Effect of intermittent hyperoxia on stem cell mobilization and cytokine expression

Short-term hyperoxia induced mitochondrial respiratory chain complexes dysfunction and oxidative stress in lung of rats

BACKGROUND

Oxygen therapy is an alternative for many patients with hypoxemia. However, this practice can be dangerous as oxygen is closely associated with the development of oxidative stress.

METHODS

Male Wistar rats were exposed to hyperoxia with a 40% fraction of inspired oxygen (FIO2) and hyperoxia (FIO2 = 60%) for 120 min. Blood and lung tissue samples were collected for gas, oxidative stress, and inflammatory analyses.

RESULTS

Hyperoxia (FIO2 = 60%) increased PaCO2 and PaO2, decreased blood pH and caused thrombocytopenia and lymphocytosis. In lung tissue, neutrophil infiltration, nitric oxide concentration, carbonyl protein formation and the activity of complexes I and II of the mitochondrial respiratory chain increased. FIO2 = 60% decreased SOD activity and caused several histologic changes.

CONCLUSION

In conclusion, we have experimentally demonstrated that short-term exposure to high FIO2 can cause oxidative stress in the lung.

Hyperbaric air mobilizes stem cells in humans; a new perspective on the hormetic dose curve

Introduction

Hyperbaric air (HBA) was first used pharmaceutically in 1662 to treat lung disease. Extensive use in Europe and North America followed throughout the 19th century to treat pulmonary and neurological disorders. HBA reached its zenith in the early 20th century when cyanotic, moribund "Spanish flu pandemic" patients turned normal color and regained consciousness within minutes after HBA treatment. Since that time the 78% Nitrogen fraction in HBA has been completely displaced by 100% oxygen to create the modern pharmaceutical hyperbaric oxygen therapy (HBOT), a powerful treatment that is FDA approved for multiple indications. Current belief purports oxygen as the active element mobilizing stem progenitor cells (SPCs) in HBOT, but hyperbaric air, which increases tensions of both oxygen and nitrogen, has been untested until now. In this study we test HBA for SPC mobilization, cytokine and chemokine expression, and complete blood count.

Methods

Ten 34-35-year-old healthy volunteers were exposed to 1.27ATA (4 psig/965 mmHg) room air for 90 min, M-F, for 10 exposures over 2-weeks. Venous blood samples were taken: (1) prior to the first exposure (served as the control for each subject), (2) directly after the first exposure (to measure the acute effect), (3) immediately prior to the ninth exposure (to measure the chronic effect), and (4) 3 days after the completion of tenth/final exposure (to assess durability). SPCs were gated by blinded scientists using Flow Cytometry.

Results

SPCs (CD45dim/CD34+/CD133-) were mobilized by nearly two-fold following 9 exposures (p = 0.02) increasing to three-fold 72-h post completion of the final (10th) exposure (p = 0.008) confirming durability.

Discussion

This research demonstrates that SPCs are mobilized, and cytokines are modulated by hyperbaric air. HBA likely is a therapeutic treatment. Previously published research using HBA placebos should be re-evaluated to reflect a dose treatment finding rather than finding a placebo effect. Our findings of SPC mobilization by HBA support further investigation into hyperbaric air as a pharmaceutical/therapy.

A Multichamber Gas System to Examine the Effect of Multiple Oxygen Conditions on Cell Culture

