Ten Maxims of Hypoxia
S. Kostianev, D.Iluchev
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
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
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 physician’s 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.