High‐altitude Pulmonary Edema: Review

Bhagi, Shuchi; Srivastava, Swati; Singh, Shashi Bala

doi:10.1539/joh.13-0256-ra

Cited by 49 publications

(47 citation statements)

References 73 publications

(91 reference statements)

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“…However, while increasing oxygen concentrations in hypobaric environments mediates stress in plants, the data presented here suggest that exposing plants to at least mild hypobaric conditions can also serve to mediate plant stress in low oxygen environments. Interestingly, although the importance of oxygen in human hypobaric stress, such as the high-altitude pulmonary edema common to extreme mountain climbers, has long been appreciated (Hackett and Roach, 1987), it is becoming increasingly clear that the combination of stresses associated with hypobaric environments elicits complex physiological responses, and requires complex mediation (Bhagi et al, 2014). The establishment of protected agriculture in extreme environments—whether on the surface of Mars, in exploration vehicles, or for terrestrial applications—will require careful management of in situ resources and engineering considerations to optimize the internal environment for plant health and productivity.…”

Section: Resultsmentioning

confidence: 99%

Dissecting Low Atmospheric Pressure Stress: Transcriptome Responses to the Components of Hypobaria in Arabidopsis

Zhou

Callaham

Reyes³

et al. 2017

Front. Plant Sci.

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Controlled hypobaria presents biology with an environment that is never encountered in terrestrial ecology, yet the apparent components of hypobaria are stresses typical of terrestrial ecosystems. High altitude, for example, presents terrestrial hypobaria always with hypoxia as a component stress, since the relative partial pressure of O2 is constant in the atmosphere. Laboratory-controlled hypobaria, however, allows the dissection of pressure effects away from the effects typically associated with altitude, in particular hypoxia, as the partial pressure of O2 can be varied. In this study, whole transcriptomes of plants grown in ambient (97 kPa/pO2 = 21 kPa) atmospheric conditions were compared to those of plants transferred to five different atmospheres of varying pressure and oxygen composition for 24 h: 50 kPa/pO2 = 10 kPa, 25 kPa/pO2 = 5 kPa, 50 kPa/pO2 = 21 kPa, 25 kPa/pO2 = 21 kPa, or 97 kPa/pO2 = 5 kPa. The plants exposed to these environments were 10 day old Arabidopsis seedlings grown vertically on hydrated nutrient plates. In addition, 5 day old plants were also exposed for 24 h to the 50 kPa and ambient environments to evaluate age-dependent responses. The gene expression profiles from roots and shoots showed that the hypobaric response contained more complex gene regulation than simple hypoxia, and that adding back oxygen to normoxic conditions did not completely alleviate gene expression changes in hypobaric responses.

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Section: Resultsmentioning

confidence: 99%

Dissecting Low Atmospheric Pressure Stress: Transcriptome Responses to the Components of Hypobaria in Arabidopsis

Zhou

Callaham

Reyes³

et al. 2017

Front. Plant Sci.

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“…A recent review identified a number of possible gene mutations that may be linked to the pathogenesis and development of HAPE -many are downstream targets of HIF-1α and also involved in either HPV or HVR. These include the angiotensin-1 converting enzyme (ACE), vascular endothelial growth factor (VEGF), tyrosine hydroxylase (TH), serotonin transporter (5HTT), endothelin 1 (EDN1) and endothelial nitric oxide synthase (eNOS) genes (29). HAPE has also recently been associated with an overactive sympathetic nervous system, (30) the major-histocompatibility complex, (31) an increase in hepcidin levels (32) as well as lack of oestrogen (33).…”

Section: Risk Factorsmentioning

confidence: 99%

High altitude respiratory physiology and pathophysiology

Cumpstey¹

2015

SOB

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SummaryAt high altitude, reduced atmospheric pressure causes the partial pressure of oxygen to decreasecreating an environment of hypobaric hypoxia which presents a unique set of challenges for the respiratory system. Pulmonary physiological responses such as the hypoxic ventilatory drive are essential for successful acclimatisation, whilst others such as hypoxic pulmonary vasoconstriction may be implicated in the development of altitude illnesses. Pulmonary conditions are some of the most common (e.g. high altitude cough) and also the most serious illnesses seen at altitude (e.g high altitude pulmonary oedema, HAPE). Minimising the chance of developing HAPE through planning an appropriate ascent profile should be strongly encouraged as HAPE can rapidly be fatal if left untreated. Whilst pharmacological agents such as nifedipine can help with the management of HAPE, rapid descent remains the single-most important treatment option once symptomatic. Given the increasing popularity of travelling to altitude, an awareness of how hypobaric hypoxia affects chronic respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) is also becoming increasingly important for respiratory physicians.

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“…8 Although sildenafil and tadalafil as well as newer anti-PHT drugs promote pulmonary vasodilation, further studies are needed to demonstrate their efficacy in HAPE treatment. 35 Chronic High-altitude Illness: Chronic Mountain Sickness CMS, also known as Monge disease, is a clinical syndrome occurring in natives or long-term residents above 2500 m. Characteristics of this disease includes severe hypoxemia with excessive erythropoiesis, which can lead to moderate or severe PHT with cor pulmonale. An international consensus statement of the International Society for Mountain Medicine summarized the clinical picture of CMS.…”

Section: High-altitude Illnessmentioning

confidence: 99%

High Altitude

Hevroni

Goldman

Kerem

2015

Clinical Pulmonary Medicine

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People have been visiting or living in the highest mountain ranges on earth throughout history. However, the hypoxic conditions at these altitudes create a challenge for the human body. The documented success of reaching the summit of Mount Everest without oxygen shows the enormous ability of the human body to adapt to these extreme conditions. Surviving in this low oxygen tension environment requires an amazing expansion of the capacity of various body systems involved in the oxygen pathway and challenges their integrative work. Sometimes, however, the adaptation mechanisms may cause unique illnesses related to high altitude. Cerebral syndromes of acute mountain sickness and high-altitude cerebral edema, and the pulmonary syndrome of high-altitude pulmonary edema, characterize the illnesses in new arrivals to high altitude; whereas chronic mountain sickness occurs in inhabitants of the highest altitude settlements. Children experience the full range of high-altitude-associated illnesses but also have their unique health issues. Symptomatic high-altitude pulmonary hypertension is a unique illness seen mostly in infants. Low birth weight, growth problems, and nutrient deficiency have been documented in children who are born and live in high altitude. Investigation of human physiology in extreme environmental conditions like highaltitude may also contribute to understanding other similar pathologies, and may help develop successful treatments for these diseases. In this review, we discuss the physiology and pathophysiology of ascent to high altitudes and discuss the adaptation processes of permanent residents at these heights in both adults and children.Key Words: high-altitude physiology, acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), high-altitude cerebral edema (HACE), chronic mountain sickness (CMS), symptomatic highaltitude pulmonary hypertension (Clin Pulm Med 2015;22:105-113)

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High‐altitude Pulmonary Edema: Review

Cited by 49 publications

References 73 publications

Dissecting Low Atmospheric Pressure Stress: Transcriptome Responses to the Components of Hypobaria in Arabidopsis

Dissecting Low Atmospheric Pressure Stress: Transcriptome Responses to the Components of Hypobaria in Arabidopsis

High altitude respiratory physiology and pathophysiology

High Altitude

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