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Zhaxi Q, Gesang L, Huang J, Suona Y, Ci B, Danzeng Z, Zhang R, Liu B. Hypermethylation of BMPR2 and TGF-β Promoter Regions in Tibetan Patients with High-Altitude Polycythemia at Extreme Altitude. Biochem Genet 2024:10.1007/s10528-024-10798-2. [PMID: 38787494 DOI: 10.1007/s10528-024-10798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/01/2024] [Indexed: 05/25/2024]
Abstract
Although the expression of many genes is associated with adaptation to high-altitude hypoxic environments, the role of epigenetics in the response to this harsh environmental stress is currently unclear. We explored whether abnormal DNA promoter methylation levels of six genes, namely, ABCA1, SOD2, AKT1, VEGFR2, TGF-β, and BMPR2, affect the occurrence and development of high-altitude polycythemia (HAPC) in Tibetans. The methylation levels of HAPC and the control group of 130 Tibetans from very high altitudes (> 4500 m) were examined using quantitative methylation-specific real-time PCR (QMSP). Depending on the type of data, the Pearson chi-square test, Wilcoxon rank-sum test, and Fisher exact test were used to assess the differences between the two groups. The correlation between the methylation levels of each gene and the hemoglobin content was explored using a linear mixed model. Our experiment revealed that the methylation levels of the TGF-β and BMPR2 genes differed significantly in the two groups (p < 0.05) and linear mixed model analysis showed that the correlation between the hemoglobin and methylation of ABCA1, TGF-β, and BMPR2 was statistically significant (p < 0.05). Our study suggests that levels of TGF-β and BMPR2 methylation are associated with the occurrence of HAPC in extreme-altitude Tibetan populations among 6 selected genes. Epigenetics may be involved in the pathogenesis of HAPC, and future experiments could combine gene and protein levels to verify the diagnostic value of TGF-β and BMPR2 methylation levels in HAPC.
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Affiliation(s)
- Quzong Zhaxi
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Luobu Gesang
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China.
| | - Ju Huang
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Yangzong Suona
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Bai Ci
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Zhuoga Danzeng
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Rui Zhang
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
| | - Binyun Liu
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, 18 Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region, People's Republic of China
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2
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Zhou S, Yan J, Song K, Ge RL. High-Altitude Hypoxia Induces Excessive Erythrocytosis in Mice via Upregulation of the Intestinal HIF2a/Iron-Metabolism Pathway. Biomedicines 2023; 11:2992. [PMID: 38001992 PMCID: PMC10669251 DOI: 10.3390/biomedicines11112992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Excessive erythrocytosis (EE) is a preclinical form of chronic mountain sickness (CMS). The dysregulation of iron metabolism in high-altitude hypoxia may induce EE. The intestinal hypoxia-inducible factor 2 alpha (HIF2a) regulates the genes involved in iron metabolism. Considering these findings, we aimed to investigate the function and mechanism of intestinal HIF2α and the iron metabolism pathway in high-altitude EE mice. C57BL/6J mice were randomized into four groups: the low-altitude group, the high-altitude group, the high-altitude + HIF2α inhibitor group, and the high-altitude + vehicle group. In-vitro experiments were performed using the human intestinal cell line HCT116 cultured under hypoxic conditions for 24 h. Results showed that high-altitude hypoxia significantly increased the expression of intestinal HIF2α and iron metabolism-related genes, including Dmt1, Dcytb, Fpn, Tfrc, and Fth in EE mice. Genetic blockade of the intestinal HIF2α-iron metabolism pathway decreased iron availability in HCT116 cells during hypoxia. The HIF2α inhibitor PT2385 suppressed intestinal HIF2α expression, decreased iron hypermetabolism, and reduced excessive erythrocytosis in mice. These data support the hypothesis that exposure to high-altitude hypoxia can lead to iron hypermetabolism by activating intestinal HIF2α transcriptional regulation, and reduced iron availability improves EE by inhibiting intestinal HIF2α signaling.
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Affiliation(s)
- Sisi Zhou
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China; (S.Z.); (J.Y.); (K.S.)
- Key Laboratory of High-Altitude Medicine, Ministry of Education, Xining 810001, China
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining 810001, China
| | - Jun Yan
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China; (S.Z.); (J.Y.); (K.S.)
