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Graham HR, King C, Rahman AE, Kitutu FE, Greenslade L, Aqeel M, Baker T, Brito LFDM, Campbell H, Czischke K, English M, Falade AG, Garcia PJ, Gil M, Graham SM, Gray AZ, Howie SRC, Kissoon N, Laxminarayan R, Li Lin I, Lipnick MS, Lowe DB, Lowrance D, McCollum ED, Mvalo T, Oliwa J, Swartling Peterson S, Workneh RS, Zar HJ, El Arifeen S, Ssengooba F. Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security. Lancet Glob Health 2025; 13:e528-e584. [PMID: 39978385 PMCID: PMC11865010 DOI: 10.1016/s2214-109x(24)00496-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 10/24/2024] [Accepted: 11/12/2024] [Indexed: 02/22/2025]
Affiliation(s)
- Hamish R Graham
- Melbourne Children's Global Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria.
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Freddy Eric Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University, Kampala, Uganda; International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Masooma Aqeel
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Harry Campbell
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Karen Czischke
- Departamento de Neumología, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Mike English
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Adegoke G Falade
- Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria; Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | | | | | - Stephen M Graham
- Melbourne Children's Global Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; Royal Children's Hospital, Melbourne, VIC, Australia
| | - Amy Z Gray
- Melbourne Children's Global Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia; Royal Children's Hospital, Melbourne, VIC, Australia
| | - Stephen R C Howie
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Inês Li Lin
- UCL Institute for Global Health, University College London, London, UK
| | - Michael S Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California, San Francisco, San Francisco, CA, USA
| | - Dianne B Lowe
- International Child Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - David Lowrance
- Pandemic Preparedness and Response, Global Fund, Geneva, Switzerland
| | - Eric D McCollum
- Global Program in Pediatric Respiratory Sciences, Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Stefan Swartling Peterson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; School of Public Health, Makerere University, Kampala, Uganda
| | | | - Heather J Zar
- Department of Pediatrics and Child Health, Red Cross Children's Hospital & South Africa-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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2
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Baig MMFA, Wong LY, Wu H. Development of mRNA nano-vaccines for COVID-19 prevention and its biochemical interactions with various disease conditions and age groups. J Drug Target 2024; 32:21-32. [PMID: 38010097 DOI: 10.1080/1061186x.2023.2288996] [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: 06/24/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
This review has focused on the development of mRNA nano-vaccine and the biochemical interactions of anti-COVID-19 mRNA vaccines with various disease conditions and age groups. It studied five major groups of individuals with different disease conditions and ages, including allergic background, infarction background, adolescent, and adult (youngsters), pregnant women, and elderly. All five groups had been reported to have background-related adverse effects. Allergic background individuals were observed to have higher chances of experiencing allergic reactions and even anaphylaxis. Individuals with an infarction background had a higher risk of vaccine-induced diseases, e.g. pneumonitis and interstitial lung diseases. Pregnant women were seen to suffer from obstetric and gynecological adverse effects after receiving vaccinations. However, interestingly, the elderly individuals (> 65 years old) had experienced milder and less frequent adverse effects compared to the adolescent (<19 and >9 years old) and young adulthood (19-39 years old), or middle adulthood (40-59 years old) age groups, while middle to late adolescent (14-17 years old) was the riskiest age group to vaccine-induced cardiovascular manifestations.
