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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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Gupta D, Wal P, Mishra M, Wal A, Rathore S, Shanker Pandey S, Saraswat N, Saxena B. Recent Progress in the Understanding and Management of Acute Mountain Sickness: A Narrative Review. Curr Rev Clin Exp Pharmacol 2024; 19:213-224. [PMID: 37888823 DOI: 10.2174/0127724328237059230919093818] [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: 11/21/2022] [Revised: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Individuals at higher altitudes may experience a decrease in blood oxygen levels, which can result in a variety of clinical illnesses, such as high-altitude pulmonary edema, high-altitude cerebral edema, and milder but more common acute mountain sickness (AMS). OBJECTIVE This study aims to review the current state of knowledge related to motion sickness, the risk of AMS, and pharmacological and non-pharmacological treatments for AMS. METHODS Several databases, including PubMed, Bentham Science, Elsevier, Springer, and Research Gate, were used to compile the data for the article following a thorough analysis of the various research findings connected to acute mountain sickness and motion sickness, along with treatments and prevention. RESULTS This article covers the research on mountain sickness as well as every imaginable form of conventional and alternative medicine. It contains ten medicinal plants that are useful in treating mountain sickness and various other remedies. Additionally, case studies are provided. CONCLUSION Therefore, the information in the paper will help travel medicine specialists better personalize their appropriate care for patients who travel to high-altitude locations. Additionally, all available antiemetic medications, serotonin agonists, nonsteroidal anti-inflammatory drugs, and herbal treatments for motion sickness were discussed. The prevention and consequences of acute mountain sickness are also covered in this study.
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Affiliation(s)
- Divyanshi Gupta
- Department of Pharmacy, Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Pranay Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Mudita Mishra
- Department of Pharmacy, Quantum School of Health Sciences, Roorkee, Uttarakhand, India
| | - Ankita Wal
- Department of Pharmacy, Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | | | | | - Nikita Saraswat
- Dr. D.Y Patil College of Pharmacy, Akurdi, Pune, Maharashtra, India
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Champigneulle B, Stauffer E, Robach P, Doutreleau S, Howe CA, Pina A, Salazar-Granara AA, Hancco I, Guergour D, Brugniaux JV, Connes P, Pichon A, Verges S. Early effects of acetazolamide on hemoglobin mass and plasma volume in chronic mountain sickness at 5100 m. Pulmonology 2023:S2531-0437(23)00095-8. [PMID: 37263861 DOI: 10.1016/j.pulmoe.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic Mountain Sickness (CMS) syndrome, combining excessive erythrocytosis and clinical symptoms in highlanders, remains a public health concern in high-altitude areas, especially in the Andes, with limited therapeutic approaches. The objectives of this study were to assess in CMS-highlanders permanently living in La Rinconada (5100-5300 m, Peru, the highest city in the world), the early efficacy of acetazolamide (ACZ) and atorvastatin to reduce hematocrit (Hct), as well as the underlying mechanisms focusing on intravascular volumes. MATERIALS AND METHODS Forty-one males (46±8 years of age) permanently living in La Rinconada for 15 [10-20] years and suffering from CMS were randomized between ACZ (250 mg once-daily; N = 13), atorvastatin (20 mg once-daily; N = 14) or placebo (N = 14) uptake in a double-blinded parallel study. Hematocrit (primary endpoint) as well as arterial blood gasses, total hemoglobin mass (Hbmass) and intravascular volumes were assessed at baseline and after a mean (±SD) treatment duration of 19±2 days. RESULTS ACZ increased PaO2 by +13.4% (95% CI: 4.3 to 22.5%) and decreased Hct by -5.2% (95% CI: -8.3 to -2.2%), whereas Hct remained unchanged with placebo or atorvastatin. ACZ tended to decrease Hbmass (-2.6%, 95% CI: -5.7 to 0.5%), decreased total red blood cell volume (RBCV, -5.3%, 95% CI: -10.3 to -0.3%) and increased plasma volume (PV, +17.6%, 95% CI: 4.9 to 30.3%). Atorvastatin had no effect on intravascular volumes, while Hbmass and RBCV increased in the placebo group (+6.1%, 95% CI: 4.2 to 7.9% and +7.0%, 95%CI: 2.7 to 11.4%, respectively). CONCLUSIONS Short-term ACZ uptake was effective to reduce Hct in CMS-highlanders living at extreme altitude >5,000 m and was associated with both an increase in PV and a reduction in RBCV.
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Affiliation(s)
- B Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France.
| | - E Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - P Robach
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - S Doutreleau
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - C A Howe
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, Canada
| | - A Pina
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy
| | - A A Salazar-Granara
- Universidad de San Martin de Porres, School of Medicine, Research Centre in Altitude Medicine, Lima, Peru
| | - I Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - D Guergour
- Unité Biochimie Immunoanalyse, Service de Biochimie Biologie Moléculaire et Toxicologie Environnementale, Institut de Biologie et Pathologie, CHU Grenoble Alpes, France
| | - J V Brugniaux
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - P Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - A Pichon
- Laboratoire Move EA 6314, Faculté des Sciences du Sport, Universit. De Poitiers, Poitiers, France
| | - S Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
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Liu X, Zhang H, Yan J, Li X, Li J, Hu J, Shang X, Yang H. Deciphering the Efficacy and Mechanism of Astragalus membranaceus on High Altitude Polycythemia by Integrating Network Pharmacology and In Vivo Experiments. Nutrients 2022; 14:4968. [PMID: 36500998 PMCID: PMC9740273 DOI: 10.3390/nu14234968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
Hypoxic exposure makes plateau migrators susceptible to high altitude polycythemia (HAPC). Astragalus membranaceus (AM) is an edible and medicinal plant with remarkable immunomodulatory activities. The purpose of this study was to discover if AM could be a candidate for the prevention of HAPC and its mechanism. Here, network pharmacology was applied to screen active compounds, key targets, and enriched pathways of AM in the treatment of HAPC. Molecular docking evaluated the affinity between compounds and core targets. Subsequently, the mechanisms of AM were further verified using the hypoxia exposure-induced mice model of HAPC. The network pharmacology analysis and molecular docking results identified 14 core targets of AM on HAPC, which were predominantly mainly enriched in the HIF-1 pathway. In the HAPC animal models, we found that AM inhibited the differentiation of hematopoietic stem cells into the erythroid lineage. It also suppressed the production of erythrocytes and hemoglobin in peripheral blood by reducing the expression of HIF-1α, EPO, VEGFA, and Gata-1 mRNA. Furthermore, AM downregulated the expression of IL-6, TNF-α, and IFN-γ mRNA, thereby alleviating organ inflammation. In conclusion, AM supplementation alleviates hypoxia-induced HAPC in mice, and TNF-α, AKT1, HIF-1α, VEGFA, IL-6, and IL-1B may be the key targets.
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Affiliation(s)
- Xiru Liu
- School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China
- Research Center of Special Environmental Biomechanics & Medical Engineering, Northwestern Polytechnical University, Xi’an 710072, China
| | - Hao Zhang
- School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China
- Research Center of Special Environmental Biomechanics & Medical Engineering, Northwestern Polytechnical University, Xi’an 710072, China
| | - Jinxiao Yan
- School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China
- Research Center of Special Environmental Biomechanics & Medical Engineering, Northwestern Polytechnical University, Xi’an 710072, China
| | - Xiang Li
- School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China
- Research Center of Special Environmental Biomechanics & Medical Engineering, Northwestern Polytechnical University, Xi’an 710072, China
| | - Jie Li
- General Station for Drug & Instrument Supervision and Control, Joint Logistics Support Force, PLA, Dalian 116041, China
| | - Jialu Hu
- School of Computer Science, Northwestern Polytechnical University, Xi’an 710072, China
| | - Xuequn Shang
- School of Computer Science, Northwestern Polytechnical University, Xi’an 710072, China
| | - Hui Yang
- School of Life Sciences, Northwestern Polytechnical University, Xi’an 710072, China
- Research Center of Special Environmental Biomechanics & Medical Engineering, Northwestern Polytechnical University, Xi’an 710072, China
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Sanchez-Azofra A, Villafuerte FC, DeYoung PN, Gilbertson D, Gu W, Moya EA, Vizcardo-Galindo G, Figueroa-Mujíca R, Anza-Ramirez C, Macarlupú JL, Pham LV, Wagner P, Malhotra A, Simonson TS, Mesarwi OA. Isovolemic hemodilution in chronic mountain sickness acutely worsens nocturnal oxygenation and sleep apnea severity. J Clin Sleep Med 2022; 18:2423-2432. [PMID: 35855526 PMCID: PMC9516589 DOI: 10.5664/jcsm.10136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Chronic mountain sickness (CMS) is commonly observed among Andean and other highland populations. Sleep-disordered breathing (SDB) is highly prevalent at high altitude, and SDB and nocturnal hypoxemia have been observed in CMS. Phlebotomy is commonly performed to treat CMS, but it is unknown whether reducing hematocrit improves SDB. We hypothesized that isovolemic hemodilution (IVHD) in CMS would reduce SBD severity and improve sleep efficiency. METHODS Six participants with CMS and 8 without CMS, all residents of Cerro de Pasco, Peru (altitude 4340 m), completed baseline nocturnal sleep studies. CMS participants then underwent IVHD, and nocturnal sleep studies were repeated 24-48 hours after IVHD. We analyzed sleep apnea severity, nocturnal oxygenation, and sleep quality in those with CMS relative to those without CMS, and the effects of IVHD in CMS participants. RESULTS Participants with CMS did not have altered sleep architecture, sleep apnea severity, or nocturnal oxygenation relative to non-CMS participants. However, IVHD in CMS increased apnea-hypopnea index (40.9 ± 6.9 events/h to 61.5 ± 7.7 events/h, P = .009). IVHD increased oxyhemoglobin desaturation index (P = .008) and the percentage of sleep time spent with oxyhemoglobin saturation at or below 80% (P = .012). There was no effect of IVHD on sleep efficiency, arousal index, or sleep staging. CONCLUSIONS In this cohort, CMS was not associated with worsened SDB or changes in sleep architecture. IVHD, a putative therapeutic option for participants with CMS, appears to worsen nocturnal oxygenation and SDB within 48 hours post-IVHD. CITATION Sanchez-Azofra A, Villafuerte FC, DeYoung PN, et al. Isovolemic hemodilution in chronic mountain sickness acutely worsens nocturnal oxygenation and sleep apnea severity. J Clin Sleep Med. 2022;18(10):2423-2432.
