Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress

Abstract Hypoxia is increasingly recognized as an important physiological driving force. A specific transcriptional program, induced by a decrease in oxygen (O2) availability, for example, inspiratory hypoxia at high altitude, allows cells to adapt to lower O2 and limited energy metabolism. This tra...

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Main Authors: Hannelore Ehrenreich, Max Gassmann, Luise Poustka, Martin Burtscher, Peter Hammermann, Anna‐Leena Sirén, Klaus‐Armin Nave, Kamilla Miskowiak
Format: Article
Language:English
Published: Wiley 2023-09-01
Series:Neuroprotection
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Online Access:https://doi.org/10.1002/nep3.15
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author Hannelore Ehrenreich
Max Gassmann
Luise Poustka
Martin Burtscher
Peter Hammermann
Anna‐Leena Sirén
Klaus‐Armin Nave
Kamilla Miskowiak
author_facet Hannelore Ehrenreich
Max Gassmann
Luise Poustka
Martin Burtscher
Peter Hammermann
Anna‐Leena Sirén
Klaus‐Armin Nave
Kamilla Miskowiak
author_sort Hannelore Ehrenreich
collection DOAJ
description Abstract Hypoxia is increasingly recognized as an important physiological driving force. A specific transcriptional program, induced by a decrease in oxygen (O2) availability, for example, inspiratory hypoxia at high altitude, allows cells to adapt to lower O2 and limited energy metabolism. This transcriptional program is partly controlled by and partly independent of hypoxia‐inducible factors. Remarkably, this same transcriptional program is stimulated in the brain by extensive motor‐cognitive exercise, leading to a relative decrease in O2 supply, compared to the acutely augmented O2 requirement. We have coined the term “functional hypoxia” for this important demand‐responsive, relative reduction in O2 availability. Functional hypoxia seems to be critical for enduring adaptation to higher physiological challenge that includes substantial “brain hardware upgrade,” underlying advanced performance. Hypoxia‐induced erythropoietin expression in the brain likely plays a decisive role in these processes, which can be imitated by recombinant human erythropoietin treatment. This article review presents hints of how inspiratory O2 manipulations can potentially contribute to enhanced brain function. It thereby provides the ground for exploiting moderate inspiratory plus functional hypoxia to treat individuals with brain disease. Finally, it sketches a planned multistep pilot study in healthy volunteers and first patients, about to start, aiming at improved performance upon motor‐cognitive training under inspiratory hypoxia.
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spelling doaj-art-18eb684a1f3e4f4f8a82ae2db81837d72025-08-20T02:40:29ZengWileyNeuroprotection2770-72962770-730X2023-09-0111556510.1002/nep3.15Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progressHannelore Ehrenreich0Max Gassmann1Luise Poustka2Martin Burtscher3Peter Hammermann4Anna‐Leena Sirén5Klaus‐Armin Nave6Kamilla Miskowiak7Clinical Neuroscience, Max Planck Institute for Multidisciplinary Sciences Göttingen GermanyInstitute of Veterinary Physiology and Zürich Center for Integrative Human Physiology University of Zürich Zürich SwitzerlandDepartment of Child and Adolescent Psychiatry and Psychotherapy University Medical Center Göttingen Göttingen GermanyFaculty of Sports Science University of Innsbruck Innsbruck AustriaHBL Investmentpartners GmbH München‐Frankfurt GermanyDepartments of Neurophysiology and Neurosurgery University of Würzburg Würzburg GermanyDepartment of Neurogenetics Max Planck Institute for Multidisciplinary Sciences Göttingen GermanyPsychiatric Centre Copenhagen University Hospital, Rigshospitalet Copenhagen DenmarkAbstract Hypoxia is increasingly recognized as an important physiological driving force. A specific transcriptional program, induced by a decrease in oxygen (O2) availability, for example, inspiratory hypoxia at high altitude, allows cells to adapt to lower O2 and limited energy metabolism. This transcriptional program is partly controlled by and partly independent of hypoxia‐inducible factors. Remarkably, this same transcriptional program is stimulated in the brain by extensive motor‐cognitive exercise, leading to a relative decrease in O2 supply, compared to the acutely augmented O2 requirement. We have coined the term “functional hypoxia” for this important demand‐responsive, relative reduction in O2 availability. Functional hypoxia seems to be critical for enduring adaptation to higher physiological challenge that includes substantial “brain hardware upgrade,” underlying advanced performance. Hypoxia‐induced erythropoietin expression in the brain likely plays a decisive role in these processes, which can be imitated by recombinant human erythropoietin treatment. This article review presents hints of how inspiratory O2 manipulations can potentially contribute to enhanced brain function. It thereby provides the ground for exploiting moderate inspiratory plus functional hypoxia to treat individuals with brain disease. Finally, it sketches a planned multistep pilot study in healthy volunteers and first patients, about to start, aiming at improved performance upon motor‐cognitive training under inspiratory hypoxia.https://doi.org/10.1002/nep3.15brain EPO circleerythropoietinfunctional hypoxiaHIFhuman pilot studyhyperoxia
spellingShingle Hannelore Ehrenreich
Max Gassmann
Luise Poustka
Martin Burtscher
Peter Hammermann
Anna‐Leena Sirén
Klaus‐Armin Nave
Kamilla Miskowiak
Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress
Neuroprotection
brain EPO circle
erythropoietin
functional hypoxia
HIF
human pilot study
hyperoxia
title Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress
title_full Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress
title_fullStr Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress
title_full_unstemmed Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress
title_short Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress
title_sort exploiting moderate hypoxia to benefit patients with brain disease molecular mechanisms and translational research in progress
topic brain EPO circle
erythropoietin
functional hypoxia
HIF
human pilot study
hyperoxia
url https://doi.org/10.1002/nep3.15
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