{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T21:57:19Z","timestamp":1757627839987,"version":"3.44.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>High-altitude deacclimatization syndrome (HADAS, commonly known as Oxygen toxicity) manifests through multi-organ system dysfunction and significantly deteriorates the quality of life. Unfortunately, there are no effective methods for serious HADAS (SHADAS) patients. To address this urgent public health challenge, we explored the therapeutic potential of erythrocyte apheresis (EA)-a technique previously used in HAPC treatment, and evaluated its efficacy in SHADAS patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study analyzed clinical data of 71 SHADAS patients undergoing EA between October 2016 and September 2024 in our hematology department. Complete blood count parameters were serially measured before and after EA. Data analysis was performed using GraphPad Prism 8.02 software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study cohort exhibited significant reductions in hemoglobin (HGB) levels after initial EA: HGB decreased from 224.75 \u00b1 12.76 g\/L to 172.92 \u00b1 22.60 g\/L (males, <jats:italic>P<\/jats:italic> &amp;lt; 0.001) and from 205.13 \u00b1 12.41 g\/L to 164.75 \u00b1 19.26 g\/L (females, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). Notably, 18 patients required repeat EA due to suboptimal response, and these patients had higher HGB baseline levels. (HGB 238.47 \u00b1 8.76 vs 219.67 \u00b1 9.98 g\/L). All subjects demonstrated marked symptomatic improvement in SHADAS manifestations including headache, somnolence, and fatigue after EA. Based on these findings, we developed a strategy for the formulation of EA parameter protocols.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although it remains challenging to prevent SHADAS in individuals transitioning to lower altitude regions, our study demonstrated that EA could rapidly reduce HGB and alleviate associated symptoms. Moreover, we have established the parameters of EA in the treatment of SHADAS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fphys.2025.1622092","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:24:32Z","timestamp":1757481872000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of erythrocyte apheresis in the management of severe high-altitude deacclimatization syndrome: a retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Xinmiao","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rong","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunrong","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Yao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai","family":"Yi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.7754\/Clin.Lab.2023.231150","article-title":"Diagnostic evaluation of polycythemia vera at high altitude","volume":"70","author":"Alkhaldy","year":"2024","journal-title":"Clin. Lab."},{"key":"B2","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.freeradbiomed.2018.01.024","article-title":"ROS and redox signaling in myocardial ischemia-reperfusion injury and cardioprotection","volume":"117","author":"Cadenas","year":"2018","journal-title":"Free Radic. Biol. Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/1479-5876-10-116","article-title":"JAK-STAT and AKT pathway-coupled genes in erythroid progenitor cells through ontogeny","volume":"10","author":"Cokic","year":"2012","journal-title":"J. Transl. Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1086\/508026","article-title":"Testing the beneficial acclimation hypothesis and its alternatives for locomotor performance","volume":"168","author":"Deere","year":"2006","journal-title":"Am. Nat."},{"key":"B5","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/j.redox.2015.08.020","article-title":"Reperfusion injury and reactive oxygen species: the evolution of a concept","volume":"6","author":"Granger","year":"2015","journal-title":"Redox Biol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e62072","DOI":"10.1371\/journal.pone.0062072","article-title":"Analysis of high-altitude de-acclimatization syndrome after exposure to high altitudes: a cluster-randomized controlled trial","volume":"8","author":"He","year":"2013","journal-title":"PLoS One"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1732352","DOI":"10.1155\/2016\/1732352","article-title":"Association between serum Interleukin-17A level and high-altitude deacclimatization syndrome","volume":"2016","author":"He","year":"2016","journal-title":"Mediat. Inflamm."},{"key":"B8","doi-asserted-by":"publisher","first-page":"4521231","DOI":"10.1155\/2019\/4521231","article-title":"Efficacy of shenqi pollen capsules for high-altitude deacclimatization syndrome via suppression of the reoxygenation injury and inflammatory response","volume":"2019","author":"He","year":"2019","journal-title":"J. Immunol. Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"109554","DOI":"10.1016\/j.cellsig.2020.109554","article-title":"Phospho-PTM proteomic discovery of novel EPO- modulated kinases and phosphatases, including PTPN18 as a positive regulator of EPOR\/JAK2 signaling","volume":"69","author":"Held","year":"2020","journal-title":"Cell Signal"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.7150\/thno.43895","article-title":"Proteomic analysis reveals ginsenoside Rb1 attenuates myocardial ischemia\/reperfusion injury through inhibiting ROS production from mitochondrial complex I","volume":"11","author":"Jiang","year":"2021","journal-title":"Theranostics"},{"key":"B12","doi-asserted-by":"publisher","first-page":"4442","DOI":"10.1038\/sj.onc.1208635","article-title":"Erythropoietin-mediated activation of JAK-STAT signaling contributes to cellular invasion in head and neck squamous cell carcinoma","volume":"24","author":"Lai","year":"2005","journal-title":"Oncogene"},{"key":"B13","doi-asserted-by":"publisher","first-page":"6317015","DOI":"10.1155\/2019\/6317015","article-title":"Gastric mucosal lesions in Tibetans with high-altitude polycythemia show increased HIF-1A expression and ROS production","volume":"2019","author":"Li","year":"2019","journal-title":"Biomed. Res. Int."