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Cui D, Huang R, Yongzong D, Lin B, Huang X, Ciren Q, Zhou X. Gender-specific association between blood cell parameters and hyperuricemia in high-altitude areas. Front Public Health 2024; 12:1336674. [PMID: 38590804 PMCID: PMC11000501 DOI: 10.3389/fpubh.2024.1336674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Background Hyperuricemia is a common metabolic disorder linked to various health conditions. Its prevalence varies among populations and genders, and high-altitude environments may contribute to its development. Understanding the connection between blood cell parameters and hyperuricemia in high-altitude areas can shed light on the underlying mechanisms. This study aimed to investigate the relationship between blood cell parameters and hyperuricemia in high-altitude areas, with a particular focus on gender differences. Methods We consecutively enrolled all eligible Tibetan participants aged 18-60 who were undergoing routine medical examinations at the People's Hospital of Chaya County between January and December 2022. During this period, demographic and laboratory data were collected to investigate the risk factors associated with hyperuricemia. Results Among the participants, 46.09% were diagnosed with hyperuricemia. In the male cohort, significant correlations were found between serum uric acid (SUA) levels and red blood cell (RBC) count, creatinine (Cr). Urea, alanine transaminase (ALT), and albumin (ALB). Notably, RBC exhibited the strongest association. Conversely, in the female cohort, elevated SUA levels were associated with factors such as white blood cell (WBC) count. Urea, ALT, and ALB, with WBC demonstrating the most significant association. Further analysis within the female group revealed a compelling relationship between SUA levels and specific white blood cell subtypes, particularly neutrophils (Neu). Conclusion This study revealed gender-specific associations between SUA levels and blood cell parameters in high-altitude areas. In males, RBC count may play a role in hyperuricemia, while in females, WBC count appears to be a significant factor. These findings contribute to our understanding of metabolic dynamics in high-altitude regions but require further research for comprehensive mechanistic insights.
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Affiliation(s)
- Danli Cui
- Chongqing Blood Center, Chongqing, China
| | - Ruoying Huang
- The People’s Hospital of Chaya County, Changdu, Tibet, China
| | - Dexi Yongzong
- The People’s Hospital of Chaya County, Changdu, Tibet, China
| | - Bo Lin
- The People’s Hospital of Chaya County, Changdu, Tibet, China
| | - Xia Huang
- Chongqing Blood Center, Chongqing, China
| | - Qimei Ciren
- The People’s Hospital of Chaya County, Changdu, Tibet, China
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Roy L, Pan N, Mondal S, Ghosh R, Hasan MN, Bhattacharyya N, Singh S, Bhattacharyya K, Chattopadhyay A, Pal SK. Ultrafast spectroscopic studies on the interaction of reactive oxygen species with a probe impregnated in nanoscopic and microscopic matrix formulation. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 308:123671. [PMID: 38000325 DOI: 10.1016/j.saa.2023.123671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/09/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
Reactive oxygen species (ROS) plays important role to maintain homeostasis in living bodies. Here we have studied interaction of ROS generated from hydrogen peroxide (H2O2) with a well-known spectroscopic probe Rose Bengal (RB) encapsulated in nanoscopic sodium dodecyl sulphate (SDS) micelles in aqueous medium and entrapped in microscopic nylon 66 solid matrix generated using electrospinning technique. A detailed spectroscopic characterization of ROS with SDS encapsulated RB (RB-SDS) shows efficient interaction compared to that in bulk medium. The time resolved analysis on the probe based on femtosecond resolved 2D-spectrum time images collected from streak camera reveal the simultaneous existence of an ultrafast electron (∼6 ps) and a hole transfer mechanism (∼93 ps) resulting from generation of hydroxyl radicals through photobleaching of the probe in presence of H2O2. Based on the spectroscopic and time resolved studies of RB in bulk and in restricted (SDS) medium, we have further translated it for the development of an in-field prototype device which utilizes RB as a ROS sensor impregnated in a nylon thin film. The microscopic nylon solid matrix characterized by scanning electron microscope (SEM) shows porous structure for holding sample containing ROS. Our study quantitatively measures the amount of ROS by using RB embedded microfiber membrane. Thus, our developed prototype device based on RB embedded on the nylon matrix would be beneficial for the potential use in quantification of ROS in extracellular fluids and food materials.
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Affiliation(s)
- Lopamudra Roy
- Department of Applied Optics and Photonics, JD-2, Sector-III, Salt Lake, Kolkata 700 106, India
| | - Nivedita Pan
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata 700 106, India
| | - Susmita Mondal
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata 700 106, India
| | - Ria Ghosh
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata 700 106, India
| | - Md Nur Hasan
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata 700 106, India
| | - Neha Bhattacharyya
- Department of Radio Physics and Electronics, University of Calcutta, 92, Acharya Prafulla Chandra Rd, Machuabazar, Kolkata 700009, India
| | - Soumendra Singh
- Department of Applied Optics and Photonics, JD-2, Sector-III, Salt Lake, Kolkata 700 106, India
| | - Kallol Bhattacharyya
- Department of Applied Optics and Photonics, JD-2, Sector-III, Salt Lake, Kolkata 700 106, India
| | - Arpita Chattopadhyay
- Department of Basic Science and Humanities, Techno International New Town, Block - DG 1/2 New Town, Action Area 1, Kolkata 700156, India.
| | - Samir Kumar Pal
- Department of Chemical and Biological Sciences, S. N. Bose National Centre for Basic Sciences, Kolkata 700 106, India.
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Demartini B, Nisticò V, Benayoun C, Cigognini AC, Ferrucci R, Vezzoli A, Dellanoce C, Gambini O, Priori A, Mrakic-Sposta S. Glutamatergic dysfunction, neuroplasticity, and redox status in the peripheral blood of patients with motor conversion disorders (functional movement disorders): a first step towards potential biomarkers discovery. Transl Psychiatry 2023; 13:212. [PMID: 37330537 DOI: 10.1038/s41398-023-02500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
Functional movement disorders (FMD) are characterized by the presence of neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. First evidence showed that, compared to healthy controls (CTR), FMD patients presented increased levels of glutamate+glutamine in the anterior cingulate cortex/medial prefrontal cortex, and decreased levels of glutamate in the cerebrospinal fluid, suggesting that a glutamatergic dysfunction might play a role in FMD pathophysiology. In this study, 12 FMD patients and 20 CTR were recruited and underwent venous blood sampling and urine collection: levels of glutamate, BDNF, dopamine, oxidative stress, creatinine, neopterin, and uric acid were analyzed. Participants also underwent a psychometric assessment investigating depression, anxiety, and alexithymia. We found that levels of glutamate, BDNF, and dopamine were significantly lower in the blood of FMD patients than CTR. Glutamate and dopamine levels were positively associated with levels of alexithymia. Our findings give further evidence that glutamatergic dysfunction might be involved in the pathophysiology of FMD, possibly representing a biomarker of disease; moreover, since glutamatergic and dopaminergic systems are closely interconnected, our results might have a relevance in terms of treatment options for FMD patients.
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Affiliation(s)
- Benedetta Demartini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy.
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy.
| | - Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy.
- Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy.
| | - Caroline Benayoun
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Anna Chiara Cigognini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Roberta Ferrucci
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Alessandra Vezzoli
- Institute of Clinical Physiology - Milan, National Research Council (CNR), Milano, Italy
| | - Cinzia Dellanoce
- Institute of Clinical Physiology - Milan, National Research Council (CNR), Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy
| | - Alberto Priori
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
- Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
- III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Simona Mrakic-Sposta
- Institute of Clinical Physiology - Milan, National Research Council (CNR), Milano, Italy
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Xu W, Xu X, Yao L, Xue B, Xi H, Cao X, Piao G, Lin S, Wang X. VEGFA-modified DPSCs combined with LC-YE-PLGA NGCs promote facial nerve injury repair in rats. Heliyon 2023; 9:e14626. [PMID: 37095964 PMCID: PMC10121407 DOI: 10.1016/j.heliyon.2023.e14626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Objective The aim of this research was to investigate the effect of vascular endothelial growth factor A (VEGFA)-overexpressing rat dental pulp stem cells (rDPSCs) combined with laminin-coated and yarn-encapsulated poly(l-lactide-co-glycolide) (PLGA) nerve guidance conduit (LC-YE-PLGA NGC) in repairing 10 mm facial nerve injury in rats. Study Design rDPSCs isolated from rat mandibular central incisor were cultured and identified in vitro and further transfected with the lentiviral vectors (Lv-VEGFA). To investigate the role and mechanisms of VEGFA in neurogenic differentiation in vitro, semaxanib (SU5416), Cell Counting Kit-8 (CCK-8), real-time quantitative polymerase chain reaction (qPCR) and Western blotting were performed. Ten-millimeter facial nerve defect models in rats were established and bridged by LC-YE-PLGA NGCs. The repair effects were detected by transmission electron microscopy (TEM), compound muscle action potential (CMAP), immunohistochemistry and immunofluorescence. Results Extracted cells exhibited spindle-shaped morphology, presented typical markers (CD44+CD90+CD34-CD45-), and presented multidirectional differentiation potential. The DPSCs with VEGFA overexpression were constructed successfully. VEGFA enhanced the proliferation and neural differentiation ability of rDPSCs, and the expression of neuron-specific enolase (NSE) and βIII-tubulin was increased. However, these trends were reversed with the addition of SU5416. This suggests that VEGFA mediates the above effects mainly through vascular endothelial growth factor receptor 2 (VEGFR2) binding. The LC-YE-NGC basically meet the requirements of facial nerve repair. For the in vivo experiment, the CMAP latency period was shorter in DPSCS-VEGFA-NGC group in comparison with other experimental groups, while the amplitude was increased. Such functional recovery correlated well with an increase in histological improvement. Further study suggested that VEGFA-modified DPSCs could increase the myelin number, thickness and axon diameter of facial nerve. NSE, βIII-tubulin and S100 fluorescence intensity and immunohistochemical staining intensity were significantly enhanced. Conclusion VEGFA-modified rDPSCs combined with LC-YE-PLGA NGCs have certain advantages in the growth and functional recovery of facial nerves in rats.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiumei Wang
- Corresponding author. Department of Dentistry, The Second Affiliated Hospital of Harbin Medical University, 148 Baojian Road, Harbin, 150001, China.