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Affiliation(s)
- Mirza Muhammad Faran Ashraf Baig
- Department of Chemistry and the Hong Kong Branch of Chinese National Engineering Research Centre for Tissue Restoration, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Lok Yin Wong
- Department of Chemistry and the Hong Kong Branch of Chinese National Engineering Research Centre for Tissue Restoration, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Hongkai Wu
- Department of Chemistry and the Hong Kong Branch of Chinese National Engineering Research Centre for Tissue Restoration, The Hong Kong University of Science and Technology, Hong Kong, China
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3
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Li J, Tang YE, Lv B, Wang J, Wang Z, Song Q. Integrated transcriptome and metabolome analysis reveals the molecular responses of Pardosa pseudoannulata to hypoxic environments. BMC ZOOL 2024; 9:15. [PMID: 38965564 PMCID: PMC11225295 DOI: 10.1186/s40850-024-00206-y] [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: 03/06/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
Terrestrial organisms are likely to face hypoxic stress during natural disasters such as floods or landslides, which can lead to inevitable hypoxic conditions for those commonly residing within soil. Pardosa pseudoannulata often inhabits soil crevices and has been extensively studied, yet research on its response to hypoxic stress remains unclear. Therefore, we investigated the adaptive strategies of Pardosa pseudoannulata under hypoxic stress using metabolomics and transcriptomics approaches. The results indicated that under hypoxic stress, metabolites related to energy and antioxidants such as ATP, D-glucose 6-phosphate, flavin adenine dinucleotide (FAD), and reduced L-glutathione were significantly differentially expressed. Pathways such as the citric acid (TCA) cycle and oxidative phosphorylation were significantly enriched. Transcriptome analysis and related assessments also revealed a significant enrichment of pathways associated with energy metabolism, suggesting that Pardosa pseudoannulata primarily copes with hypoxic environments by modulating energy metabolism and antioxidant-related substances.
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Affiliation(s)
- Jinjin Li
- College of Life Science, Hunan Normal University, Changsha, Hunan, 410006, China
| | - Yun-E Tang
- College of Life Science, Hunan Normal University, Changsha, Hunan, 410006, China
| | - Bo Lv
- Division of Plant Sciences and Technology, University of Missouri, Columbia, MO, 65211, USA
| | - Juan Wang
- College of Life Science, Hunan Normal University, Changsha, Hunan, 410006, China
| | - Zhi Wang
- College of Life Science, Hunan Normal University, Changsha, Hunan, 410006, China.
| | - Qisheng Song
- Division of Plant Sciences and Technology, University of Missouri, Columbia, MO, 65211, USA
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4
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Richalet JP, Hermand E, Lhuissier FJ. Cardiovascular physiology and pathophysiology at high altitude. Nat Rev Cardiol 2024; 21:75-88. [PMID: 37783743 DOI: 10.1038/s41569-023-00924-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/04/2023]
Abstract
Oxygen is vital for cellular metabolism; therefore, the hypoxic conditions encountered at high altitude affect all physiological functions. Acute hypoxia activates the adrenergic system and induces tachycardia, whereas hypoxic pulmonary vasoconstriction increases pulmonary artery pressure. After a few days of exposure to low oxygen concentrations, the autonomic nervous system adapts and tachycardia decreases, thereby protecting the myocardium against high energy consumption. Permanent exposure to high altitude induces erythropoiesis, which if excessive can be deleterious and lead to chronic mountain sickness, often associated with pulmonary hypertension and heart failure. Genetic factors might account for the variable prevalence of chronic mountain sickness, depending on the population and geographical region. Cardiovascular adaptations to hypoxia provide a remarkable model of the regulation of oxygen availability at the cellular and systemic levels. Rapid exposure to high altitude can have adverse effects in patients with cardiovascular diseases. However, intermittent, moderate hypoxia might be useful in the management of some cardiovascular disorders, such as coronary heart disease and heart failure. The aim of this Review is to help physicians to understand the cardiovascular responses to hypoxia and to outline some recommendations that they can give to patients with cardiovascular disease who wish to travel to high-altitude destinations.
