Ten Maxims of Hypoxia

S. Kostianev, D.Iluchev

Docendo illuminamus
By teaching we illuminate

Hypoxia, along with inflammation, is one of the most common pathological processes in clinical practice. Acute and chronic respiratory insufficiency and cardio-circulatory insufficiency have hypoxia as their basis (1). For these reasons, the concepts of hypoxia acquired by students during their training in clinical physiology are of utmost importance for their future clinical practice.
The metaphors used in the process of teaching turn it into an attractive and effective duty. Many a lecture of our favorite professors in the past is etched on our minds because of the memorable parallels and vivid examples.
Following the cordial professional comments concerning our previous contribution (2) to this heading, we would like to share our experience with the artistic formulation of key points of hypoxia designated as ten maxims of hypoxia. The allusion with The Ten Commandments is used not only to charge our message with more emotions, but also to remind the pleasant fact that they are only ten in number.

Ten Maxims of Hypoxia

1. Oxygen is a free fuel, but the body pays for it at a high price to ensure that all cells receive adequate oxygenation.
2. Oxygen is both a servant and a master for aerobic organisms.
3. The oxygen cascade (alveoli > mitochondria) is the river of life that diseases try to dry up.
4. Hypoxia represents a whole world.
5. Hypoxia adaptations also represent a whole world.
6. As to our susceptibility to hypoxia we are as different as we are in our outward appearance.
7. HIFs (hypoxia-inducible factors) are simultaneously Harry Potter and Voldemort.
8. Tumor cells hate oxygen. All other human cells love it.
9. In quite a lot of aspects the physicians practice is essentially an antihypoxic practice.
10. The more efficient the oxygen metabolism, the more pleasant and long the life itself.

In conclusion, in our department we have been using these ten hypoxic maxims for years as a basis for creative discussion in hypoxic education. It is quite possible that they are not formulated in the best possible way and that they are not even the existential minimum of knowledge in this field. And yet, though we are not endowed with Shakespearean eloquence, it is worth convincing our students that clinical physiology tells one of the most interesting fairy-tales about disease.


1. Semenza GL. Genomics of Oxygen Sensing. In: Oxygen Sensing: Responses and
Adaptation to Hypoxia. Lahiri S, Semenza GL, Prabhakar NB, Eds.. Lung Biology in
Health and Disease. Vol.175. New York, Marcel Dekker, Inc, 2003, part 1, p1-6.
2. Kostianev S, Iluchev D. Two-dimensional oxygen map for graphic representation of
different hypoxic conditions. Adv Physiol Educ 27:242, 2003.






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