Decrease in exhaled hydrogen as marker of congestive heart failure

Changes in the negative logarithm of end-tidal hydrogen partial pressure indicate the variation of electrode potential in healthy Japanese subjects

Molecular hydrogen (H2) is produced by human colon microbiomes and exhaled. End-tidal H2 sampling is a simple method of measuring alveolar H2. The logarithm of the hydrogen ion (H+)/H2 ratio suggests the electrode potential in the solution according to the Nernst equation. As pH is defined as the negative logarithm of the H+ concentration, pH2 is defined as the negative logarithm of the H2 effective pressure in this study. We investigated whether changes in pH2 indicated the variation of electrode potential in the solution and whether changes in end-tidal pH2 could be measured using a portable breath H2 sensor. Changes in the electrode potential were proportional to ([Formula: see text]) in phosphate-buffered solution (pH = 7.1). End-tidal H2 was measured in the morning (baseline) and at noon (after daily activities) in 149 healthy Japanese subjects using a handheld H2 sensor. The median pH2 at the baseline was 4.89, and it increased by 0.15 after daily activities. The variation of electrode potential was obtained by multiplying the pH2 difference, which suggested approximately + 4.6 mV oxidation after daily activities. These data suggested that changes in end-tidal pH2 indicate the variation of electrode potential during daily activities in healthy human subjects.

The Effect of Molecular Hydrogen on Functional States of Erythrocytes in Rats with Simulated Chronic Heart Failure

Molecular hydrogen has an anti-inflammatory and cardioprotective effect, which is associated with its antioxidant properties. Erythrocytes are subjected to oxidative stress in pathologies of the cardiovascular system, which is the cause of a violation of the gas transport function of blood and microcirculation. Therefore, our aim was to investigate the effects of H₂ inhalation on the functional states of red blood cells (RBCs) in chronic heart failure (CHF) in rats. The markers of lipid peroxidation, antioxidant capacity, electrophoretic mobility of erythrocytes (EPM), aggregation, levels of adenosine triphosphate (ATP) and 2,3-diphosphoglyceric acid (2,3-DPG), hematological parameters were estimated in RBCs. An increase in EPM and a decrease in the level of aggregation were observed in groups with multiple and single H₂ application. The orientation of lipoperoxidation processes in erythrocytes was combined with the dynamics of changes in oxidative processes in blood plasma, it was observed with both single and multiple exposures, although the severity of the changes was greater with multiple H₂ inhalations. Probably, the antioxidant effects of molecular hydrogen mediate its metabolic action. Based on these data, we conclude the use of H₂ improves microcirculation and oxygen transport function of blood and can be effective in the treatment of CHF.

Influence of Milk on Exhaled Carbon Monoxide (CO) Measurement by Portable CO Monitors

Background

A portable breath carbon monoxide (CO) monitor has a high cross-sensitivity to hydrogen (H₂). This study examined the influences of H₂ after consuming milk on the detected CO values using three types of portable CO monitors.

Materials and Methods

Exhaled breath from seven participants (four healthy nonsmokers and three smokers with otherwise unknown comorbidities) was collected in sampling bags. The participants then consumed 200 mL of milk, and the exhaled breath of each was collected in separate bags every 30 minutes until 9 hours later. CO and H₂ in the bag were measured using a gas chromatograph as a reference analyzer, and CO was also measured using three types of portable CO monitors.

Results

After consuming milk, H₂ levels were significantly higher, and CO levels were not significantly elevated as measured by the reference analyzer. However, CO levels in monitors A and B were significantly elevated, even though participants did not smoke. The H₂ levels in the reference analyzer significantly increased and reached a maximum 4.5 hours after consuming milk. The difference in CO levels between the reference analyzer and each monitor increased significantly after 5 or 5.5 hours.

Conclusions

This study suggested that the breath CO monitors with a cross-sensitivity to H₂ responded to H₂ as CO in the exhaled gas and measured higher than actual values after milk consumption. The extent of the influence of H₂ differed depending on the type of CO monitor. It is necessary to consider milk consumption when assessing the smoking status of people using portable CO monitors.

