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Hanaoka M, Kobayashi T, Droma Y, Ota M, Kobayashi N, Wada Y, Kitaguchi Y, Koizumi T, Kubo K. Clinical and Pathophysiological Features of High-altitude Pulmonary Edema in the Japanese Population: A Review of Studies on High-altitude Pulmonary Edema in Japan. Intern Med 2024; 63:2355-2366. [PMID: 38171855 DOI: 10.2169/internalmedicine.2533-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
High-altitude pulmonary edema (HAPE) is a life-threatening, noncardiogenic pulmonary edema that occurs in unacclimatized individuals rapidly ascending to high altitudes above 2,500 m above sea level. Until the entity of HAPE was first identified in a case report published in Japan in 1966, the symptoms of severe dyspnea or coma occurring in climbers of the Japan Alps were incorrectly attributed to pneumonia or congestive heart failure. The Shinshu University Hospital serves as the central facility for rescuing and treating patients with HAPE in the region. Over the past 50 years, a series of studies have been conducted at Shinshu University to gain a better understanding of the characteristics of HAPE. This review summarizes the major achievements of these studies, including their clinical features, management, and pathogenesis of HAPE, particularly in the Japanese population.
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Affiliation(s)
- Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Toshio Kobayashi
- Department of Internal Medicine, Kakeyu Misayama Rehabilitation Center, Japan
| | - Yunden Droma
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Masao Ota
- Department of Internal Medicine, Division of Hepatology and Gastroenterology, Shinshu University School of Medicine, Japan
| | - Nobumitsu Kobayashi
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Yosuke Wada
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Yoshiaki Kitaguchi
- First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Japan
| | - Keishi Kubo
- Medical Education and Training Center of Nagano Prefecture, Shinshu University School of Medicine, Japan
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Zhang H, Wang X, Liu J, Zhang Y, Ka M, Ma Y, Xu J, Zhang W. Role of neutrophil myeloperoxidase in the development and progression of high-altitude pulmonary edema. Biochem Biophys Res Commun 2024; 703:149681. [PMID: 38382360 DOI: 10.1016/j.bbrc.2024.149681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/28/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Neutrophil infiltration and hypoxic pulmonary vasoconstriction induced by hypobaric hypoxic stress are vital in high-altitude pulmonary edema (HAPE). Myeloperoxidase (MPO), an important enzyme in neutrophils, is associated with inflammation and oxidative stress and is also involved in the regulation of nitric oxide synthase (NOS), an enzyme that catalyzes the production of the vasodilatory factor nitric oxide (NO). However, the role of neutrophil MPO in HAPE's progression is still uncertain. Therefore, we hypothesize that MPO is involved in the development of HAPE via NOS. METHODS In Xining, China (altitude: 2260 m), C57BL/6 N wild-type and mpo-/- mice served as normoxic controls, while a hypobaric chamber simulated 7000 m altitude for hypoxia. L-NAME, a nitric oxide synthase (NOS) inhibitor to inhibit NO production, was the experimental drug, and D-NAME, without NOS inhibitory effects, was the control. After measuring pulmonary artery pressure (PAP), samples were collected and analyzed for blood neutrophils, oxidative stress, inflammation, vasoactive substances, pulmonary alveolar-capillary barrier permeability, and lung tissue morphology. RESULTS Wild-type mice's lung injury scores, permeability, and neutrophil counts rose at 24 and 48 h of hypoxia exposure. Under hypoxia, PAP increased from 12.89 ± 1.51 mmHg under normoxia to 20.62 ± 3.33 mmHg significantly in wild-type mice and from 13.24 ± 0.79 mmHg to 16.50 ± 2.07 mmHg in mpo-/- mice. Consistent with PAP, inducible NOS activity, lung permeability, lung injury scores, oxidative stress response, and inflammation showed more significant increases in wild-type mice than in mpo-/- mice. Additionally, endothelial NOS activity and NO levels decreased more pronouncedly in wild-type mice than in mpo-/- mice. NOS inhibition during hypoxia led to more significant increases in PAP, permeability, and lung injury scores compared to the drug control group, especially in wild-type mice. CONCLUSION MPO knockout reduces oxidative stress and inflammation to preserve alveolar-capillary barrier permeability and limits the decline in endothelial NOS activity to reduce PAP elevation during hypoxia. MPO inhibition emerges as a prospective therapeutic strategy for HAPE, offering avenues for precise interventions.