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Affiliation(s)
- Jean-Paul Richalet
- Hypoxie et Poumon, Université Sorbonne Paris Nord, INSERM U1272, Paris, France.
| | - Eric Hermand
- Unité de Recherche Pluridisciplinaire Sport Santé Société, ULR 7369-URePSSS, Université Littoral Côte d'Opale, Université Artois, Université Lille, CHU Lille, Dunkirk, France
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5
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Yuan M, Feng Y, Zhao M, Xu T, Li L, Guo K, Hou D. Identification and verification of genes associated with hypoxia microenvironment in Alzheimer's disease. Sci Rep 2023; 13:16252. [PMID: 37759083 PMCID: PMC10533856 DOI: 10.1038/s41598-023-43595-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 09/29/2023] Open
Abstract
As the incidence of Alzheimer's disease (AD) increases year by year, more people begin to study this disease. In recent years, many studies on reactive oxygen species (ROS), neuroinflammation, autophagy, and other fields have confirmed that hypoxia is closely related to AD. However, no researchers have used bioinformatics methods to study the relationship between AD and hypoxia. Therefore, our study aimed to screen the role of hypoxia-related genes in AD and clarify their diagnostic significance. A total of 7681 differentially expressed genes (DEGs) were identified in GSE33000 by differential expression analysis and cluster analysis. Weighted gene co-expression network analysis (WGCNA) was used to detect 9 modules and 205 hub genes with high correlation coefficients. Next, machine learning algorithms were applied to 205 hub genes and four key genes were selected. Through the verification of external dataset and quantitative real-time PCR (qRT-PCR), the AD diagnostic model was established by ANTXR2, BDNF and NFKBIA. The bioinformatics analysis results suggest that hypoxia-related genes may increase the risk of AD. However, more in-depth studies are still needed to investigate their association, this article would guide the insights and directions for further research.
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Affiliation(s)
- Mingyang Yuan
- The Third Xiangya Hospital, Department of Neurology, Central South University, Changsha, 410000, China
| | - Yanjin Feng
- The Third Xiangya Hospital, Department of Neurology, Central South University, Changsha, 410000, China
| | - Mingri Zhao
- School of Life Sciences, Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, 410000, China
| | - Ting Xu
- The Third Xiangya Hospital, Department of Neurology, Central South University, Changsha, 410000, China
| | - Liuhong Li
- The Third Xiangya Hospital, Department of Neurology, Central South University, Changsha, 410000, China
| | - Ke Guo
- The Third Xiangya Hospital, Department of Neurology, Central South University, Changsha, 410000, China
| | - Deren Hou
- The Third Xiangya Hospital, Department of Neurology, Central South University, Changsha, 410000, China.
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6
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Kozlova E, Sherstyukova E, Sergunova V, Grechko A, Kuzovlev A, Lyapunova S, Inozemtsev V, Kozlov A, Chernysh A. Atomic Force Microscopy and High-Resolution Spectrophotometry for Study of Anoxemia and Normoxemia in Model Experiment In Vitro. Int J Mol Sci 2023; 24:11043. [PMID: 37446221 PMCID: PMC10341442 DOI: 10.3390/ijms241311043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
The oxygen content in the blood may decrease under the influence of various physicochemical factors and different diseases. The state of hypoxemia is especially dangerous for critically ill patients. In this paper, we describe and analyze the changes in the characteristics of red blood cells (RBCs) with decreasing levels of oxygen in the RBC suspension from normoxemia to hypoxemia/anoxemia in an in vitro model experiment. The RBCs were stored in hypoxemia/anoxemia and normoxemia conditions in closed and open tubes correspondingly. For the quantitative study of RBC parameter changes, we used atomic force microscopy, digital spectrophotometry, and nonlinear curve fitting of the optical spectra. In both closed and open tubes, at the end of the storage period by day 29, only 2% of discocytes remained, and mainly irreversible types, such as microspherocytes and ghosts, were observed. RBC hemolysis occurred at a level of 25-30%. Addition of the storage solution, depending on the concentration, changed the influence of hypoxemia on RBCs. The reversibility of the change in hemoglobin derivatives was checked. Based on the experimental data and model approach, we assume that there is an optimal level of hypoxemia at which the imbalance between the oxidative and antioxidant systems, the rate of formation of reactive oxygen species, and, accordingly, the disturbances in RBCs, will be minimal.
