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Review
. 2025 Jan 22;17(782):eadr4049.
doi: 10.1126/scitranslmed.adr4049. Epub 2025 Jan 22.

Hypoxia as a medicine

Robert S Rogers  1   2 , Vamsi K Mootha  1   2   3   4
Affiliations
Review

Hypoxia as a medicine

Robert S Rogers et al. Sci Transl Med. .

Abstract

Oxygen is essential for human life, yet a growing body of preclinical research is demonstrating that chronic continuous hypoxia can be beneficial in models of mitochondrial disease, autoimmunity, ischemia, and aging. This research is revealing exciting new and unexpected facets of oxygen biology, but translating these findings to patients poses major challenges, because hypoxia can be dangerous. Overcoming these barriers will require integrating insights from basic science, high-altitude physiology, clinical medicine, and sports technology. Here, we explore the foundations of this nascent field and outline a path to determine how chronic continuous hypoxia can be safely, effectively, and practically delivered to patients.

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Conflict of interest statement

VKM is listed as an inventor on patents owned by Massachusetts General Hospital on therapeutic uses of hypoxia (“Compositions and methods that promote hypoxia or the hypoxia response for the treatment and prevention of mitochondrial dysfunction and oxidative stress disorders”: US-20190015444-A1, US-10842812-B2, US-20210093660-A1. “Methods to treat mitochondrial-associated dysfunctions or diseases”: US-20220096541-A1.). VKM is a paid advisor to 5AM Ventures. RSR was previously employed by Vertex Pharmaceuticals and is currently employed by Tectonic Therapeutic; neither company had any role in the writing of this manuscript.

Figures

Figure 1.
Figure 1.. New facets of oxygen biology.
(A) When arterial oxygen delivery exceeds tissue oxygen consumption, the resulting “unused oxygen” can manifest as venous hyperoxia. (B) Oxygen toxicity is classically attributed to partially reduced oxygen species (for example, O2−, H2O2) or ROS that are targeted by traditional antioxidants. Hypoxia therapy, however, acts upstream to prevent ROS formation and to prevent damage that emerges from excess oxidation of biomolecules (denoted as “X”) that have reduced the O2. (C) In healthy states, there is a “basal tone” of hypoxia-sensing programs which can be suppressed in the setting of hyperoxia. “HIF” = hypoxia inducible factor, “HPV” = hypoxic pulmonary vasoconstriction. (D) For both wildtype genotypes and essential gene mutants, the phenotypes are independent of oxygen tension (solid circle is healthy phenotype, dotted circle is disease phenotype). By contrast, for OxyS mutants, the disease phenotype is suppressed at low oxygen tension but becomes clinically apparent as oxygen tension increases. (E) The developmental fates of wildtype, OxyS, and essential gene mutants are overlaid on a plot of arterial oxygen (PaO2) (y-axis) versus life-stage (x-axis). Birth leads to an abrupt transition in PaO2. CREDIT: A. FISHER/SCIENCE TRANSLATIONAL MEDICINE
Figure 2.
Figure 2.. Physiological responses to and pathological consequences of hypoxia for different organ systems.
Quantitative estimates are based on studies of healthy adult volunteers in the first 48 hours after moving from sea level to a 13% normobaric hypoxia chamber or the altitude equivalent to this oxygen concentration (hypobaric hypoxia). “CMRO2” = cerebral metabolic rate of oxygen consumption (–110). CREDIT: A. FISHER/SCIENCE TRANSLATIONAL MEDICINE
See this image and copyright information in PMC

References

    1. Rusina PV, Falaguera MJ, Romero JMR, McDonagh EM, Dunham I, Ochoa D, Genetic support for FDA-approved drugs over the past decade. Nat Rev Drug Discov 22, 864 (2023). - PubMed
    1. Chancellor D, Barrett D, Nguyen-Jatkoe L, Millington S, Eckhardt F, The state of cell and gene therapy in 2023. Mol Ther 31, 3376–3388 (2023). - PMC - PubMed
    1. Jacobs SS, Lederer DJ, Garvey CM, Hernandez C, Lindell KO, McLaughlin S, Schneidman AM, Casaburi R, Chang V, Cosgrove GP, Devitt L, Erickson KL, Ewart GW, Giordano SP, Harbaugh M, Kallstrom TJ, Kroner K, Krishnan JA, Lamberti JP, Porte P, Prieto-Centurion V, Sherman SE, Sullivan JL, Sward E, Swigris JJ, Upson DJ, Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 15, 1369–1381 (2018). - PubMed
    1. Biggs AT, Littlejohn LF, Dainer HM, Alternative Uses of Hyperbaric Oxygen Therapy in Military Medicine: Current Positions and Future Directions. Mil Med 187, e40–e46 (2022). - PubMed
    1. Jain IH, Zazzeron L, Goli R, Alexa K, Schatzman-Bone S, Dhillon H, Goldberger O, Peng J, Shalem O, Sanjana NE, Zhang F, Goessling W, Zapol WM, Mootha VK, Hypoxia as a therapy for mitochondrial disease. Science 352, 54–61 (2016). - PMC - PubMed

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