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Eugenín J, Richerson GB. Editorial: Alternative and expanding views on central respiratory chemoreception in health and disease. Front Physiol 2024; 15:1403768. [PMID: 38645691 PMCID: PMC11026679 DOI: 10.3389/fphys.2024.1403768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Jaime Eugenín
- Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - George B. Richerson
- Departments of Neurology and Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
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Eugenín J, Beltrán-Castillo S, Irribarra E, Pulgar-Sepúlveda R, Abarca N, von Bernhardi R. Microglial reactivity in brainstem chemosensory nuclei in response to hypercapnia. Front Physiol 2024; 15:1332355. [PMID: 38476146 PMCID: PMC10927973 DOI: 10.3389/fphys.2024.1332355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Microglia, the resident immune cells of the CNS, surveil, detect, and respond to various extracellular signals. Depending on the nature of these signals, an integrative microglial response can be triggered, resulting in a phenotypic transformation. Here, we evaluate whether hypercapnia modifies microglia phenotype in brainstem respiratory-related nuclei. Adult C57BL/6 inbred mice were exposed to 10% CO2 enriched air (hypercapnia), or pure air (control), for 10 or 30 min and immediately processed for immunohistochemistry to detect the ubiquitous microglia marker, ionized calcium binding adaptor molecule 1 (Iba1). Hypercapnia for thirty, but not 10 min reduced the Iba1 labeling percent coverage in the ventral respiratory column (VRC), raphe nucleus (RN), and nucleus tractus solitarius (NTS) and the number of primary branches in VRC. The morphological changes persisted, at least, for 60 min breathing air after the hypercapnic challenge. No significant changes were observed in Iba1+ cells in the spinal trigeminal nucleus (Sp5) and the hippocampus. In CF-1 outbred mice, 10% CO2 followed by 60 min of breathing air, resulted in the reduction of Iba1 labeling percent coverage and the number and length of primary branches in VRC, RN, and NTS. No morphological change was observed in Iba1+ cells in Sp5 and hippocampus. Double immunofluorescence revealed that prolonged hypercapnia increased the expression of CD86, an inflammatory marker for reactive state microglia, in Iba1+ cells in VRC, RN, and NTS, but not in Sp5 and hippocampus in CF-1 mice. By contrast, the expression of CD206, a marker of regulatory state microglia, persisted unmodified. In brainstem, but not in hippocampal microglia cultures, hypercapnia increased the level of IL1β, but not that of TGFβ measured by ELISA. Our results show that microglia from respiratory-related chemosensory nuclei, are reactive to prolonged hypercapnia acquiring an inflammatory-like phenotype.
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Affiliation(s)
- Jaime Eugenín
- Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - Sebastián Beltrán-Castillo
- Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
- Centro Integrativo de Biología y Química Aplicada (CIBQA), Universidad Bernardo O’Higgins, Santiago, Chile
| | - Estefanía Irribarra
- Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | | | - Nicolás Abarca
- Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - Rommy von Bernhardi
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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Baglyas S, Valkó L, Móró V, Podmaniczky E, Czövek D, Makan G, Gingl Z, Gál J, Hantos Z, Lorx A. Using intra-breath oscillometry in obesity hypoventilation syndrome to detect tidal expiratory flow limitation: a potential marker to optimize CPAP therapy. BMC Pulm Med 2023; 23:477. [PMID: 38017501 PMCID: PMC10685591 DOI: 10.1186/s12890-023-02777-x] [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: 09/07/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy has profound effects in obesity hypoventilation syndrome (OHS). Current therapy initiation focuses on upper airway patency rather than the assessment of altered respiratory mechanics due to increased extrapulmonary mechanical load. METHODS We aimed to examine the viability of intra-breath oscillometry in optimizing CPAP therapy for OHS. We performed intra-breath oscillometry at 10 Hz in the sitting and supine positions, followed by measurements at increasing CPAP levels (none-5-10-15-20 cmH2O) in awake OHS patients. We plotted intra-breath resistance and reactance (Xrs) values against flow (V') and volume (V) to identify tidal expiratory flow limitation (tEFL). RESULTS Thirty-five patients (65.7% male) completed the study. We found a characteristic looping of the Xrs vs V' plot in all patients in the supine position revealing tEFL: Xrs fell with decreasing flow at end-expiration. Intra-breath variables representing expiratory decrease of Xrs became more negative in the supine position [end-expiratory Xrs (mean ± SD): -1.9 ± 1.8 cmH2O·s·L- 1 sitting vs. -4.2 ± 2.2 cmH2O·s·L- 1 supine; difference between end-expiratory and end-inspiratory Xrs: -1.3 ± 1.7 cmH2O·s·L- 1 sitting vs. -3.6 ± 2.0 cmH2O·s·L- 1 supine, p < 0.001]. Increasing CPAP altered expiratory Xrs values and loop areas, suggesting diminished tEFL (p < 0.001). 'Optimal CPAP' value (able to cease tEFL) was 14.8 ± 4.1 cmH2O in our cohort, close to the long-term support average of 13.01(± 2.97) cmH2O but not correlated. We found no correlation between forced spirometry values, patient characteristics, apnea-hypopnea index and intra-breath oscillometry variables. CONCLUSIONS tEFL, worsened by the supine position, can be diminished by stepwise CPAP application in most patients. Intra-breath oscillometry is a viable method to detect tEFL during CPAP initiation in OHS patients and tEFL is a possible target for optimizing therapy in OHS patients.