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Affiliation(s)
- Ana Sanchez-Azofra
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
- Servicio de Neumología, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - Francisco C. Villafuerte
- Laboratorio de Fisiología Comparada, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Pamela N. DeYoung
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
| | - Dillon Gilbertson
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
| | - Wanjun Gu
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
| | - Esteban A. Moya
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
| | - Gustavo Vizcardo-Galindo
- Laboratorio de Fisiología Comparada, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rómulo Figueroa-Mujíca
- Laboratorio de Fisiología Comparada, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Cecilia Anza-Ramirez
- Laboratorio de Fisiología Comparada, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jose L. Macarlupú
- Laboratorio de Fisiología Comparada, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Luu V. Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Peter Wagner
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
- Center for Physiological Genomics of Low Oxygen, University of California, San Diego, California
| | - Tatum S. Simonson
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
- Center for Physiological Genomics of Low Oxygen, University of California, San Diego, California
| | - Omar A. Mesarwi
- Division of Pulmonary, Critical Care, & Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, California
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Villafuerte FC, Simonson TS, Bermudez D, León-Velarde F. High-Altitude Erythrocytosis: Mechanisms of Adaptive and Maladaptive Responses. Physiology (Bethesda) 2022; 37:0. [PMID: 35001654 PMCID: PMC9191173 DOI: 10.1152/physiol.00029.2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Erythrocytosis, or increased production of red blood cells, is one of the most well-documented physiological traits that varies within and among in high-altitude populations. Although a modest increase in blood O2-carrying capacity may be beneficial for life in highland environments, erythrocytosis can also become excessive and lead to maladaptive syndromes such as chronic mountain sickness (CMS).
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Affiliation(s)
- Francisco C. Villafuerte
- 1Laboratorio de Fisiología Comparada/Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Tatum S. Simonson
- 2Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Daniela Bermudez
- 1Laboratorio de Fisiología Comparada/Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Fabiola León-Velarde
- 1Laboratorio de Fisiología Comparada/Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
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Chen X, Liu B, Deng Y, Yang F, Wang W, Lin X, Yu L, Pu H, Zhang P, Li Z, Zhong Q, Jia Q, Li Y, Wang X, Chen W, Burkhoff D, He K. Cardiac Adaptation to Prolonged High Altitude Migration Assessed by Speckle Tracking Echocardiography. Front Cardiovasc Med 2022; 9:856749. [PMID: 35677688 PMCID: PMC9167963 DOI: 10.3389/fcvm.2022.856749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Exposure to high altitudes represents physiological stress that leads to significant changes in cardiovascular properties. However, long-term cardiovascular adaptions to high altitude migration of lowlanders have not been described. Accordingly, we measured changes in cardiovascular properties following prolonged hypoxic exposure in acclimatized Han migrants and Tibetans. Methods Echocardiographic features of recently adapted Han migrant (3–12 months, n = 64) and highly adapted Han migrant (5–10 years, n = 71) residence in Tibet (4,300 m) using speckle tracking echocardiography were compared to those of age-matched native Tibetans (n = 75) and Han lowlanders living at 1,400 m (n = 60). Results Short-term acclimatized migrants showed increased estimated pulmonary artery systolic pressure (PASP) (32.6 ± 5.1 mmHg vs. 21.1 ± 4.2 mmHg, p < 0.05), enlarged right ventricles (RVs), and decreased fractional area change (FAC) with decreased RV longitudinal strain (−20 ± 2.8% vs. −25.5 ± 3.9%, p < 0.05). While left ventricular ejection fraction (LVEF) was preserved, LV diameter (41.7 ± 3.1 mm vs. 49.7 ± 4.8 mm, p < 0.05) and LV longitudinal strain (−18.8 ± 3.2% vs. −22.9 ± 3.3%, p < 0.05) decreased. Compared with recent migrants, longer-term migrants had recovered RV structure and functions with slightly improved RV and LV longitudinal strain, though still lower than lowlander controls; LV size remained small with increased mass index (68.3 ± 12.7 vs. 59.3 ± 9.6, p < 0.05). In contrast, native Tibetans had slightly increased PASP (26.1 ± 3.4 mmHg vs. 21.1 ± 4.2 mmHg, p < 0.05) with minimally altered cardiac deformation compared to lowlanders. Conclusion Right ventricular systolic function is impaired in recent (<1 year) migrants to high altitudes but improved during the long-term dwelling. LV remodeling persists in long-term migrants (>5 years) but without impairment of LV systolic or diastolic function. In contrast, cardiac size, structure, and function of native Tibetans are more similar to those of lowland dwelling Hans.
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Affiliation(s)
- Xu Chen
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Bohan Liu
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yujiao Deng
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Feifei Yang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Wenjun Wang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Xixiang Lin
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Liheng Yu
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Haitao Pu
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Peifang Zhang
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Zongren Li
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Qin Zhong
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Jia
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yao Li
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao Wang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Chen
- Department of Ultrasound Diagnosis, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, United States
| | - Kunlun He
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Kunlun He
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Macarlupu J, Marchant D, Jeton F, Villafuerte F, Richalet J, Voituron N. Effect of exercise training in rats exposed to chronic hypoxia: Application for Monge's disease. Physiol Rep 2021; 9:e14750. [PMID: 33904648 PMCID: PMC8077116 DOI: 10.14814/phy2.14750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
Physical exercise may improve hematological conditions in high altitude dwellers suffering from Chronic Mountain Sickness (CMS), in reducing hemoglobin concentration. Therefore, the present study aimed to characterize the effects of 1-month exercise training session in a model of rats exposed to chronic hypoxia. Four groups of male rats were studied: normoxic sedentary (NS, n = 8), normoxic training (NT, n = 8), hypoxic sedentary (HS, n = 8), and hypoxic training group (HT, n = 8). Hypoxic groups were exposed to hypobaric hypoxia for one month (PB =433 Torr). Training intensity was progressively increased from a running speed of 10.4 to 17.8 m/min. Chronic hypoxia led to an increase in hematocrit (HCT) associated with a decrease in plasma volume despite an increase in water intake. Training led to a reduction in HCT (p < 0.01), with a non-significant increase in plasma volume and weight gain. Hypoxia and training had inhibitory effects on haptoglobin (NS group: 379 ± 92; HT: 239 ± 34 µg/ml, p < 0.01). Chronic hypoxia and exercise training increased SpO2 measured after acute hypoxic exposure. Training blunted the decrease in V ˙ O2 peak, time of exhaustion, and maximum speed associated with chronic exposure to hypoxia. Chronic hypoxia led to a right ventricular hypertrophy, which was not corrected by 1-month exercise training. Altogether, by decreasing hematocrit, reducing body weight, and limiting performance decrease, training in hypoxia may have a beneficial effect on excessive erythropoiesis in chronic hypoxia. Therefore, regular exercise training might be beneficial to avoid worsening of CMS symptoms in high altitude dwellers and to improve their quality of life.
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Affiliation(s)
- José‐Luis Macarlupu
- Laboratorio de Fisiología ComparadaLaboratorio de Adaptación a la Altura‐LIDUnidad de Transporte de Oxigeno‐IIAUniversidad Peruana Cayetano HerediaLimaPeru
- Laboratoire Hypoxie et PoumonUMR INSERM U1272Université Sorbonne Paris NordBobignyFrance
| | - Dominique Marchant
- Laboratoire Hypoxie et PoumonUMR INSERM U1272Université Sorbonne Paris NordBobignyFrance
| | - Florine Jeton
- Laboratoire Hypoxie et PoumonUMR INSERM U1272Université Sorbonne Paris NordBobignyFrance
- Laboratory of Excellence GReXParisFrance
| | - Francisco Villafuerte
- Laboratorio de Fisiología ComparadaLaboratorio de Adaptación a la Altura‐LIDUnidad de Transporte de Oxigeno‐IIAUniversidad Peruana Cayetano HerediaLimaPeru
| | - Jean‐Paul Richalet
- Laboratoire Hypoxie et PoumonUMR INSERM U1272Université Sorbonne Paris NordBobignyFrance
- Laboratory of Excellence GReXParisFrance
| | - Nicolas Voituron
- Laboratoire Hypoxie et PoumonUMR INSERM U1272Université Sorbonne Paris NordBobignyFrance
- Laboratory of Excellence GReXParisFrance
- Département STAPSUniversité Sorbonne Paris NordBobignyFrance
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9
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Tremblay JC, Hoiland RL, Howe CA, Coombs GB, Vizcardo-Galindo GA, Figueroa-Mujíca RJ, Bermudez D, Gibbons TD, Stacey BS, Bailey DM, Tymko MM, MacLeod DB, Gasho C, Villafuerte FC, Pyke KE, Ainslie PN. Global REACH 2018: High Blood Viscosity and Hemoglobin Concentration Contribute to Reduced Flow-Mediated Dilation in High-Altitude Excessive Erythrocytosis. Hypertension 2019; 73:1327-1335. [PMID: 31006327 DOI: 10.1161/hypertensionaha.119.12780] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Excessive erythrocytosis (EE; hemoglobin concentration [Hb] ≥21 g/dL in adult males) is associated with increased cardiovascular risk in highlander Andeans. We sought to quantify shear stress and assess endothelial function via flow-mediated dilation (FMD) in male Andeans with and without EE. We hypothesized that FMD would be impaired in Andeans with EE after accounting for shear stress and that FMD would improve after isovolemic hemodilution. Brachial artery shear stress and FMD were assessed in 23 male Andeans without EE (age: 40±15 years [mean±SD]; Hb<21 g/dL) and 19 male Andeans with EE (age: 43±14 years; Hb≥21 g/dL) in Cerro de Pasco, Peru (4330 m). Shear stress was quantified from Duplex ultrasound measures of shear rate and blood viscosity. In a subset of participants (n=8), FMD was performed before and after isovolemic hemodilution with blood volume replaced by an equal volume of human serum albumin. Blood viscosity and Hb were 48% and 23% higher (both P<0.001) and FMD was 28% lower after adjusting for the shear stress stimulus ( P=0.013) in Andeans with EE compared to those without. FMD was inversely correlated with blood viscosity ( r2=0.303; P<0.001) and Hb ( r2=0.230; P=0.001). Isovolemic hemodilution decreased blood viscosity by 30±10% and Hb by 14±5% (both P<0.001) and improved shear stress stimulus-adjusted FMD from 2.7±1.9% to 4.3±1.9% ( P=0.022). Hyperviscosity, high Hb, or both, actively contribute to acutely reversible impairments in FMD in EE, suggesting that this plays a pathogenic role in the increased cardiovascular risk.