Modification of baseline status to improve breath tests performance

Breath tests used to evaluate carbohydrates malabsorption require baseline H₂ and CH₄ levels as low as possible. Test cancellation is recommended when exceeding certain cut-offs (H₂ ≥ 20 ppm and CH₄ ≥ 10 ppm). Although following preparation protocols, many patients have baseline levels above those cut-offs. We investigated if light walking can reduce baseline H₂ and CH₄ levels. We retrospectively analyzed baseline H₂ and CH₄ levels from 1552 breath tests. Baseline levels (B1), especially in H₂, were lower when obtained at later hours of the day. In those with baseline levels above cut-off, re-sampling (B2) after light walking for one hour, decreased H₂ levels 8 ppm (Q1–Q3: 1–18 ppm), and 2 ppm (Q1–Q3: 0–3 ppm) for CH₄. Consequently, 40% of tests with elevated B1 levels, presented B2 levels below mentioned cut-offs. Ten percent of tests considered negative when using B1 for calculations, turned positive when using B2 instead. All positive tests when using B1 values, remained elevated when using B2. Re-sampling after light walking for one hour could allow test performance in those with previous elevated baseline levels, avoiding diagnosis delays. Using the second sample for delta calculations identifies positive patients for malabsorption that would have been considered negative.

Role of Molecular Hydrogen in Ageing and Ageing-Related Diseases

Ageing is a physiological process of progressive decline in the organism function over time. It affects every organ in the body and is a significant risk for chronic diseases. Molecular hydrogen has therapeutic and preventive effects on various organs. It has antioxidative properties as it directly neutralizes hydroxyl radicals and reduces peroxynitrite level. It also activates Nrf2 and HO-1, which regulate many antioxidant enzymes and proteasomes. Through its antioxidative effect, hydrogen maintains genomic stability, mitigates cellular senescence, and takes part in histone modification, telomere maintenance, and proteostasis. In addition, hydrogen may prevent inflammation and regulate the nutrient-sensing mTOR system, autophagy, apoptosis, and mitochondria, which are all factors related to ageing. Hydrogen can also be used for prevention and treatment of various ageing-related diseases, such as neurodegenerative disorders, cardiovascular disease, pulmonary disease, diabetes, and cancer. This paper reviews the basic research and recent application of hydrogen in order to support hydrogen use in medicine for ageing prevention and ageing-related disease therapy.

Direct Targets and Subsequent Pathways for Molecular Hydrogen to Exert Multiple Functions: Focusing on Interventions in Radical Reactions

Molecular hydrogen (H₂) was long regarded as non-functional in mammalian cells. We overturned the concept by demonstrating that H₂ exhibits antioxidant effects and protects cells against oxidative stress. Subsequently, it has been revealed that H₂ has multiple functions in addition to antioxidant effects, including antiinflammatory, anti-allergic functions, and as cell death and autophagy regulation. Additionally, H₂ stimulates energy metabolism. As H₂ does not readily react with most biomolecules without a catalyst, it is essential to identify the primary targets with which H₂ reacts or interacts directly. As a first event, H₂ may react directly with strong oxidants, such as hydroxyl radicals (•OH) in vivo. This review addresses the key issues related to this in vivo reaction. •OH may have a physiological role because it triggers a free radical chain reaction and may be involved in the regulation of Ca2+- or mitochondrial ATP-dependent K+-channeling. In the subsequent pathway, H₂ suppressed a free radical chain reaction, leading to decreases in lipid peroxide and its end products. Derived from the peroxides, 4-hydroxy-2-nonenal functions as a mediator that up-regulates multiple functional PGC-1α. As the other direct target in vitro and in vivo, H₂ intervenes in the free radical chain reaction to modify oxidized phospholipids, which may act as an antagonist of Ca2+-channels. The resulting suppression of Ca2+-signaling inactivates multiple functional NFAT and CREB transcription factors, which may explain H₂ multi-functionality. This review also addresses the involvement of NFAT in the beneficial role of H₂ in COVID-19, Alzheimer's disease and advanced cancer. We discuss some unsolved issues of H₂ action on lipopolysaccharide signaling, MAPK and NF-κB pathways and the Nrf2 paradox. Finally, as a novel idea for the direct targeting of H2, this review introduces the possibility that H₂ causes structural changes in proteins via hydrate water changes.