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Affiliation(s)
- Szabolcs Baglyas
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary.
| | - Luca Valkó
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Vivien Móró
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Eszter Podmaniczky
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Dorottya Czövek
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Gergely Makan
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - Zoltán Gingl
- Department of Technical Informatics, University of Szeged, Szeged, Hungary
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - Zoltán Hantos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
| | - András Lorx
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1082 Üllői út 78/B, Budapest, Hungary
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Young R, Benjamin A. The assessment and management of obstructive sleep apnoea-hypopnoea syndrome and obesity hypoventilation syndrome in obesity. Clin Med (Lond) 2023; 23:372-379. [PMID: 38614652 PMCID: PMC10541031 DOI: 10.7861/clinmed.2023-0151] [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] [Indexed: 08/02/2023]
Abstract
Obesity is associated with respiratory dysfunction. It is a key risk and contributory factor in the sleep related breathing disorders, obstructive sleep apnoea/hypopnoea syndrome (OSAHS) and obesity hypoventilation syndrome (OHS). Weight management is an integral part of the management of these disorders, in addition to continuous positive airways pressure (CPAP) and non-invasive ventilation (NIV). Untreated, these conditions are associated with a high disease burden and as treatment is effective, early recognition and referral is critical. Best practice in on-going care is multidisciplinary.
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Shah NM, Kaltsakas G. Respiratory complications of obesity: from early changes to respiratory failure. Breathe (Sheff) 2023. [DOI: 10.1183/20734735.0263-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Obesity is a significant and increasingly common cause of respiratory compromise. It causes a decrease in static and dynamic pulmonary volumes. The expiratory reserve volume is one of the first to be affected. Obesity is associated with reduced airflow, increased airway hyperresponsiveness, and an increased risk of developing pulmonary hypertension, pulmonary embolism, respiratory tract infections, obstructive sleep apnoea and obesity hypoventilation syndrome. The physiological changes caused by obesity will eventually lead to hypoxic or hypercapnic respiratory failure. The pathophysiology of these changes includes a physical load of adipose tissue on the respiratory system and a systemic inflammatory state. Weight loss has clear, well-defined benefits in improving respiratory and airway physiology in obese individuals.
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Moya EA, Mesarwi OA. How far would you go to sleep better at high altitude? Sleep 2023; 46:6839988. [PMID: 36413093 PMCID: PMC9905773 DOI: 10.1093/sleep/zsac277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Esteban A Moya
- Section of Physiology, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Omar A Mesarwi
- Section of Physiology, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
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Pennings N, Golden L, Yashi K, Tondt J, Bays HE. Sleep-disordered breathing, sleep apnea, and other obesity-related sleep disorders: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 4:100043. [PMID: 37990672 PMCID: PMC10662058 DOI: 10.1016/j.obpill.2022.100043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of sleep-disordered breathing, (e.g., sleep-related hypopnea, apnea), and other obesity-related sleep disorders. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Obesity contributes to sleep-disordered breathing, with the most prevalent manifestation being obstructive sleep apnea. Obesity is also associated with other sleep disorders such as insomnia, primary snoring, and restless legs syndrome. This CPS outlines the evaluation, diagnosis, and treatment of sleep apnea and other sleep disorders, as well as the clinical implications of altered circadian system. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on "Sleep-Disordered Breathing, Sleep Apnea, and Other Obesity-Related Sleep Disorders" is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.
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Affiliation(s)
- Nicholas Pennings
- Chair and Associate Professor of Family Medicine, Campbell University School of Osteopathic Medicine, Buies Creek, NC, 27506, USA
| | - Leslie Golden
- Watertown Family Practice, Clinical Preceptor, University of Wisconsin Family Medicine Residency, Madison, WI, USA
| | - Kanica Yashi
- Division of Hospitalist Medicine, Bassett Healthcare Network, Assistant Clinical Professor of Medicine Columbia University, 1 Atwell Road, Cooperstown, NY, 13326, USA
| | - Justin Tondt
- Department of Family and Community Medicine, Penn State Health, Penn State College of Medicine 700 HMC Crescent Rd Hershey, PA, 17033, USA
| | - Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Palma G, Sorice GP, Genchi VA, Giordano F, Caccioppoli C, D’Oria R, Marrano N, Biondi G, Giorgino F, Perrini S. Adipose Tissue Inflammation and Pulmonary Dysfunction in Obesity. Int J Mol Sci 2022; 23:ijms23137349. [PMID: 35806353 PMCID: PMC9267094 DOI: 10.3390/ijms23137349] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Obesity is a chronic disease caused by an excess of adipose tissue that may impair health by altering the functionality of various organs, including the lungs. Excessive deposition of fat in the abdominal area can lead to abnormal positioning of the diaphragm and consequent reduction in lung volume, leading to a heightened demand for ventilation and increased exposure to respiratory diseases, such as chronic obstructive pulmonary disease, asthma, and obstructive sleep apnoea. In addition to mechanical ventilatory constraints, excess fat and ectopic deposition in visceral depots can lead to adipose tissue dysfunction, which promotes metabolic disorders. An altered adipokine-secretion profile from dysfunctional adipose tissue in morbid obesity fosters systemic, low-grade inflammation, impairing pulmonary immune response and promoting airway hyperresponsiveness. A potential target of these adipokines could be the NLRP3 inflammasome, a critical component of the innate immune system, the harmful pro-inflammatory effect of which affects both adipose and lung tissue in obesity. In this review, we will investigate the crosstalk between adipose tissue and the lung in obesity, highlighting the main inflammatory mediators and novel therapeutic targets in preventing pulmonary dysfunction.
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