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The "ON-OFF" Switching Response of Reactive Oxygen Species in Acute Normobaric Hypoxia: Preliminary Outcome. Int J Mol Sci 2023; 24:ijms24044012. [PMID: 36835421 PMCID: PMC9965553 DOI: 10.3390/ijms24044012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Exposure to acute normobaric hypoxia (NH) elicits reactive oxygen species (ROS) accumulation, whose production kinetics and oxidative damage were here investigated. Nine subjects were monitored while breathing an NH mixture (0.125 FIO2 in air, about 4100 m) and during recovery with room air. ROS production was assessed by Electron Paramagnetic Resonance in capillary blood. Total antioxidant capacity, lipid peroxidation (TBARS and 8-iso-PFG2α), protein oxidation (PC) and DNA oxidation (8-OH-dG) were measured in plasma and/or urine. The ROS production rate (μmol·min-1) was monitored (5, 15, 30, 60, 120, 240 and 300 min). A production peak (+50%) was reached at 4 h. The on-transient kinetics, exponentially fitted (t1/2 = 30 min r2 = 0.995), were ascribable to the low O2 tension transition and the mirror-like related SpO2 decrease: 15 min: -12%; 60 min: -18%. The exposure did not seem to affect the prooxidant/antioxidant balance. Significant increases in PC (+88%) and 8-OH-dG (+67%) at 4 h in TBARS (+33%) one hour after hypoxia offset were also observed. General malaise was described by most of the subjects. Under acute NH, ROS production and oxidative damage resulted in time and SpO2-dependent reversible phenomena. The experimental model could be suitable for evaluating the acclimatation level, a key element in the context of mountain rescues in relation to technical/medical workers who have not had enough time for acclimatization-as, for example, during helicopter flights.
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Zhang X, Cao Z, Yang H, Wang Y, Wang W, Li S. Analysis of serum antioxidant capacity and gut microbiota in calves at different growth stages in Tibet. Front Microbiol 2023; 13:1089488. [PMID: 36798869 PMCID: PMC9927023 DOI: 10.3389/fmicb.2022.1089488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/22/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction The hypoxic environment at high altitudes poses a major physiological challenge to animals, especially young animals, as it disturbs the redox state and induces intestinal dysbiosis. Information about its effects on Holstein calves is limited. Methods Here, serum biochemical indices and next-generation sequencing were used to explore serum antioxidant capacity, fecal fermentation performance, and fecal microbiota in Holstein calves aged 1, 2, 3, 4, 5, and 6 months in Tibet. Results and Discussion Serum antioxidant capacity changed with age, with the catalase and malondialdehyde levels significantly decreasing (p < 0.05), and superoxide dismutase levels significantly increasing (p < 0.05) with age. No significant differences (p > 0.05) in total volatile fatty acid levels were noted between the groups. In all groups, Firmicutes, Bacteroidetes, and Actinobacteria were the three most dominant phyla in the gut. Gut microbial alpha diversity significantly increased (p < 0.05) with age. Principal coordinate analysis plot based on Bray-Curtis dissimilarity revealed significant differences (p = 0.001) among the groups. Furthermore, the relative abundance of various genera changed dynamically with age, and the serum antioxidant capacity was associated with certain gut bacteria. The study provides novel insights for feeding Holstein calves in high-altitude regions.
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Hu B, Wang J, Li Y, Ge J, Pan J, Li G, He Y, Zhong H, Wang B, Huang Y, Han S, Xing Y, He H. Gut microbiota facilitates adaptation of the plateau zokor ( Myospalax baileyi) to the plateau living environment. Front Microbiol 2023; 14:1136845. [PMID: 36910168 PMCID: PMC9998695 DOI: 10.3389/fmicb.2023.1136845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Gut microbiota not only helps the hosts to perform many key physiological functions such as food digestion, energy harvesting and immune regulation, but also influences host ecology and facilitates adaptation of the host to extreme environments. Plateau zokors epitomize successful physiological adaptation to their living environment in the face of the harsh environment characterized by low temperature, low pressure and hypoxia in the Tibetan plateau region and high concentrations of CO2 in their burrows. Therefore, here we used a metagenomic sequencing approach to explore how gut microbiota contributed to the adaptive evolution of the plateau zokor on the Qinghai-Tibet Plateau. Our metagenomic results show that the gut microbiota of plateau zokors on the Tibetan plateau is not only enriched in a large number of species related to energy metabolism and production of short-chain fatty acids (SCFAs), but also significantly enriched the KO terms that involve carbohydrate uptake pathways, which well address energy uptake in plateau zokors while also reducing inflammatory responses due to low pressure, hypoxia and high CO2 concentrations. There was also a significant enrichment of tripeptidyl-peptidase II (TPPII) associated with antigen processing, apoptosis, DNA damage repair and cell division, which may facilitate the immune response and tissue damage repair in plateau zokors under extreme conditions. These results suggest that these gut microbiota and their metabolites together contribute to the physiological adaptation of plateau zokors, providing new insights into the contribution of the microbiome to the evolution of mammalian adaptation.
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Affiliation(s)
- Bin Hu
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Jiamin Wang
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Ying Li
- College of Agriculture and Animal Husbandry, Qinghai University, Xining, China
| | - Jin Ge
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Jinchao Pan
- College of Animal Sciences, Anhui University of Science and Technology, Huainan, China
| | - Gaojian Li
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Yongcai He
- College of Agriculture and Animal Husbandry, Qinghai University, Xining, China
| | - Haishun Zhong
- Animal Husbandry and Veterinary Station of Xunhua, Xining, Qinghai, China
| | - Bo Wang
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Yanyi Huang
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Shuyi Han
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Yanan Xing
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China.,College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Hongxuan He
- Institute of Zoology, Chinese Academy of Sciences, Beijing, China
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Fertility Impairment after Trekking at High Altitude: A Proof of Mechanisms on Redox and Metabolic Seminal Changes. Int J Mol Sci 2022; 23:ijms23169066. [PMID: 36012330 PMCID: PMC9409093 DOI: 10.3390/ijms23169066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Many authors described negative but reversible effects of high-altitude hypoxic exposure on animal and human fertility in terms of sperm concentration, function, and biochemical alterations. The aim of this study was to evaluate the acute and chronic effects of high-altitude exposure on classical sperm parameters, redox status, and membrane composition in a group of travellers. Five healthy Italian males, all lowlanders not accustomed to the altitude, were evaluated after 19 days-trekking through low, moderate, and high altitudes in the Himalayas. Sperm samples were collected before (Pre), 10 days after (Post), and 70 days after the end of the expedition (Follow-up). Sperm concentration, cholesterol and oxysterol membrane content, and redox status were measured. Hypoxic trek led to a significant reduction in sperm concentration (p < 0.001, η2p = 0.91), with a reduction from Pre to Post (71.33 ± 38.81 to 60.65 ± 34.63 × 106/mL) and a further reduction at Follow-up (to 37.13 ± 39.17 × 106/mL). The seminal volume was significantly affected by the hypoxic trek (p = 0.001, η2p = 0.75) with a significant reduction from Pre to Post (2.86 ± 0.75 to 1.68 ± 0.49 mL) and with partial recovery at Follow-up (to 2.46 ± 0.45 mL). Moreover, subjects had an increase in ROS production (+86%), and a decrease in antioxidant capacity (−37%) in the Post period with partial recovery at Follow-up. These results integrated the hormonal response on thyroid function, hypothalamus−pituitary−gonadal axis, and the prolactin/cortisol pathways previously reported. An uncontrolled ROS production, rather than a compromised antioxidant activity, was likely the cause of impaired sperm quality. The reduction in fertility status observed in this study may lie in an evolutionary Darwinian explanation, i.e., limiting reproduction due to the “adaptive disadvantage” offered by the combined stressors of high-altitude hypoxia and daily physical exercise.
