HIGH ALTITUDE PHYSIOLOGY AND PHYSIOPATHOLOGY, FROM THE ORGANISM TO THE MOLECULE - HAPPOM PREGNANGY AND HIGH ALTITUDE

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1 HIGH ALTITUDE PHYSIOLOGY AND PHYSIOPATHOLOGY, FROM THE ORGANISM TO THE MOLECULE - HAPPOM PREGNANGY AND HIGH ALTITUDE DR. ANÍBAL LLANOS FACULTAD DE MEDICINA, UNIVERSIDAD DE CHILE APRIL 18, 25

2 ATMOSPHERIC O 2 LEVEL VS TIME

3 EL O 2 ES UN PRODUCTO DE DESHECHO DEL METABOLISMO VEGETAL, PARTICULARMENTE DE LA FOTOSÍNTESIS ESTE PRODUCTO DE DESHECHO ES UTILIZADO POR LOS ANIMALES COMO NUTRIENTE O 2 + GLUCOSA! CO 2 + H 2 O + ENERGIA ESTA ENERGÍA ES EMPLEADA EN FUNCIONES DE SÍNTESIS, TRANSPORTE, METABOLISMO BASAL, CRECIMIENTO Y DESARROLLO, ETC.

4 BIRTH WEIGHT FALLS WITH INCREASING ALTITUDE TOTAL O 2 CONSUMPTION IS REDUCED IN FETUSES AND NEWBORN WITH GROWTH RESTRICTION

5 EFFECTS OF HIGH ALTITUDE ON INFANT BIRTH WEIGHT AND INFANT OXIGENATION

19 a

20 Is high altitude a greater determinant than poor nutrition of intrauterine growth retardation and low birth weight?

21 Pediatric Research 49: 49, 21 Effects of altitude vs. economic status on birth weight and body shape at birth Giussani, D.A., Phillips, P.S., Anstee, S. & Barker, D.J.P. La Paz High Altitude Santa Cruz Low Altitude Low income High income Low income High income Hypothesis: Babies born at high altitude have a lower birth weight than babies born at low altitude, independent of maternal economic status

22 Birth weight (g) La Paz Santa Cruz b a a,b Head circumference: body length.75 a,b.65 a b.55 high low income high low inco me a, P<.5: La Paz vs. Santa Cruz b, P<.5: High income vs. Low income

Hypothesis If oxygen has a role on fetal growth independent of genetic and nutritional factors, then: 1 2 Chick embryos from lowland hens incubated at high altitude

23 Hypothesis If oxygen has a role on fetal growth independent of genetic and nutritional factors, then: 1 2 Chick embryos from lowland hens incubated at high altitude should lead to fetal growth retardation Chick embryos from hens native to high altitude, usually with growth restriction, should recover their growth when incubated at sea level

24 Blood gas status : Chorio-allantoic vein ph PO 2 (mmhg) a b SLSL SLHA HAHA HASL n = 16 n = 16 n = 16 n = 16

25 Fetal biometry at day 2 of a 21d incubation Egg weight prior to incubation (g) Fetal weight (g) 8 3 c 6 4 a a 2 b 2 1 SLSL SLHA HAHA HASL n = 16 n = 16 n = 16 n = 16

26 Fetal biometry at day 2 of a 21d incubation Body length (mm) Bi-parietal diameter (mm) 8 6 a b SLSL SLHA HAHA HASL n = 16 n = 16 n = 16 n = 16

27 SLSL SLHA AORTIC wall:lumen area 8 * 7 5 μm HAHA HASL SLSL SLHA HAHA HASL

28 Summary Human and chick embryo Fetal oxygenation, independent of genetic or nutritional factors, has an important role in the control of fetal growth Generations of residence at high altitude may influence the effects of hypoxia on the developing fetus

29 HYPOTHESIS THE CHRONICALLY HYPOXIC NEONATAL SHEEP AT PUTRE (3,6m) HAVE AN ALTERED CARDIOVASCULAR AND HORMONAL STATUS BASALLY AND DURING A SUPERIMPOSED EPISODE OF ACUTE HYPOXIA

30 Figure 1 NEWBORN SHEEP NEWBORN LLAMA Herrera EA et al A. a B. 4 SLSH PAP (mmhg) HLSH 3 ab 2 bc 1 PAP (mmhg) b a SLLL HLLL PVR (mmhg.ml -1.min.Kg) C. B B + LNAME D.,3,2,1 bc B c ab a B + LNAME PVR (mmhg.ml -1.min.Kg),3,2,1 B B B + LNAME a a B + LNAME A. PAP in NB sheep with and without L-NAME, B. PAP in NB llama with and without L-NAME, C. PVR in NB sheep with and without L-NAME, D. PVR in NB llama with and without L-NAME Significant differences p<.5 : a, vs basal; b, low-altitude vs high-altitude; c, sheep vs llama (at same altitude).

