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Webb KL, Gorman EK, Morkeberg OH, Klassen SA, Regimbal RJ, Wiggins CC, Joyner MJ, Hammer SM, Senefeld JW. The relationship between hemoglobin and [Formula: see text]: A systematic review and meta-analysis. PLoS One 2023; 18:e0292835. [PMID: 37824583 PMCID: PMC10569622 DOI: 10.1371/journal.pone.0292835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake ([Formula: see text]) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin and [Formula: see text]. Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) and [Formula: see text] (absolute and relative [Formula: see text]) among both observational and interventional studies. METHODS A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels and [Formula: see text] values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels and [Formula: see text] values. For interventional studies, meta-analysis models were performed to determine the change in [Formula: see text] values (standard paired difference) associated with interventions designed to modify hemoglobin levels or [Formula: see text]. Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change in [Formula: see text] values. RESULTS Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absolute [Formula: see text] and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absolute [Formula: see text] (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)). CONCLUSION These findings suggest that [Formula: see text] values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.
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Affiliation(s)
- Kevin L. Webb
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ellen K. Gorman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Olaf H. Morkeberg
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephen A. Klassen
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Riley J. Regimbal
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Shane M. Hammer
- Department of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, Oklahoma, United States of America
| | - Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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2
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Gasier HG, Suliman HB, Piantadosi CA. The HO-1/CO System and Mitochondrial Quality Control in Skeletal Muscle. Exerc Sport Sci Rev 2021; 50:49-55. [PMID: 34690283 DOI: 10.1249/jes.0000000000000277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Inducible heme oxygenase (HO)-1 catalyzes the breakdown of heme to biliverdin, iron and carbon monoxide (CO). CO binds to cytochrome c oxidase and alters mitochondrial redox balance and coordinately regulates mitochondrial quality control (MQC) during oxidant stress and inflammation. The hypothesis presented is that skeletal muscle HO-1/CO system helps modulate components in the MQC cycle during metabolic stress.
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Affiliation(s)
- Heath G Gasier
- Department of Anesthesiology Department of Pathology Department of Medicine, Duke University Medical Center, Durham, NC
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3
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SCHMIDT WALTERFJ, HOFFMEISTER TORBEN, HAUPT SANDRA, SCHWENKE DIRK, WACHSMUTH NADINEB, BYRNES WILLIAMC. Chronic Exposure to Low-Dose Carbon Monoxide Alters Hemoglobin Mass and V˙O2max. Med Sci Sports Exerc 2020; 52:1879-1887. [DOI: 10.1249/mss.0000000000002330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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4
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Goebel U, Wollborn J. Carbon monoxide in intensive care medicine-time to start the therapeutic application?! Intensive Care Med Exp 2020; 8:2. [PMID: 31919605 PMCID: PMC6952485 DOI: 10.1186/s40635-020-0292-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/05/2020] [Indexed: 12/18/2022] Open
Abstract
Carbon monoxide (CO) is not only known as a toxic gas due to its characteristics as an odorless molecule and its rapid binding to haem-containing molecules, thus inhibiting the respiratory chain in cells resulting in hypoxia. For decades, scientists established evidence about its endogenously production in the breakdown of haem via haem-oxygenase (HO-1) and its physiological effects. Among these, the modulation of various systems inside the body are well described (e.g., anti-inflammatory, anti-oxidative, anti-apoptotic, and anti-proliferative). Carbon monoxide is able to modulate several extra- and intra-cellular signaling molecules leading to differentiated response according to the specific stimulus. With our growing understanding in the way CO exerts its effects, especially in the mitochondria and its intracellular pathways, it is tempting to speculate about a clinical application of this substance. Since HO-1 is not easy to induce, research focused on the application of the gaseous molecule CO by itself or the implementation of carbon monoxide releasing molecules (CO-RM) to deliver the molecule at a time- and dose dependently safe way to any target organ. After years of research in cellular systems and animal models, summing up data about safety issues as well as possible target to treat in various diseases, the first feasibility trials in humans were established. Up-to-date, safety issues have been cleared for low-dose carbon monoxide inhalation (up to 500 ppm), while there is no clinical data regarding the injection or intake of any kind of CO-RM so far. Current models of human research include sepsis, acute lung injury, and acute respiratory distress syndrome as well as acute kidney injury. Carbon monoxide is a most promising candidate in terms of a therapeutic agent to improve outbalanced organ conditions. In this paper, we summarized the current understanding of carbon monoxide’s biology and its possible organ targets to treating the critically ill patients in tomorrow’s ICU.
