Abstract:Improving hypoxia is the most important element to ameliorate respiratory failure. Notably, several unique non-mammalian species have evolved to adapt and survive under hypoxic environments by establishing accessory respiration mechanisms in organs other than lungs or gills. For example, loaches (Misgumus anguillicandatus), sea cucumbers, Corydoras, and Tetragnatha praedonia use their posterior intestines for respiration.1, 2, 3 Earlier studies in the 1950s and 1960s explored such mechanisms in humans and animals yet with highly questionable outcomes regarding the breathing capabilities of mammalian digestive tracts mainly through the upper gastrointestinal (GI) organs.4, 5, 6, 7 The mammalian rectum represents a body cavity covered by a relatively thin mucosal layer, particularly around the anal canal, in which abundant vascular drainage is made possible through hemorrhoidal plexuses connected both with the portal and the systemic circulation. Therefore, intra-anally administered drugs can be easily introduced and quickly absorbed around the rectal region.8 Due to such anatomical features, we hypothesized that the mammalian distal gut enables efficient luminal access to submucosal blood vessels for potential gas exchange.