- Key Laboratory of High-Altitude Medicine, Ministry of Education, Xining 810001, China
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining 810001, China
| | - Kang Song
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China; (S.Z.); (J.Y.); (K.S.)
- Key Laboratory of High-Altitude Medicine, Ministry of Education, Xining 810001, China
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining 810001, China
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining 810001, China; (S.Z.); (J.Y.); (K.S.)
- Key Laboratory of High-Altitude Medicine, Ministry of Education, Xining 810001, China
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province, Xining 810001, China
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3
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Fayazi B, Tadibi V, Ranjbar K. The role of hypoxia related hormones responses in acute mountain sickness susceptibility individuals unaccustomed to high altitude. PLoS One 2023; 18:e0292173. [PMID: 37796960 PMCID: PMC10553285 DOI: 10.1371/journal.pone.0292173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
Acute mountain sickness (AMS) is caused by rapid ascent to altitude (>2500 m) and remains a poorly understood pathophysiological condition. Accordingly, we investigated the relationship between acute exposure to high altitude and hypoxia related biochemical proteins. 21 healthy subjects (Female (8) and male (13), Age: 36.7±8.5, BMI: 23.2±3.1) volunteers participated in this project and fasting blood samples were taken before (sea level) and after 1 and 24-h exposure to high altitude (3,550 m). Blood oxygen saturation (SpO2), AMS status (Lake Louise Score) and serum HIF-1, Endothelin-1, VEGF and Orexin-A were measured (via ELISA) at 1, 6 and 24 h after exposure to high altitude. Pre-ascent measurement of hypoxia related proteins (Orexin-A, HIF-1, VEGF and Endothelin-1) where all significantly (<0.05) higher in the AMS-resistant individuals (No-AMS) when compared to AMS susceptible individuals (AMS+). Upon ascent to high altitude, 11 out of 21 volunteers had AMS (10.1±0.6 in AMS+ vs. 0.9±0.6 in No-AMS, P<0.05) and presented with lower resting SpO2 levels (77.7±0.4 vs. 83.5±0.3 respectively, p<0.05). Orexin-A, HIF-1, VEGF and Endothelin-1, significantly increased 24 hrs after exposure to high altitude in both AMS+ and No-AMS. The response of Orexin-A was similar between two groups, also, HIF-1 elevation 24 hrs after exposure to altitude was more in AMS+ (13% vs. 19%), but the increase of VEGF and Endothelin-1, 1 and 24 hrs after exposure to altitude in No-AMS was double that of AMS+. Hypoxia related proteins include Orexin-A, HIF-1, VEGF and Endothelin-1 may play a pathophysiological role in those who are susceptible to AMS.
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Affiliation(s)
- Bayan Fayazi
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Vahid Tadibi
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Kamal Ranjbar
- Department of Exercise Physiology, Faculty of Sport Sciences, Bandar Abbas Branch, Islamic Azad University, Bandar Abbas, Iran
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4
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Samaja M, Ottolenghi S. The Oxygen Cascade from Atmosphere to Mitochondria as a Tool to Understand the (Mal)adaptation to Hypoxia. Int J Mol Sci 2023; 24:ijms24043670. [PMID: 36835089 PMCID: PMC9960749 DOI: 10.3390/ijms24043670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Hypoxia is a life-threatening challenge for about 1% of the world population, as well as a contributor to high morbidity and mortality scores in patients affected by various cardiopulmonary, hematological, and circulatory diseases. However, the adaptation to hypoxia represents a failure for a relevant portion of the cases as the pathways of potential adaptation often conflict with well-being and generate diseases that in certain areas of the world still afflict up to one-third of the populations living at altitude. To help understand the mechanisms of adaptation and maladaptation, this review examines the various steps of the oxygen cascade from the atmosphere to the mitochondria distinguishing the patterns related to physiological (i.e., due to altitude) and pathological (i.e., due to a pre-existing disease) hypoxia. The aim is to assess the ability of humans to adapt to hypoxia in a multidisciplinary approach that correlates the function of genes, molecules, and cells with the physiologic and pathological outcomes. We conclude that, in most cases, it is not hypoxia by itself that generates diseases, but rather the attempts to adapt to the hypoxia condition. This underlies the paradigm shift that when adaptation to hypoxia becomes excessive, it translates into maladaptation.