The classic bone tissue engineering model for bone regeneration combines three elements: scaffolds, biomaterials, and mesenchymal stem cells (MSCs). Incorporation of MSCs and growth factors into a scaffold implanted into the area of bone injury is a proven strategy to achieve successful bone regeneration as demonstrated in the literature. However, a major limitation of using bone grafts or scaffolds is oxygen (O₂) deprivation in the inner sections of the construct, due to lack of adequate vascularization. To address this limitation, we proposed two treatment strategies for MSC-seeded constructs or adipose tissue scaffolds before implantation: (1) O₂ enrichment and (2) acclimation to hypoxia. Based on previous studies, the significance of the different O₂ concentrations on MSC biological characteristics remains controversial. Therefore, the optimal O₂ condition for engineered bone tissues should be determined. Thus, we designed an innovative multichamber gas system aimed to simultaneously assess the effects of different O₂ levels on cell culture. This system was assembled using three isolated chambers integrated into a single incubator. To explore the efficacy of our method, we investigated the effect of hyperoxia, normoxia, and hypoxia, (50-60%, 21%, and 5-7.5% O₂, respectively) on the biological characteristics of human adipose-derived MSCs: immunophenotyping, adhesion, proliferation, and osteogenic, and angiogenic differentiation. Our findings demonstrated that hypoxic adipose-derived mesenchymal stem cells (ASCs) conditions exhibited significantly lower levels of CD34 (p = 0.014), with significantly higher osteogenic and angiogenic differentiation capacities (p = 0.023 and p = 0.0042, respectively) than normoxia. Conversely, hyperoxia-cultured ASCs demonstrated significantly higher levels of CD73 and CD90 expression than both normoxic ASCs (p = 0.006 and p = 0.025, respectively) and hypoxic ASCs (p = 0.003 and p = 0.003, respectively). In addition, hyperoxic ASCs showed significantly reduced proliferation capacity by day 11 (p = 0.032) and significantly enhanced migration rates after 48 h (p = 0.044). The newly developed controllable multichamber gas system was cost-effective and easy to use. Different assays can be performed concurrently while preserving all other conditions identical, and the use of other ranges of O₂ concentrations is feasible and also necessary to determine the ideal O₂ concentration. Furthermore, the multichamber gas system has the potential for wide application, including other cell cultures, grafts, or scaffolds for in vitro and in vivo experimentation. This study was approved by the Galilee Medical Center Helsinki Committee (No. 0009-19-NHR). Impact statement The introduced multichamber gas system provides a custom-made setup for simultaneous control of three oxygen (O₂) levels in a single incubator. The use of our innovative multichamber gas system is essential to determine the ideal O₂ levels for engineered tissues by examining multiple O₂ concentrations on cells in vitro. The determined ideal O₂ concentration will then be used through this system to investigate the engrafted cell survival ex vivo, to ensure successful integration of the engineered tissues and tissue regeneration in vivo. Use of this method may promote a therapeutic tool for a major limitation in tissue engineering due to the problematic O₂ insufficiency in tissue scaffolds.

Hyperoxia Alters Ultrastructure and Induces Apoptosis in Leukemia Cell Lines

Oxygenation conditions are crucial for growth and tumor progression. Recent data suggests a decrease in cancer cell proliferation occurring after exposure to normobaric hyperoxia. Those changes are associated with fractal dimension. The purpose of this research was to study the impact of hyperoxia on apoptosis and morphology of leukemia cell lines. Two hematopoietic lymphoid cancer cell lines (a T-lymphoblastoid line, JURKAT and a B lymphoid line, CCRF-SB) were tested under conditions of normobaric hyperoxia (FiO₂ > 60%, ± 18h) and compared to a standard group (FiO₂ = 21%). We tested for apoptosis using a caspase-3 assay. Cell morphology was evaluated by cytospin, microphotography after coloration, and analysis by a fractal dimension calculation software. Our results showed that exposure of cell cultures to transient normobaric hyperoxia induced apoptosis (elevated caspase-3) as well as significant and precocious modifications in cell complexity, as highlighted by increased fractal dimensions in both cell lines. These features are associated with changes in structure (pycnotic nucleus and apoptosis) recorded by microscopic analysis. Such morphological alterations could be due to several molecular mechanisms and rearrangements in the cancer cell, leading to cell cycle inhibition and apoptosis as shown by caspase-3 activity. T cells seem less resistant to hyperoxia than B cells.

The Role of Hyperbaric Oxygen Treatment for COVID-19: A Review

The recent coronavirus disease 2019 (COVID-19) pandemic produced high and excessive demands for hospitalizations and equipment with depletion of critical care resources. The results of these extreme therapeutic efforts have been sobering. Further, we are months away from a robust vaccination effort, and current therapies provide limited clinical relief. Therefore, several empirical oxygenation support initiatives have been initiated with intermittent hyperbaric oxygen (HBO) therapy to overcome the unrelenting and progressive hypoxemia during maximum ventilator support in intubated patients, despite high FiO2. Overall, few patients have been successfully treated in different locations across the globe. More recently, less severe patients at the edge of impending hypoxemia were exposed to HBO preventing intubation and obtaining the rapid resolution of symptoms. The few case descriptions indicate large variability in protocols and exposure frequency. This summary illustrates the biological mechanisms of action of increased O₂ pressure, hoping to clarify more appropriate protocols and more useful application of HBO in COVID-19 treatment.