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Fothergill DM, Gertner JW. Exhaled Nitric Oxide and Pulmonary Oxygen Toxicity Susceptibility. Metabolites 2023; 13:930. [PMID: 37623874 PMCID: PMC10456729 DOI: 10.3390/metabo13080930] [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: 06/23/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Individual susceptibility to pulmonary oxygen toxicity (PO2tox) is highly variable and currently lacks a reliable biomarker for predicting pulmonary hyperoxic stress. As nitric oxide (NO) is involved in many respiratory system processes and functions, we aimed to determine if expired nitric oxide (FENO) levels can provide an indication of PO2tox susceptibility in humans. Eight U.S. Navy-trained divers volunteered as subjects. The hyperoxic exposures consisted of six- and eight-hour hyperbaric chamber dives conducted on consecutive days in which subjects breathed 100% oxygen at 202.65 kPa. Subjects' individual variability in pulmonary function and FENO was measured twice daily over five days and compared with their post-dive values to assess susceptibility to PO2tox. Only subjects who showed no decrements in pulmonary function following the six-hour exposure conducted the eight-hour dive. FENO decreased by 55% immediately following the six-hour oxygen exposure (n = 8, p < 0.0001) and by 63% following the eight-hour exposure (n = 4, p < 0.0001). Four subjects showed significant decreases in pulmonary function immediately following the six-hour exposure. These subjects had the lowest baseline FENO, had the lowest post-dive FENO, and had clinical symptoms of PO2tox. Individuals with low FENO were the first to develop PO2tox symptoms and deficits in pulmonary function from the hyperoxic exposures. These data suggest that endogenous levels of NO in the lungs may protect against the development of PO2tox.
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The Effects of Hyperbaric Oxygenation on Oxidative Stress, Inflammation and Angiogenesis. Biomolecules 2021; 11:biom11081210. [PMID: 34439876 PMCID: PMC8394403 DOI: 10.3390/biom11081210] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
Hyperbaric oxygen therapy (HBOT) is commonly used as treatment in several diseases, such as non-healing chronic wounds, late radiation injuries and carbon monoxide poisoning. Ongoing research into HBOT has shown that preconditioning for surgery is a potential new treatment application, which may reduce complication rates and hospital stay. In this review, the effect of HBOT on oxidative stress, inflammation and angiogenesis is investigated to better understand the potential mechanisms underlying preconditioning for surgery using HBOT. A systematic search was conducted to retrieve studies measuring markers of oxidative stress, inflammation, or angiogenesis in humans. Analysis of the included studies showed that HBOT-induced oxidative stress reduces the concentrations of pro-inflammatory acute phase proteins, interleukins and cytokines and increases growth factors and other pro-angiogenesis cytokines. Several articles only noted this surge after the first HBOT session or for a short duration after each session. The anti-inflammatory status following HBOT may be mediated by hyperoxia interfering with NF-κB and IκBα. Further research into the effect of HBOT on inflammation and angiogenesis is needed to determine the implications of these findings for clinical practice.
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Castagna O, Bergmann C, Blatteau JE. Is a 12-h Nitrox dive hazardous for pulmonary function? Eur J Appl Physiol 2019; 119:2723-2731. [PMID: 31676994 DOI: 10.1007/s00421-019-04248-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 10/26/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Prolonged exposure to a high partial pressure of oxygen leads to inflammation of pulmonary tissue [pulmonary oxygen toxicity (POT)], which is associated with tracheobronchial irritation, retrosternal pain and coughing, and decreases in vital capacity (VC). The nitric oxide (NO) concentration in exhaled gas (FeNO) has been used as an indicator of POT, but the effect of SCUBA diving on FeNO has rarely been studied. The study presented here aimed to assess alterations to pulmonary function and FeNO following a 12-h dive using breathing apparatus with a relatively high partial pressure of oxygen. METHODS Six healthy, male, non-smoking military SCUBA divers were recruited (age 31.8 ± 2.7 years, height 179 ± 0.09 cm, and body weight 84.6 ± 14 kg). Each diver completed a 12-h dive using a demand-controlled semi-closed-circuit rebreather. During the 12 h of immersion, divers were subjected to 672 oxygen toxicity units (OTU). A complete pulmonary function test (PFT) was completed the day before and immediately after immersion. FeNO was measured using a Nobreath™ Quark (COSMED™, Rome, Italy), three times for each diver. The first datapoint was collected before the dive to establish the "basal state", a second was collected immediately after divers emerged from the water, and the final measurement was taken 24 h after the dive. RESULT Despite prolonged inhalation of a hyperoxic hyperbaric gas mixture, no clinical pulmonary symptoms were observed, and no major changes in pulmonary function were detected. However, a major decrease in FeNO values was observed immediately after emersion [0-12 ppb (median, 3.8 ppb)], with a return to baseline [2-60 ppb (median, 26 ppb) 24 h later (3-73 ppb (median, 24.7 ppb)]. CONCLUSION These results suggest that if the OTU remain below the recommended limit values, but does alter FeNO, this type of dive does not persistently impair lung function.