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Affiliation(s)
- Huan Zhang
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, 810001, China; Key Laboratory of High Altitude Medicine (Ministry of Education), 810000, China; Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province (Qinghai-Utah Joint Research Key Lab for High Altitude Medicine), Qinghai University, Xining, Qinghai, 810001, China; Department of Pathology, The Second Affiliated Hospital of Xi'an Jiaotong University, 710004, China.
| | - Xiaojun Wang
- Department of Basic Medicine, Medical College of Qinghai University, Xining, Qinghai, 810001, China.
| | - Jie Liu
- Department of Pathology, Xi'an Chest Hospital, Xian, Shaanxi, 710000, China.
| | - Yu Zhang
- Department of Basic Medicine, Medical College of Qinghai University, Xining, Qinghai, 810001, China.
| | - Maojia Ka
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, 810001, China; Key Laboratory of High Altitude Medicine (Ministry of Education), 810000, China; Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province (Qinghai-Utah Joint Research Key Lab for High Altitude Medicine), Qinghai University, Xining, Qinghai, 810001, China.
| | - Yi Ma
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, 810001, China; Key Laboratory of High Altitude Medicine (Ministry of Education), 810000, China; Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province (Qinghai-Utah Joint Research Key Lab for High Altitude Medicine), Qinghai University, Xining, Qinghai, 810001, China.
| | - Jiaolong Xu
- Department of Basic Medicine, Medical College of Qinghai University, Xining, Qinghai, 810001, China; Linyi Central Hospital, Linyi, Shandong, 276400, China.
| | - Wei Zhang
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, 810001, China; Key Laboratory of High Altitude Medicine (Ministry of Education), 810000, China; Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province (Qinghai-Utah Joint Research Key Lab for High Altitude Medicine), Qinghai University, Xining, Qinghai, 810001, China.
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Li Y, Han J, Chen Y, Chen C, Chu B, Zhang Y. p-Coumaric acid as a prophylactic measure against normobaric hypoxia induced pulmonary edema in mice. Life Sci 2018; 211:215-223. [PMID: 30248349 DOI: 10.1016/j.lfs.2018.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/14/2018] [Accepted: 09/21/2018] [Indexed: 01/07/2023]
Abstract
AIMS Previous studies indicate that the anti-hypoxia effects of Tibetan Turnip (Brassica rapa ssp. rapa) were closely related to its characteristic components being p-coumaric acid (CA) and p-coumaric acid‑β‑d‑glucopyranoside (CAG). Since CAG would be converted to CA in vivo, this study aims to further examine the efficacy and mechanism of CA against pulmonary edema induced by normobaric hypoxia. MAIN METHODS Male ICR mice were assigned to the normoxia group and several hypoxia groups, given sterile water, CA or dexamethasone orally, once daily for four consecutive days. One hour after the final gavage, mice in the above hypoxia groups were put into the normobaric hypoxia chamber (9.5% O2) for 24 h while mice in normoxia group remained outside the chamber. After hypoxia exposure, lung water content (LWC), pulmonary vascular permeability, the protein content of bronchoalveolar lavage fluid (BALF), plasma total nitrate/nitrite (NOx) and endothelin-1 (ET-1) content, histological and ultra-microstructure analyses were performed. Expression of occludin was assayed by immunohistochemistry. KEY FINDINGS In a hypoxic environment of 9.5% O2, mice treated with 100 mg/kg body wt CA had significantly lower LWC and BALF protein content than mice in the hypoxia vehicle group. Meanwhile, mice in CA group showed intact lung blood-gas-barrier, increased levels of plasma total NO, decreased levels of plasma ET-1 and upregulation of occludin expression. SIGNIFICANCE CA exerts preventive effects against normobaric hypoxic pulmonary edema in mice, its mechanisms involved improving the integrity of the lung barrier, inhibiting oxidative stress and inflammation.
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Affiliation(s)
- Yunhong Li
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Jianxin Han
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Yufeng Chen
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Chun Chen
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China
| | - Bingquan Chu
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China; School of Biological and Chemical Engineering, Zhejiang Provincial Key Lab for Chem & Bio Processing Technology of Farm Product, Zhejiang University of Science & Technology, Hangzhou 310023, Zhejiang, China
| | - Ying Zhang
- College of Biosystems Engineering and Food Science, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang Engineering Center for Food Technology and Equipment, Zhejiang University, Hangzhou 310058, Zhejiang, China.
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