High Altitude and Hypoxia
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Rising altitude drives distinct biomarker profiles in healthy Tibetans, with CXCL8/IFN-γ/FGF/VEGF/CXCL4/TPO exhibiting an inverted U-shaped response peaking at 4,750m, and isolated MMP-3 elevation at 5,373m, indicating a transition from adaptive angiogenesis to pathological tissue remodeling at extreme-high altitude.
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AIM: Native Tibetans have adapted to chronic hypoxia, yet remain susceptible to Chronic Mountain Sickness (CMS), including high-altitude polycythemia (HAPC) and high-altitude pulmonary hypertension (HAPH). CMS prevalence rises with altitude, but mechanisms remain unclear. We aim to investigate biomarker profiles in native Tibetans with and without CMS across altitudes, including extreme altitude >5,000m. METHODS: We enrolled 91 native Tibetans across 4 altitudes (500m/3,680m/4,750m/5,373m), categorized into healthy, HAPC and HAPH groups. Seventeen biomarkers were quantified via Luminex. Biomarker associations with altitude and disease were analyzed using linear regression with Type-III-F-tests, followed by post-hoc comparison and effect-size analysis. RESULTS: Among healthy Tibetans, multiple biomarkers exhibited non-linear altitude-dependent changes. C-X-C motif chemokine ligand 8 (CXCL8), interferon-γ (IFN-γ), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), C-X-C motif chemokine ligand 4 (CXCL4) and thrombopoietin (TPO) peaked at 4,750m and declined at 5,373m, whereas matrix metalloproteinase-3 (MMP-3) increased at 5,373m. Among plateau-dwelling Tibetans (including HAPC and HAPH), no independent main disease-status effects were detected across biomarkers. However, an altitude-disease interaction was observed for angiogenin, with reduction at 5373m in HAPH, but not in HAPC. CONCLUSION: Rising altitude drives distinct biomarker profiles in healthy Tibetans, with CXCL8/IFN-γ/FGF/VEGF/CXCL4/TPO exhibiting an inverted U-shaped response peaking at 4,750m, and isolated MMP-3 elevation at 5,373m, indicating a transition from adaptive angiogenesis to pathological tissue remodeling at extreme-high altitude. The altitude-dependent angiogenin reduction observed exclusively in HAPH at extreme altitude, indicating a dysregulated vascular reparative signaling in Tibetans with HAPH. These findings provide new insights into CMS pathogenesis across hypoxic gradient.
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@article{Zhang2026Altitude,
title = {Altitude-associated circulating biomarker profiles in native Tibetans with and without chronic mountain sickness},
author = {Yutian Zhang and Xiaoou Li and Tao Wang and Lian Liu and Bi Ran and Kangzhuo Baima and Yue Liao and Fuqiang Wen and Jun Chen and Chen Lei},
journal = {Travel Medicine and Infectious Disease},
year = {2026},
doi = {10.1016/j.tmaid.2026.103030},
url = {https://doi.org/10.1016/j.tmaid.2026.103030}
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