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Champigneulle B, Caton F, Seyve L, Stauffer É, Pichon A, Brugniaux JV, Furian M, Hancco I, Deschamps B, Kaestner L, Robach P, Connes P, Bouzat P, Polack B, Marlu R, Verges S. Are coagulation profiles in Andean highlanders with excessive erythrocytosis favouring hypercoagulability? Exp Physiol 2024; 109:899-914. [PMID: 38554124 PMCID: PMC11140178 DOI: 10.1113/ep091670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024]
Abstract
Chronic mountain sickness is a maladaptive syndrome that affects individuals living permanently at high altitude and is characterized primarily by excessive erythrocytosis (EE). Recent results concerning the impact of EE in Andean highlanders on clotting and the possible promotion of hypercoagulability, which can lead to thrombosis, were contradictory. We assessed the coagulation profiles of Andeans highlanders with and without excessive erythrocytosis (EE+ and EE-). Blood samples were collected from 30 EE+ and 15 EE- in La Rinconada (Peru, 5100-5300 m a.s.l.), with special attention given to the sampling pre-analytical variables. Rotational thromboelastometry tests were performed at both native and normalized (40%) haematocrit using autologous platelet-poor plasma. Thrombin generation, dosages of clotting factors and inhibitors were measured in plasma samples. Data were compared between groups and with measurements performed at native haematocrit in 10 lowlanders (LL) at sea level. At native haematocrit, in all rotational thromboelastometry assays, EE+ exhibited hypocoagulable profiles (prolonged clotting time and weaker clot strength) compared with EE- and LL (all P < 0.01). At normalized haematocrit, clotting times were normalized in most individuals. Conversely, maximal clot firmness was normalized only in FIBTEM and not in EXTEM/INTEM assays, suggesting abnormal platelet activity. Thrombin generation, levels of plasma clotting factors and inhibitors, and standard coagulation assays were mostly normal in all groups. No highlanders reported a history of venous thromboembolism based on the dedicated survey. Collectively, these results indicate that EE+ do not present a hypercoagulable profile potentially favouring thrombosis.
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Affiliation(s)
- Benoit Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
| | | | - Landry Seyve
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
| | - Émeric Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
- Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Aurélien Pichon
- Université de Poitiers, Laboratoire Move UR 20296, STAPS, Poitiers, France
| | | | - Michael Furian
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Ivan Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | - Lars Kaestner
- Dynamics of Fluids, Experimental Physics, Saarland University, Homburg, Germany
- Theoretical Medicine and Biosciences, Medical Faculty, Saarland University, Homburg, Germany
| | - Paul Robach
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - Pierre Bouzat
- Department of Anaesthesia and Critical Care, CHU Grenoble Alpes, Grenoble, France
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, Grenoble, France
| | - Benoit Polack
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Raphael Marlu
- Hemostasis Laboratory, Grenoble University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Samuel Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
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Champigneulle B, Brugniaux JV, Stauffer E, Doutreleau S, Furian M, Perger E, Pina A, Baillieul S, Deschamps B, Hancco I, Connes P, Robach P, Pichon A, Verges S. Expedition 5300: limits of human adaptations in the highest city in the world. J Physiol 2023. [PMID: 38146929 DOI: 10.1113/jp284550] [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: 08/31/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023] Open
Abstract
Exposure to chronic hypobaric hypoxia imposes a significant physiological burden to more than 80 million humans living above 2500 m throughout the world. Among them, 50 000 live in the world's highest city, La Rinconada, located at 5000-5300 m in southern Peru. Expedition 5300 is the first scientific and medical programme led in La Rinconada to investigate the physiological adaptations and altitude-related health issues in this unique population. Dwellers from La Rinconada have very high haemoglobin concentration (20.3 ± 2.4 g/dL; n = 57) and those with chronic mountain sickness (CMS) exhibit even higher concentrations (23.1 ± 1.7 g/dL; n = 150). These values are associated with large total haemoglobin mass and blood volume, without an associated iron deficit. These changes in intravascular volumes lead to a substantial increase in blood viscosity, which is even larger in CMS patients. Despite these large haematological changes, 24 h blood pressure monitoring is essentially normal in La Rinconada, but some results suggest impaired vascular reactivity. Echocardiography revealed large right heart dilatation and high pulmonary arterial pressure as well as left ventricle concentric remodelling and grade I diastolic dysfunction. These changes in heart dimension and function tend to be more severe in highlanders with CMS. Polygraphy evaluations revealed a large reduction in nocturnal pulse oxygen saturation (median SpO2 = 79%), which is even more severe in CMS patients who also tended to show a higher oxygen desaturation index. The population of La Rinconada offers a unique opportunity to investigate the human responses to chronic severe hypoxia, at an altitude that is probably close to the maximum altitude human beings can permanently tolerate without presenting major health issues.
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Affiliation(s)
- Benoit Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
| | - Julien V Brugniaux
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
| | - Emeric Stauffer
- Interuniversity Laboratory of Human Movement Biology (LIBM, EA7424), "Red Blood cell and Vascular Biology" Team, Univ Lyon - University Claude Bernard Lyon 1, Villeurbanne, France
| | - Stéphane Doutreleau
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
| | - Michael Furian
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Alessandra Pina
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Sébastien Baillieul
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
| | - Blandine Deschamps
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
| | - Ivan Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
| | - Philippe Connes
- Interuniversity Laboratory of Human Movement Biology (LIBM, EA7424), "Red Blood cell and Vascular Biology" Team, Univ Lyon - University Claude Bernard Lyon 1, Villeurbanne, France
| | - Paul Robach
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
- National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - Aurélien Pichon
- Laboratory Mobility, Aging & Exercise (MOVE, EA6314), Faculty of Sport Sciences, University of Poitiers, Poitiers, France
| | - Samuel Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2 laboratory, Grenoble, France
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