Hydrogen: An Endogenous Regulator of Liver Homeostasis

Basic and clinical studies have shown that hydrogen (H₂), the lightest gas in the air, has significant biological effects of anti-oxidation, anti-inflammation, and anti-apoptosis. The mammalian cells have no abilities to produce H₂ due to lack of the expression of hydrogenase. The endogenous H₂ in human body is mainly produced by anaerobic bacteria, such as Firmicutes and Bacteroides, in gut and other organs through the reversible oxidation reaction of 2 H⁺ + 2 e^- ⇌ H₂. Supplement of exogenous H₂ can improve many kinds of liver injuries, modulate glucose and lipids metabolism in animal models or in human beings. Moreover, hepatic glycogen has strong ability to accumulate H₂, thus, among the organs examined, liver has the highest concentration of H₂ after supplement of exogenous H₂ by various strategies in vivo. The inadequate production of endogenous H₂ play essential roles in brain, heart, and liver disorders, while enhanced endogenous H₂ production may improve hepatitis, hepatic ischemia and reperfusion injury, liver regeneration, and hepatic steatosis. Therefore, the endogenous H₂ may play essential roles in maintaining liver homeostasis.

H2 Protects Against Lipopolysaccharide-Induced Cardiac Dysfunction via Blocking TLR4-Mediated Cytokines Expression

Background and Purpose: Septic cardiomyopathy, which is one of the features of multi-organ dysfunction in sepsis, is characterized by ventricular dilatation, reduced ventricular contractility, and reduction in ejection fraction and, if severe, can lead to death. To date, there is no specific therapy that exists, and its treatment represents a large unmet clinical need. Herein, we investigated the effects and underlying anti-inflammatory mechanisms of hydrogen gas in the setting of lipopolysaccharide (LPS)-induced cardiomyocytes injury.

Experimental Approach: Hydrogen gas was intraperitoneally injected to mice in LPS plus hydrogen group and hydrogen group for 4 days. On fourth, LPS was given by intraperitoneal injection to mice in LPS group and to mice in LPS plus hydrogen group. In addition, H9c2 cardiomyocytes were treated with hydrogen-rich medium for 30 min before LPS. The transthoracic echocardiography was performed at 6 h post‐LPS to assess left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (EF%), fractional shortening (FS%), left ventricular mass average weight (LV mass AW), and LV mass AW (Corrected). The histological and morphological analyses of left ventricular were performed by hematoxylin and eosin (H&E) staining and Masson’s trichrome staining. The mRNA levels of ANP and BNP were examined by PCR in vitro. The expression of cytokines were assayed by Enzyme Linked Immunosorbent Assay (ELISA) and PCR. Moreover, Western blotting was performed to examine the expression of TLR4, the activation of ERK1/2, p38, JNK, and the expression of NF-κB in nucleus after 6 h of LPS challenge in vivo and in vitro.

Key Results: LPS induced cardiac dysfunction; hydrogen therapy improved cardiac function after LPS challenge. Furthermore, pretreatment with hydrogen resulted in cardioprotection during septic cardiomyopathy via inhibiting the expression of pro-inflammatory cytokines TNFα, IL-1β, and IL-18; suppressing the phosphorylation of ERK1/2, p38, and JNK; and reducing the nuclear translocation of NF-κB and the expression of TLR4 by LPS.

Conclusion and Implications: Hydrogen therapy prevents LPS-induced cardiac dysfunction in part via downregulation of TLR4-mediated pro-inflammatory cytokines expression.