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Affiliation(s)
- Joshua C Tremblay
- From the Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada (J.C.T., K.E.P.)
| | - Ryan L Hoiland
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - Connor A Howe
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - Geoff B Coombs
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - Gustavo A Vizcardo-Galindo
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Rómulo J Figueroa-Mujíca
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Daniela Bermudez
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Travis D Gibbons
- School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, Dunedin, New Zealand (T.D.G.)
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, United Kingdom (B.S.S., D.M.B.)
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, United Kingdom (B.S.S., D.M.B.)
| | - Michael M Tymko
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - David B MacLeod
- Human Pharmacology and Physiology Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC (D.B.M.)
| | - Chris Gasho
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University School of Medicine, CA (C.G.)
| | - Francisco C Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Kyra E Pyke
- From the Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada (J.C.T., K.E.P.)
| | - Philip N Ainslie
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
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10
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Li M, Zhu Y, Li J, Chen L, Tao W, Li X, Qiu Y. Effect and mechanism of verbascoside on hypoxic memory injury in plateau. Phytother Res 2019; 33:2692-2701. [PMID: 31364205 DOI: 10.1002/ptr.6443] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/23/2019] [Accepted: 06/27/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Maoxing Li
- Department of PharmacyThe 940th Hospital of Joint Logistic Support Force, PLA Lanzhou China
- Key Laboratory of the Prevention and Treatment for Injure in Plateau of PLA Lanzhou China
- Department of PharmacyLanzhou University Lanzhou China
- School of PharmacyGansu University of Chinese Medicine Lanzhou China
| | - Yuting Zhu
- Department of PharmacyThe 940th Hospital of Joint Logistic Support Force, PLA Lanzhou China
- Key Laboratory of the Prevention and Treatment for Injure in Plateau of PLA Lanzhou China
- Department of PharmacyLanzhou University Lanzhou China
| | - Jing Li
- Department of PharmacyThe 940th Hospital of Joint Logistic Support Force, PLA Lanzhou China
- Key Laboratory of the Prevention and Treatment for Injure in Plateau of PLA Lanzhou China
| | - Liping Chen
- Department of PharmacyThe 940th Hospital of Joint Logistic Support Force, PLA Lanzhou China
- Key Laboratory of the Prevention and Treatment for Injure in Plateau of PLA Lanzhou China
| | - Wendi Tao
- Department of PharmacyThe 940th Hospital of Joint Logistic Support Force, PLA Lanzhou China
- Key Laboratory of the Prevention and Treatment for Injure in Plateau of PLA Lanzhou China
- Department of PharmacyLanzhou University Lanzhou China
| | - Xiaoling Li
- Department of PharmacyThe 940th Hospital of Joint Logistic Support Force, PLA Lanzhou China
- Key Laboratory of the Prevention and Treatment for Injure in Plateau of PLA Lanzhou China
- School of PharmacyGansu University of Chinese Medicine Lanzhou China
| | - Yan Qiu
- Department of PharmacyPudong Hospital of Shanghai University of Medicine and Health Science Shanghai China
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11
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Soria R, Egger M, Scherrer U, Bender N, Rimoldi SF. Pulmonary arterial pressure at rest and during exercise in chronic mountain sickness: a meta-analysis. Eur Respir J 2019; 53:13993003.02040-2018. [PMID: 31023845 DOI: 10.1183/13993003.02040-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/21/2019] [Indexed: 01/22/2023]
Abstract
Up to 10% of the more than 140 million high-altitude dwellers worldwide suffer from chronic mountain sickness (CMS). Patients suffering from this debilitating problem often display increased pulmonary arterial pressure (PAP), which may contribute to exercise intolerance and right heart failure. However, there is little information on the usual PAP in these patients.We systematically reviewed and meta-analysed all data published in English or Spanish until June 2018 on echocardiographic estimations of PAP at rest and during mild exercise in CMS patients.Nine studies comprising 287 participants fulfilled the inclusion criteria. At rest, the point estimate from meta-analysis of the mean systolic PAP was 27.9 mmHg (95% CI 26.3-29.6 mmHg). These values are 11% (+2.7 mmHg) higher than those previously meta-analysed in apparently healthy high-altitude dwellers. During mild exercise (50 W) the difference in mean systolic PAP between patients and high-altitude dwellers was markedly more accentuated (48.3 versus 36.3 mmHg) than at rest.These findings indicate that in patients with CMS PAP is moderately increased at rest, but markedly increased during mild exercise, which will be common with activities of daily living.
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Affiliation(s)
- Rodrigo Soria
- Dept of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Urs Scherrer
- Dept of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland.,Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile
| | - Nicole Bender
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.,These two authors contributed equally to this work
| | - Stefano F Rimoldi
- Dept of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland .,These two authors contributed equally to this work
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12
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Velotta JP, Cheviron ZA. Remodeling Ancestral Phenotypic Plasticity in Local Adaptation: A New Framework to Explore the Role of Genetic Compensation in the Evolution of Homeostasis. Integr Comp Biol 2019; 58:1098-1110. [PMID: 30272147 DOI: 10.1093/icb/icy117] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Phenotypic plasticity is not universally adaptive. In certain cases, plasticity can result in phenotypic shifts that reduce fitness relative to the un-induced state. A common cause of such maladaptive plasticity is the co-option of ancestral developmental and physiological response systems to meet novel challenges. Because these systems evolved to meet specific challenges in an ancestral environment (e.g., localized and transient hypoxia), their co-option to meet a similar, but novel, stressor (e.g., reductions in ambient pO2 at high elevation) can lead to misdirected responses that reduce fitness. In such cases, natural selection should act to remodel phenotypic plasticity to suppress the expression of these maladaptive responses. Because these maladaptive responses reduce the fitness of colonizers in new environments, this remodeling of ancestral plasticity may be among the earliest steps in adaptive walks toward new local optima. Genetic compensation has been proposed as a general form of adaptive evolution that leads to the suppression of maladaptive plasticity to restore the ancestral trait value in the face of novel stimuli. Given their central role in the regulation of basic physiological functions, we argue that genetic compensation may often be achieved by modifications of homeostatic regulatory systems. We further suggest that genetic compensation to modify homeostatic systems can be achieved by two alternative strategies that differ in their mechanistic underpinnings; to our knowledge, these strategies have not been formally recognized by previous workers. We then consider how the mechanistic details of these alternative strategies may constrain their evolution. These considerations lead us to argue that genetic compensation is most likely to evolve by compensatory physiological changes that safeguard internal homeostatic conditions to prevent the expression of maladaptive portions of conserved reaction norms, rather than direct evolution of plasticity itself. Finally, we outline a simple experimental framework to test this hypothesis. Our goal is to stimulate research aimed at providing a deeper mechanistic understanding of whether and how phenotypic plasticity can be remodeled following environmental shifts that render ancestral responses maladaptive, an issue with increasing importance in our current era of rapid environmental change.
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Affiliation(s)
- Jonathan P Velotta
- Division of Biological Sciences, University of Montana, Missoula, MT 59812, USA
| | - Zachary A Cheviron
- Division of Biological Sciences, University of Montana, Missoula, MT 59812, USA
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13
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Velotta JP, Ivy CM, Wolf CJ, Scott GR, Cheviron ZA. Maladaptive phenotypic plasticity in cardiac muscle growth is suppressed in high-altitude deer mice. Evolution 2018; 72:2712-2727. [PMID: 30318588 DOI: 10.1111/evo.13626] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 12/19/2022]
Abstract
How often phenotypic plasticity acts to promote or inhibit adaptive evolution is an ongoing debate among biologists. Recent work suggests that adaptive phenotypic plasticity promotes evolutionary divergence, though several studies have also suggested that maladaptive plasticity can potentiate adaptation. The role of phenotypic plasticity, adaptive, or maladaptive, in evolutionary divergence remains controversial. We examined the role of plasticity in evolutionary divergence between two species of Peromyscus mice that differ in native elevations. We used cardiac mass as a model phenotype, since ancestral hypoxia-induced responses of the heart may be both adaptive and maladaptive at high-altitude. While left ventricle growth should enhance oxygen delivery to tissues, hypertrophy of the right ventricle can lead to heart failure and death. We compared left- and right-ventricle plasticity in response to hypoxia between captive-bred P. leucopus (representing the ancestral lowland condition) and P. maniculatus from high-altitude. We found that maladaptive ancestral plasticity in right ventricle hypertrophy is reduced in high-altitude deer mice. Analysis of the heart transcriptome suggests that changes in expression of inflammatory signaling genes, particularly interferon regulatory factors, contribute to the suppression of right ventricle hypertrophy. We found weak evidence that adaptive plasticity of left ventricle mass contributes to evolution. Our results suggest that selection to suppress ancestral maladaptive plasticity plays a role in adaptation.