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Affiliation(s)
- Olivier Castagna
- Underwater Research Team, ERRSO, Military Biomedical Research Institute (IRBA), BP 600, 83800, Toulon Cedex 9, France. .,Laboratoire Motricité Humaine Expertise Sport Santé -LAMHESS (EA 6312), Université Nice Sophia Antipolis/Université Côte d'Azur, Nice, France.
| | | | - Jean Eric Blatteau
- Hôpital d'Instruction des Armées, Service de Médecine Hyperbare et Expertise Plongée (Military Teaching Hospital, Hyperbaric Medicine and Diving Expertise Department), Toulon, France
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Resanovic I, Gluvic Z, Zaric B, Sudar-Milovanovic E, Jovanovic A, Milacic D, Isakovic R, Isenovic ER. Early Effects of Hyperbaric Oxygen on Inducible Nitric Oxide Synthase Activity/Expression in Lymphocytes of Type 1 Diabetes Patients: A Prospective Pilot Study. Int J Endocrinol 2019; 2019:2328505. [PMID: 30755771 PMCID: PMC6348926 DOI: 10.1155/2019/2328505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 02/05/2023] Open
Abstract
This study aimed at examining the early effects of hyperbaric oxygen therapy (HBOT) on inducible nitric oxide synthase (iNOS) activity/expression in lymphocytes of type 1 diabetes mellitus (T1DM) patients. A group of 19 patients (mean age: 63 ± 2.1) with T1DM and with the peripheral arterial disease were included in this study. Patients were exposed to 10 sessions of HBOT in the duration of 1 h to 100% oxygen inhalation at 2.4 ATA. Blood samples were collected for the plasma C-reactive protein (CRP), plasma free fatty acid (FFA), serum nitrite/nitrate, and serum arginase activity measurements. Expression of iNOS and phosphorylation of p65 subunit of nuclear factor-κB (NFκB-p65), extracellular-regulated kinases 1/2 (ERK1/2), and protein kinase B (Akt) were examined in lymphocyte lysates by Western blot. After exposure to HBOT, plasma CRP and FFA were significantly decreased (p < 0.001). Protein expression of iNOS and serum nitrite/nitrate levels were decreased (p < 0.01), while serum arginase activity was increased (p < 0.05) versus before exposure to HBOT. Increased phosphorylation of NFκB-p65 at Ser536 (p < 0.05) and decreased level of NFκB-p65 protein (p < 0.001) in lymphocytes of T1DM patients were observed after HBOT. Decreased phosphorylation of ERK1/2 (p < 0.05) and Akt (p < 0.05) was detected after HBOT. Our results indicate that exposure to HBO decreased iNOS activity/expression via decreasing phosphorylation of ERK1/2 and Akt followed by decreased activity of NFκB.