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Affiliation(s)
- Elena Kozlova
- Laboratory of Biophysics of Cell Membranes under Critical State, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, 107031 Moscow, Russia; (E.K.); (E.S.); (V.S.); (V.I.); (A.C.)
- Department of Medical and Biological Physics, Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
- Faculty of Physics, Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Ekaterina Sherstyukova
- Laboratory of Biophysics of Cell Membranes under Critical State, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, 107031 Moscow, Russia; (E.K.); (E.S.); (V.S.); (V.I.); (A.C.)
- Department of Medical and Biological Physics, Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Viktoria Sergunova
- Laboratory of Biophysics of Cell Membranes under Critical State, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, 107031 Moscow, Russia; (E.K.); (E.S.); (V.S.); (V.I.); (A.C.)
| | - Andrey Grechko
- Administration, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (A.G.); (A.K.)
| | - Artem Kuzovlev
- Administration, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (A.G.); (A.K.)
| | - Snezhanna Lyapunova
- Laboratory of Biophysics of Cell Membranes under Critical State, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, 107031 Moscow, Russia; (E.K.); (E.S.); (V.S.); (V.I.); (A.C.)
| | - Vladimir Inozemtsev
- Laboratory of Biophysics of Cell Membranes under Critical State, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, 107031 Moscow, Russia; (E.K.); (E.S.); (V.S.); (V.I.); (A.C.)
| | - Aleksandr Kozlov
- Department of Medical and Biological Physics, Sechenov First Moscow State Medical University, 119991 Moscow, Russia;
| | - Aleksandr Chernysh
- Laboratory of Biophysics of Cell Membranes under Critical State, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, 107031 Moscow, Russia; (E.K.); (E.S.); (V.S.); (V.I.); (A.C.)
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7
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Salyha N, Oliynyk I. Hypoxia modeling techniques: A review. Heliyon 2023; 9:e13238. [PMID: 36718422 PMCID: PMC9877323 DOI: 10.1016/j.heliyon.2023.e13238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Hypoxia is the main cause and effect of a large number of diseases, including the most recent one facing the world, the coronavirus disease (COVID-19). Hypoxia is divided into short-term, long-term, and periodic, it can be the result of diseases, climate change, or living and traveling in the high mountain regions of the world. Since each type of hypoxia can be a cause and a consequence of various physiological changes, the methods for modeling these hypoxias are also different. There are many techniques for modeling hypoxia under experimental conditions. The most common animal for modeling hypoxia is a rat. Hypoxia models (hypoxia simulations) in rats are a tool to study the effect of various conditions on the oxygen supply of the body. These models can provide a necessary information to understand hypoxia and also provide effective treatment, highlighting the importance of various reactions of the body to hypoxia. The main parameters when choosing a model should be reproducibility and the goal that the scientist wants to achieve. Hypoxia in rats can be reproduced both ways exogenously and endogenously. The reason for writing this review was the aim to systematize the models of rats available in the literature in order to facilitate their selection by scientists. The relative strengths and limitations of each model need to be identified and understood in order to evaluate the information obtained from these models and extrapolate these results to humans to develop the necessary generalizations. Despite these problems, animal models have been and remain vital to understanding the mechanisms involved in the development and progression of hypoxia. The eligibility criteria for the selected studies was a comprehensive review of the methods and results obtained from the studies. This made it possible to make generalizations and give recommendations on the application of these methods. The review will assist scientists in choosing an appropriate hypoxia simulation method, as well as assist in interpreting the results obtained with these methods.