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Effects of Prolonged Exposure to Hypobaric Hypoxia on Oxidative Stress: Overwintering in Antarctic Concordia Station. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:4430032. [PMID: 35535360 PMCID: PMC9078816 DOI: 10.1155/2022/4430032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/25/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022]
Abstract
Concordia Station is the permanent, research station on the Antarctic Plateau at 3230 m. During the eleventh winter-over campaign (DC11-2015; February 2015 to November 2015) at Antarctic Concordia Station, 13 healthy team members were studied and blood samples were collected at six different time points: baseline measurements (T0), performed at sea level before the departure, and during the campaign at 3, 7, 20, 90, and 300 days after arrival at Concordia Station. Reducing the partial pressure of O2 as barometric pressure falls, hypobaric hypoxia (HH) triggers several physiological adaptations. Among the others, increased oxidative stress and enhanced generation of reactive oxygen/nitrogen species (ROS/RNS), resulting in severe oxidative damage, were observed, which can share potential physiopathological mechanisms associated with many diseases. This study characterized the extent and time-course changes after acute and chronic HH exposure, elucidating possible fundamental mechanisms of adaptation. ROS, oxidative stress biomarkers, nitric oxide, and proinflammatory cytokines significantly increased (range 24-135%) during acute and chronic hypoxia exposure (peak 20th day) with a decrease in antioxidant capacity (peak 90th day: -52%). Results suggest that the adaptive response of oxidative stress balance to HH requires a relatively long time, more than 300th days, as all the observed variables do not return to the preexposition level. These findings may also be relevant to patients in whom oxygen availability is limited through disease (i.e., chronic heart and lung and/or kidney disease) and/or during long-duration space missions.
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Mrakic-Sposta S, Biagini D, Bondi D, Pietrangelo T, Vezzoli A, Lomonaco T, Di Francesco F, Verratti V. OxInflammation at High Altitudes: A Proof of Concept from the Himalayas. Antioxidants (Basel) 2022; 11:antiox11020368. [PMID: 35204250 PMCID: PMC8869289 DOI: 10.3390/antiox11020368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/14/2022] Open
Abstract
High-altitude locations are fascinating for investigating biological and physiological responses in humans. In this work, we studied the high-altitude response in the plasma and urine of six healthy adult trekkers, who participated in a trek in Nepal that covered 300 km in 19 days along a route in the Kanchenjunga Mountain and up to a maximum altitude of 5140 m. Post-trek results showed an unbalance in redox status, with an upregulation of ROS (+19%), NOx (+28%), neopterin (+50%), and pro-inflammatory prostanoids, such as PGE2 (+120%) and 15-deoxy-delta12,14-PGJ2 (+233%). The isoprostane 15-F2t-IsoP was associated with low levels of TAC (−18%), amino-thiols, omega-3 PUFAs, and anti-inflammatory CYP450 EPA-derived mediators, such as DiHETEs. The deterioration of antioxidant systems paves the way to the overload of redox and inflammative markers, as triggered by the combined physical and hypoxic stressors. Our data underline the link between oxidative stress and inflammation, which is related to the concept of OxInflammation into the altitude hypoxia fashion.
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Affiliation(s)
- Simona Mrakic-Sposta
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20162 Milan, Italy; (S.M.-S.); (A.V.)
| | - Denise Biagini
- Department of Chemistry and Industrial Chemistry, University of Pisa, 56126 Pisa, Italy; (T.L.); (F.D.F.)
- Correspondence:
| | - Danilo Bondi
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti, 66100 Chieti, Italy; (D.B.); (T.P.)
| | - Tiziana Pietrangelo
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti, 66100 Chieti, Italy; (D.B.); (T.P.)
| | - Alessandra Vezzoli
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20162 Milan, Italy; (S.M.-S.); (A.V.)
| | - Tommaso Lomonaco
- Department of Chemistry and Industrial Chemistry, University of Pisa, 56126 Pisa, Italy; (T.L.); (F.D.F.)
| | - Fabio Di Francesco
- Department of Chemistry and Industrial Chemistry, University of Pisa, 56126 Pisa, Italy; (T.L.); (F.D.F.)
| | - Vittore Verratti
- Department of Psychological, Health and Territorial Sciences, University “G. d’Annunzio” of Chieti, 66100 Chieti, Italy;
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Vitiello L, De Bernardo M, Capasso L, Cornetta P, Rosa N. Optic Nerve Ultrasound Evaluation in Animals and Normal Subjects. Front Med (Lausanne) 2022; 8:797018. [PMID: 35071277 PMCID: PMC8766506 DOI: 10.3389/fmed.2021.797018] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
In recent years, ultrasonographic measurement of the optic nerve sheath diameter (ONSD) has been widely used to identify the presence of increased intracranial pressure (ICP). Intracranial hypertension is a life-threatening condition that can be caused by various neurological and non-neurological disorders, and it is associated to poor clinical results. Ultrasonography could be used to qualitatively and efficiently detect ICP increases, but to reach this purpose, clear cut-off values are mandatory. The aim of this review is to provide a wide overview of the most important scientific publications on optic nerve ultrasound normal values assessment published in the last 30 years. A total of 42 articles selected from PubMed medical database was included in this review. Our analysis showed that ocular ultrasonography is considered to be a valuable diagnostic tool, especially when intracranial hypertension is suspected, but unfortunately this research provided conflicting results that could be due to the different ultrasound protocols. This is mainly caused by the use of B scan alone, which presents several limitations. The use of B-scan coupled with the standardized A-scan approach could give more accurate, and reliable ultrasound evaluation, assuring higher data objectivity.
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Affiliation(s)
- Livio Vitiello
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Maddalena De Bernardo
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Luigi Capasso
- Corneal Transplant Unit, Azienda Sanitaria Locale (ASL) Napoli 1, Naples, Italy
| | - Palmiro Cornetta
- Eye Unit, "Maria SS Addolorata" Hospital, Azienda Sanitaria Locale (ASL) Salerno, Eboli, Italy
| | - Nicola Rosa
- Eye Unit, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
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12
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Levenez M, Lambrechts K, Mrakic-Sposta S, Vezzoli A, Germonpré P, Pique H, Virgili F, Bosco G, Lafère P, Balestra C. Full-Face Mask Use during SCUBA Diving Counters Related Oxidative Stress and Endothelial Dysfunction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020965. [PMID: 35055791 PMCID: PMC8776018 DOI: 10.3390/ijerph19020965] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/29/2022]
Abstract
Impaired flow mediated dilation (FMD), an index of vascular stress, is known after SCUBA diving. This is related to a dysfunction of nitric oxide (NO) availability and a disturbance of the redox status, possibly induced by hyperoxic/hyperbaric gas breathing. SCUBA diving is usually performed with a mask only covering “half face” (HF) and therefore forcing oral breathing. Nasal NO production is involved in vascular homeostasis and, as consequence, can significantly reduce NO possibly promoting vascular dysfunction. More recently, the utilization of “full-face” (FF) mask, allowing nasal breathing, became more frequent, but no reports are available describing their effects on vascular functions in comparison with HF masks. In this study we assessed and compared the effects of a standard shallow dive (20 min at 10 m) wearing either FF or a HF mask on different markers of vascular function (FMD), oxidative stress (ROS, 8-iso-PGF2α) and NO availability and metabolism (NO2, NOx and 3-NT and iNOS expression). Data from a dive breathing a hypoxic (16% O2 at depth) gas mixture with HF mask are shown allowing hyperoxic/hypoxic exposure. Our data suggest that nasal breathing might significantly reduce the occurrence of vascular dysfunction possibly due to better maintenance of NO production and bioavailability, resulting in a better ability to counter reactive oxygen and nitrogen species. Besides the obvious outcomes in terms of SCUBA diving safety, our data permit a better understanding of the effects of oxygen concentrations, either in normal conditions or as a strategy to induce selected responses in health and disease.
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Affiliation(s)
- Morgan Levenez
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium; (M.L.); (K.L.); (P.G.); (H.P.); (P.L.)
| | - Kate Lambrechts
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium; (M.L.); (K.L.); (P.G.); (H.P.); (P.L.)
| | - Simona Mrakic-Sposta
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Piazza dell’Ospedale Maggiore, 20162 Milano, Italy; (S.M.-S.); (A.V.)
| | - Alessandra Vezzoli
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Piazza dell’Ospedale Maggiore, 20162 Milano, Italy; (S.M.-S.); (A.V.)
| | - Peter Germonpré
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium; (M.L.); (K.L.); (P.G.); (H.P.); (P.L.)
- Hyperbaric Centre, Queen Astrid Military Hospital, 1120 Brussels, Belgium
- DAN Europe Research Division, Contrada Padune, 64026 Roseto, Italy
| | - Hadrien Pique
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium; (M.L.); (K.L.); (P.G.); (H.P.); (P.L.)
| | - Fabio Virgili
- Council for Agricultural Research and Economics—Food and Nutrition Research Centre (CREA-AN), Via Ardeatina 548, 00187 Rome, Italy
- Correspondence: (F.V.); (C.B.)
| | - Gerardo Bosco
- Environmental Physiology & Medicine Laboratory, Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy;
| | - Pierre Lafère
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium; (M.L.); (K.L.); (P.G.); (H.P.); (P.L.)
- DAN Europe Research Division, Contrada Padune, 64026 Roseto, Italy
| | - Costantino Balestra
- Environmental, Occupational, Aging (Integrative) Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), 1180 Brussels, Belgium; (M.L.); (K.L.); (P.G.); (H.P.); (P.L.)
- DAN Europe Research Division, Contrada Padune, 64026 Roseto, Italy
- Physical Activity Teaching Unit, Motor Sciences Department, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Correspondence: (F.V.); (C.B.)