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Affiliation(s)
- Ivana Resanovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Zoran Gluvic
- Clinic for Internal Medicine, Zemun Clinical Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bozidarka Zaric
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Emina Sudar-Milovanovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Aleksandra Jovanovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Davorka Milacic
- Department of Hyperbaric Medicine, Zemun Clinical Hospital, Belgrade, Serbia
| | - Radmilo Isakovic
- Department of Hyperbaric Medicine, Zemun Clinical Hospital, Belgrade, Serbia
| | - Esma R. Isenovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
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van Ooij PJAM, Sterk PJ, van Hulst RA. Oxygen, the lung and the diver: friends and foes? Eur Respir Rev 2017; 25:496-505. [PMID: 27903670 PMCID: PMC9487554 DOI: 10.1183/16000617.0049-2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 12/31/2022] Open
Abstract
Worldwide, the number of professional and sports divers is increasing. Most of them breathe diving gases with a raised partial pressure of oxygen (PO2). However, if the PO2 is between 50 and 300 kPa (375–2250 mmHg) (hyperoxia), pathological pulmonary changes can develop, known as pulmonary oxygen toxicity (POT). Although in its acute phase, POT is reversible, it can ultimately lead to non-reversible pathological changes. Therefore, it is important to monitor these divers to prevent them from sustaining irreversible lesions. This review summarises the pulmonary pathophysiological effects when breathing oxygen with a PO2 of 50–300 kPa (375–2250 mmHg). We describe the role and the limitations of lung function testing in monitoring the onset and development of POT, and discuss new techniques in respiratory medicine as potential markers in the early development of POT in divers. To prevent the early development of pulmonary oxygen toxicity divers must be properly monitoredhttp://ow.ly/RVJL301fySb
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Affiliation(s)
- Pieter-Jan A M van Ooij
- Diving Medical Center, Royal Netherlands Navy Den Helder, The Netherlands .,Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam
| | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam
| | - Robert A van Hulst
- Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Centre, University of Amsterdam
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Guo Y, Ma J, Lu W, He J, Zhang R, Yuan J, Chen W. Associations of Exhaled Carbon Monoxide and Fractional Exhaled Nitric Oxide with Metabolic Syndrome: A Cohort Study. Sci Rep 2016; 6:24532. [PMID: 27076211 PMCID: PMC4830973 DOI: 10.1038/srep24532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/30/2016] [Indexed: 01/06/2023] Open
Abstract
Exhaled carbon monoxide (eCO) and fractional exhaled nitric oxide (FeNO) could reflect underlying inflammatory and oxidative stresses, which play important roles in pathogenetic pathways of metabolic syndrome (MetS). However, epidemiologic evidence was limited. We conducted a study in Wuhan-Zhuhai (WHZH) cohort of 3649 community participants to investigate the association between eCO, FeNO and MetS in both cross-sectional and prospective ways. The results showed that higher eCO and FeNO were associated cross-sectionally with a higher prevalence of MetS. The multivariable-adjusted odds ratios for MetS at baseline were 1.22 (95% confidence interval [CI]: 1.11 to 1.35) associated with per log eCO and 1.14 (95% CI: 1.00 to 1.30) associated with per log FeNO. During a follow-up of 3 years, 358/2181 new developed MetS cases were identified. Compared with lowest quartile of eCO and FeNO, the multivariable-adjusted risk ratios (95% CI) for MetS were 1.48 (1.06 to 2.06) related to the highest quartile of eCO. These findings remained consistent across sex but not smoking status, eCO was only associated with MetS in non-smokers when stratified by smoking status. In conclusion, our study demonstrated that eCO and FeNO were independently and positively associated with the prevalence of MetS cross-sectionally, while only eCO was positively related with the incidence of MetS prospectively.