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Affiliation(s)
- Jonathan P Velotta
- Division of Biological Sciences, University of Montana, Missoula, Montana, 59812
| | - Catherine M Ivy
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| | - Cole J Wolf
- Division of Biological Sciences, University of Montana, Missoula, Montana, 59812
| | - Graham R Scott
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| | - Zachary A Cheviron
- Division of Biological Sciences, University of Montana, Missoula, Montana, 59812
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14
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Zhang Z, Xiao Z, Deng B, Liu X, Liu W, Nie H, Li X, Chen Z, Yang D, Duan R. Therapeutic Efficacy of Methazolamide Against Intermittent Hypoxia-Induced Excessive Erythrocytosis in Rats. High Alt Med Biol 2018; 19:69-80. [DOI: 10.1089/ham.2017.0044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Zhiqing Zhang
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Zhonghai Xiao
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Bingnan Deng
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Xiaohua Liu
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Wei Liu
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Hongjing Nie
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Xi Li
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Zhaoli Chen
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Danfeng Yang
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Ruifeng Duan
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
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15
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Cerebral Edema in Chronic Mountain Sickness: a New Finding. Sci Rep 2017; 7:43224. [PMID: 28233815 PMCID: PMC5324104 DOI: 10.1038/srep43224] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/20/2017] [Indexed: 11/09/2022] Open
Abstract
We observed patients with chronic mountain sickness (CMS) in our clinic who developed progressive neurological deterioration (encephalopathy) and we wished to investigate this. We studied nine such CMS patients, and compared them to 21 CMS patients without encephalopathy, and to 15 healthy control subjects without CMS. All 45 subjects lived permanently at 3200–4000 m. Measurements at 2260 m included CMS symptom score, multi-slice CT, perfusion CT, pulse oximetry (SpO2%), and hemoglobin concentration (Hb). One patient had MRI imaging but not CT; 5 had CSF pressure measurements. CMS subjects had lower SpO2, higher Hb, higher brain blood density, lower mean cerebral blood flow (CBF), and significant cerebral circulatory delay compared to controls. The nine CMS subjects with neurological deterioration showed diffuse cerebral edema on imaging and more deranged cerebral hemodynamics. CSF pressure was elevated in those with edema. We conclude that cerebral edema, a previously unrecognized complication, may develop in CMS patients and cause encephalopathy. Contributing factors appear to be exaggerated polycythemia and hypoxemia, and lower and sluggish CBF compared to CMS patients without cerebral edema; but what triggers this complication is unknown. Recognition and treatment of this serious complication will help reduce morbidity and mortality from CMS.
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16
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Healy K, Labrique AB, Miranda JJ, Gilman RH, Danz D, Davila-Roman VG, Huicho L, León-Velarde F, Checkley W. Dark Adaptation at High Altitude: An Unexpected Pupillary Response to Chronic Hypoxia in Andean Highlanders. High Alt Med Biol 2016; 17:208-213. [PMID: 27454014 DOI: 10.1089/ham.2016.0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Healy, Katherine, Alain B. Labrique, J. Jaime Miranda, Robert H. Gilman, David Danz, Victor G. Davila-Roman, Luis Huicho, Fabiola León-Velarde, and William Checkley. Dark adaptation at high altitude: an unexpected pupillary response to chronic hypoxia in Andean highlanders. High Alt Med Biol. 17:208-213, 2016.-Chronic mountain sickness is a maladaptive response to high altitude (>2500 m above sea level) and is characterized by excessive erythrocytosis and hypoxemia resulting from long-term hypobaric hypoxia. There is no known early predictor of chronic mountain sickness and the diagnosis is based on the presence of excessive erythrocytosis and clinical features. Impaired dark adaptation, or an inability to visually adjust from high- to low-light settings, occurs in response to mild hypoxia and may serve as an early predictor of hypoxemia and chronic mountain sickness. We aimed to evaluate the association between pupillary response assessed by dark adaptometry and daytime hypoxemia in resident Andean highlanders aged ≥35 years living in Puno, Peru. Oxyhemoglobin saturation (SpO2) was recorded using a handheld pulse oximeter. Dark adaptation was quantitatively assessed as the magnitude of pupillary contraction to light stimuli of varying intensities (-2.9 to 0.1 log-cd/m2) using a portable dark adaptometer. Individual- and stimulus-specific multilevel analyses were conducted using mixed-effect models to elicit the relationship between SpO2 and pupillary responsiveness. Among 93 participants, mean age was 54.9 ± 11.0 years, 48% were male, 44% were night blind, and mean SpO2 was 89.3% ± 3.4%. The magnitude of pupillary contraction was greater with lower SpO2 (p < 0.01), and this dose relationship remained significant in multiple variable analyses (p = 0.047). Pupillary responsiveness to light stimuli under dark-adapted conditions was exaggerated with hypoxemia and may serve as an early predictor of chronic mountain sickness. This unexpected association is potentially explained as an excessive and unregulated sympathetic response to hypoxemia at altitude.
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Affiliation(s)
- Katherine Healy
- 1 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University , Baltimore, Maryland.,2 Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Alain B Labrique
- 2 Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - J Jaime Miranda
- 3 CRONICAS Center of Excellence in Chronic Diseases , Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- 2 Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - David Danz
- 4 Biomedical Research Unit , A.B. PRISMA, Lima, Peru
| | - Victor G Davila-Roman
- 5 Division of Cardiovascular, Cardiovascular Imaging and Clinical Research Core Laboratory, School of Medicine, Washington University , St. Louis, Missouri
| | - Luis Huicho
- 3 CRONICAS Center of Excellence in Chronic Diseases , Universidad Peruana Cayetano Heredia, Lima, Peru .,6 Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia , Lima, Peru
| | - Fabiola León-Velarde
- 7 Departamento de Ciencias Biológicas y Fisiológicas, Universidad Peruana Cayetano Heredia , Lima, Peru
| | - William Checkley
- 1 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University , Baltimore, Maryland.,2 Program in Global Disease Epidemiology and Control, Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
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17
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Miranda JJ, Bernabé-Ortiz A, Diez-Canseco F, Málaga G, Cárdenas MK, Carrillo-Larco RM, Lazo-Porras M, Moscoso-Porras M, Pesantes MA, Ponce V, Araya R, Beran D, Busse P, Boggio O, Checkley W, García PJ, Huicho L, León-Velarde F, Lescano AG, Mohr DC, Pan W, Peiris D, Perel P, Rabadán-Diehl C, Rivera-Chira M, Sacksteder K, Smeeth L, Trujillo AJ, Wells JCK, Yan LL, García HH, Gilman RH. Towards sustainable partnerships in global health: the case of the CRONICAS Centre of Excellence in Chronic Diseases in Peru. Global Health 2016; 12:29. [PMID: 27255370 PMCID: PMC4890274 DOI: 10.1186/s12992-016-0170-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality research." The Centre's identity is embedded in its core values - generosity, innovation, integrity, and quality- and its trajectory is a result of various interactions between multiple individuals, collaborators, teams, and institutions, which together with the challenges confronted, enables us to make an objective assessment of the partnership we would like to pursue, nurture and support. We do not intend to provide a single example of a successful partnership, but in contrast, to highlight what can be translated into opportunities to be faced by research groups based in low- and middle-income countries, and how these encounters can provide a strong platform for fruitful and sustainable partnerships. In defiant contexts, partnerships require to be nurtured and sustained. Acknowledging that all partnerships are not and should not be the same, we also need to learn from the evolution of such relationships, its key successes, hurdles and failures to contribute to the promotion of a culture of global solidarity where mutual goals, mutual gains, as well as mutual responsibilities are the norm. In so doing, we will all contribute to instil a new culture where expectations, roles and interactions among individuals and their teams are horizontal, the true nature of partnerships.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Internal Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - María K Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Miguel Moscoso-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - M Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Vilarmina Ponce
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Ricardo Araya
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | | | - Oscar Boggio
- Division of Non-Communicable Diseases, Dirección General de Salud de las Personas, Ministerio de Salud, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia J García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Andrés G Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Parasitology, and Public Health Training Program, USA Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Pan
- Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - David Peiris
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- World Heart Federation, Geneva, Switzerland
| | - Cristina Rabadán-Diehl
- Office of Global Affairs, U.S. Department of Health & Human Services, Washington, DC, USA
| | | | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, University College London, London, UK
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Héctor H García
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Center for Global Health - Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Robert H Gilman
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Asociación Benéfica PRISMA, Lima, Peru
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Lu MQ, Tsring N, Yu TY, Wu JC, Wong S, Chen GY, Dekyi P, Pan F, Xian ST, Rinchen D, Mao YQ, Zhang LF, Yao BB. Protective effects of traditional Tibetan medicine Zuo-Mu-A Decoction () on the blood parameters and myocardium of high altitude polycythemia model rats. Chin J Integr Med 2016; 23:908-915. [PMID: 27145942 DOI: 10.1007/s11655-016-2500-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the protective effects of Tibetan medicine Zuo-Mu-A Decoction (, ZMAD) on the blood parameters and myocardium of high altitude polycythemia (HAPC) model rats. METHODS Forty male Wistar rats were randomly divided into 4 groups by a random number table, including the normal, model, Rhodiola rosea L. (RRL) and ZMAD groups (10 in each group). Every group was raised in Lhasa to create a HAPC model except the normal group. After modeling, rats in the RRL and the ZMAD groups were administered intragastrically with RRL (20 mL/kg) and ZMAD (7.5 mL/kg) once a day for 2 months, respectively; for the normal and the model groups, 5 mL of distilled water was administered intragastrically instead of decoction. Then routine blood and hematologic rheology parameters were taken, levels of erythropoietin and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were tested, and ultrastructural change in the left ventricular myocardium was observed using transmission electron microscopy. RESULTS Compared with the model group, ZMAD significantly reduced the red blood cell count, hemoglobin levels, whole blood viscosity at low/middle shear rates, plasma viscosity, erythrocyte electrophoretic time, erythropoietin and 8-OHdG levels, and also increased the erythrocyte deformation index (P<0.05). There was no difference in all results between the RRL and the ZMAD groups. The cardiac muscle fibers were well-protected, mitochondrial matrix swelled mildly and ultrastructure changes were less prominent in the ZMAD group compared with the model group. CONCLUSION ZMAD has significant protective effects on the blood parameters against HAPC, and also has the beneficial effect in protecting against myocardial injury.
