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ABSTRACT
Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; COX, cytochrome c oxidase;
CXE, Caudwell Xtreme Everest; EBC, Everest Base Camp;
EM, electron microscopy; HIF-1, hypoxia inducible factor 1;
HOAD, -hydroxyacyl-CoA-dehydrogenase; mir-210, microRNA 210; NRF1, nuclear respiratory factor 1; PGC1, peroxisome proliferator activated receptor co-activator 1;
PPAR, peroxisome proliferator activated receptor ; ROS,
reactive oxygen species; UCP3, uncoupling protein 3.
0892-6638/12/0026-1431 FASEB
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Figure 1. Ascent profile of Caudwell Xtreme Everest investigator group. Laboratories where testing was performed are
labeled; intermediate altitudes indicate overnight stops without testing. Dotted line indicates base camp laboratory staff
ascent profile; continuous line indicates climbing team ascent
profile. Biopsies were taken at baseline in London for both
groups (expedition d 0). Base camp laboratory staff altitude
biopsies were taken at 530 0 m on expedition d 19. Climbing
team altitude biopsies were taken at 5300 m on expedition d 66.
were performed under aseptic conditions. A 5-mm incision
was made, and a sample of 200 mg muscle was obtained
using Tilley-Henkel forceps. Part of each biopsy was fixed in
buffered glutaraldehyde solution for EM as described previously (25), with the remainder snap-frozen in liquid N2.
Biopsies were stored in liquid N2 for transport to a commercial storage facility in the United Kingdom, where they
remained in liquid N2 until analysis.
Morphometric analysis
Fixed biopsy samples were processed and sectioned according
to standard protocols (25, 26). Tissue blocks were sectioned
using an isotropic uniform random method to obtain an
unbiased estimation of capillary length and fiber size (27).
For ultrastructural analysis, point counts were taken from 40
micrographs (at a view of 24,000), whereas for the determination of capillary length density and fiber size, they were
taken from 16 (at 1800). Note that no biopsy was fixed for
morphometry from one member of the base camp laboratory
staff for whom protein and mRNA data are reported.
Gene
Amplicon
size
ATP5b
149
NDUFS7
150
Citrate synthase
108
Cox4i2
108
Primer sequences
F: GACCCGTGAAGGCAATGAT
R: ACAGTCAGCCCAGTCAGAGC
F: CTCCCGCTTGATCTTCCTCT
R: AACGGAGGAGGCTACTACCA
F: GAGCAGGGTAAAGCCAAGAA
R: CCCAAACAGGACCGTGTAGT
F: GAGCTTGGTGCTGAGGAAAG
R: TGGGCATAGCAGTTGGTGTA
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Amplicon size
Exons
118
83
73
86
74
98
81
100
139
Hs00947538_m1
Hs00173304_m1
Hs00971639_m1
Hs01075225_m1
Hs01106052_m1
Hs99999904_m1
Hs00984230_m1
Hs99999909_m1
Hs03023943_g1
67
78
23
45
45
44
34
67
11
PPAR
Pgc1
Cox4i1
UCP2
UCP3
PPIA
B2M
HPRT
Actin
RESULTS
Biopsies were successfully taken from 6 base camp
laboratory staff and 12 climbers at sea level and EBC
(5300 m). The measured mean barometric pressure at
EBC was 53.8 kPa, giving an inspired Pio2 of 9.9 kPa. Of
the climbing team, the maximum altitudes attained
prior to the final biopsy were 6400 m (1 subject),
7100 m (1 subject), 8000 m (2 subjects), and 8848 m (8
subjects). There were no adverse complications from
the biopsies at sea level or altitude. Baseline characteristics of the subjects are summarized in Table 3. There
was no difference in age, height, body weight, or body
mass index (BMI) between the groups prior to altitude
exposure. Similarly, there was no difference in body
weight between the groups at the time of biopsy,
although the climbing team members lost 9% of their
baseline body weight after 66 d of high-altitude exposure (P0.0001). Sea-level Vo2max was not different
between the groups either before or after altitude exposure and had fallen by 31% in base camp laboratory staff
(P0.001) and by 30% in the climbing team (P0.0001)
by the time of the altitude biopsy (Table 3).
Muscle ultrastructure
Sample EM images of biopsies taken from the base
camp laboratory staff at sea level and after 19 d exposure to hypobaric hypoxia are shown in Fig. 2A, and
sample EM images of biopsies from the climbing team
n
Male gender
Previous altitude exposure (5000 m)
Age (yr)
Height (cm)
Weight (kg)
Sea level
5300 m
BMI (kg/m2)
Sea level
5300 m
Vo2max (ml/kg/min)
Sea level
5300 m
Vo2max (ml/min)
Sea level
5300 m
6
3
4
39.5 12.4
173.2 7.1
Climbing team
12
11
12
38 4.9
179.9 4.4
74.2 11.2
73.3 11.6
81.9 13.8
72.3 9.3****
24.7 2.8
24.4 3
25.2 3.6
22.3 2.2****
43.8 5.4
30.2 3.8***
46.3 8.8
32.2 2.5****
3266 760
2220 460***
3754 540
2320 300****
Age, height, body weight, body mass index (BMI), and Vo2max of base camp laboratory staff and
climbing team at sea level prior to altitude exposure and at the time of altitude biopsy. Values are
means sd. ***P 0.001, ****P 0.0001 vs. time of sea-level biopsy.
