Friends in high places: Researchers go global for answers at high altitude (Part 1)

December 19, 2018

By Alexandra Williams, @AlexM_Williams

Global Research Expedition on Altitude Related Chronic Health (or Global REACH) is an international collaboration of academics and physicians from 14 institutions across Canada, the UK, the US, Peru and Nepal. While the “Global REACH” title is relatively new, its leaders have conducted a multitude of expeditions over the last decade to Nepal’s Himalaya, California’s White Mountains and now Peru’s Andes. With a collective interest in heart, lung and vascular health and altitude medicine, Global REACH’s collaborations ultimately aim to understand how the human body adapts, or maladapts, chronically to the low oxygen environments of earth’s highest altitudes.

I am writing this from 4,300 m, at the Laboratorio de Cerro de Pasco and Institutio de Investigaciones de la Altura in Peru. Our team of over 40 researchers, trainees, principal investigators and physicians are currently conducting approximately 20 studies examining heart, lung and brain physiology in lowlanders (us) and Andean highlanders with and without chronic mountain sickness.

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Example of a centrifuged blood sample from an Andean participant with chronic mountain sickness. A normal, healthy lowlander’s hematocrit (i.e. fraction of red cells in the blood) is ~40%; several Andean participants including this one had hematocrit values of 75-80%.

This series of blogs, however, does not intend to outline our experiments or specific scientific findings (which was described in a recent issue of Physiology News). Instead, you will get a raw, behind-the-scenes look at what transpires on these expeditions: the challenges we face, the experiences we gain, and most importantly the team values that drive the success of these international collaborations.

30 June 2018: Day 1 at altitude

Yesterday, the last of three groups of the Global REACH team drove from sea level in Lima up to 4,300 m in Cerro de Pasco, Peru. Amongst the team, some individuals are feeling “okay” (say, a rating of 7/10), while others have been in bed with splitting headaches for more than 24 hours. We would later discover that one, in fact, had a bout of pneumonia. Nevertheless, one thing remains constant across the team – the excitement. It is palpable. Seven lab bays are set up, participants are being scheduled in, the equipment is (mostly) accounted for and working. Data collection has already begun today, and our first Andean participants are coming in tomorrow morning. This is what we came for, and we’re ready for the fun to begin.

For those who haven’t experienced the thin air of Earth’s highest mountain ranges, a 7-hour jump from sea level to over 4,300 m altitude is significant, one which often leaves individuals feeling much worse than “not great.” Yet, with advanced knowledge of the side effects of altitude and hypoxic exposure, Global REACH members have joined forces to answer a plethora of physiological questions. For many, this will mark more than four expeditions to high altitude, a select few even in the double digits. In the first few days, most – including our team leaders – will have headaches, nausea, sleep disturbances and apnoeas. The inter-individual variability of these symptoms is quite high, as a select few may feel fine, most will feel some magnitude and combination of the list, and others will be periodically out of commission.

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Performing a carbon monoxide rebeathe test to measure red cell volume and total blood volume with an Andean participant in Cerro de Pasco. This method is technically challenging, and is made more difficult with a significant language barrier.

So, why do we do it? Why do we involve ourselves with the potential suffering at altitude and any additional risks (i.e. transport, illness) kindred to these trips? From my experience, three fundamental elements outweigh the risks and define the success of expeditions and collaborations like Global REACH: the science, the experience, and the team.

Science

1 July 2018: Day 2 at altitude

“MAS FUERTE, MAS FUERTE, yeah Johnny!” Johnny, our first Andean participant is laying on the bed of testing Bay 1, currently practising a handgrip protocol for a vascular study. Johnny already has a venous catheter placed in his forearm and will be shuttled through a screening circuit: ultrasound imaging (cardiac, ocular and vascular), a maximal exercise test and assessment of total blood volume. Our Spanish skills are currently dismal, but we’re managing to compliment the amazing work of our translators to collect a large cardiovascular dataset on approximately 50 Andean participants.

3 July 2018: Day 4 at altitude

Four of us are working in the bloods room to measure total blood volume, hematocrit and viscosity. We knew from previous reports that Andeans would have augmented total blood volumes and hematocrit levels compared to us lowlanders but seeing those bloods ourselves was staggering. ‘A hematocrit of SEVENTY-EIGHT per cent!’ a colleague yelled, astounded. For reference, a lowlander’s normal hematocrit is ~40%. (Fig. 1) An undeniable passion for physiology underpins collaborations like Global REACH.

The energy amongst the group drives impressive productivity and allows us to complete multiple studies in relatively restricted time periods. During the 2016 Nepal Expedition our team conducted 18 major studies, including a total of 335 study sessions in just three weeks at 5,050 m (further to multiple sea level and ascent testing sessions). This high-density data collection is relatively uncommon outside of field work and is only made possible by the vast breadth of technical fluency, specific expertise and research experience amongst the team. The expeditions allow us to not only answer our current questions but further breed a multitude of ideas for future study.

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‘We could answer that one next, Ethiopia 2020? Another Nepal expedition?’ Of course, these expeditions allow us as trainees and investigators to be productive, and to present and publish high-quality data and exciting findings. They strongly contribute to our development and career progression in academia. But what is undoubtedly most important is the greater aim of Global REACH: to understand altitude health on a ‘global’ scale. This collaboration and research ultimately aims to understand why chronic mountain sickness occurs, how different high-altitude communities have adapted (or maladapted) to low oxygen, and what might ultimately be done to improve the health of individuals exposed to acute or chronic hypoxia.

Stay tuned for Part 2 next week, or read the full article in its original version in Physiology News magazine.

Read Next Instalment

Friends in high places: Researchers go global for answers at high altitude (Part 2)
https://www.physoc.org/blog/friends-in-high-places-researchers-go-global-for-answers-at-high-altitude-part-ii/

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