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Affiliation(s)
- Ulrich Goebel
- Department of Anaesthesiology and Critical Care, St. Franziskus-Hospital, Hohenzollernring 70, 48145, Münster, Germany.
| | - Jakob Wollborn
- Department of Anaesthesiology and Critical Care, Medical Centre - University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany
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5
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Goodrich JA, Frisco DJ, Ryan SPP, Newman AA, Trikha SRJ, Braun B, Bell C, Byrnes WC. Intermittent low dose carbon monoxide inhalation does not influence glucose regulation in overweight adults: a randomized controlled crossover trial. Exp Physiol 2020; 105:460-467. [PMID: 31912958 DOI: 10.1113/ep088329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/03/2020] [Indexed: 01/03/2023]
Abstract
NEW FINDINGS What is the central question of this study? Low dose carbon monoxide (CO) inhalation plays a role in regulating proteins involved in glucose metabolism; does low dose CO improve glucose and insulin responses to an oral glucose tolerance test in overweight adults? What is the main finding and its importance? Five days of intermittent CO inhalation does not alter the glucose or insulin responses to ingestion of a glucose bolus in overweight adults. Low dose CO is utilized in various physiological assessment procedures; these findings allow researchers and clinicians to utilize these procedures without concern of altering glucose metabolism. ABSTRACT Low dose carbon monoxide (CO) inhalation upregulates several proteins important for glucose metabolism. Such changes could be clinically significant and may be relevant to those who use CO as a research tool. We hypothesized that low dose CO inhalation would improve glucose and insulin responses to an oral glucose bolus in overweight humans. Eleven young adults (5 men, 6 women; body mass index: 25-35 kg m-2 ) were included in this randomized, placebo-controlled, single-blinded crossover study. Following screening, participants completed two 7-day protocols with a 4-week washout. Twenty-four hours prior to and following five consecutive days of either once daily CO (men: 1.2 ml (kg body mass)-1 ; women: 1.0 ml (kg body mass)-1 ) or placebo (room air) inhalation, participants underwent oral glucose tolerance tests (OGTT). For key outcome variables, there were no significant main effects or interactions across condition or time point (mean ± SD), including fasting glucose (mg dl-1 : pre-placebo: 85.2 ± 10.1; post-placebo: 82.9 ± 10.6; pre-CO: 83.6 ± 7.7; post-CO: 84.0 ± 9.0), 2 h post glucose (mg dl-1 : pre-placebo: 100.9 ± 20.0; post-placebo: 98.7 ± 13.1; pre-CO: 94.2 ± 23.2; post-CO: 94.4 ± 14.9), or the Matsuda index (pre-placebo: 16.1 ± 11.5; post-placebo: 20.3 ± 24.7; pre-CO: 15.6 ± 15.3; post-CO: 17.5 ± 16.8). In conclusion, 5 days of low dose CO administration did not influence glucose and insulin responses to an OGTT in overweight adults. Low dose CO inhalation is utilized in a variety of physiological assessment procedures; these findings allow researchers to utilize these procedures without concern of altering glucose metabolism.
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Affiliation(s)
- J A Goodrich
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - D J Frisco
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - S P P Ryan
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - A A Newman
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - S R J Trikha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - B Braun
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - C Bell
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - W C Byrnes
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
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6
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Muller PDT, Barbosa GW, O'Donnell DE, Neder JA. Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease. Front Physiol 2019; 10:859. [PMID: 31354517 PMCID: PMC6635481 DOI: 10.3389/fphys.2019.00859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
Smoking and physical inactivity are important preventable causes of disability and early death worldwide. Reduced exercise tolerance has been described in smokers, even in those who do not fulfill the extant physiological criteria for chronic obstructive pulmonary disease (COPD) and are not particularly sedentary. In this context, it is widely accepted that exercise capacity depends on complex cardio-pulmonary interactions which support oxygen (O2) delivery to muscle mitochondria. Although peripheral muscular factors, O2 transport disturbances (including the effects of increased carboxyhemoglobin) and autonomic nervous system unbalance have been emphasized, other derangements have been more recently described, including early microscopic emphysema, pulmonary microvascular disease, ventilatory and gas exchange inefficiency, and left ventricular diastolic dysfunction. Using an integrative physiological approach, the present review summarizes the recent advances in knowledge on the effects of smoking on the lung-heart-muscle axis under the stress of exercise. Special attention is given to the mechanisms connecting physiological abnormalities such as early cardio-pulmonary derangements, inadequate oxygen delivery and utilization, and generalized bioenergetic disturbances at the muscular level with the negative sensations (sense of heightened muscle effort and breathlessness) that may decrease the tolerance of smokers to physical exercise. A deeper understanding of the systemic effects of smoking in subjects who did not (yet) show evidences of COPD and ischemic heart disease - two devastating smoking related diseases - might prove instrumental to fight their ever-growing burden.
