Did Rob beat the odds and survive his burn injury because he had a genetic or physiological advantage over the average individual? Given the extent of his burn, and where it occurred, he was at very high risk of death, and yet he survived. We know that one in five of us will be admitted to intensive care during the course of our lives – unfortunately, two fifths of those admitted will not survive their stay. Is there something that we can learn from what happened, by conducting experiments that can probe the secrets of his cells?
Why Antarctica?
The stress his body will undergo during sustained exercise in extreme cold will reproduce some of the metabolic and physiological changes that occurred when he was burned, as the team work to survive in this extreme environment. Not only is the Antarctic plateau one of the coldest places on Earth, it is also very high up, with an average elevation of about 3000m. The spin of the Earth means that there is even less atmosphere above, with the result that the amount of oxygen available to breathe is similar to that in some of the highest villages in the Himalayas. Critically ill patients also have low oxygen levels in their blood, a condition known as hypoxia. By comparing what happens in the body of an intensive care survivor exposed to both extreme exercise and hypoxia on Shackleton’s unfinished journey with research previously conducted in the Himalayas, we can gain a unique insight into hitherto hidden areas of knowledge.
How will Rob’s body cope?
By working with scientists from the UCL Centre for Altitude, Space and Extreme Environment Medicine, Portex Unit, Institute of Child Health, London, United Kingdom and the Institute of Sports, Exercise and Health, the team will be adding information to the large database available from the Xtreme-Everest expeditions, but with the important difference that Rob has already been exposed to the life-changing stresses of critical illness. What changes has that induced? In addition, how will the specific burn-related injuries cope in this cold, high environment?
The team will look at how Rob’s body handles oxygen during exercise, to aim to understand more about how delivery of oxygen to the cells may influence the course of critical illness. This will be done using cardiopulmonary exercise testing, a technique used by elite athletes, before major operations to predict the need for intensive care after surgery, and in the research previously undertaken. There is increasing evidence, however, that what really matters is whether oxygen is able to reach the level of the microvasculature, the tiny blood vessels that carry it to the cells. This too will be looked at in a variety of ways, in an attempt to understand if variations in this microcirculatory flow, which is know to be altered both at altitude and in Sherpas, is also different in Rob.
Significance of Rob’s genes
Other areas of research will include body mass regulation, which will be influenced both by the altitude, and the extreme cold and effort that is required to survive and walk on the Antarctic plateau. The team will have to consume vast amounts of calories to stay warm and pull sleds, but not all will be in the same position. The massive challenge of surviving his burn means that Rob may have changed the expression of genes and proteins in his muscles in a way that makes them more efficient, more resistant to the wasting of muscle that will challenge the team, and leads to the weakness associated with critical illness. All muscles can be affected, even the heart, and scans of heart function will be taken before and after to determine if these functions, too, are different in those who survive. By looking at his genotype, it may be possible to understand if he has genes that predict survival in the face of illness, or whether the “switching on or off” of genes, epigenetics, by his experience, has changed him in ways that will allow him to undertake the journey to the Pole.
Rob the survivor
What is it that allows some people to dig deep in the face of overwhelming odds? Like Shackleton, Rob stood little chance of surviving where he was, burned and alone, and yet instead of giving up at that point, he found the strength to make his way home, to survive. Psychological profiling may shed light on what it is that drives survivors. As technology changes and becomes more portable, Rob will be able to collect a vast amount of data that, in combination with the other studies, will put him on the forefront of personalized medicine.
By comparing the differences between Rob, the other expedition members, and previous subjects studied by the research team, we may gain clues that will allow Intensive Care Doctors and Burns Surgeons to save the lives of those with life-threatening injuries.