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Affiliation(s)
- Michele Samaja
- MAGI GROUP, San Felice del Benaco, 25010 Brescia, Italy
- Correspondence:
| | - Sara Ottolenghi
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy
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5
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Liu H, Tang F, Su J, Ma J, Qin Y, Ji L, Geng H, Wang S, Zhang P, Liu J, Cui S, Ge RL, Li Z. EPAS1 regulates proliferation of erythroblasts in chronic mountain sickness. Blood Cells Mol Dis 2020; 84:102446. [PMID: 32470757 DOI: 10.1016/j.bcmd.2020.102446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/13/2023]
Abstract
Excessive erythrocytosis (EE) is a characteristic of chronic mountain sickness (CMS). Currently, the pathogenesis of CMS remains unclear. This study was intended to investigate the role of EPAS1 in the proliferation of erythroblasts in CMS. Changes of HIF-1α and EPAS1/HIF-2α in the bone marrow erythroblasts of 21 patients with CMS and 14 control subjects residing at the same altitudes were determined by RT-qPCR and western blotting. We also developed a lentiviral vector, Lv-EPAS1/sh-EPAS1, to over-express/silence EPAS1 in K562 cells. Cells cycle and proliferation were detected by flow cytometry. Transcriptome analyses were carried out on Illumina. CMS patients showed a higher expression of EPAS1/HIF-2α in the bone marrow erythroblasts than those of controls. Variations in EPAS1 expression in CMS patients were positively correlated with RBC levels, and negatively correlated with SaO2. Over-expressing of EPAS1 in K562 cells accelerated the erythroid cells cycle progression and promoted the erythroid cells proliferation-and vice versa. Transcriptome data indicated that proliferation-related DEGs were significantly enriched in EPAS1 overexpression/silencing K562 cells. Our results suggest that EPAS1 might participate in the pathogenesis of EE by regulating the proliferation of erythroblasts.
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Affiliation(s)
- Huihui Liu
- Research Center for High Altitude Medicine, Qinghai University, Xining, China; Qinghai Key Laboratory of Science and Technology for High Altitude Medicine, Xining, China; Qinghai-Utah Joint Research Key Lab for High Altitude Medicine, Xining, China; Department of Rheumatology, Affiliated Hospital of Qinghai University, Xining, China
| | - Feng Tang
- Research Center for High Altitude Medicine, Qinghai University, Xining, China; Qinghai Key Laboratory of Science and Technology for High Altitude Medicine, Xining, China; Qinghai-Utah Joint Research Key Lab for High Altitude Medicine, Xining, China
| | - Juan Su
- Department of Rheumatology, Affiliated Hospital of Qinghai University, Xining, China
| | - Jie Ma
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, China
| | - Yajing Qin
- Department of Rheumatology, Affiliated Hospital of Qinghai University, Xining, China
| | - Linhua Ji
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, China
| | - Hui Geng
- Department of Rheumatology, Affiliated Hospital of Qinghai University, Xining, China
| | - Shengyan Wang
- Research Center for High Altitude Medicine, Qinghai University, Xining, China; Qinghai Key Laboratory of Science and Technology for High Altitude Medicine, Xining, China; Qinghai-Utah Joint Research Key Lab for High Altitude Medicine, Xining, China
| | - Peili Zhang
- Research Center for High Altitude Medicine, Qinghai University, Xining, China; Qinghai Key Laboratory of Science and Technology for High Altitude Medicine, Xining, China; Qinghai-Utah Joint Research Key Lab for High Altitude Medicine, Xining, China
| | - Junli Liu
- Research Center for High Altitude Medicine, Qinghai University, Xining, China; Qinghai Key Laboratory of Science and Technology for High Altitude Medicine, Xining, China; Qinghai-Utah Joint Research Key Lab for High Altitude Medicine, Xining, China
| | - Sen Cui
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, China
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, China; Qinghai Key Laboratory of Science and Technology for High Altitude Medicine, Xining, China; Qinghai-Utah Joint Research Key Lab for High Altitude Medicine, Xining, China
| | - Zhanquan Li
- Department of Rheumatology, Affiliated Hospital of Qinghai University, Xining, China.