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Affiliation(s)
- Meng-Qian Lu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Nyima Tsring
- Tibetan Traditional Medical College, Lhasa, 850000, China.
| | - Tian-Yuan Yu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Jian-Cong Wu
- Department of Tuina, Beijing Massage Hospital, Beijing, 100035, China
| | - Steven Wong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Guo-Yong Chen
- Information Center, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Pasang Dekyi
- Tibet Academy of Tibetan Medicine, Lhasa, 850000, China
| | - Fan Pan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Si-Tong Xian
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Dorje Rinchen
- Tibetan Traditional Medical College, Lhasa, 850000, China
| | - Ying-Qiu Mao
- Center of Scientific Experiment, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Lin-Feng Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Bin-Bin Yao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
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Okumiya K, Sakamoto R, Ishimoto Y, Kimura Y, Fukutomi E, Ishikawa M, Suwa K, Imai H, Chen W, Kato E, Nakatsuka M, Kasahara Y, Fujisawa M, Wada T, Wang H, Dai Q, Xu H, Qiao H, Ge RL, Norboo T, Tsering N, Kosaka Y, Nose M, Yamaguchi T, Tsukihara T, Ando K, Inamura T, Takeda S, Ishine M, Otsuka K, Matsubayashi K. Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland. BMJ Open 2016; 6:e009728. [PMID: 26908520 PMCID: PMC4769430 DOI: 10.1136/bmjopen-2015-009728] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To clarify the association between glucose intolerance and high altitudes (2900-4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing. DESIGN Cross-sectional epidemiological study on Tibetan highlanders. PARTICIPANTS We enrolled 1258 participants aged 40-87 years. The rural population comprised farmers in Domkhar (altitude 2900-3800 m) and nomads in Haiyan (3000-3100 m), Ryuho (4400 m) and Changthang (4300-4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m). MAIN OUTCOME MEASURE Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression. RESULTS The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500-4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance. CONCLUSIONS Socioeconomic factors, hypoxaemia and the effects of altitudes >3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and ageing.
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Affiliation(s)
- Kiyohito Okumiya
- Research Department, Research Institute for Humanity and Nature, Kyoto, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Ryota Sakamoto
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
- Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan
| | - Yasuko Ishimoto
- Faculty of Medicine, Public Health Nursing, School of Nursing, Mie University, Tsu, Mie, Japan
| | - Yumi Kimura
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Eriko Fukutomi
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Motonao Ishikawa
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Kuniaki Suwa
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Hissei Imai
- Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Wenling Chen
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Emiko Kato
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | | | - Yoriko Kasahara
- College of Nursing, Kanto Gakuin University, Yokohama, Japan
| | - Michiko Fujisawa
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Taizo Wada
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Hongxin Wang
- Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Qingxiang Dai
- Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Huining Xu
- Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Haisheng Qiao
- Qinghai Academy of Animal and Veterinary Sciences, Xining, Qinghai, China
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China
| | | | | | - Yasuyuki Kosaka
- Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nose
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | | | - Toshihiro Tsukihara
- Faculty of Education and Regional Studies, University of Fukui, Fukui, Japan
| | - Kazuo Ando
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | | | - Shinya Takeda
- Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan
| | | | - Kuniaki Otsuka
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
- Chronomics & Gerontology, Tokyo Women's Medical University, Tokyo, Japan
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Villafuerte FC. New genetic and physiological factors for excessive erythrocytosis and Chronic Mountain Sickness. J Appl Physiol (1985) 2015; 119:1481-6. [PMID: 26272318 PMCID: PMC4683346 DOI: 10.1152/japplphysiol.00271.2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/07/2015] [Indexed: 01/03/2023] Open
Abstract
In the last few years, genetic and functional studies have provided important insight on the pathophysiology of excessive erythrocytosis (EE), the main sign of Chronic Mountain Sickness (CMS). The recent finding of the association of the CMS phenotype with a single-nucleotide polymorphism (SNP) in the Sentrin-specific Protease 1 (SENP1) gene, and its differential expression pattern in Andean highlanders with and without CMS, has triggered large interest in high-altitude studies because of the potential role of its gene product in the control of erythropoiesis. The SENP1 gene encodes for a protease that regulates the function of hypoxia-relevant transcription factors such as Hypoxia-Inducible Factor (HIF) and GATA, and thus might have an erythropoietic regulatory role in CMS through the modulation of the expression of erythropoietin (Epo) or Epo receptors. The different physiological patterns in the Epo-EpoR system found among Andeans, even among highlanders with CMS, together with their different degrees of erythropoietic response, might indicate specific underlying genetic backgrounds, which in turn might reflect different levels of adaptation to lifelong high-altitude hypoxia. This minireview discusses recent genetic findings potentially underlying EE and CMS, and their possible physiological mechanisms in Andean highlanders.
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Affiliation(s)
- Francisco C Villafuerte
- Laboratorio de Fisiología Comparada, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
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21
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Is restless legs syndrome associated with chronic mountain sickness? Sleep Med 2015; 16:976-80. [DOI: 10.1016/j.sleep.2015.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/06/2015] [Accepted: 03/14/2015] [Indexed: 11/20/2022]
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22
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Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness. Int J Cardiovasc Imaging 2015; 31:743-52. [DOI: 10.1007/s10554-015-0614-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
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23
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Zhao HW, Gu XQ, Chailangkarn T, Perkins G, Callacondo D, Appenzeller O, Poulsen O, Zhou D, Muotri AR, Haddad GG. Altered iPSC-derived neurons' sodium channel properties in subjects with Monge's disease. Neuroscience 2015; 288:187-99. [PMID: 25559931 DOI: 10.1016/j.neuroscience.2014.12.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 12/17/2022]
Abstract
Monge's disease, also known as chronic mountain sickness (CMS), is a disease that potentially threatens more than 140 million highlanders during extended time living at high altitudes (over 2500m). The prevalence of CMS in Andeans is about 15-20%, suggesting that the majority of highlanders (non-CMS) are rather healthy at high altitudes; however, CMS subjects experience severe hypoxemia, erythrocytosis and many neurologic manifestations including migraine, headache, mental fatigue, confusion, and memory loss. The underlying mechanisms of CMS neuropathology are not well understood and no ideal treatment is available to prevent or cure CMS, except for phlebotomy. In the current study, we reprogrammed fibroblast cells from both CMS and non-CMS subjects' skin biopsies into the induced pluripotent stem cells (iPSCs), then differentiated into neurons and compared their neuronal properties. We discovered that CMS neurons were much less excitable (higher rheobase) than non-CMS neurons. This decreased excitability was not caused by differences in passive neuronal properties, but instead by a significantly lowered Na(+) channel current density and by a shift of the voltage-conductance curve in the depolarization direction. Our findings provide, for the first time, evidence of a neuronal abnormality in CMS subjects as compared to non-CMS subjects, hoping that such studies can pave the way to a better understanding of the neuropathology in CMS.
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Affiliation(s)
- H W Zhao
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - X Q Gu
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - T Chailangkarn
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - G Perkins
- National Center for Microscopy and Imaging Research, University of California San Diego, La Jolla, CA, USA
| | - D Callacondo
- Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima 36, Peru
| | - O Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, Albuquerque, NM 87122, USA
| | - O Poulsen
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - D Zhou
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | - A R Muotri
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA 92093, USA; The Rady Children's Hospital, San Diego, CA 92123, USA
| | - G G Haddad
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA; Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA; The Rady Children's Hospital, San Diego, CA 92123, USA.