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Affiliation(s)
- Nataliya Salyha
- Institute of Animal Biology NAAS, Lviv, Ukraine,Corresponding author
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8
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Short-Term Mild Hypoxia Modulates Na,K-ATPase to Maintain Membrane Electrogenesis in Rat Skeletal Muscle. Int J Mol Sci 2022; 23:ijms231911869. [PMID: 36233169 PMCID: PMC9570130 DOI: 10.3390/ijms231911869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
The Na,K-ATPase plays an important role in adaptation to hypoxia. Prolonged hypoxia results in loss of skeletal muscle mass, structure, and performance. However, hypoxic preconditioning is known to protect against a variety of functional impairments. In this study, we tested the possibility of mild hypoxia to modulate the Na,K-ATPase and to improve skeletal muscle electrogenesis. The rats were subjected to simulated high-altitude (3000 m above sea level) hypobaric hypoxia (HH) for 3 h using a hypobaric chamber. Isolated diaphragm and soleus muscles were tested. In the diaphragm muscle, HH increased the α2 Na,K-ATPase isozyme electrogenic activity and stably hyperpolarized the extrajunctional membrane for 24 h. These changes were accompanied by a steady increase in the production of thiobarbituric acid reactive substances as well as a decrease in the serum level of endogenous ouabain, a specific ligand of the Na,K-ATPase. HH also increased the α2 Na,K-ATPase membrane abundance without changing its total protein content; the plasma membrane lipid-ordered phase did not change. In the soleus muscle, HH protected against disuse (hindlimb suspension) induced sarcolemmal depolarization. Considering that the Na,K-ATPase is critical for maintaining skeletal muscle electrogenesis and performance, these findings may have implications for countermeasures in disuse-induced pathology and hypoxic therapy.
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Halawa S, Pullamsetti SS, Bangham CRM, Stenmark KR, Dorfmüller P, Frid MG, Butrous G, Morrell NW, de Jesus Perez VA, Stuart DI, O'Gallagher K, Shah AM, Aguib Y, Yacoub MH. Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: a global perspective. Nat Rev Cardiol 2022; 19:314-331. [PMID: 34873286 PMCID: PMC8647069 DOI: 10.1038/s41569-021-00640-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
The lungs are the primary target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with severe hypoxia being the cause of death in the most critical cases. Coronavirus disease 2019 (COVID-19) is extremely heterogeneous in terms of severity, clinical phenotype and, importantly, global distribution. Although the majority of affected patients recover from the acute infection, many continue to suffer from late sequelae affecting various organs, including the lungs. The role of the pulmonary vascular system during the acute and chronic stages of COVID-19 has not been adequately studied. A thorough understanding of the origins and dynamic behaviour of the SARS-CoV-2 virus and the potential causes of heterogeneity in COVID-19 is essential for anticipating and treating the disease, in both the acute and the chronic stages, including the development of chronic pulmonary hypertension. Both COVID-19 and chronic pulmonary hypertension have assumed global dimensions, with potential complex interactions. In this Review, we present an update on the origins and behaviour of the SARS-CoV-2 virus and discuss the potential causes of the heterogeneity of COVID-19. In addition, we summarize the pathobiology of COVID-19, with an emphasis on the role of the pulmonary vasculature, both in the acute stage and in terms of the potential for developing chronic pulmonary hypertension. We hope that the information presented in this Review will help in the development of strategies for the prevention and treatment of the continuing COVID-19 pandemic.
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Affiliation(s)
| | - Soni S Pullamsetti
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Justus-Liebig University, Giessen, Germany
- Institute for Lung Health (ILH), Justus Liebig University, Giessen, Germany
| | - Charles R M Bangham
- Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Kurt R Stenmark
- Divisions of Paediatric Critical Care Medicine and Cardiovascular Pulmonary Research, University of Colorado Denver, Denver, CO, USA
| | - Peter Dorfmüller
- Department of Pathology, Universities of Giessen and Marburg Lung Center (UGMLC), Justus-Liebig University, Giessen, Germany
| | - Maria G Frid
- Divisions of Paediatric Critical Care Medicine and Cardiovascular Pulmonary Research, University of Colorado Denver, Denver, CO, USA
| | - Ghazwan Butrous
- Medway School of Pharmacy, University of Kent at Canterbury, Canterbury, UK
| | - Nick W Morrell
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - David I Stuart
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kevin O'Gallagher
- King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Ajay M Shah
- King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Yasmine Aguib
- Aswan Heart Centre, Aswan, Egypt
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Magdi H Yacoub
- Aswan Heart Centre, Aswan, Egypt.
