The Mechanisms of Action of Hyperbaric Oxygen in Restoring Host Homeostasis during Sepsis

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The perception of sepsis has shifted over time; however, it remains a leading cause of death worldwide. Sepsis is now recognized as an imbalance in host cellular functions triggered by the invading pathogens, both related to immune cells, endothelial function, glucose and oxygen metabolism, tissue repair and restoration. Many of these key mechanisms in sepsis are also targets of hyperbaric oxygen (HBO2) treatment. HBO2 treatment has been shown to improve survival in clinical studies on patients with necrotizing soft tissue infections as well as experimental sepsis models. High tissue oxygen tension during HBO2 treatment may affect oxidative phosphorylation in mitochondria. Oxygen is converted to energy, and, as a natural byproduct, reactive oxygen species are produced. Reactive oxygen species can act as mediators, and both these and the HBO2-mediated increase in oxygen supply have the potential to influence the cellular processes involved in sepsis. The pathophysiology of sepsis can be explained comprehensively through resistance and tolerance to infection. We argue that HBO2 treatment may protect the host from collateral tissue damage during resistance by reducing neutrophil extracellular traps, inhibiting neutrophil adhesion to vascular endothelium, reducing proinflammatory cytokines, and halting the Warburg effect, while also assisting the host in tolerance to infection by reducing iron-mediated injury and upregulating anti-inflammatory measures. Finally, we show how inflammation and oxygen-sensing pathways are connected on the cellular level in a self-reinforcing and detrimental manner in inflammatory conditions, and with support from a substantial body of studies from the literature, we conclude by demonstrating that HBO2 treatment can intervene to maintain homeostasis.

OriginalsprogEngelsk
Artikelnummer1228
TidsskriftBiomolecules
Vol/bind13
Udgave nummer8
Antal sider19
ISSN2218-273X
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
J.V and O.H were supported by the PERMIT project (grant 8113-00009B), which is funded by Innovation Fund Denmark and EU Horizon 2020 under the ERA PerMed (project 2018-151) and PERAID (grant 8114-00005B) frameworks, which are funded by Innovation Fund Denmark and Nordforsk (project 90456). O.H. also received a research grant from the Ellab-Fonden of Denmark.

Publisher Copyright:
© 2023 by the authors.

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