31 SYSTEMIC CIRCULATION - NEWBORN SHEEP HR (min -1 ) SAP (mmhg) SVR (mmhg.ml -1.min.Kg),4,2, * * Basal Hypoxemia Recovery HAHA SLSL Time (min) p<.5, vs basal, * vs RNTB.

32 FEMORAL CIRCULATION - NEWBORN SHEEP 1 HYPOXEMIA FBF (ml min -1 kg -1 ) 5 HAHA SLSL 3 FVR (mmhg ml -1 min kg) TIME (min)

33 POSSIBLE MECHANISMS INVOLVED IN THE PULMONARY VESSEL RESPONSES TO CHRONIC HYPOXIA NITRIC OXIDE CARBON MONOXIDE sgc AND PDE; cgmp PROSTACYCLIN AND THROMBOXANE ENDOTHELINS OTHERS

34 GUANYLATE CYCLASE MECHANISMS OF SMOOTH MUSCLE RELAXATION

35 Figure 2 Herrera EA et al A. 1 B. 1 mrna enos/β-actin (arbitrary units),75,5,25 enos/β-actin (arbitrary units),75,5,25 6 SLSH HLSH SLLL HLLL C. D. 1 SLSH HLSH SLLL HLLL L-citruline formation (pmol.μg prot -1.3 min -1 ) sgc/β-actin (arbitrary units),75,5,25 SLSH HLSH SLLL HLLL SLSH HLSH SLLL HLLL A. RT-PCR of enos, B. Western blot of enos, C. NOS total activity, D. Western blot of sgc Significant differences p<.5 : a, vs basal; b, low-altitude vs high-altitude; c, sheep vs llama (at same altitude).

36 Figure 3 Herrera EA et al A. B. 1,5 1,5 mrna HO-1/β-actin (arbitrary units) 1,5 mrna HO-2/β-actin (arbitrary units) 1,5 SLSH HLSH SLLL HLLL C. 1 D. 1,5 SLSH HLSH SLLL HLLL HO-1/β-actin (arbitrary units),75,5,25 HO-2/β-actin (arbitrary units) 1,5 SLSH HLSH SLLL HLLL SLSH HLSH SLLL HLLL A. RT-PCR of HO-1, B. RT-PCR of HO-2, C. Western blot of HO-1, D. Western blot of HO-2. Significant differences p<.5 : a, vs basal; b, low-altitude vs high-altitude; c, sheep vs llama (at same altitude).

37 mrna expression for COX-1 and 2 in lung from low (STGO) and high altitude (PUTRE) newborn sheep COX-1 COX-2 COX-1 /β actin 2 1 STGO PUTRE COX-2 /β actin 6 3 STGO * PUTRE * p<.1 vs STGO

38 SUMMARY HIGH ALTITUDE NEWBORN LAMBS HAD PULMONARY HYPERTENSION WITH INCREASED PULMONARY VASCULAR RESISTANCE WHEN COMPARED TO LOWLAND NEWBORN LAMBS. HIGH ALTITUDE NEWBORN LAMBS HAD AN IMPORTANT NITRIC OXIDE TONE IN THE PULMONARY CIRCULATION NEWBORN LAMBS NATIVE TO HIGH ALTITUDE SHOW INCREASED CARDIAC OUTPUT AND LOWER SYSTEMIC VASCULAR RESISTANCE THAN LOWLAND NEWBORN SHEEP. FEMORAL BLOOD FLOW DECREASED AND FEMORAL VASCULAR RESISTANCE INCREASED BRISKLY DURING HYPOXIA IN HIGH ALTITUDE NEWBORN LAMBS.

39 SUMMARY (cont) enos EXPRESSION MEASURED BY WESTERN BLOT, IS DECREASED IN THE LUNG OF HIGHLAND NEWBORN SHEEP. NEVERTHELESS IS ACTIVITY IS INCREASED sgc, HO-1, EXPRESSION MEASURED BY WESTERN BLOT, IS DECREASED IN THE LUNG OF HIGHLAND NEWBORN SHEEP COX-2 mrna EXPRESSION, ENZYMES INVOLVED IN THE PRODUCTION OF SEVERAL PG, AMONG THEM PGI 2 ARE REDUCED IN THE LUNG OF HIGHLAND NEWBORN SHEEP

40 SINCE CHRONIC HYPOXIA MODIFIES THE CONTRACTILE CAPACITY OF SMALL ARTERIES, WE STUDIED THIS VARIABLE IN SMALL RESISTANCE ARTERIES OF HIGHLAND AND LOWLAND NEWBORN SHEEP

41 HYPOTHESIS IN HIGHLAND NEWBORN SHEEP SMALL ARTERIES FROM THE PULMONARY AND SYSTEMIC CIRCULATION HAVE A HIGHER CONTRACTILE CAPACITY THAN SMALL ARTERIES IN LOWLAND NEWBORN SHEEP AIM TO STUDY IN PULMONARY AND FEMORAL SMALL ARTERIES FROM HIGHLAND AND LOWLAND NEWBORN SHEEP Ex vivo RESPONSES POTASSIUM CHLORIDE NOREPINEPHRINE SODIUM NITROPRUSSIDE