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13
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High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 3:59-69. [PMID: 35782163 PMCID: PMC9219347 DOI: 10.1016/j.smhs.2021.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 01/19/2023] Open
Abstract
Areas at high-altitude, annually attract millions of tourists, skiers, trekkers, and climbers. If not adequately prepared and not considering certain ascent rules, a considerable proportion of those people will suffer from acute mountain sickness (AMS) or even from life-threatening high-altitude cerebral (HACE) or/and pulmonary edema (HAPE). Reduced inspired oxygen partial pressure with gain in altitude and consequently reduced oxygen availability is primarily responsible for getting sick in this setting. Appropriate acclimatization by slowly raising the hypoxic stimulus (e.g., slow ascent to high altitude) and/or repeated exposures to altitude or artificial, normobaric hypoxia will largely prevent those illnesses. Understanding physiological mechanisms of acclimatization and pathophysiological mechanisms of high-altitude diseases, knowledge of symptoms and signs, treatment and prevention strategies will largely contribute to the risk reduction and increased safety, success and enjoyment at high altitude. Thus, this review is intended to provide a sound basis for both physicians counseling high-altitude visitors and high-altitude visitors themselves.
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Gaur P, Prasad S, Kumar B, Sharma SK, Vats P. High-altitude hypoxia induced reactive oxygen species generation, signaling, and mitigation approaches. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:601-615. [PMID: 33156424 DOI: 10.1007/s00484-020-02037-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
Homeostasis between pro-oxidants and anti-oxidants is necessary for aerobic life, which if perturbed and shifted towards pro-oxidants results in oxidative stress. It is generally agreed that reactive oxygen species (ROS) production is accelerated with mountainous elevation, which may play a role in spawning serious health crisis. Exposure to increasing terrestrial altitude leads to a reduction in ambient O2 availability in cells producing a series of hypoxic oxidative stress reactions and altering the redox balance in humans. Enormous literature on redox signaling drove research activity towards understanding the role of oxidative stress under normal and challenging conditions like high-altitude hypoxia which grounds for disturbed redox signaling. Excessive ROS production and accumulation of free radicals in cells and tissues can cause various pulmonary, cardiovascular, and metabolic pathophysiological conditions. In order to counteract this oxidative stress and maintain the balance of pro-oxidants and anti-oxidants, an anti-oxidant system exists in the human body, which, however, gets surpassed by elevated ROS levels, but can be strengthened through the use of anti-oxidant supplements. Such cumulative studies of fundamentals on a global concept like oxidative stress and role of anti-oxidants can act as a foundation to further smoothen for researchers to study over health, disease, and other pathophysiological conditions. This review highlights the interconnection between high altitude and oxidative stress and the role of anti-oxidants to protect cells from oxidative damages and to lower the risk of altitude-associated sickness.
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Affiliation(s)
- Priya Gaur
- Endocrinology & Metabolism Division, Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, Delhi, 110054,, India
| | - Suchita Prasad
- Department of Chemistry, University of Delhi, Delhi, 110007,, India
| | - Bhuvnesh Kumar
- Endocrinology & Metabolism Division, Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, Delhi, 110054,, India
| | - Sunil K Sharma
- Department of Chemistry, University of Delhi, Delhi, 110007,, India.
| | - Praveen Vats
- Endocrinology & Metabolism Division, Defence Institute of Physiology and Allied Sciences (DIPAS), DRDO, Lucknow Road, Timarpur, Delhi, 110054,, India.
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15
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Vitamin C deficiency and risk of metabolic complications among adults with chronic respiratory diseases: A case-control study. Clin Nutr ESPEN 2021; 43:448-455. [PMID: 34024554 DOI: 10.1016/j.clnesp.2021.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/12/2021] [Accepted: 03/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic respiratory disease (CRD) is an airflow limitation that represents a wide array of serious diseases. The aim of this study is to examine the influence of vitamin C deficiency on metabolic health-related quality in individuals with and without chronic respiratory disease in the Gaza Strip. METHODS A matched case-control study including 52 cases of CRD and 52 controls of healthy participants were matched by age, sex, body mass index (BMI) and waist circumferences (WC). The study was conducted at the Ministry of Health secondary health-care centers in Gaza strip, Palestine. The biochemical data included Protein Carbonyl (PC), high sensitivity C reactive protein (CRP), vitamin C, fasting blood glucose (FBG) and markers of the lipid profile. RESULTS By the qualitative estimation of vitamin C consumption, there was a significantly lower consumption of foods that are rich in vitamin C by CRD patients than the matched controls. By comparing the results between both groups, CRD patients had significantly lower plasma concentrations of vitamins C than the control group (18.43 ± 11.93 μgm/ml vs. 24.06 ± 11.19 μgm/ml, P = 0.025), but significantly higher in PC (3.86 ± 4.21 μgm/ml vs. 2.11 ± 0.97 μgm/ml, P = 0.005), CRP (5.98 ± 8.84 mg/l vs. 1.87 ± 1.96 mg/l, P = 0.001), and FBG (102.46 ± 15.09 mg/dl vs. 95.92 ± 10.88 mg/dl, P = 0.017). The results revealed that CRD patients had significantly lower blood oxygen saturation than the control group (96.36 ± 3.81 vs. 98.51 ± 0.75, P < 0.001), whereas no significant differences were observed regarding the lipid profiles markers. CONCLUSION CRD patients have lower levels of vitamin C in their plasma and their diet than do healthy matched people; they also have higher oxidative stress and inflammatory markers than healthy people, which are risk factors for predicting metabolic complications.
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16
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Rumman M, Pandey S, Singh B, Gupta M, Ubaid S, Mahdi AA. Genistein Prevents Hypoxia-Induced Cognitive Dysfunctions by Ameliorating Oxidative Stress and Inflammation in the Hippocampus. Neurotox Res 2021; 39:1123-1133. [PMID: 33740236 DOI: 10.1007/s12640-021-00353-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 12/26/2022]
Abstract
Genistein (GE), a plant-derived isoflavone, is a polyphenolic non-steroidal compound. Studies showed that GE possesses anti-cancer, anti-inflammatory, anti-microbial, anti-oxidant, and anti-apoptotic activities. However, the neuroprotective role of GE in amnesia has not been studied. This study aimed to evaluate the anti-amnesic potential of GE in a mice model of hypoxia-induced amnesia and to understand the underlying mechanism. Mice were exposed to hypoxia (10% O2) and administered vehicle or GE (10, 20, 30 mg/kg) orally for 28 days. Thereafter, Morris water maze (MWM), novel object recognition (NOR), and passive avoidance task (PAT) were performed to evaluate cognitive behavior. Next, we performed biochemical tests and gene expression analysis to uncover the mechanism underlying GE mode of action. Our results showed that GE-treatment ameliorated hypoxia-induced cognitive dysfunctions in mice. Further, GE-treatment suppressed the oxidative stress in the hippocampus of amnesic mice as evidenced by reduced lipid peroxidation, reduced nitrite and ROS levels, and increased levels of reduced glutathione (GSH) and increased total antioxidant capacity. GE treatment reduced the expression of pro-inflammatory cytokines TNFα, IL1β, IL6, and MCP-1 and increased the expression of anti-inflammatory cytokine IL10 in the hippocampus of amnesic mice. Finally, GE treatment enhanced the expression of neuroprotective genes including BDNF, CREB, CBP, and IGF1 in the hippocampus of amnesic mice. Altogether, our results showed that GE treatment prevents hypoxia-induced cognitive dysfunction in mice by reducing oxidative stress and suppressing neuroinflammation while increasing the expression of neuroprotective genes in the hippocampus.
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Affiliation(s)
- Mohammad Rumman
- Department of Biochemistry, King George's Medical University (KGMU), Lucknow, India
| | - Shivani Pandey
- Department of Biochemistry, King George's Medical University (KGMU), Lucknow, India.
| | - Babita Singh
- Department of Biochemistry, King George's Medical University (KGMU), Lucknow, India
| | - Mrinal Gupta
- Department of Biochemistry, King George's Medical University (KGMU), Lucknow, India
| | - Saba Ubaid
- Department of Biochemistry, King George's Medical University (KGMU), Lucknow, India
| | - Abbas Ali Mahdi
- Department of Biochemistry, King George's Medical University (KGMU), Lucknow, India
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17
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Segarra M, Aburto MR, Acker-Palmer A. Blood-Brain Barrier Dynamics to Maintain Brain Homeostasis. Trends Neurosci 2021; 44:393-405. [PMID: 33423792 DOI: 10.1016/j.tins.2020.12.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 10/03/2020] [Accepted: 12/07/2020] [Indexed: 01/18/2023]
Abstract
The blood-brain barrier (BBB) is a dynamic platform for exchange of substances between the blood and the brain parenchyma, and it is an essential functional gatekeeper for the central nervous system (CNS). While it is widely recognized that BBB disruption is a hallmark of several neurovascular pathologies, an aspect of the BBB that has received somewhat less attention is the dynamic modulation of BBB tightness to maintain brain homeostasis in response to extrinsic environmental factors and physiological changes. In this review, we summarize how BBB integrity adjusts in critical stages along the life span, as well as how BBB permeability can be altered by common stressors derived from nutritional habits, environmental factors and psychological stress.