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6
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Liu YS, Huang H, Zhou SM, Tian HJ, Li P. Excessive Iron Availability Caused by Disorders of Interleukin-10 and Interleukin-22 Contributes to High Altitude Polycythemia. Front Physiol 2018; 9:548. [PMID: 29872401 PMCID: PMC5972294 DOI: 10.3389/fphys.2018.00548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Because the pathogenesis of high altitude polycythemia (HAPC) is unclear, the aim of the present study was to explore whether abnormal iron metabolism is involved in the pathogenesis of HAPC and the possible cause. Methods: We examined the serum levels of iron, total iron binding capacity, soluble transferrin receptor (sTfR), ferritin, and hepcidin as well as erythropoietin (EPO) and inflammation-related cytokines in 20 healthy volunteers at sea level, 36 healthy high-altitude migrants, and 33 patients with HAPC. Mice that were exposed to a simulated hypoxic environment at an altitude of 5,000 m for 4 weeks received exogenous iron or intervention on cytokines, and the iron-related and hematological indices of peripheral blood and bone marrow were detected. The in vitro effects of some cytokines on hematopoietic cells were also observed. Results: Iron mobilization and utilization were enhanced in people who had lived at high altitudes for a long time. Notably, both the iron storage in ferritin and the available iron in the blood were elevated in patients with HAPC compared with the healthy high-altitude migrants. The correlation analysis indicated that the decreased hepcidin may have contributed to enhanced iron availability in HAPC, and decreased interleukin (IL)-10 and IL-22 were significantly associated with decreased hepcidin. The results of the animal experiments confirmed that a certain degree of iron redundancy may promote bone marrow erythropoiesis and peripheral red blood cell production in hypoxic mice and that decreased IL-10 and IL-22 stimulated iron mobilization during hypoxia by affecting hepcidin expression. Conclusion: These data demonstrated, for the first time, that an excess of obtainable iron caused by disordered IL-10 and IL-22 was involved in the pathogenesis of some HAPC patients. The potential benefits of iron removal and immunoregulation for the prevention and treatment of HAPC deserve further research.
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Affiliation(s)
- Yun-Sheng Liu
- Department of High Altitude Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Department of Medical Geography, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Physiology and High Altitude Disease, Chinese People's Liberation Army, Chongqing, China
| | - He Huang
- Department of High Altitude Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Physiology and High Altitude Disease, Chinese People's Liberation Army, Chongqing, China
| | - Si-Min Zhou
- Department of High Altitude Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Physiology and High Altitude Disease, Chinese People's Liberation Army, Chongqing, China
| | - Huai-Jun Tian
- Department of High Altitude Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Physiology and High Altitude Disease, Chinese People's Liberation Army, Chongqing, China
| | - Peng Li
- Department of High Altitude Hygiene, College of High Altitude Military Medicine, Third Military Medical University, Chongqing, China.,Key Laboratory of High Altitude Environmental Medicine, Ministry of Education, Chongqing, China.,Key Laboratory of High Altitude Physiology and High Altitude Disease, Chinese People's Liberation Army, Chongqing, China
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7
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Zhao Y, Zhang Z, Liu L, Zhang Y, Fan X, Ma L, Li J, Zhang Y, He H, Kang L. Associations of high altitude polycythemia with polymorphisms in EPAS1, ITGA6 and ERBB4 in Chinese Han and Tibetan populations. Oncotarget 2017; 8:86736-86746. [PMID: 29156832 PMCID: PMC5689722 DOI: 10.18632/oncotarget.21420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/29/2017] [Indexed: 01/01/2023] Open
Abstract
High altitude polycythemia (HAPC) is a common chronic disease at high altitude, which is characterized by excessive erythrocytosis (females, hemoglobin ≥ 190 g/L; males, hemoglobin ≥ 210 g/L). It is the most common disease in chronic mountain sickness casued primarily by persistent arterial hypoxia and ventilatory impairment. However, the disease is still unmanageable and related molecular mechanisms remain largely unclear. This study aims to explore the genetic basis of HAPC in the Chinese Han and Tibetan populations. Subjects were screened for HAPC using the latest approved diagnostic criteria. To explore the hereditary basis of HAPC and investigate the association between three genes (EPAS1, ITGA6, ERBB4) and HAPC in Chinese Han and Tibetan populations. We enrolled 100 patients (70 Han, 30 Tibetan) with HAPC and 100 healthy control subjects (30 Han, 70 Tibetan). Subjects were screened for HAPC using the latest approved diagnostic criteria combined with excessive erythrocytosis and clinical symptoms. Analysis of variance was used to evaluate the impact of polymorphism on HAPC based on genetic variation. The Chi-squared test and analyses of genetic models, rs75591953 and rs75984373 in EPAS1, rs6744873 in ITGA6, rs17335043 in ERBB4 showed associations with reduced HAPC susceptibility in Han populations. Additionally, in Tibetan populations, rs3749148 in ITGA6, rs934607 and rs141267844 in ERBB4 showed a reduced risk of HAPC, whereas rs6710946 in ERBB4 increased the risk of HAPC. Our study suggest that the polymorphisms in the EPAS1, ITGA6 and ERBB4 correlate with susceptibility to HAPC.