42 PULMONARY ARTERIES RESPONSE TO KCl 3, Tension, % K MAX % Kmax pd2 2, 1,, 2, 1,, LLNB HLNB KCl, mm p<.5 vs LLNB

43 PULMONARY ARTERIES RESPONSE TO SODIUM NITROPRUSSIDE 1 Tension, % K MAX 5 pd2 7,5 5, 2,5, LLNB HLNB Log [SNP], M p<.5 vs LLNB

44 Tension, % K MAX FEMORAL ARTERIES RESPONSE TO KCl % Kmax pd2 15, 1, 5,, 2, 1, , LLNB HLNB KCl, mm p<.5 vs LLNB

45 FEMORAL ARTERIES RESPONSE TO NOREPINEPHRINE 15 Tension, % K MAX Log [NE], M % Kmax pd LLNB p<.5 HLNB vs LLNB

46 FEMORAL ARTERIES RESPONSE TO PHENYLEPHRINE 1 % Kmax 5 15 Tension, % K MAX 1 5 pd2 6 3 LLNB HLNB Log [PE], M p<.5 vs LLNB

47 FEMORAL ARTERIES RESPONSE TO SODIUM NITROPRUSSIDE 1 Tension, % K MAX 5 pd2 7,5 5 2,5 LLNB HLNB Log [SNP], M p<.5 vs LLNB

48 CONCLUSIONS 1.- IN THE PULMONARY ARTERIES, HIGHLAND NEWBORN SHEEP SHOW A GREATER CONTRACTILE CAPACITY THAN LOWLAND NEWBORN SHEEP. 2.- IN THE FEMORAL ARTERIES, HIGHLAND NEWBORN SHEEP SHOW A LOWER CONTRACTILE CAPACITY THAN LOWLAND NEWBORN SHEEP, WITH A MAJOR ROLE OF ADRENERGIC- DEPENDENT MECHANISMS. 3.- IN PULMONARY AND FEMORAL ARTERIES, HIGHLAND NEWBORN SHEEP SHOW A GREATER SENSITIVITY TO SNP THAN LOWLAND NEWBORN SHEEP, CONSISTENT WITH AN INCREASED ACTIVITY OF NOS AND THE ROLE OF NO IN THE CONTROL OF THE PULMONARY AND PERIPHERAL VASCULAR BEDS IN THE NEWBORN LAMB OF THE ANDEAN ALTIPLANO.

49 WHICH IS THE PITUITARY-ADRENAL AXIS FUNCTION IN CHRONICALLY HYPOXIC NEWBORN LAMBS? WE INITIALLY MEASURED ACTH AND CORTISOL PLASMA CONCENTRATION BASALLY AND DURING A SUPERIMPOSED EPISODE OF ACUTE HYPOXIA

50 NEWBORN SHEEP IN LOW AND HIGH ALTITUDES CORTISOL RESPONSE TO HYPOXIA Cortisol (ng/ml) 8 4 SLSL HAHA Mean baseline H15 H45 R45 Time

51 HIGH AND LOW ALTITUDE NEWBORN LAMBS 25 HAHA 25 SLSL Cortisol (ng/ml) Cortisol (ng/ml) ACTH (pg/ml) ACTH (pg/ml)

52 THE CORTISOL RESPONSE TO ACTH IS BLUNTED IN THE HIGH ALTITUDE NEWBORN SHEEP WHETHER THE ADRENAL FUNCTION REMAINED ALTERED LATER IN LIFE NEEDS TO BE INVESTIGATED AS WELL AS THE MECHANISMS PRODUCING THIS BLUNTING

53 I HAVE SHOWED YOU EFFECTS OF HIGH ALTITUDE CHRONIC HYPOXIA ON INFANT BIRTH WEIGHT AND INFANT OXIGENATION I HAVE ALSO SHOWED YOU EFFECTS OF HIGH ALTITUDE CHRONIC HYPOXIA ON ANIMAL BIRTH WEIGHT, CARDIOVASCULAR AND ENDOCRINE FUNCTION WHETHER THESE CHANGES INDUCED BY CHRONIC HYPOXIA CAN PROGRAMME FETAL ORIGINS OF ADULT DISEASE REMAINS TO BE ELUCIDATED

PULMONARY HYPERTENSION IN HIGH ALTITUDE NEWBORNS

ALFA-HAPPOM, DECEMBER 3, 25-LYON, FRANCE PULMONARY HYPERTENSION IN HIGH ALTITUDE NEWBORNS ANÍBAL LLANOS M.D. Laboratorio de Fisiología y Fisiopatología del Desarrollo Programa de Fisiopatología, ICBM,