Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine
Should we block inflammation or boost it? It depends. In the case of sepsis, blocking inflammation is most often useless or counterproductive. On the other hand, blocking inflammation with dexamethasone had better success in COVID. However, inflammation also protects against COVID. Pro-inflammatory interferon is highest in young people who seem […]
Proton pump inhibitors are drugs that block the hydrogen/potassium ATP-ase enzyme responsible for the secretion of stomach acid. In recent years, the prescription rate for proton pump inhibitors (PPIs) has increased from about 4% to almost 8% in the US. Many of these prescriptions are not accompanied by an appropriate […]
Why does the immune system over-react and sometimes kill us? This is a conundrum that has attracted much attention, at least from evolutionary biologists. One explanation is the smoke detector principle. It is often better to over-react than to under-react. Here is a summary that I wrote in the evolution […]
I have been thinking a lot over the last decade about what features of the microbiota really matter. On the one hand, myriad studies using germ free animal models have shown powerful effects of the microbiota on physiology – with evidence for a causal role of the microbiota in obesity, […]
Over evolutionary time, organisms have had to evolve ways to cope with varying oxygen levels. Hypoxia inducible factor, HIF, is the primary way our bodies respond to changes in oxygen availability. HIF-1 alpha is stabilized during hypoxia, allowing it to reach the cell nucleus and alter the expression of hypoxia […]
Humans and other animals have evolved adaptations to hypoxia, most famously among high altitude people. Oxygen availability, especially at the tissue level, varies at sea level too. Adaptation to hypoxic stress is important in wound healing, defense against infection, and protection from sepsis. Hypoxia stimulated HIF-1α has a key role […]
Is it normal to be hypoxic in the earliest stages of life? Maltepe and Saugstad 2009 write: “It is known that oxygen levels are low in fetal life with saturations as low as 50% or even lower. After birth, arterial oxygen saturation increases slowly and reaches 90% with a median […]
Posing “why” questions is a classic approach in evolutionary medicine. I have been interested in why oxygen regulates the immune system since medical school when I learned about diving and hyperbaric medicine and high altitude medicine. For both, oxygen treatment plays a key role. High altitude illnesses share many of […]
My colleagues and I had another paper published last week. From the title page, click on the image to read the paper. I worked with Henry Lin at the NM VA Healthcare System, the UNM CTSC, and UNM Sleep disorders clinic to study whether increased exposure to the stress hormone […]
Thymosin α1 is an immune modulating drug that was recently the subject of a large scale multi-center randomized clinical trial in China. Thymosin α1 modulates T-cell function and improves antigen presentation among other things. It had shown promise in multiple single center trials. The most recent by Wu et al. […]
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