- National Heart & Lung Institute, Imperial College London, London, UK.
- Harefield Heart Science Centre, London, UK.
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10
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Richalet J, Hermand E. Modeling the oxygen transport to the myocardium at maximal exercise at high altitude. Physiol Rep 2022; 10:e15262. [PMID: 35439356 PMCID: PMC9017981 DOI: 10.14814/phy2.15262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023] Open
Abstract
Exposure to high altitude induces a decrease in oxygen pressure and saturation in the arterial blood, which is aggravated by exercise. Heart rate (HR) at maximal exercise decreases when altitude increases in prolonged exposure to hypoxia. We developed a simple model of myocardial oxygenation in order to demonstrate that the observed blunting of maximal HR at high altitude is necessary for the maintenance of a normal myocardial oxygenation. Using data from the available scientific literature, we estimated the myocardial venous oxygen pressure and saturation at maximal exercise in two conditions: (1) with actual values of maximal HR (decreasing with altitude); (2) with sea-level values of maximal heart rate, whatever the altitude (no change in HR). We demonstrated that, in the absence of autoregulation of maximal HR, myocardial tissue oxygenation would be incompatible with life above 6200 m-7600 m, depending on the hypothesis concerning a possible increase in coronary reserve (increase in coronary blood flow at exercise). The decrease in maximal HR at high altitude could be explained by several biological mechanisms involving the autonomic nervous system and its receptors on myocytes. These experimental and clinical observations support the hypothesis that there exists an integrated system at the cellular level, which protects the myocardium from a hazardous disequilibrium between O2 supply and O2 consumption at high altitude.
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Affiliation(s)
- Jean‐Paul Richalet
- UMR INSERM U1272 Hypoxie & PoumonUniversité Sorbonne Paris NordBobignyFrance
| | - Eric Hermand
- Université Littoral Côte d’OpaleUniversité ArtoisUniversité Lille, CHU LilleULR 7369 ‐ URePSSS‐Unité de Recherche Pluridisciplinaire Sport Santé SociétéDunkerqueFrance
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11
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Exercising in Hypoxia and Other Stimuli: Heart Rate Variability and Ventilatory Oscillations. Life (Basel) 2021; 11:life11070625. [PMID: 34203350 PMCID: PMC8306822 DOI: 10.3390/life11070625] [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: 06/01/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 12/24/2022] Open
Abstract
Periodic breathing is a respiratory phenomenon frequently observed in patients with heart failure and in normal subjects sleeping at high altitude. However, until recently, periodic breathing has not been studied in wakefulness and during exercise. This review relates the latest findings describing this ventilatory disorder when a healthy subject is submitted to simultaneous physiological (exercise) and environmental (hypoxia, hyperoxia, hypercapnia) or pharmacological (acetazolamide) stimuli. Preliminary studies have unveiled fundamental physiological mechanisms related to the genesis of periodic breathing characterized by a shorter period than those observed in patients (11~12 vs. 30~60 s). A mathematical model of the respiratory system functioning under the aforementioned stressors corroborated these data and pointed out other parameters, such as dead space, later confirmed in further research protocols. Finally, a cardiorespiratory interdependence between ventilatory oscillations and heart rate variability in the low frequency band may partly explain the origin of the augmented sympathetic activation at exercise in hypoxia. These nonlinear instabilities highlight the intrinsic "homeodynamic" system that allows any living organism to adapt, to a certain extent, to permanent environmental and internal perturbations.
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