High-altitude (HA) hypoxia has the potential to alter the structural-functional integrity of the neurovascular unit (NVU) in humans. For the first time, we examined to what extent chronic and lifelong hypoxia impacts multimodal biomarkers reflecting NVU structure and function in lowlanders and native Andean highlanders. Despite lowlanders presenting with a reduction in systemic oxidative-nitrosative stress and maintained cerebral bioenergetics and cerebrovascular function during chronic hypoxia, there was evidence for increased axonal injury and cognitive impairment. Compared to lowlanders at sea level, highlanders exhibited elevated vascular NO bioavailability, improved dynamic regulatory capacity and cerebrovascular reactivity, comparable cerebral substrate delivery and neurovascular coupling, and maintained cognition. Unlike lowlanders following chronic HA, highlanders presented with lower concentrations of S100B, neurofilament light chain and total tau. These findings highlight novel integrated adaptations towards the regulation of the NVU in highlanders that may represent a neuroprotective phenotype underpinning successful adaptation to the lifelong stress of HA hypoxia.
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Affiliation(s)
- Benjamin S. Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Ryan L. Hoiland
- Department of Anaesthesiology, Pharmacology and Therapeutics, Vancouver General HospitalUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Department of Cellular and Physiological Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Hannah G. Caldwell
- Centre for Heart, Lung and Vascular HealthUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - Connor A. Howe
- Centre for Heart, Lung and Vascular HealthUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - Tyler Vermeulen
- Centre for Heart, Lung and Vascular HealthUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - Michael M. Tymko
- Centre for Heart, Lung and Vascular HealthUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
- Faculty of Kinesiology, Sport, and RecreationUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Gustavo A. Vizcardo‐Galindo
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y FilosofíaUniversidad Peruana Cayetano HerediaLima 31Peru
| | - Daniella Bermudez
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y FilosofíaUniversidad Peruana Cayetano HerediaLima 31Peru
| | - Rómulo J. Figueroa‐Mujíica
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y FilosofíaUniversidad Peruana Cayetano HerediaLima 31Peru
| | - Christopher Gasho
- Division of Pulmonary and Critical CareLoma Linda University School of MedicineLoma LindaCAUSA
| | - Edouard Tuaillon
- Department of Infectious DiseasesUniversity of MontpellierMontpellierFrance
| | - Christophe Hirtz
- LBPC‐PPCUniversité de Montpellier, IRMB CHU de Montpellier, INM INSERMMontpellierFrance
| | - Sylvain Lehmann
- LBPC‐PPCUniversité de Montpellier, IRMB CHU de Montpellier, INM INSERMMontpellierFrance
| | - Nicola Marchi
- Laboratory of Cerebrovascular and Glia Research, Department of Neuroscience, Institute of Functional GenomicsUniversity of MontpellierMontpellierFrance
| | - Hayato Tsukamoto
- Faculty of Sport and Health ScienceRitsumeikan UniversityKusatsuShigaJapan
| | - Francisco C. Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y FilosofíaUniversidad Peruana Cayetano HerediaLima 31Peru
| | - Philip N. Ainslie
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Centre for Heart, Lung and Vascular HealthUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
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Ogoh S, Washio T, Stacey BS, Tsukamoto H, Iannetelli A, Owens TS, Calverley TA, Fall L, Marley CJ, Bailey DM. Effects of continuous hypoxia on flow-mediated dilation in the cerebral and systemic circulation: on the regulatory significance of shear rate phenotype. J Physiol Sci 2022; 72:16. [PMID: 35858836 DOI: 10.1186/s12576-022-00841-5] [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: 04/01/2022] [Accepted: 07/07/2022] [Indexed: 11/10/2022]
Abstract
Emergent evidence suggests that cyclic intermittent hypoxia increases cerebral arterial shear rate and endothelial function, whereas continuous exposure decreases anterior cerebral oxygen (O2) delivery. To examine to what extent continuous hypoxia impacts cerebral shear rate, cerebral endothelial function, and consequent cerebral O2 delivery (CDO2), eight healthy males were randomly assigned single-blind to 7 h passive exposure to both normoxia (21% O2) and hypoxia (12% O2). Blood flow in the brachial and internal carotid arteries were determined using Duplex ultrasound and included the combined assessment of systemic and cerebral endothelium-dependent flow-mediated dilatation. Systemic (brachial artery) flow-mediated dilatation was consistently lower during hypoxia (P = 0.013 vs. normoxia), whereas cerebral flow-mediated dilation remained preserved (P = 0.927 vs. normoxia) despite a reduction in internal carotid artery antegrade shear rate (P = 0.002 vs. normoxia) and CDO2 (P < 0.001 vs. normoxia). Collectively, these findings indicate that the reduction in CDO2 appears to be independent of cerebral endothelial function and contrasts with that observed during cyclic intermittent hypoxia, highlighting the regulatory importance of (hypoxia) dose duration and flow/shear rate phenotype.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan.,Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Takuro Washio
- Department of Biomedical Engineering, Toyo University, Kawagoe, Saitama, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK.,Faculty of Sport and Health Science, Ritsumeikan University, Shiga, Japan
| | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Thomas S Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Thomas A Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Lewis Fall
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Christopher J Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, CF37 4AT, UK. .,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
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