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24
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Negi PC, Asotra S, V RK, Marwah R, Kandoria A, Ganju NK, Sharma R, Bhardwaj R. Epidemiological study of chronic mountain sickness in natives of Spiti Valley in the Greater Himalayas. High Alt Med Biol 2014; 14:220-9. [PMID: 24067183 DOI: 10.1089/ham.2012.1127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study determined the prevalence of chronic mountain sickness (CMS) and its predisposing factors among natives of Spiti Valley in the northern state of Indian Himalayas. A cross-sectional survey study was conducted in natives of Spiti Valley aged ≥ 20 years residing at altitudes of 3000 to 4200 meters. CMS was diagnosed using Qinghai criteria. Demographics, behavioral characteristics, specified symptoms of CMS were recorded, including BP, anthropometrics, evidence of RHF, PAH, and severe cyanosis. ECG, echocardiography, PFT, and Sao2 were recorded, and Hb level was estimated with the cyanmethhemoglobin method. RESULTS 694 subjects free of cardiorespiratory diseases were analyzed. Prevalence of CMS was 28.7%, (95% C.I. of 25.9%-32.8%) and was higher in women than in men (36.6% vs. 15.7%, p<0.001). Erythrocythemia and hypoxemia were recorded in 10.5% and 7.5%, respectively. Age, truncal obesity, female gender, altitude of residence, and physical activity index were independent predictors of CMS with z statistics of 4.2, 2.29, -3.7, 2.8, and -2.8, respectively, and were statistically significant p<0.001. 6.2% of the surveyed population had HAPH. CONCLUSION 28.7% (95% C.I. of 25.9%-32.8%) of the natives of the Spiti Valley in the Indian Himalayas are affected with CMS. Higher prevalence of CMS amongst women needs further studies. Westernized lifestyle appears to have predisposition to CMS.
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Affiliation(s)
- Prakash Chand Negi
- Department of Cardiology, Indira Gandhi Medical College , Shimla Himachal Pradesh, India
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25
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Sahota IS, Panwar NS. Prevalence of Chronic Mountain Sickness in high altitude districts of Himachal Pradesh. Indian J Occup Environ Med 2014; 17:94-100. [PMID: 24872667 PMCID: PMC4035612 DOI: 10.4103/0019-5278.130839] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Chronic Mountain Sickness (CMS) is a maladaptation condition that can affect people who reside permanently at high altitude (HA). It is characterized by polycythemia, hypoxemia and dyspnea and can be fatal. Over 140 million people live permanently at HA around the world. Unfortunately, research into CMS is lacking and accurate data on the prevalence of this condition do not exist for many regions around the world. In this study, we sought to examine prevalence rates of CMS in the Indian Himalayas, focusing on the Northern State of Himachal Pradesh. Materials and Methods: We surveyed 83 individuals (69 males) in eight towns across the HA districts of Sirmaur, Kinnaur and Lahaul and Spiti in Himachal Pradesh, India. Altitudes ranged from 2350 to 4150 m. We used an adapted Qinghai CMS scoring system to diagnose CMS. Information related to subject demographics, medical history, socioeconomic status, and geography were collected to identify risk factors for CMS. Physiologic recordings of oxygen saturation (SpO2) and pulse rate were made through pulse oximetry. Results: Overall CMS prevalence was 6.17% and mean altitude was 3281 m. At altitudes above 3000 m CMS prevalence rose to 13.73%. All cases of CMS were mild and there was a significant positive correlation between CMS scores and altitude (R = 0.784, P = 0.0213). Mean SpO2 was 90.7 ± 0.4% and mean pulse rate was 80.3 ± 1.3 bpm. SpO2 significantly correlated with altitude (R = −0.929, P < 0.001). In our study, age, gender, and tobacco use were not independent risk factors for CMS. Individuals with CMS lived at higher altitudes than their non-CMS counterparts (3736.00 ± 113.30 m vs. 3279.80 ± 69.50 m, respectively; P = 0.017). Conclusion: CMS prevalence in HA towns of the Indian Himalayas of Himachal Pradesh is 6.17% and 13.73% for towns above 3000 m. Further research is required to determine the prevalence of CMS in other regions of the world and to determine risk factors associated with CMS.
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Affiliation(s)
- Inderjeet Singh Sahota
- Office of Development Research, A Thousand Metres Above Foundation, Vancouver, BC, Canada
| | - Nidhi Singh Panwar
- Office of Development Research, A Thousand Metres Above Foundation, Vancouver, BC, Canada
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26
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Abstract
Carbonic anhydrase (CA) inhibitors, particularly acetazolamide, have been used at high altitude for decades to prevent or reduce acute mountain sickness (AMS), a syndrome of symptomatic intolerance to altitude characterized by headache, nausea, fatigue, anorexia and poor sleep. Principally CA inhibitors act to further augment ventilation over and above that stimulated by the hypoxia of high altitude by virtue of renal and endothelial cell CA inhibition which oppose the hypocapnic alkalosis resulting from the hypoxic ventilatory response (HVR), which acts to limit the full expression of the HVR. The result is even greater arterial oxygenation than that driven by hypoxia alone and greater altitude tolerance. The severity of several additional diseases of high attitude may also be reduced by acetazolamide, including high altitude cerebral edema (HACE), high altitude pulmonary edema (HAPE) and chronic mountain sickness (CMS), both by its CA-inhibiting action as described above, but also by more recently discovered non-CA inhibiting actions, that seem almost unique to this prototypical CA inhibitor and are of most relevance to HAPE. This chapter will relate the history of CA inhibitor use at high altitude, discuss what tissues and organs containing carbonic anhydrase play a role in adaptation and maladaptation to high altitude, explore the role of the enzyme and its inhibition at those sites for the prevention and/or treatment of the four major forms of illness at high altitude.
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Affiliation(s)
- Erik R Swenson
- VA Puget Sound Health Care System and Department of Medicine, University of Washington, Seattle, WA, USA,
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27
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Naeije R, Vanderpool R. Pulmonary Hypertension and Chronic Mountain Sickness. High Alt Med Biol 2013; 14:117-25. [DOI: 10.1089/ham.2012.1124] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Robert Naeije
- Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Rebecca Vanderpool
- Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
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28
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Tufts DM, Revsbech IG, Cheviron ZA, Weber RE, Fago A, Storz JF. Phenotypic plasticity in blood-oxygen transport in highland and lowland deer mice. ACTA ACUST UNITED AC 2012; 216:1167-73. [PMID: 23239893 DOI: 10.1242/jeb.079848] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In vertebrates living at high altitude, arterial hypoxemia may be ameliorated by reversible changes in the oxygen-carrying capacity of the blood (regulated by erythropoiesis) and/or changes in blood-oxygen affinity (regulated by allosteric effectors of hemoglobin function). These hematological traits often differ between taxa that are native to different elevational zones, but it is often unknown whether the observed physiological differences reflect fixed, genetically based differences or environmentally induced acclimatization responses (phenotypic plasticity). Here, we report measurements of hematological traits related to blood-O2 transport in populations of deer mice (Peromyscus maniculatus) that are native to high- and low-altitude environments. We conducted a common-garden breeding experiment to assess whether altitude-related physiological differences were attributable to developmental plasticity and/or physiological plasticity during adulthood. Under conditions prevailing in their native habitats, high-altitude deer mice from the Rocky Mountains exhibited a number of pronounced hematological differences relative to low-altitude conspecifics from the Great Plains: higher hemoglobin concentrations, higher hematocrits, higher erythrocytic concentrations of 2,3-diphosphoglycerate (an allosteric regulator of hemoglobin-oxygen affinity), lower mean corpuscular hemoglobin concentrations and smaller red blood cells. However, these differences disappeared after 6 weeks of acclimation to normoxia at low altitude. The measured traits were also indistinguishable between the F1 progeny of highland and lowland mice, indicating that there were no persistent differences in phenotype that could be attributed to developmental plasticity. These results indicate that the naturally occurring hematological differences between highland and lowland mice are environmentally induced and are largely attributable to physiological plasticity during adulthood.
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Affiliation(s)
- Danielle M Tufts
- School of Biological Sciences, University of Nebraska, Lincoln, NE 68588, USA.
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29
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Zhou JY, Zhou SW, Du XH, Zeng SY. Protective effect of total flavonoids of seabuckthorn (Hippophae rhamnoides) in simulated high-altitude polycythemia in rats. Molecules 2012; 17:11585-97. [PMID: 23023684 PMCID: PMC6269044 DOI: 10.3390/molecules171011585] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 11/28/2022] Open
Abstract
Seabuckthorn (Hippophae rhamnoides L.) has been used to treat high altitude diseases. The effects of five-week treatment with total flavonoids of seabuckthorn (35, 70, 140 mg/kg, ig) on cobalt chloride (5.5 mg/kg, ip)- and hypobaric chamber (simulating 5,000 m)-induced high-altitude polycythemia in rats were measured. Total flavonoids decreased red blood cell number, hemoglobin, hematocrit, mean corpuscular hemoglobin levels, span of red blood cell electrophoretic mobility, aggregation index of red blood cell, plasma viscosity, whole blood viscosity, and increased deformation index of red blood cell, erythropoietin level in serum. Total flavonoids increased pH, pO2, SpO2, pCO2 levels in arterial blood, and increased Na+, HCO3−, Cl−, but decreased K+ concentrations. Total flavonoids increased mean arterial pressure, left ventricular systolic pressure, end-diastolic pressure, maximal rate of rise and decrease, decreased heart rate and protected right ventricle morphology. Changes in hemodynamic, hematologic parameters, and erythropoietin content suggest that administration of total flavonoids from seabuckthorn may be useful in the prevention of high altitude polycythaemia in rats.
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Affiliation(s)
- Ji-Yin Zhou
- Base for Drug Clinical Trial, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China; (J.-Y.Z.); (S.-Y.Z.)
| | - Shi-Wen Zhou
- Base for Drug Clinical Trial, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China; (J.-Y.Z.); (S.-Y.Z.)
- Author to whom correspondence should be addressed; ; Tel./Fax: +86-23-6875-5311
| | - Xiao-Huang Du
- Research Division, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;
| | - Sheng-Ya Zeng
- Base for Drug Clinical Trial, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China; (J.-Y.Z.); (S.-Y.Z.)