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Figure 2. Representative electron micrographs of M. vastus lateralis biopsies from members of the base camp laboratory staff (A)
and the climbing team (B) before (i) and after (ii) acclimatization to high-altitude hypoxia. m, mitochondria. Biopsies of base
camp laboratory staff were taken when unacclimatized at sea level (London) and after 19 d of high-altitude exposure at 5300 m
(EBC). Biopsies of the climbing team were taken when unacclimatized at sea level (London) and after 66 d of high-altitude
exposure following ascent 6400 m (Everest).
TABLE 4. Morphometry data from skeletal muscle biopsies in base camp laboratory staff and climbing team before and after
acclimatization to high-altitude hypoxia
Base camp staff, n 5
Parameter
London
EBC
Climbing team, n 12
Change (%)
London
5.0 0.2
4.3 0.2*
14.3
39.0
0.7 0.2
0.2 0.1*
73.1
14.7
5.7 0.3
4.5 0.2**
21.3
25.1
7.4
0.26 0.05
78.4 0.8
Everest
Change (%)
0.19 0.03
80.2 0.8
25.4
2.4
22.4
3.5
1.6
15.7 0.7
1.62 0.13
285.1 21.3
15.1 0.7
1.70 0.13
299.9 22.8
3.7
5.5
5.2
1.6
7.7
416.3 31.2
5785 353
437.9 33.2
5845 487
5.2
1.1
Biopsies were taken from 5 subjects when unacclimatized at sea level (London) and after 19 d of high-altitude exposure at 5300 m (EBC),
and from vastus lateralis of 12 subjects when unacclimatized at sea level (London) and at 5300 m after 66 d of high-altitude exposure (Everest).
Note that no biopsy was preserved for morphometry from one subject in the base camp laboratory staff group for whom protein and mRNA
data are reported. Data are shown as means sd. *P 0.05, **P 0.01 vs. London, P 0.0001 vs. base camp staff at baseline.
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Figure 3. Expression of mitochondrial proteins and metabolic regulators in base camp laboratory staff before and after 19 d
acclimatization to high-altitude hypoxia. Biopsies were taken from 6 subjects when unacclimatized at sea level (London) and
after 19 d of high-altitude exposure at 5300 m (EBC).
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Figure 4. Expression of mitochondrial proteins and metabolic regulators in the climbing team before and after 66 d
acclimatization to high-altitude hypoxia. Biopsies were taken from 12 subjects when unacclimatized at sea level (London) and
at 5300 m after 66 d of high-altitude exposure (Everest). *P 0.05 vs. London.
DISCUSSION
We have shown here that the process of metabolic
acclimatization of skeletal muscle to high altitude is
characterized by distinct patterns of changes in gene
and protein expression in subacute and more sustained
exposure to hypobaric hypoxia. The study reports a
unique combination of measurements of muscle morphometry, gene expression, protein levels, and meta-
Figure 5. Metabolic enzyme activities in M. vastus lateralis biopsies before and after acclimatization to high-altitude hypoxia.
HOAD and hexokinase activity were measured in biopsies from 5 base camp laboratory staff subjects when unacclimatized at sea
level (London) and after 19 d of high-altitude exposure at 5300 m (EBC; A) and 11 climbing team subjects when unacclimatized
at sea level (London) and at 5300 m after 66 d of high-altitude exposure (Everest; B). Note that insufficient biopsy remained
from one subject from each group for enzyme assay analysis, for whom protein and mRNA data are reported. *P 0.05 vs.
London.
MITOCHONDRIAL ADAPTATION TO HIGH-ALTITUDE HYPOXIA
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responses of the 2 mitochondrial subpopulations, although it is clear that skeletal muscle shows energetic
changes following acclimatization (8). Finally, it is currently unclear whether restoration of mitochondrial metabolism would be beneficial or detrimental for performance at high altitude, yet survival of critically ill patients
is strongly associated with early induction of mitochondrial biogenesis (53). Elite high-altitude performers, or
highland natives, may demonstrate more moderate repression of mitochondrial function than lowlanders who acclimatize poorly, and this warrants further investigation.
Caudwell Xtreme Everest (CXE) is a project coordinated
by the UCL Centre for Altitude, Space, and Extreme Environment Medicine, with the aim of conducting research into
hypoxia and human performance at high altitude to improve
understanding of hypoxia in critical illness. The research was
funded by unrestricted grants from a variety of sources, none
of which are public, including the entrepreneur John
Caudwell (BOC Medical, now part of Linde Gas Therapeutics), Lilly Critical Care, the London Clinic, Smiths Medical,
Deltex Medical, and the Rolex Foundation. Specific grants
were awarded by the Association of Anesthetists of Great
Britain and Ireland, the UK Intensive Care Foundation, and
the Sir Halley Stuart Trust. The CXE volunteers who trekked
to EBC also kindly donated to support the research. The CXE
Research Group contributed to the design and conduct of
experiments. The members of the CXE Research Group are
listed on the projects website (http://www.xtreme-everest.
co.uk). In particular, the authors thank Prof. Chris Imray and
Prof. David Howard for collecting muscle biopsies at EBC,
Adolfo Odriozola for preparing ultrathin sections of biopsies
and producing some of the EM images included in this
article, and the CXE Project Manager, Kay Mitchell, for her
tireless work that made the expedition possible. A.J.M. thanks
the Research Councils UK for supporting his academic fellowship and the Department of Physiology, Development,
and Neuroscience, University of Cambridge, for welcoming
him so warmly as a new member of the academic staff.
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