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J Appl Physiol 102: 1726, 2007; doi:10.1152/japplphysiol.00016.2007
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LETTER TO THE EDITOR

Reply to Valic, Palada, and Dujic

REPLY: We thank both Dr. Moon (5) for his editorial and Dr. Valic et al. (8) for their response to the very same editorial regarding our manuscript in the December issue of the Journal of Applied Physiology (4).

As has been stated previously, exercise and nitrates do affect the vascular gas bubbles, but how they do this is not clear. Several studies have been performed with smaller rodents and humans, but there are conflicting results (1–3, 6, 7). The value in doing translational research, going from models with smaller animals through larger ones before doing human testing, is important to be recognized by all those interested in finding the basal mechanisms behind decompression-related disorders. The work that has been done and still is being conducted by Dr. Dujic and his colleagues in Croatia is of great importance. As stated both in the editorial by Dr. Moon (5) in the December issue, and in the letter from Dr. Valic et al. (8), there are several possibilities/options in how to more deeply investigate the mechanisms behind all the recent findings. It should be possible to test whether hemodynamic effects may play a role. The suggestion by Dr. Valic et al. to look into one of the cofactors in the synthesis of nitric oxide, tetrahydrobiopterine, is also exiting.

As Dr. Moon (5) stated in the editorial and again outlined by Dr. Valic et al. (8) in the letter, and as we tried to say in our article (4), it is premature to recommend nitrates being used in diving. But the potential of pharmacological means to increase safety in emergency situations such as submarine escapes must be explored. Several questions remain unanswered and need further research, and to target the investigations more to the biochemical mechanisms seems reasonable based on the latest findings.

FOOTNOTES


Address for reprint requests and other correspondence: A. Møllerløkken, Dept. of Circulation and Medical Imaging, Faculty of Medicine, Norwegian Univ. of Science and Technology, Olav Kyrres gt. 3, N-7489 Trondheim, Norway (e-mail: andreas.mollerlokken{at}ntnu.no)

REFERENCES

  1. Blatteau JE, Gempp E, Galland FM, Pontier JM, Sainty JM, Robinet C. Aerobic exercise 2 hours before a dive to 30 msw decreases bubble formation after decompression. Aviat Space Environ Med 76: 666–669, 2005.[Medline]
  2. Dujic Z, Duplancic D, Marinovic-Terzic I, Bakuvik D, Ivancev V, Valic Z, Eterovic D, Petri NM, Wisløff U, Brubakk AO. Aerobic exercise before diving reduces venous gas bubble formation in humans. J Physiol 555: 637–642, 2004.[Abstract/Free Full Text]
  3. Dujic Z, Palada I, Valic Z, Dupancic D, Obad A, Wisløff U, Brubakk AO. Exogenous nitric oxide and bubble formation in divers. Med Sci Sports Exerc 38: 1432–1435, 2006.
  4. Møllerløkken A, Berge VJ, Jørgensen A, Wisløff U, Brubakk AO. Effect of a short-acting NO donor on bubble formation from a saturation dive in pigs. J Appl Physiol 101: 1541–1545, 2006.[Abstract/Free Full Text]
  5. Moon RE. Nitroglycerine: relief from the heartache of decompression sickness? J Appl Physiol 101: 1537–1538, 2006.[Free Full Text]
  6. Wisløff U, Richardson RS, Brubakk AO. Exercise and nitric oxide prevent bubble formation: a novel approach to the prevention of decompression sickness? J Physiol 555: 825–829, 2004.[Abstract/Free Full Text]
  7. Wisløff U, Rickadson RS, Brubakk AO. NOS inhibition increases bubble formation and reduces survival in sedentary but not exercised rats. J Physiol 546: 577–582, 2003.[Abstract/Free Full Text]
  8. Valic Z, Palada I, and Dujic Z. Short-acting NO donor and decompression sickness in humans. J Appl Physiol 102: 1725, 2007.[Free Full Text]

Møollerløokken Andreas
Brubakk Alf
 Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway





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