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Carey HV, Martin SL, Horwitz BA, Yan L, Bailey SM, Podrabsky J, Storz JF, Ortiz RM, Wong RP, Lathrop DA. Elucidating nature's solutions to heart, lung, and blood diseases and sleep disorders. Circ Res 2012; 110:915-21. [PMID: 22461362 DOI: 10.1161/circresaha.111.255398] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Evolution has provided a number of animal species with extraordinary phenotypes. Several of these phenotypes allow species to survive and thrive in environmental conditions that mimic disease states in humans. The study of evolved mechanisms responsible for these phenotypes may provide insights into the basis of human disease and guide the design of new therapeutic approaches. Examples include species that tolerate acute or chronic hypoxemia like deep-diving mammals and high-altitude inhabitants, as well as those that hibernate and interrupt their development when exposed to adverse environments. The evolved traits exhibited by these animal species involve modifications of common biological pathways that affect metabolic regulation, organ function, antioxidant defenses, and oxygen transport. In 2006, the National Heart, Lung, and Blood Institute released a funding opportunity announcement to support studies that were designed to elucidate the natural molecular and cellular mechanisms of adaptation in species that tolerate extreme environmental conditions. The rationale for this funding opportunity is detailed in this article, and the specific evolved mechanisms examined in the supported research are described. Also highlighted are past medical advances achieved through the study of animal species that have evolved extraordinary phenotypes as well as the expectations for new understanding of nature's solutions to heart, lung, blood, and sleep disorders through future research in this area.
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Affiliation(s)
- Hannah V Carey
- Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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Li X, Pei T, Xu H, Tao F, You H, Liu Y, Gao Y. Ecological study of community-level factors associated with chronic mountain sickness in the young male chinese immigrant population in Tibet. J Epidemiol 2012; 22:136-43. [PMID: 22343324 PMCID: PMC3798592 DOI: 10.2188/jea.je20110058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Chronic mountain sickness (CMS) is a complex medical and public health problem that seriously affects highland immigrants. This study investigated relationships between community-level factors and CMS. Methods In this ecological study, data on age- and ethnicity-standardized CMS rates, community factors, and controlling variables were obtained from 2009–2010 surveys of 108 Chinese highland military units. Associations among variables were examined using correlation tests, analyses of covariance, and logistic regression. Results The rate of CMS ranged from 1.25% to 36.58% (mean: 14.65%, standard deviation: 8.15%) among military units. Partial correlation tests indicated that medicine expenditure was strongly negatively correlated with CMS (r = −0.267, P = 0.005). Analyses of covariance indicated that communities with oxygen-generating systems had lower CMS rates (F = 9.780, P = 0.002), whereas urban location (F = 5.442, P = 0.022) and construction duty (F = 4.735, P = 0.011) were associated with higher CMS rates. The multiple logistic model showed that medicine expenditure (OR = 0.897, P = 0.022), oxygen-generating system (available vs unavailable: OR = 0.827, P = 0.020), community type (urban vs rural: OR = 1.228, P = 0.019), and occupation (construction vs logistics: OR = 1.240, P = 0.029) were significantly associated with CMS. Conclusions We identified community-level, health-related factors that were associated with CMS among young male immigrants. To alleviate the burden of CMS in these highland immigrant populations, further investment should be made in medicine and oxygen-generating systems, and preventive interventions should be implemented among construction workers. Further research should investigate the effects of urbanization on CMS development.
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Affiliation(s)
- Xiaoxiao Li
- Department of Health Service, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, P. R. China
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Arestegui AH, Fuquay R, Sirota J, Swenson ER, Schoene RB, Jefferson JA, Chen W, Yu XQ, Kelly JP, Johnson RJ, Escudero E. High Altitude Renal Syndrome (HARS). J Am Soc Nephrol 2011; 22:1963-8. [PMID: 21566053 DOI: 10.1681/asn.2010121316] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Storz JF, Scott GR, Cheviron ZA. Phenotypic plasticity and genetic adaptation to high-altitude hypoxia in vertebrates. J Exp Biol 2010; 213:4125-36. [PMID: 21112992 PMCID: PMC2992463 DOI: 10.1242/jeb.048181] [Citation(s) in RCA: 274] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2010] [Indexed: 01/08/2023]
Abstract
High-altitude environments provide ideal testing grounds for investigations of mechanism and process in physiological adaptation. In vertebrates, much of our understanding of the acclimatization response to high-altitude hypoxia derives from studies of animal species that are native to lowland environments. Such studies can indicate whether phenotypic plasticity will generally facilitate or impede adaptation to high altitude. Here, we review general mechanisms of physiological acclimatization and genetic adaptation to high-altitude hypoxia in birds and mammals. We evaluate whether the acclimatization response to environmental hypoxia can be regarded generally as a mechanism of adaptive phenotypic plasticity, or whether it might sometimes represent a misdirected response that acts as a hindrance to genetic adaptation. In cases in which the acclimatization response to hypoxia is maladaptive, selection will favor an attenuation of the induced phenotypic change. This can result in a form of cryptic adaptive evolution in which phenotypic similarity between high- and low-altitude populations is attributable to directional selection on genetically based trait variation that offsets environmentally induced changes. The blunted erythropoietic and pulmonary vasoconstriction responses to hypoxia in Tibetan humans and numerous high-altitude birds and mammals provide possible examples of this phenomenon. When lowland animals colonize high-altitude environments, adaptive phenotypic plasticity can mitigate the costs of selection, thereby enhancing prospects for population establishment and persistence. By contrast, maladaptive plasticity has the opposite effect. Thus, insights into the acclimatization response of lowland animals to high-altitude hypoxia can provide a basis for predicting how altitudinal range limits might shift in response to climate change.
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Affiliation(s)
- Jay F Storz
- School of Biological Sciences, University of Nebraska, Lincoln, NE 68588, USA.
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Esteva S, Pedret R, Fort N, Torrella JR, Pagès T, Viscor G. Oxidative stress status in rats after intermittent exposure to hypobaric hypoxia. Wilderness Environ Med 2010; 21:325-31. [PMID: 21168785 DOI: 10.1016/j.wem.2010.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Programs of intermittent hypobaric hypoxia (IHH) exposure are used to raise hemoglobin concentration and erythrocyte mass. Although acclimation response increases blood oxygen transport capacity leading to a VO(2max) increase, the effects of reactive oxygen species (ROS) might determine the behavior of erythrocytes and plasma, thus causing a worse peripheral blood flow. The goals of the study were to establish the hematological changes and to discern whether an IHH protocol modifies the antioxidant/pro-oxidant balance in laboratory rats. METHODS Male rats were subjected to an IHH program consisting of a daily 4-hour session for 5 days/week until completing 22 days of hypoxia exposure in a hypobaric chamber at a simulated altitude of 5000 m. Blood samples were taken at the end of the exposure period (H) and at 20 (P20) and 40 (P40) days after the end of the program, and compared to control (C), maintained at sea-level pressure. Hematological parameters were measured together with several oxidative stress indicators: plasma thiobarbituric acid reactive substances (TBARS) and erythrocyte catalase (CAT) and superoxide dismutase (SOD). RESULTS Red blood cell (RBC) count, hemoglobin concentration and hematocrit were higher in H group as compared to all the other groups (p < 0.001). However, there were no significant differences between the 4 groups in any of the oxidative stress-related parameters. CONCLUSIONS The absence of significant differences between groups indicates that our IHH program has little impact on the general redox status, even in the laboratory rat, which is more sensitive to hypoxia than humans. We conclude that IHH does not increase oxidative stress.
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Affiliation(s)
- Santiago Esteva
- Departament de Fisiologia, Facultat de Biologia, Universitat de Barcelona, Av. Diagonal 645, Barcelona, Spain
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Abstract
Chronic Mountain Sickness (CMS) is an important high-altitude (HA) pathology in most mountainous regions of the world. Although its most characteristic sign is excessive erytrocytosis (EE), in the more severe stages of the disease, high-altitude pulmonary hypertension (HAPH), with remodeling of pulmonary arterioles and right ventricular enlargement is commonly found. The degree of ventricular hypertrophy depends on the vasoconstrictor pulmonary response, the intensity of vascular resistance and the level of altitude, and therefore on the degree of hypoxemia. This chapter briefly summarizes the existing data regarding the clinical and pathophysiological features of the cardiopulmonary system in CMS, with emphasis in findings from research in the Andes. The literature shows variability in cardiac output values in CMS, which might be related to the degree of EE. Recent findings have shown that cardiac output (l/min) is lower in CMS when compared with sea-level (SL) dwellers. Mean pulmonary acceleration time (ms) is significantly lower in CMS subjects than in SL and HA natives, and pulmonary vascular resistance index (Wood units) is higher in CMS and HA natives when compared with SL dwellers. Systemic blood pressure has similar values in CMS patients and healthy HA natives, but some differences arise in its control mechanisms. Although CMS individuals have a less effective vasoconstrictor reflex, their tolerance to orthostatic stress is similar to that of healthy HA natives which might be explained in terms of the larger blood volume present in CMS subjects. At present research is directed to design strategies on pharmacological intervention for CMS treatment. Recently, a clinical trial with acetazolamide, in patients with CMS has proven to be effective in increasing mean pulmonary acceleration time and decreasing pulmonary vascular resistance index, which might be indirectly due the reduction of hematocrit.