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Affiliation(s)
- Yiduo Zhao
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Zhiying Zhang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Lijun Liu
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Yao Zhang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Xiaowei Fan
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Lifeng Ma
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Jing Li
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Yuan Zhang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Haijin He
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
| | - Longli Kang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, Xizang Minzu University, Xianyang 712082, Shaanxi, China.,Key Laboratory of High Altitude Environment and Gene Related to Disease of Tibet Ministry of Education, School of Medicine, Xizang Minzu University, Xianyang 712082, Shaanxi, China
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8
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Abstract
More than 140 million people permanently reside in high-altitude regions of Asia, South America, North America, and Africa. Another 40 million people travel to these places annually for occupational and recreational reasons, and are thus exposed to the low ambient partial pressure of oxygen. This review will focus on the pulmonary circulatory responses to acute and chronic high-altitude hypoxia, and the various expressions of maladaptation and disease arising from acute pulmonary vasoconstriction and subsequent remodeling of the vasculature when the hypoxic exposure continues. These unique conditions include high-altitude pulmonary edema, high-altitude pulmonary hypertension, subacute mountain sickness, and chronic mountain sickness.
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Affiliation(s)
- Maniraj Neupane
- Mountain Medicine Society of Nepal, Maharajgunj, Kathmandu, Nepal
| | - Erik R. Swenson
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA
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9
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Miranda JJ, Bernabé-Ortiz A, Diez-Canseco F, Málaga G, Cárdenas MK, Carrillo-Larco RM, Lazo-Porras M, Moscoso-Porras M, Pesantes MA, Ponce V, Araya R, Beran D, Busse P, Boggio O, Checkley W, García PJ, Huicho L, León-Velarde F, Lescano AG, Mohr DC, Pan W, Peiris D, Perel P, Rabadán-Diehl C, Rivera-Chira M, Sacksteder K, Smeeth L, Trujillo AJ, Wells JCK, Yan LL, García HH, Gilman RH. Towards sustainable partnerships in global health: the case of the CRONICAS Centre of Excellence in Chronic Diseases in Peru. Global Health 2016; 12:29. [PMID: 27255370 PMCID: PMC4890274 DOI: 10.1186/s12992-016-0170-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality research." The Centre's identity is embedded in its core values - generosity, innovation, integrity, and quality- and its trajectory is a result of various interactions between multiple individuals, collaborators, teams, and institutions, which together with the challenges confronted, enables us to make an objective assessment of the partnership we would like to pursue, nurture and support. We do not intend to provide a single example of a successful partnership, but in contrast, to highlight what can be translated into opportunities to be faced by research groups based in low- and middle-income countries, and how these encounters can provide a strong platform for fruitful and sustainable partnerships. In defiant contexts, partnerships require to be nurtured and sustained. Acknowledging that all partnerships are not and should not be the same, we also need to learn from the evolution of such relationships, its key successes, hurdles and failures to contribute to the promotion of a culture of global solidarity where mutual goals, mutual gains, as well as mutual responsibilities are the norm. In so doing, we will all contribute to instil a new culture where expectations, roles and interactions among individuals and their teams are horizontal, the true nature of partnerships.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Internal Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - María K Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Miguel Moscoso-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - M Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Vilarmina Ponce
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Ricardo Araya
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | | | - Oscar Boggio
- Division of Non-Communicable Diseases, Dirección General de Salud de las Personas, Ministerio de Salud, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia J García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Andrés G Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Parasitology, and Public Health Training Program, USA Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Pan
- Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - David Peiris
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- World Heart Federation, Geneva, Switzerland
| | - Cristina Rabadán-Diehl
- Office of Global Affairs, U.S. Department of Health & Human Services, Washington, DC, USA
| | | | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, University College London, London, UK
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Héctor H García
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Center for Global Health - Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Robert H Gilman
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Asociación Benéfica PRISMA, Lima, Peru
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