Hypoxia, or lack of
oxygen, can occur in both physiological (high altitude) and pathological conditions (
respiratory diseases). In this narrative review, we introduce high altitude
pulmonary edema (HAPE),
acute respiratory distress syndrome (ARDS),
Chronic Obstructive Pulmonary Disease (
COPD), and
Cystic Fibrosis (CF) as examples of maladaptation to
hypoxia, and highlight some of the potential mechanisms influencing the prognosis of the affected patients. Among the specific pathways modulated in response to
hypoxia,
iron metabolism has been widely explored in recent years. Recent evidence emphasizes
hepcidin as highly involved in the compensatory response to
hypoxia in healthy subjects. A less investigated field in the adaptation to
hypoxia is the
sphingolipid (SPL) metabolism, especially through
Ceramide and
sphingosine 1
phosphate. Both individually and in concert,
iron and SPL are active players of the (mal)adaptation to physiological
hypoxia, which can result in the pathological HAPE. Our aim is to identify some pathways and/or markers involved in the physiological adaptation to low atmospheric pressures (high altitudes) that could be involved in pathological adaptation to
hypoxia as it occurs in pulmonary inflammatory diseases.
Hepcidin, Cer, S1P, and their interplay in
hypoxia are raising growing interest both as prognostic factors and therapeutical targets.