},{"key":"B14","doi-asserted-by":"publisher","first-page":"106857","DOI":"10.1016\/j.ejps.2024.106857","article-title":"Ameliorating effects of the HIF-2\u03b1 inhibitor PT2385 on high-altitude polycythemia","volume":"201","author":"Li","year":"2024","journal-title":"Eur. J. Pharm. Sci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e38815","DOI":"10.1097\/md.0000000000038815","article-title":"The efficacy of erythrocyte apheresis for treatment of secondary erythrocytosis: an observational study","volume":"103","author":"Ma","year":"2024","journal-title":"Med. Baltim."},{"key":"B16","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1089\/ham.2004.5.457","article-title":"VI world Congress on Mountain medicine and high altitude physiology, Xining, Qinghai, and Lhasa, Tibet, August 12-18, 2004","volume":"5","author":"Milledge","year":"2004","journal-title":"High. Alt. Med. Biol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"14768","DOI":"10.1038\/s41598-023-40576-w","article-title":"Quantifying systemic molecular networks affected during high altitude de-acclimatization","volume":"13","author":"Paul","year":"2023","journal-title":"Sci. Rep."},{"key":"B18","doi-asserted-by":"publisher","first-page":"113","DOI":"10.3892\/ijmm.2021.4946","article-title":"Attenuation of the upregulation of NF-\u03baB and AP-1 DNA-binding activities induced by tunicamycin or hypoxia\/reoxygenation in neonatal rat cardiomyocytes by SERCA2a overexpression","volume":"47","author":"Qu","year":"2021","journal-title":"Int. J. Mol. Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/s0140-6736(11)60242-0","article-title":"The cryoglobulinaemias","volume":"379","author":"Ramos-Casals","year":"2012","journal-title":"Lancet"},{"key":"B20","doi-asserted-by":"publisher","first-page":"395","DOI":"10.3736\/jcim20110408","article-title":"Three preparations of compound Chinese herbal medicines for de-adaptation to high altitude: a randomized, placebo-controlled trial","volume":"9","author":"Shi","year":"2011","journal-title":"Zhong Xi Yi Jie He Xue Bao"},{"key":"B21","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1089\/ham.2015.0015","article-title":"The local HIF-2\u03b1\/EPO pathway in the bone marrow is associated with excessive erythrocytosis and the increase in bone marrow microvessel density in chronic Mountain sickness","volume":"16","author":"Su","year":"2015","journal-title":"High. Alt. Med. Biol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"116","DOI":"10.21037\/atm-22-5991","article-title":"7.0T cardiac magnetic resonance imaging of right ventricular function in rats with high-altitude deacclimatization","volume":"11","author":"Sun","year":"2023","journal-title":"Ann. Transl. Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1375360","DOI":"10.3389\/fmolb.2024.1375360","article-title":"Assessment of metabolomic variations among individuals returning to plain areas after exposure to high altitudes: a metabolomic analysis of human plasma samples with high-altitude de-acclimatization syndrome","volume":"11","author":"Tan","year":"2024","journal-title":"Front. Mol. Biosci."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e2102463118","DOI":"10.1073\/pnas.2102463118","article-title":"Global and country-level estimates of human population at high altitude","volume":"118","author":"Tremblay","year":"2021","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1161\/hypertensionaha.119.12780","article-title":"Global REACH 2018: high blood viscosity and hemoglobin concentration contribute to reduced flow-mediated dilation in high-altitude excessive erythrocytosis","volume":"73","author":"Tremblay","year":"2019","journal-title":"Hypertension"},{"key":"B26","doi-asserted-by":"publisher","first-page":"0","DOI":"10.1152\/physiol.00029.2021","article-title":"High-Altitude erythrocytosis: mechanisms of adaptive and maladaptive responses","volume":"37","author":"Villafuerte","year":"2022","journal-title":"Physiol. (Bethesda)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.16016\/j.2097-0927.202308074","article-title":"Effect of lifestyle modification during the whole process of entering and existing the plateau on high-altitude de-adaptation","volume":"46","author":"Wang","year":"2024","journal-title":"J. Army Med. Univ."},{"key":"B11","doi-asserted-by":"publisher","first-page":"242","DOI":"10.13517\/j.cnki.ccm.2021.03.006","article-title":"Research Progress in control measures of Plateau de-adaptation and its hazards","volume":"30","author":"Zhang","year":"2021","journal-title":"Chin. J. Convalesc. Med."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1622092\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:24:34Z","timestamp":1757481874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1622092\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":27,"alternative-id":["10.3389\/fphys.2025.1622092"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2025.1622092","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,10]]},"article-number":"1622092"}}