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Affiliation(s)
- Marta Segarra
- Neuro and Vascular Guidance, Buchmann Institute for Molecular Life Sciences (BMLS) and Institute of Cell Biology and Neuroscience, Max-von-Laue-Strasse 15, D-60438, Frankfurt am Main, Germany; Cardio-Pulmonary Institute (CPI), Max-von-Laue-Strasse 15, D-60438, Frankfurt am Main, Germany.
| | - Maria R Aburto
- Neuro and Vascular Guidance, Buchmann Institute for Molecular Life Sciences (BMLS) and Institute of Cell Biology and Neuroscience, Max-von-Laue-Strasse 15, D-60438, Frankfurt am Main, Germany
| | - Amparo Acker-Palmer
- Neuro and Vascular Guidance, Buchmann Institute for Molecular Life Sciences (BMLS) and Institute of Cell Biology and Neuroscience, Max-von-Laue-Strasse 15, D-60438, Frankfurt am Main, Germany; Cardio-Pulmonary Institute (CPI), Max-von-Laue-Strasse 15, D-60438, Frankfurt am Main, Germany; Max Planck Institute for Brain Research, Max-von-Laue-Strasse 4, 60438 Frankfurt am Main, Germany.
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18
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Tsai TY, Gozari G, Su YC, Lee YK, Tu YK. Optic nerve sheath diameter changes at high altitude and in acute mountain sickness: meta-regression analyses. Br J Ophthalmol 2020; 106:731-735. [PMID: 33310776 DOI: 10.1136/bjophthalmol-2020-317717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To assess changes in optic nerve sheath diameter (ONSD) at high altitude and in acute mountain sickness (AMS). METHODS Cochrane Library, EMBASE, Google Scholar and PubMed were searched for articles published from their inception to 31st of July 2020. Outcome measures were mean changes of ONSD at high altitude and difference in ONSD change between subjects with and without AMS. Meta-regressions were conducted to investigate the relation of ONSD change to altitude and time spent at that altitude. RESULTS Eight studies with 248 participants comparing ONSD from sea level to high altitude, and five studies with 454 participants comparing subjects with or without AMS, were included. ONSD increased by 0.14 mm per 1000 m after adjustment for time (95% CI: 0.10 to 0.18; p<0.01). Restricted cubic spline regression revealed an almost linear relation between ONSD change and time within 2 days. ONSD was greater in subjects with AMS (mean difference=0.47; 95% CI: 0.14 to 0.80; p=0.01; I2=89.4%). CONCLUSION Our analysis shows that ONSD changes correlate with altitude and tend to increase in subjects with AMS. Small study number and high heterogeneity are the limitations of our study. Further large prospective studies are required to verify our findings.
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Affiliation(s)
- Tou-Yuan Tsai
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - George Gozari
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yung-Cheng Su
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Kung Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan .,Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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19
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Wang T, Hou J, Xiao W, Zhang Y, Zhou L, Yuan L, Yin X, Chen X, Hu Y. Chinese medicinal plants for the potential management of high-altitude pulmonary oedema and pulmonary hypertension. PHARMACEUTICAL BIOLOGY 2020; 58:815-827. [PMID: 32883127 PMCID: PMC8641673 DOI: 10.1080/13880209.2020.1804407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 05/29/2023]
Abstract
CONTEXT Despite the abundance of knowledge regarding high-altitude pulmonary edoema (HAPE) and high-altitude pulmonary hypertension (HAPH), their prevalence continues to be on the rise. Thus, there is an urgent need for newer safe, effective, and relatively economic drug candidates. China is particularly known for the use of medicinal plants. OBJECTIVE This review summarizes the medicinal plants used for HAPE and HAPH in the past 30 years, as well as some potential plants. METHODS Publications on HAPE and HAPH from 1990 to 2020 were identified using Web of Science, PubMed, SCOPUS, Springer Link, Google Scholar databases, Chinese Clinical Trial Registry and CNKI with the following keywords: 'medicinal plants,' 'hypoxia,' 'high altitude pulmonary edema,' 'high altitude pulmonary hypertension,' 'pathophysiology,' 'mechanisms,' 'prevention,' 'treatment,' 'human,' 'clinical,' 'safety,' and 'pharmacokinetics.' RESULTS We found 26 species (from 20 families) out of 5000 plants which are used for HAPE and HAPH prevention or treatment. Rhodiola rosea Linn. (Crassulaceae) is the most widely utilized. The most involved family is Lamiaceae, which contains 5 species. DISCUSSION AND CONCLUSIONS We mainly reviewed the medicinal plants and mechanisms for the treatment of HAPE and HAPH, and we also assessed related toxicology experiments, pharmacokinetics and bioavailability. Potential medicinal plants were also identified. Further research is needed to determine the pharmacological effects and active ingredients of these potential medicinal plants.
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Affiliation(s)
- Tingting Wang
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Jun Hou
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Wenjing Xiao
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Yaolei Zhang
- Faculty of Medical, Southwest Jiaotong University, Chengdu, Sichuan, P. R. China
| | - Longfu Zhou
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Li Yuan
- Faculty of Medical, Southwest Jiaotong University, Chengdu, Sichuan, P. R. China
| | - Xiaoqiang Yin
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Xin Chen
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu/Affiliated Hospital of Southwest, Jiaotong University, Chengdu, Sichuan, P. R. China
| | - Yonghe Hu
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
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Effects of acute and sub-acute hypobaric hypoxia on oxidative stress: a field study in the Alps. Eur J Appl Physiol 2020; 121:297-306. [PMID: 33057877 DOI: 10.1007/s00421-020-04527-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE High altitude results in lower barometric pressure and hence partial pressure of O2 decrease can lead to several molecular and cellular changes, such as generation of reactive oxygen species (ROS). Electron Paramagnetic Resonance technique was adopted in the field, to evaluate the effects of acute and sub-acute hypobaric hypoxia (HH) on ROS production by micro-invasive method. Biological biomarkers, indicators of oxidative stress, renal function and inflammation were investigated too. METHODS Fourteen lowlander subjects (mean age 27.3 ± 5.9 years) were exposed to HH at 3269 m s.l. ROS production, related oxidative damage to cellular components, systemic inflammatory response and renal function were determined through blood and urine profile performed at 1st, 2nd, 4th, 7th, and 14th days during sojourn. RESULTS Kinetics of changes during HH exposition showed out significant (range p < 0.05-0.0001) increases that at max corresponds to 38% for ROS production rate, 140% for protein carbonyl, 44% for lipid peroxidation, 42% for DNA damage, 200% for inflammatory cytokines and modifications in renal function (assessed by neopterin concentration: 48%). Conversely, antioxidant capacity significantly (p < 0.0001) decreased - 17% at max. CONCLUSION This 14 days in-field study describes changes of oxidative-stress biomarkers during HH exposure in lowlanders. The results show an overproduction of ROS and consequent oxidative damage to protein, lipids and DNA with a decrease in antioxidant capacity and the involvement of inflammatory status and a transient renal dysfunction. Exposure at high altitude induces a hypoxic condition during acute and sub-acute phases accompanied by molecular adaptation mechanism indicating acclimatization.
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21
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Langbøl M, Saruhanian S, Baskaran T, Tiedemann D, Mouhammad ZA, Toft-Kehler AK, Jun B, Vohra R, Bazan NG, Kolko M. Increased Antioxidant Capacity and Pro-Homeostatic Lipid Mediators in Ocular Hypertension-A Human Experimental Model. J Clin Med 2020; 9:jcm9092979. [PMID: 32942740 PMCID: PMC7563216 DOI: 10.3390/jcm9092979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
The main risk factor for primary open-angle glaucoma (POAG) is increased intraocular pressure (IOP). It is of interest that about half of the patients have an IOP within the normal range (normal-tension glaucoma, NTG). Additionally, there is a group of patients with a high IOP but no glaucomatous neurodegeneration (ocular hypertension, OHT). Therefore, risk factors other than IOP are involved in the pathogenesis of glaucoma. Since the retina has a very high oxygen-demand, decreased autoregulation and a fluctuating oxygen supply to the retina have been linked to glaucomatous neurodegeneration. To assess the significance of these mechanisms, we have utilized a human experimental model, in which we stress participants with a fluctuating oxygen supply. Levels of oxidative stress molecules, antioxidants, and lipid mediators were measured in the plasma. Patients with NTG, OHT, and control subjects were found to have similar levels of oxidative stress markers. In contrast, patients with OHT had a higher level of total antioxidant capacity (TAC) and pro-homeostatic lipid mediators. Thus, we suggest that OHT patients manage fluctuating oxygen levels more efficiently and, thus, are less susceptible to glaucomatous neurodegenerations, due to enhanced systemic antioxidant protection.
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Affiliation(s)
- Mia Langbøl
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
- Correspondence: (M.L.); (M.K.); Tel.: +45-30-50-26-62 (M.L.); +45-29-80-76-67 (M.K.)
| | - Sarkis Saruhanian
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
| | - Thisayini Baskaran
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
| | - Daniel Tiedemann
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
| | - Zaynab A. Mouhammad
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
| | - Anne Katrine Toft-Kehler
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
| | - Bokkyoo Jun
- Neuroscience Center of Excellence, Louisiana State University Health New Orleans, New Orleans, LA 70112, USA; (B.J.); (N.G.B.)
| | - Rupali Vohra
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
- Department of Veterinary and Animal Sciences, University of Copenhagen, 2000 Frederiksberg, Denmark
| | - Nicolas G. Bazan
- Neuroscience Center of Excellence, Louisiana State University Health New Orleans, New Orleans, LA 70112, USA; (B.J.); (N.G.B.)