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Affiliation(s)
- Yanjun Guo
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health in Ministry of Education &Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jixuan Ma
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health in Ministry of Education &Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Lu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health in Ministry of Education &Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jintong He
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health in Ministry of Education &Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Runbo Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health in Ministry of Education &Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yuan
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health in Ministry of Education &Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Environment and Health in Ministry of Education &Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Uusijärvi J, Eriksson K, Larsson AC, Nihlén C, Schiffer T, Lindholm P, Weitzberg E. Effects of hyperbaric oxygen on nitric oxide generation in humans. Nitric Oxide 2014; 44:88-97. [PMID: 25498903 DOI: 10.1016/j.niox.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/12/2014] [Accepted: 12/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hyperbaric oxygen (HBO2) has been suggested to affect nitric oxide (NO) generation in humans. Specific NO synthases (NOSs) use L-arginine and molecular oxygen to produce NO but this signaling radical may also be formed by serial reduction of the inorganic anions nitrate and nitrite. Interestingly, commensal facultative anaerobic bacteria in the oral cavity are necessary for the first step to reduce nitrate to nitrite. The nitrate-nitrite-NO pathway is greatly potentiated by hypoxia and low pH in contrast to classical NOS-dependent NO generation. We investigated the effects of HBO2 on NO generation in healthy subjects including orally and nasally exhaled NO, plasma and salivary nitrate and nitrite as well as plasma cGMP and plasma citrulline/arginine ratio. In addition, we also conducted in-vitro experiments in order to investigate the effects of hyperoxia on nitrate/nitrite metabolism and NO generation by oral bacteria. METHODS Two separate HBO2 experiments were performed. In a cross-over experiment (EXP1) subjects breathed air at 130 kPa (control) or oxygen at 250 kPa for 100 minutes and parameters were measured before and after exposure. In experiment 2 (EXP 2) measurements were performed also during HBO2 at 250 kPa for 110 minutes. RESULTS HBO2 acutely reduced orally and nasally exhaled NO by 30% and 16%, respectively. There was a marked decrease in salivary nitrite/nitrate ratio during and after HBO2, indicating a reduced bacterial conversion of nitrate to nitrite and NO. This was supported by in vitro experiments with oral bacteria showing that hyperoxia inhibited bacterial nitrate and nitrite reduction leading to reduced NO generation. Plasma nitrate was unaffected by HBO2 while plasma nitrite was reduced during HBO2 treatment. In contrast, plasma cGMP increased during HBO2 as did citrulline/arginine ratio after treatment and control. CONCLUSION HBO2-exposure in humans affects NO generation in the airways and systemically differently. These data suggest that the individual NOSs as well as the nitrate-nitrite-NO pathway do not respond in a similar way to HBO2.
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Affiliation(s)
- Johan Uusijärvi
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Deparment of Anesthesia & Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Eriksson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Deparment of Anesthesia & Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta C Larsson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Carina Nihlén
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Schiffer
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eddie Weitzberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Deparment of Anesthesia & Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
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8
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van Ooij PJAM, Hollmann MW, van Hulst RA, Sterk PJ. Assessment of pulmonary oxygen toxicity: relevance to professional diving; a review. Respir Physiol Neurobiol 2013; 189:117-28. [PMID: 23886638 DOI: 10.1016/j.resp.2013.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 01/07/2023]
Abstract
When breathing oxygen with partial oxygen pressures PO₂ of between 50 and 300 kPa pathological pulmonary changes develop after 3-24h depending on the PO₂. This kind of injury (known as pulmonary oxygen toxicity) is not only observed in ventilated patients but is also considered an occupational hazard in oxygen divers or mixed gas divers. To prevent these latter groups from sustaining irreversible lesions adequate prevention is required. This review summarizes the pathophysiological effects on the respiratory tract when breathing oxygen with PO₂ of 50-300 kPa (hyperoxia). We discuss to what extent the most commonly used lung function parameters change after exposure to hyperoxia and its role in monitoring the onset and development of pulmonary oxygen toxicity in daily practice. Finally, new techniques in respiratory medicine are discussed with regard to their usefulness in monitoring pulmonary oxygen toxicity in divers.
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Affiliation(s)
- P J A M van Ooij
- Diving Medical Center, Royal Netherlands Navy, The Netherlands; Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Stefanska J, Sokolowska M, Sarniak A, Wlodarczyk A, Doniec Z, Nowak D, Pawliczak R. Apocynin decreases hydrogen peroxide and nirtate concentrations in exhaled breath in healthy subjects. Pulm Pharmacol Ther 2010; 23:48-54. [DOI: 10.1016/j.pupt.2009.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 07/03/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
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