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Okumiya K, Sakamoto R, Kimura Y, Ishine M, Kosaka Y, Wada T, Wada C, Nakatsuka M, Ishimoto Y, Hirosaki M, Kasahara Y, Konno A, Chen W, Fujisawa M, Otsuka K, Nakashima M, Wang H, Dai Q, Yang A, Qiao H, Gao J, Li Z, Zhang Y, Ge RL, Matsubayashi K. Comprehensive geriatric assessment of elderly highlanders in Qinghai, China II: the association of polycythemia with lifestyle-related diseases among the three ethnicities. Geriatr Gerontol Int 2010; 9:342-51. [PMID: 20002753 DOI: 10.1111/j.1447-0594.2009.00555.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The objective of this study is to disclose the association of polycythemia with lifestyle-related diseases (hypertension, obesity and glucose intolerance) among the three ethnicities in Qinghai, China. METHODS The subjects were 393 elderly people (247 Han, 97 Tibetan and 49 Mongolian) aged 60 years and more living in Qinghai (3000 m a.s.l.) in China. The associated factors with polycythemia were analyzed in the subjects. Excessive polycythemia was defined as hemoglobin concentration over 20 mg/dL. RESULTS Polycythemia was associated with men, hypoxemia, obesity and high diastolic blood pressure (DBP) in the elderly in Qinghai. Male sex was associated with polycythemia in all ethnicities. Obesity was associated with Han and Tibetan men. Glucose intolerance and activities of daily living were not directly associated with polycythemia after adjustment for sex. There were 7.9% with excessive polycythemia. Independently-associated factors for excessive polycythemia were male sex, body mass index of 25 or more, SpO(2) of less than 85%, DBP of 85 mmHg or more and Han ethnicity (vs Tibetan) by multiple logistic regression. CONCLUSION There was a close association of polycythemia with diastolic hypertension and obesity in lifestyle-related diseases in high-altitude elderly people. Han people had a higher hemoglobin concentration after adjustment of lifestyle-related diseases compared with Tibetan people. The difference of hemoglobin concentration may be due to Tibetans undergoing a much longer period of adaptation than Han people. Further study is needed to disclose the association between the difference of hypoxic adaptation, lifestyle-related diseases and chronic mountain sickness for their prevention.
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Affiliation(s)
- Kiyohito Okumiya
- Research Institute for Humanity and Nature, 457-4 Motoyama, Kamigamo, Kita-ku, Kyoto 603-8047, Japan.
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Esteva S, Panisello P, Torrella JR, Pagés T, Viscor G. Blood rheology adjustments in rats after a program of intermittent exposure to hypobaric hypoxia. High Alt Med Biol 2009; 10:275-81. [PMID: 19775218 DOI: 10.1089/ham.2008.1086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Intermittent hypobaric hypoxia (IHH) exposure induces a rise in hemoglobin concentration and an increase in erythrocyte mass in both rats and humans. Although this response increases blood oxygen transport capacity, paradoxically, it could impair blood flow and gas exchange because of the blood viscosity alterations associated with the rising hematocrit. In the present study, male rats were subjected to an IHH program consisting of a daily 4-h session for 5 days/week until they had completed 22 days of hypoxia exposure in a hypobaric chamber at a simulated altitude of 5000 m. Blood samples were taken at the end of the exposure period (H) and at 20 (P20) and 40 (P40) days after the end of the program and were compared to control (C) maintained at sea- level pressure. Apparent blood viscosity (eta(a)) and plasma viscosity (eta(p)) were measured in a cone-plate microviscometer. Although the hematocrit significantly increased in the H group, blood apparent viscosity did not differ among groups, ranging from 7.67 to 6.57 mPa*sec at a shear rate of 90 sec(-1). Relative blood viscosity showed a clear increase (about 27%) in H rats, mainly due to the significant decrease in plasma viscosity. This finding could be interpreted as a compensatory response, which reduced the effect of increased erythrocyte mass volume on whole-blood viscosity. Oxygen delivery index and blood oxygen potential transport capacity remained unchanged in all groups. These data indicate that the IHH program has a deep but transitory effect on red cell parameters and a moderate effect on blood rheological behavior.
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Affiliation(s)
- Santiago Esteva
- Departament de Fisiologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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Jin S, Chen Z, Lunan Y, Zeng Y, Wen T, Li B, Zhao J, Wang W, Xu M, Yang J. Can Liver Transplantation Achieve Similar Effects at High Altitudes Compared With Plains: Case Report. Transplant Proc 2009; 41:2003-5. [DOI: 10.1016/j.transproceed.2009.01.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 11/21/2008] [Accepted: 01/08/2009] [Indexed: 10/20/2022]
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Gonzales GF, Gasco M, Tapia V, Gonzales-Castañeda C. High serum testosterone levels are associated with excessive erythrocytosis of chronic mountain sickness in men. Am J Physiol Endocrinol Metab 2009; 296:E1319-25. [PMID: 19318512 PMCID: PMC2692401 DOI: 10.1152/ajpendo.90940.2008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic mountain sickness (CMS) is characterized by excessive erythrocytosis (EE) secondary to hypoventilation. Erythropoietin (Epo) and testosterone regulate erythrocyte production. Low thyroid hormone levels are also associated to hypoventilation. Hence, these hormones can play a role in etiopathogeny of EE. The purpose of this study was to elucidate the effect of sexual and thyroid hormones and Epo in residents from Lima (150 m) and Cerro de Pasco (4,340 m), Peru, and the response to human chorionic gonadotrophin stimulation (hCG). Three groups, one at low altitude and two at high altitude [1 with hemoglobin values >16-21 g/dl and the second with Hb >or=21 g/dl (EE)], were studied. hCG was administered intramuscularly in a single dose (1,000 IU), and blood samples were obtained at 0, 6, 12, 24, 48, and 72 h after injection. High-altitude natives present similar levels of gonadotropins and thyroid hormones but lower dehydroepiandrosterone sulphate (DHEAS) levels (P < 0.01) and greater Epo (P < 0.01), 17alpha-hydroxyprogesterone (P < 0.01), and testosterone levels (P < 0.01) than those at 150 m. Serum testosterone levels (524.13 +/- 55.91 microg/dl vs. 328.14 +/- 53.23 ng/dl, means +/- SE; P < 0.05) and testosterone/DHEAS ratios are higher (7.98 +/- 1.1 vs. 3.65 +/- 1.1; P < 0.01) and DHEAS levels lower in the EE group (83.85 +/- 14.60 microg/dl vs. 148.95 +/- 19.11 ug/dl; P < 0.05), whereas Epo was not further affected. Testosterone levels were highest and DHEAS levels lowest in the EE group at all times after hCG stimulation. In conclusion, high androgen activity could be involved in the etiopathogeny of CMS. This evidence provides an opportunity to develop new therapeutic strategies.
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Affiliation(s)
- Gustavo F Gonzales
- Laboratory of Endocrinology and Reproduction, Faculty of Sciences and Philosophy, "Alberto Cazorla Tálleri" Universidad Peruana Cayetano Heredia, Ave. Honorio Delgado 430, Lima 31, Peru.
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Maignan M, Rivera-Ch M, Privat C, Leòn-Velarde F, Richalet JP, Pham I. Pulmonary Pressure and Cardiac Function in Chronic Mountain Sickness Patients. Chest 2009; 135:499-504. [DOI: 10.1378/chest.08-1094] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Huicho L, Xing G, Qualls C, Rivera-Ch M, Gamboa JL, Verma A, Appenzeller O. Abnormal energy regulation in early life: childhood gene expression may predict subsequent chronic mountain sickness. BMC Pediatr 2008; 8:47. [PMID: 18954447 PMCID: PMC2582028 DOI: 10.1186/1471-2431-8-47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 10/27/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Life at altitude depends on adaptation to ambient hypoxia. In the Andes, susceptibility to chronic mountain sickness (CMS), a clinical condition that occurs to native highlanders or to sea level natives with prolonged residence at high altitude, remains poorly understood. We hypothesized that hypoxia-associated gene expression in children of men with CMS might identify markers that predict the development of CMS in adults. We assessed distinct patterns of gene expression of hypoxia-responsive genes in children of highland Andean men, with and without CMS. METHODS We compared molecular signatures in children of highland (HA) men with CMS (n = 10), without CMS (n = 10) and in sea level (SL) children (n = 20). Haemoglobin, haematocrit, and oxygen saturation were measured. Gene expression in white cells was assessed at HA and then, in the same subjects, within one hour of arrival at sea level. RESULTS HA children showed higher expression levels of genes regulated by HIF (hypoxia inducible factor) and lower levels of those involved in glycolysis and in the tricarboxylic acid (TCA) cycle. Pyruvate dehydrogenase kinase 1(PDK1) and HIF prolyl hydroxylase 3 (HPH3) mRNA expressions were lowest in children of CMS fathers at altitude. At sea level the pattern of gene expression in the 3 children's groups was indistinguishable. CONCLUSION The molecular signatures of children of CMS patients show impaired adaptation to hypoxia. At altitude children of CMS fathers had defective coupling between glycolysis and mitochondria TCA cycle, which may be a key mechanism/biomarker for adult CMS. Early biologic markers of disease susceptibility in Andeans might impact health services and social planning.
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Affiliation(s)
- Luis Huicho
- Departament of Paediatrics, Universidad Nacional Mayor de San Marcos, Universidad Peruana Cayetano Heredia, and Instituto de Salud del Niño, Lima, Peru.
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Richalet JP, Rivera-Ch M, Maignan M, Privat C, Pham I, Macarlupu JL, Petitjean O, León-Velarde F. Acetazolamide for Monge's Disease. Am J Respir Crit Care Med 2008; 177:1370-6. [DOI: 10.1164/rccm.200802-196oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Frappell PB, León-Velarde F, Rivera-Ch M. Oxygen transport at high altitude--an integrated perspective. Introduction. Respir Physiol Neurobiol 2007; 158:115-20. [PMID: 17889816 DOI: 10.1016/j.resp.2007.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 08/13/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Peter B Frappell
- Adaptational and Evolutionary Respiratory Physiology Laboratory, Department of Zoology, La Trobe University, Melbourne, Victoria, Australia.
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