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark; (S.S.); (T.B.); (D.T.); (Z.A.M.); (A.K.T.-K.); (R.V.)
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, 2600 Glostrup, Denmark
- Correspondence: (M.L.); (M.K.); Tel.: +45-30-50-26-62 (M.L.); +45-29-80-76-67 (M.K.)
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Williamson J, Hughes CM, Burke G, Davison GW. A combined γ-H2AX and 53BP1 approach to determine the DNA damage-repair response to exercise in hypoxia. Free Radic Biol Med 2020; 154:9-17. [PMID: 32360611 DOI: 10.1016/j.freeradbiomed.2020.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
This study examines the interplay between exercise and hypoxia in relation to the DNA damage-repair response; with specific interest to DNA double strand damage. Following two V̇O2max tests, 14 healthy, male participants completed two exercise trials (hypoxia; 12% FiO2, normoxia; 20.9% FiO2) consisting of cycling for 30-min at 80-85% of V̇O2max relative to the environmental condition. Blood was sampled pre-, immediately post-, 2-, and 4-h post-exercise with additional blood cultured in vitro for 24-, 48-, and 72-h following the experimental trial. Samples were analysed for single- and double-strand DNA damage, FPG-sensitive sites, lipid hydroperoxides, lipid soluble antioxidants, and the ascorbyl free radical quantified by EPR. Exercise increased single strand breaks and FPG-sensitive sites (P < 0.05) which was exacerbated following hypoxia (P = 0.02) and a similar increase in DNA double strand breaks occurred as a result of hypoxia per se (P < 0.000). With respect to the DNA damage-repair response, single strand breaks, FPG-sensitive sites, and double strand lesions were fully repaired by the 4- (in vivo), 24-, and 48-h (in vitro) time-points respectively. Changes in lipid hydroperoxides (P = 0.001), the ascorbyl free radical (P = 0.02), and lipid soluble antioxidants (P > 0.05), were also observed following exercise in hypoxia. These findings highlight significant single- and double strand DNA damage and oxidative stress as a function of high-intensity exercise, which is substantially exacerbated in hypoxia and may be attributed to multiple mechanisms of ROS generation. In addition, full repair of DNA damage (SSB, DSB, and FPG-sensitive sites) was observed within 24- and 48-h of normoxic and hypoxic exercise, respectively.
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Affiliation(s)
- Josh Williamson
- Ulster University, Sport and Exercise Research Institute, Newtownabbey, Northern Ireland, United Kingdom
| | - Ciara M Hughes
- Ulster University, Nursing and Health Research Institute, Newtownabbey, Northern Ireland, United Kingdom
| | - George Burke
- Ulster University, Engineering Research Institute, Newtownabbey, Northern Ireland, United Kingdom
| | - Gareth W Davison
- Ulster University, Sport and Exercise Research Institute, Newtownabbey, Northern Ireland, United Kingdom.
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Mrakic-Sposta S, Bosco G, Vezzoli A. Commentary on: "Targeted and untargeted metabolomics applied to occupational exposure to hyperbaric atmosphere". Toxicol Lett 2020; 330:71-72. [PMID: 32439579 DOI: 10.1016/j.toxlet.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Simona Mrakic-Sposta
- National Research Council - Institute of Clinical Physiology (CNR-IFC), Milano, Italy
| | - Gerardo Bosco
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Alessandra Vezzoli
- National Research Council - Institute of Clinical Physiology (CNR-IFC), Milano, Italy
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Nepal G, Yadav JK, Rehrig JH, Bhandari N, Baniya S, Ghimire R, Mahotra N. Efficacy and safety of inhaled budesonide on prevention of acute mountain sickness during emergent ascent: a meta-analysis of randomized controlled trials. BMC Emerg Med 2020; 20:38. [PMID: 32404064 PMCID: PMC7222565 DOI: 10.1186/s12873-020-00329-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background Acute Mountain Sickness (AMS) is a pathophysiologic process that occurs in non-acclimated susceptible individuals rapidly ascending to high-altitude. Barometric pressure falls at high altitude and it translates to a decreased partial pressure of alveolar oxygen (PAO2) and arterial oxygen (PaO2). A gradual staged ascent with sufficient acclimatization can prevent AMS but emergent circumstances requiring exposure to rapid atmospheric pressure changes – such as for climbers, disaster or rescue team procedures, and military operations – establishes a need for effective prophylactic medications. This systematic review and meta-analysis aim to analyze the incidence of AMS during emergent ascent of non-acclimatized individuals receiving inhaled budesonide compared to placebo. Methods This current meta-analysis was conducted according to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched PubMed, Google Scholar and Embase for relevant studies. The efficacy of budesonide in reducing incidence of AMS was evaluated by calculating the pooled ORs and 95% CIs. The efficacy of budesonide in maintaining hemoglobin-oxygen saturation was evaluated by calculating standard mean difference (SMD) and 95% confidence intervals. Results We found that at high altitude, inhaled budesonide was effective in reducing the incidence of mild AMS [OR: 0.37; 95% CI, 0.14 to 0.9, p = 0.042] but was ineffective in reducing the incidence of severe AMS [OR: 0.46; 95% CI, 0.14 to 1.41, p = 0.17]. Inhaled budesonide was also effective in maintaining SpO2 (SMD: 0.47; 95% CI, 0.09 to 0.84, p = 0.014) at high altitude. However, it was not effective in maintaining or improving pulmonary function at high altitude. Systematic-review found no adverse effects of budesoide in the dose used for prophylaxis of AMS. Conclusions Our systematic review showed that prophylactic inhaled budesonide is effective in preventing mild AMS during emergency ascent but not effective in preventing severe AMS. Though statistically significant, authors recommend caution in interpretation of data and questions for further well designed randomized studies to evaluate the role of budesonide in prophylaxis of AMS during an emergent ascent.
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Affiliation(s)
- Gaurav Nepal
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal. .,Mountain Medicine Society of Nepal, Kathmandu, Nepal.
| | - Jayant Kumar Yadav
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.,Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | | | - Niroj Bhandari
- Kathmandu University School of Medical Sciences, Panauti, Nepal
| | - Santosh Baniya
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.,Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - Rakesh Ghimire
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Narayan Mahotra
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
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25
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Jain S, Paul S, Meena RN, Gangwar A, Panjwani U, Ahmad Y, Bhargava K. Saliva panel of protein candidates: A comprehensive study for assessing high altitude acclimatization. Nitric Oxide 2019; 95:1-11. [PMID: 31778801 DOI: 10.1016/j.niox.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 01/01/2023]
Abstract
Altitude acclimatization describes the processes whereby lowland humans respond to decreased partial pressure of oxygen. It refers to the changes seen as beneficial and involves a series of physiological adjustments that compensate for reduced ambient PO2, as opposed to changes that are pathological. Although numerous reports document the physiological effects of exposure to hypobaric hypoxia of varying durations but an interesting aspect overlooked by many researchers is that of acclimatization related studies. As proteome, a dynamic entity responds immediately to external stimuli, protein markers and their trends can be studied to assess acclimatization status of an individual. Compared to blood, the use of saliva is advantageous because sample collection and processing are easy, minimally invasive, low cost and better tolerated by individuals. In this study, we employed iTRAQ based LC-MS/MS technique for comparing saliva samples from humans exposed to hypobaric hypoxia from 7 to 120 days with normoxic controls followed by analysis using Ingenuity Pathway Analysis software and validation by immunoassays. Nearly 67 proteins were found to be differentially expressed in the exposed groups as compared to normoxia indicating modulated canonical pathways as lipid metabolism; acute phase response signalling and proteins as carbonic anhydrase 6, alpha-enolase, albumin, and prolactin inducible protein. Collectively, this study provides the proof of concept for the non-invasive assessment of high altitude acclimatization.
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Affiliation(s)
- Shikha Jain
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Subhojit Paul
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Ram Niwas Meena
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Anamika Gangwar
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Usha Panjwani
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Yasmin Ahmad
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India.
| | - Kalpana Bhargava
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India.