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Affiliation(s)
- Paulo de Tarso Muller
- Laboratory of Respiratory Pathophysiology, Respiratory Division, Department of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Gisele Walter Barbosa
- Laboratory of Respiratory Pathophysiology, Respiratory Division, Department of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology, Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Respiratory Investigation Unit, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
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7
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Wang J, Ji Y, Zhou L, Xiang Y, Heinonen I, Zhang P. A New Method to Improve Running Economy and Maximal Aerobic Power in Athletes: Endurance Training With Periodic Carbon Monoxide Inhalation. Front Physiol 2019; 10:701. [PMID: 31244675 PMCID: PMC6562501 DOI: 10.3389/fphys.2019.00701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/20/2019] [Indexed: 11/14/2022] Open
Abstract
Background Altitude training stimulates erythropoietin hormone (EPO) release and increases blood hemoglobin (Hb) mass, which may result in improved oxygen (O2) transport capacity. It was hypothesized in the present study that periodic inhalation of carbon monoxide (CO) might elicit similar physiological adaptations compared to altitude training. Methods Twelve male college student athletes, who were well-trained soccer players, participated. They performed a 4-week treadmill-training program, five times a week. Participants were randomly assigned into an experimental group with inhaling CO (INCO) (1 mL/kg body weight for 2 min) in O2 (4 L) before all training sessions and a control group without inhaling CO (NOCO). CO and EPO concentrations in venous blood were first measured acutely at the 1st, 2nd, 4th, 6th, and 8th hour after INCO, and total hemoglobin mass (tHb), running economy and VO2max were measured before and after the 4 weeks training intervention. Results HbCO% increased from 0.7 to 4.4% (P < 0.05) after 1 h of CO inhalation and EPO increased from 1.9 to 2.7 mIU/mL after 4 h post CO inhalation (P < 0.05) acutely before the intervention. After the training, the tHb and VO2max in the INCO group increased significantly by 3.7 and 2.7%, respectively, while no significant differences were observed in the NOCO condition. O2 uptake at given submaximal speeds declined by approximately 4% in the INCO group. Conclusion Acutely, EPO increased sharply post CO inhalation, peaking at 4 h post inhalation. 4-weeks of training with CO inhalation before exercise sessions improved tHb and VO2max as well as running economy, suggesting that moderate CO inhalation could be a new method to improve the endurance performance in athletes.
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Affiliation(s)
- Jun Wang
- The Belt and Road Joint Laboratory for Winter Sports, Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Yunhui Ji
- Department of Physical Education, Shanxi Medical University, Taiyuan, China
| | - Li Zhou
- The Belt and Road Joint Laboratory for Winter Sports, Department of Exercise Physiology, Beijing Sport University, Beijing, China
| | - Yang Xiang
- School of Physical Education, Yan'an University, Yan'an, China
| | - Ilkka Heinonen
- Turku PET Centre, Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland.,Rydberg Laboratory for Applied Sciences, Department of Environmental and Biosciences, Halmstad University, Halmstad, Sweden
| | - Peng Zhang
- Department of Exercise Science, East Stroudsburg University of Pennsylvania, East Stroudsburg, PA, United States
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8
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Goodrich JA, Ryan BJ, Byrnes WC. The Influence of Oxygen Saturation on the Relationship Between Hemoglobin Mass and VO 2 max. Sports Med Int Open 2018; 2:E98-E104. [PMID: 30539125 PMCID: PMC6225968 DOI: 10.1055/a-0655-7207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/11/2018] [Accepted: 06/05/2018] [Indexed: 11/04/2022] Open
Abstract
Hemoglobin mass (tHb) is a key determinant of maximal oxygen uptake (VO
2
max). We examined whether oxyhemoglobin desaturation (ΔS
a
O
2
) at VO
2
max modifies the relationship between tHb and VO
2
max at moderate altitude (1,625 m). Seventeen female and 16 male competitive, endurance-trained moderate-altitude residents performed two tHb assessments and two graded exercise tests on a cycle ergometer to determine VO
2
max and ΔS
a
O
2
. In males and females respectively, VO
2
max (ml·kg
−1
·min
−1
) ranged from 62.5–83.0 and 44.5–67.3; tHb (g·kg
−1
) ranged from 12.1–17.5 and 9.1–13.0; and S
a
O
2
at VO
2
max (%) ranged from 81.7–94.0 and 85.7–95.0. tHb was related to VO
2
max when expressed in absolute terms and after correcting for body mass (r=0.94 and 0.86, respectively); correcting by ΔS
a
O
2
did not improve these relationships (r=0.93 and 0.83). Additionally, there was a negative relationship between tHb and S
a
O
2
at VO
2
max (r=–0.57). In conclusion, across a range of endurance athletes at moderate altitude, the relationship between tHb and VO
2
max was found to be similar to that observed at sea level. However, correcting tHb by ΔS
a
O
2
did not explain additional variability in VO
2
max despite significant variability in ΔS
a
O
2
; this raises the possibility that tHb and exercise-induced ΔS
a
O
2
are not independent in endurance athletes.
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Affiliation(s)
- Jesse A Goodrich
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
| | - Benjamin J Ryan
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
| | - William C Byrnes
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
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