Normobaric Oxygen Paradox (NOP) PDF

Normobaric Oxygen Paradox (NOP) From diving to patient bed care Professeur Pierre Lafère, MD-PhD Laboratoire ORPHY, EA4324 Introduction Erythropoïétine Introduction Dopage à l’EPO ì Hb et Htc 10% ì VO2 Max 6 à 8% ì TÉpuisement 13 à 17% Cardio-protection Neuro-protection ...

Normobaric Oxygen Paradox (NOP) From diving to patient bed care Professeur Pierre Lafère, MD-PhD Laboratoire ORPHY, EA4324 Introduction Erythropoïétine Introduction Dopage à l’EPO ì Hb et Htc 10% ì VO2 Max 6 à 8% ì TÉpuisement 13 à 17% Cardio-protection Neuro-protection  Condition normale Normoxie vs hypoxie Prolyl-Hydroxylase OH Ub GSH OH HIF1-α OH OH HIF1-α VHL GS- OH SG Noyau HIF1-α EPO HIF1-α β GSH HIF1-α Adaptation métabolique Approche par le GSH Nobel prize physiology and medicine - 2019 Autres Stimulus? Hcrt an Hb Values in 7 apneists after 5 days of practice (Apnea Academy) 45 NS 114% 17.5 40 ** 15.0 35 Haematocrit (%) 12.5 30 Hb Value 25 10.0 20 7.5 15 5.0 10 5 2.5 0 0.0 b e r e fte or H or ef ef A B B t cr t cr H H  ΔPtO2 Hypoxique? Descente Remontée Normoxie ì P = ΣPi î PO2 PO2 Hyperoxie Hyperoxie Normobarique Hyperoxie Hyperbarique  Percentual variation from control group 180 *** % from control group 160 ** 140 * 120 Control group mean levels 100 80 NOB OHB 60 40 * ** ** 0 4 8 12 16 20 24 28 32 36 time (h) The Abyss Project 2008 Serum EPO levels after several days at 9 m depth in water habitat (The Abyss project) n = 6 150 *** s-EPO % of control value 100 *** 50 *** *** 0 ys ys ve st st po da di da po e h 7 14 h pr 24 2 Immersion days  Percentual variation from control group Condition normale 180 *** % from control group 160 ** Normoxie vs hypoxie 140 * 120 Control group mean levels 100 80 NOB OHB 60 40 * ** OH Ub 0 4 8 ** 12 16 20 24 28 32 36 GSH time (h) OH HIF1-α OH OH HIF1-α VHL GS- OH SG Noyau HIF1-α EPO HIF1-α β GSH HIF1-α  Normobaric Hyperoxia Normoxia vs Hyperoxia Prolyl-Hydroxylase OH Ub GSH OH OH OHOH HIF1-α + OH OH OH HIF1-α VHL GS-OH GS- OH SGGS- SG SG Noyau HIF1- α OH EPO HIF1-α β GS- OH HIF1-α SG GSH GSH GSH  Hyperbaric hyperoxia Normoxia vs Superoxia Prolyl-Hydroxylase OH Ub GSH OH OH + OHOH OH HIF1-α + OH OH OH OH HIF1-α VHL GS-OH GS- OH SGGS- SG SG Noyau HIF1- α OH OH OH OH EPO HIF1-α β GS- GS- OH HIF1-α SG GSH SG GSH GSH HUVEC Cell What about Hemoglobin? Hb Variation after 100% O2 breathing (30 minutes every other day) 125 Control (n=12) 120 (compressed air % of control value breathing) 115 100% (n=18) 110 15% (n=12) 105 32% (n=12) 100 95 90 e 2 4 6 da 8 da 4 20 D 0 D 7 pr 1 1 1 y y y y da da da da ay ay y y day 14 m eans 4 days after cessation of NOB Whhat about Hemoglobin? Relative hypoxia Rule of proportionality  Et le Patient… Cas cliniques Hemoglobin level 15 14 13 Hb g/dl 12 11 10 Arrêt 9 de NOB 0 25 l’O 50 2 75 100 125 Days of treatement  Hb increase tendency 16 y=0.05 x + 9.4 R² = 0.79 Hb levels (g/dl) 14 p