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26
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Malacrida S, Giannella A, Ceolotto G, Reggiani C, Vezzoli A, Mrakic-Sposta S, Moretti S, Turner R, Falla M, Brugger H, Strapazzon G. Transcription Factors Regulation in Human Peripheral White Blood Cells during Hypobaric Hypoxia Exposure: an in-vivo experimental study. Sci Rep 2019; 9:9901. [PMID: 31289332 PMCID: PMC6617471 DOI: 10.1038/s41598-019-46391-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/27/2019] [Indexed: 01/10/2023] Open
Abstract
High altitude is a natural laboratory, within which the clinical study of human physiological response to hypobaric hypoxia (HH) is possible. Failure in the response results in progressive hypoxemia, inflammation and increased tissue oxidative stress (OxS). Thus, investigating temporal changes in key transcription factors (TFs) HIF-1α, HIF-2α, NF-κB and NRF2 mRNA levels, relative to OxS and inflammatory markers, may reveal molecular targets which contrast deleterious effects of hypoxia. Biological samples and clinical data from 15 healthy participants were collected at baseline and after rapid, passive ascent to 3830 m (24 h and 72 h). Gene expression was assessed by qPCR and ROS generation was determined by EPR spectroscopy. Oxidative damage and cytokine levels were estimated by immuno or enzymatic methods. Hypoxia transiently enhanced HIF-1α mRNA levels over time reaching a peak after 24 h. Whereas, HIF-2α and NRF2 mRNA levels increased over time. In contrast, the NF-κB mRNA levels remained unchanged. Plasma levels of IL-1β and IL-6 also remained within normal ranges. ROS production rate and markers of OxS damage were significantly increased over time. The analysis of TF-gene expression suggests that HIF-1α is a lead TF during sub-acute HH exposure. The prolongation of the HH exposure led to a switch between HIF-1α and HIF-2α/NRF2, suggesting the activation of new pathways. These results provide new insights regarding the temporal regulation of TFs, inflammatory state, and ROS homeostasis involved in human hypoxic response, potentially also relevant to the mediation of diseases that induce a hypoxic state.
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Affiliation(s)
- Sandro Malacrida
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy. .,Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Alessandra Giannella
- Department of Medicine-DIMED, Campus Biomedico Pietro D'Abano, University of Padova, Padova, Italy
| | - Giulio Ceolotto
- Department of Medicine-DIMED, Campus Biomedico Pietro D'Abano, University of Padova, Padova, Italy
| | - Carlo Reggiani
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Alessandra Vezzoli
- Institute of Bioimaging and Molecular Physiology, National Council of Research, Segrate (Milan), Italy
| | - Simona Mrakic-Sposta
- Institute of Bioimaging and Molecular Physiology, National Council of Research, Segrate (Milan), Italy
| | - Sarah Moretti
- Institute of Bioimaging and Molecular Physiology, National Council of Research, Segrate (Milan), Italy
| | - Rachel Turner
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Marika Falla
- Department of Neurology, General Hospital of Bolzano, Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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27
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Salivary proteome patterns of individuals exposed to High Altitude. Arch Oral Biol 2018; 96:104-112. [DOI: 10.1016/j.archoralbio.2018.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/09/2018] [Accepted: 09/05/2018] [Indexed: 11/18/2022]
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Schatz A, Guggenberger V, Fischer MD, Schommer K, Bartz-Schmidt KU, Gekeler F, Willmann G. Optic nerve oedema at high altitude occurs independent of acute mountain sickness. Br J Ophthalmol 2018; 103:bjophthalmol-2018-312224. [PMID: 29973364 DOI: 10.1136/bjophthalmol-2018-312224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS The study aims to investigate changes in the optic nerve sheath diameter (ONSD) at high altitude and to assess correlation to optic disc oedema (ODE) and acute mountain sickness (AMS). This investigation is part of the Tübingen High Altitude Ophthalmology study. METHODS Fourteen volunteers ascended to 4559 m for 4 days before returning to low altitude. Ultrasonography of ONSD, quantification of optic disc parameters using a scanning laser ophthalmoscope and fluorescein angiography were performed at 341 m and at high altitude. Pearson's coefficient was used to correlate changes in ONSD with the optic disc and AMS. Assessment of AMS was performed using the Lake Louise (LL) and AMS-cerebral (AMS-C) scores of the Environmental Symptom Questionnaire-III. All volunteers were clinically monitored for heart rate (HR) and oxygen saturation (SpO2). RESULTS The mean ONSD at high altitude (4.6±0.3 mm, p<0.05) was significantly increased compared with baseline (3.8±0.4 mm) and remained enlarged throughout high-altitude exposure. This change in ONSD did not correlate with AMS (AMS-C, r=0.26, p=0.37; LL, r=0.21, p=0.48) and high-altitude headache (r=0.54, p=0.046), or clinical parameters of SpO2 (r=0.11, p=0.72) and HR (r=0.22, p=0.44). Increased ONSD did not correlate with altered key stereometric parameters of the optic disc describing ODE at high altitude (r<0.1, p>0.5). CONCLUSION High-altitude exposure leads to marked oedema formation of the optic nerve independent of AMS. Increased ONSD and ODE reflect hypoxia-driven oedema formation of the optic nerve at high altitude, providing important pathophysiological insight into high-altitude illness development and for future research.
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Affiliation(s)
- Andreas Schatz
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | | | - M Dominik Fischer
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Kai Schommer
- Medizinischer Dienst der Krankenversicherungen, MDK Baden-Württemberg, Mannheim, Germany
| | | | - Florian Gekeler
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
| | - Gabriel Willmann
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, Katharinenhospital, Stuttgart, Germany
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29
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Moretti S, Mrakic-Sposta S, Roncoroni L, Vezzoli A, Dellanoce C, Monguzzi E, Branchi F, Ferretti F, Lombardo V, Doneda L, Scricciolo A, Elli L. Oxidative stress as a biomarker for monitoring treated celiac disease. Clin Transl Gastroenterol 2018; 9:157. [PMID: 29880904 PMCID: PMC5992147 DOI: 10.1038/s41424-018-0031-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/11/2018] [Accepted: 05/07/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION High levels of reactive oxygen species (ROS) and impaired antioxidant defense systems lead to oxidative stress (OxS) and tissue injury in different intestinal and extra intestinal conditions, including celiac disease (CD). The aim of the present study was to investigate the role and potential use of ROS and other biomarkers of OxS in the clinical management of CD. METHODS We collected duodenal specimens and blood samples from naïve patients (N-CD), patients on a gluten free diet (GFD) including responders (CD-GFD) and non-responders (NRCD). We measured plasmatic ROS production (electron paramagnetic resonance, EPR), lipid peroxidation (thiobarbituric acid-reactive substances, TBARS), protein oxidation (protein carbonyl, PC), total antioxidant capacity (TAC), nitric oxides and glutathione (GSH) in erythrocytes. RESULTS Fifty-four patients affected by CD were enrolled (17 N-CD, 18 CD-GFD and 19 NRCD; 44 F; age 44 ± 13 years). A significant increase of plasmatic OxS biomarkers (ROS, peroxidated lipids, oxidized proteins, and nitrate concentrations) and decrease of antioxidant species (TAC and GSH levels) were found in NRCD and N-CD compared to CD-GFD. Comparably, a significant direct relationship between the severity of duodenal atrophy, ROS production rates and TBARS was found; conversely, TAC and GSH presented an inverse correlation. DISCUSSION OxS is involved in CD tissue damage and correlates with the degree of duodenal atrophy. These findings suggest the possible role of OxS biomarkers as indicators of CD activity during the clinical follow-up.
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Affiliation(s)
- Sarah Moretti
- Institute of Bioimaging and Molecular Physiology, National Research Council (CNR), Via Fratelli Cervi 93, 20090, Segrate, Italy
| | - Simona Mrakic-Sposta
- Institute of Bioimaging and Molecular Physiology, National Research Council (CNR), Via Fratelli Cervi 93, 20090, Segrate, Italy
| | - Leda Roncoroni
- Center for Prevention and Diagnosis of Celiac Disease- Div. of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milano, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milano, Italy
| | - Alessandra Vezzoli
- Institute of Bioimaging and Molecular Physiology, National Research Council (CNR), Via Fratelli Cervi 93, 20090, Segrate, Italy
| | - Cinzia Dellanoce
- Institute of Clinical Physiology, National Research Council (CNR), Niguarda Ca' Granda Hospital, Via G. Moruzzi 1, 56124, Pisa, Italy
| | - Erika Monguzzi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milano, Italy
| | - Federica Branchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milano, Italy
| | - Francesca Ferretti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milano, Italy
| | - Vincenza Lombardo
- Center for Prevention and Diagnosis of Celiac Disease- Div. of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milano, Italy
| | - Luisa Doneda
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via Festa del Perdono, 20122, Milano, Italy
| | - Alice Scricciolo
- Center for Prevention and Diagnosis of Celiac Disease- Div. of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milano, Italy
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease- Div. of Gastroenterology and Endoscopy, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milano, Italy.
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Yanamandra U, Gupta A, Yanamandra S, Das SK, Patyal S, Nair V. Bedside Ultrasonography as an Alternative to Computed Tomography Scan for the Measurement of Optic Nerve Sheath Diameter. J Neurosci Rural Pract 2018; 9:252-255. [PMID: 29725178 PMCID: PMC5912033 DOI: 10.4103/jnrp.jnrp_537_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Optic nerve sheath diameter (ONSD) as measured by optic nerve sheath ultrasonography (ONSU) is used as a surrogate marker of intracranial pressure (ICP), especially in resource-limited settings. There is a growing interest in the use of ONSU in emergency and high-altitude setups. Notwithstanding multiple studies done on this subject, there is a paucity of data regarding standardization of techniques and comparison of ONSU with computed tomography (CT). Materials and Methods Thirty-five patients with a diagnosis of high-altitude cerebral edema were enrolled in the study. ONSD was measured in all patients using ONSU, along visual and coronal axis, and CT scan. We repeated ONSU in these patients on days 3, 7, 10, and 15 (day of discharge). Correlation between visual and coronal axis as well as CT scan was analyzed. Results The correlation of visual to coronal and coronal to visual was equally significant (both correlation coefficients being R2 = 0.983). Correlation of ONSD by visual axis to CT scan was better than coronal axis (correlation coefficient R2 = 0.986 vs. 0.96, respectively). Conclusion In our study, we found a strong correlation between the visual and coronal axes. Thus, either of the two axes can be used for monitoring ICP. However, it has been found that measurements along the coronal axis are challenging, especially in the emergency setup. ONSD measured along visual axis correlated better with CT scan as compared to the coronal axis.
