Acute hyperbaric stress during diving combines increased ambient pressure, hyperoxia, hemodynamic shifts, and often muscular workload. Identifying real-time blood biomarkers sensitive to these individual and combined physiological loads remains a challenge. Neuregulin-4 (NRG4), an adipokine secreted by thermogenic and subcutaneous white fat, responds to adrenergic stimulation and modulates redox homeostasis. We investigated NRG4 dynamics alongside oxidative protein carbonyls in divers in warm (thermoneutral) water (∼33.6 °C ambient water temperature) to avoid cold stress.
Two field campaigns were conducted: a first depth response campaign involved divers exposed to 20, 30, or 40 m on separate days, without exercise, with serial blood sampling; a second physical effort study involved 15 m dives with or without slow-pedalling exercise. Serum NRG4 was quantified by ELISA and expressed as log2 fold change relative to baseline. Protein carbonyls were measured as markers of oxidative damage. Statistical analysis employed single-sample tests and false-discovery rate control.
NRG4 exhibited a robust early increase at 30 m, significant after correction, and nominal elevations at 40 m, but remained unchanged at 20 m. Exercise at 15 m triggered a significant early NRG4 rise absent during passive dives at the same depth. Protein carbonyls remained stable in early post-emersion windows but increased significantly at later time points (180- and 240-min post-emersion) following dives to 40 m, indicating delayed oxidative burden.
Our findings position NRG4 as a fast, pressure- and workload-responsive biomarker of diving stress, temporally distinct from classical oxidative injury markers that manifest later. This temporal dissociation underscores the potential of NRG4 for real-time monitoring of acute physiological load during hyperbaric exposure, integrating pressure- and workload-related stressors.
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