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Affiliation(s)
- Uday Yanamandra
- Department of Hematology, Army Hospital (Research & Referral), New Delhi, India
| | - Amul Gupta
- Department of Radiology, Military Hospital, Jaipur, Rajasthan, India
| | - Sushma Yanamandra
- Research Associate, Army Hospital (Research & Referral), New Delhi, India
| | - Subrat Kumar Das
- Research Associate, Army Hospital (Research & Referral), New Delhi, India
| | | | - Velu Nair
- Ex-Director General Medical Services (Army), New Delhi, India
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Bosco G, Rizzato A, Quartesan S, Camporesi E, Mangar D, Paganini M, Cenci L, Malacrida S, Mrakic-Sposta S, Moretti S, Paoli A. Effects of the Ketogenic diet in overweight divers breathing Enriched Air Nitrox. Sci Rep 2018; 8:2655. [PMID: 29422679 PMCID: PMC5805750 DOI: 10.1038/s41598-018-20933-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 01/25/2018] [Indexed: 02/07/2023] Open
Abstract
Central Nervous System Oxygen Toxicity (CNS-OT) is one of the most harmful effects of Enriched Air Nitrox (EAN) diving. Protective factors of the Ketogenic Diet (KD) are antioxidant activity, the prevention of mitochondrial damage and anti-inflammatory mechanisms. We aimed to investigate if a short-term KD may reduce oxidative stress and inflammation during an hyperoxic dive. Samples from six overweight divers (mean ± SD, age: 55.2 ± 4.96 years; BMI: 26.7 ± 0.86 kg/m2) were obtained a) before and after a dive breathing Enriched Air Nitrox and performing 20-minute mild underwater exercise, b) after a dive (same conditions) performed after 7 days of KD. We measured urinary 8-isoprostane and 8-OH-2-deoxyguanosine and plasmatic IL-1β, IL-6 and TNF-α levels. The KD was successful in causing weight loss (3.20 ± 1.31 Kgs, p < 0.01) and in limiting lipid peroxidation (3.63 ± 1.16 vs. 1.11 ± 0.22; p < 0.01) and inflammatory response (IL-1β = 105.7 ± 25.52 vs. 57.03 ± 16.32, p < 0.05; IL-6 = 28.91 ± 4.351 vs. 14.08 ± 1.74, p < 0.001; TNF-α = 78.01 ± 7.69 vs. 64.68 ± 14.56, p < 0.05). A short-term KD seems to be effective in weight loss, in decreasing inflammation and protective towards lipid peroxidation during hyperoxic diving.
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Affiliation(s)
- Gerardo Bosco
- Environmental physiology & medicine Lab, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Alex Rizzato
- Environmental physiology & medicine Lab, Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Silvia Quartesan
- Environmental physiology & medicine Lab, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | | | - Matteo Paganini
- Emergency Medicine Residency Program, University of Padova, Padova, Italy
| | - Lorenzo Cenci
- Environmental physiology & medicine Lab, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Sandro Malacrida
- Environmental physiology & medicine Lab, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | - Sara Moretti
- CNR Institute of Bioimaging and Molecular Physiology, Segrate (Milano), Italy
| | - Antonio Paoli
- Environmental physiology & medicine Lab, Department of Biomedical Sciences, University of Padova, Padova, Italy
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Mrakic-Sposta S, Vezzoli A, Malacrida S, Falla M, Strapazzon G. "Direct" and "Indirect" Methods to Detect Oxidative Stress During Acute or Chronic High-Altitude Exposure. High Alt Med Biol 2017; 18:303-304. [PMID: 28753037 DOI: 10.1089/ham.2017.0067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Simona Mrakic-Sposta
- 1 Institute of Bioimaging and Molecular Physiology, National Research Council (CNR), Segrate (Milan), Italy
| | - Alessandra Vezzoli
- 1 Institute of Bioimaging and Molecular Physiology, National Research Council (CNR), Segrate (Milan), Italy
| | - Sandro Malacrida
- 2 Department of Biomedical Sciences, University of Padova , Padova, Italy .,3 Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Marika Falla
- 4 Department of Neurology and Psychiatry, Sapienza University , Roma, Italy .,5 Department of Neurology, General Hospital of Bolzano , Bolzano, Italy
| | - Giacomo Strapazzon
- 3 Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
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Chen X, Zhao X, Cai H, Sun H, Hu Y, Huang X, Kong W, Kong W. The role of sodium hydrosulfide in attenuating the aging process via PI3K/AKT and CaMKKβ/AMPK pathways. Redox Biol 2017; 12:987-1003. [PMID: 28499253 PMCID: PMC5429232 DOI: 10.1016/j.redox.2017.04.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/16/2017] [Accepted: 04/23/2017] [Indexed: 12/01/2022] Open
Abstract
Age-related dysfunction of the central auditory system, known as central presbycusis, is characterized by defects in speech perception and sound localization. It is important to determine the pathogenesis of central presbycusis in order to explore a feasible and effective intervention method. Recent work has provided fascinating insight into the beneficial function of H2S on oxidative stress and stress-related disease. In this study, we investigated the pathogenesis of central presbycusis and tried to explore the mechanism of H2S action on different aspects of aging by utilizing a mimetic aging rat and senescent cellular model. Our results indicate that NaHS decreased oxidative stress and apoptosis levels in an aging model via CaMKKβ and PI3K/AKT signaling pathways. Moreover, we found that NaHS restored the decreased activity of antioxidants such as GSH, SOD and CAT in the aging model in vivo and in vitro by regulating CaMKKβ and PI3K/AKT. Mitochondria function was preserved by NaHS, as indicated by the following: DNA POLG and OGG-1, the base excision repair enzymes in mitochondrial, were upregulated; OXPHOS activity was downregulated; mitochondrial membrane potential was restored; ATP production was increased; and mtDNA damage, indicated by the common deletion (CD), declined. These effects were also achieved by activating CaMKKβ/AMPK and PI3K/AKT signaling pathways. Lastly, protein homeostasis, indicated by HSP90 alpha, was strengthened by NaHS via CaMKKβ and PI3K/AKT. Our findings demonstrate that the ability to resist oxidative stress and mitochondria function are both decreased as aging developed; however, NaHS, a novel free radical scavenger and mitochondrial protective agent, precludes the process of oxidative damage by activating CaMKKβ and PI3K/AKT. This study might provide a therapeutic target for aging and age-related disease.
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Affiliation(s)
- Xubo Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xueyan Zhao
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua Cai
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Haiying Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yujuan Hu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiang Huang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wen Kong
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Tremblay JC, Thom SR, Yang M, Ainslie PN. Oscillatory shear stress, flow-mediated dilatation, and circulating microparticles at sea level and high altitude. Atherosclerosis 2016; 256:115-122. [PMID: 28010936 DOI: 10.1016/j.atherosclerosis.2016.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/25/2016] [Accepted: 12/01/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Exposing the endothelium to acute periods of imposed oscillatory shear stress reduces endothelial function and elevates circulating microparticles (MPs). Oscillatory shear stress may be especially pathogenic when superimposed on hypoxia, an environmental stimulus that disrupts the endothelial milieu. We examined the effects of acute manipulation of oscillatory shear stress on endothelial function and circulating MPs at sea level (SL) and high altitude (HA). METHODS Healthy adults (n = 12) participated, once at SL and once on the second or third day at HA (3800 m). Oscillatory shear stress was provoked using a 30-min distal cuff occlusion intervention (75 mmHg). Endothelial function was assessed before and immediately after the intervention in the brachial artery by reactive hyperaemia flow-mediated dilatation (FMD). Venous blood samples of MPs (flow cytometry) were obtained before and during the last five minutes of the shear intervention. RESULTS At baseline, circulating MPs were two-fold higher at HA (p = 0.011) and brachial artery diameter was constricted (p = 0.015). Although the intervention at SL increased endothelial-derived MPs by 83 ± 39% (mean ± SEM; p = 0.021), FMD was unaltered. Conversely, at HA, the intervention elicited a 26 ± 11% reduction in FMD (p = 0.020); this reduction was inversely correlated with the change in total circulating MPs (r = -0.737, p = 0.006) and the change in endothelial-derived MPs (r = -0.614, p = 0.034). CONCLUSIONS The vascular endothelium appears to be susceptible to periods of oscillatory shear stress at HA, where impairments in endothelium-dependent vasodilatation may be amplified by endothelial injury. These findings have important implications for understanding the early impact of clinical situations of hypoxaemia on the vascular endothelium.
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Affiliation(s)
- Joshua C Tremblay
- Centre for Heart, Lung, and Vascular Health School of Health and Exercise Science, University of British Columbia, Kelowna, Canada.
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland, Baltimore, USA
| | - Ming Yang
- Department of Emergency Medicine, University of Maryland, Baltimore, USA
| | - Philip N Ainslie
- Centre for Heart, Lung, and Vascular Health School of Health and Exercise Science, University of British Columbia, Kelowna, Canada
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