Pathogenesis of retinoic acid-induced ear malformations in primate model

Retrospective study on unilateral polyotia combined with microtia utilizing the technique of preserving residual ear tissue

BACKGROUND

The presence of polyotia in individuals with microtia is a rare deformity. Due to the intricate structure of the auricle, uncertain etiology, and challenging corrective techniques, it has always been a focal point in the field of plastic surgery. The present study presents a technique for correcting the combination of polyotia and microtia by utilizing residual ear tissue as graft material.

METHODS

The retrospective study included 23 patients with polyotia and microtia from 2018 to 2022. The residual ear tissue was used to rectify auricular deformities in all patients. The patients were instructed to evaluate the satisfaction of the auricle shape using a visual analog scale (VAS) both before and 6 months after the surgical procedure. The esthetic outcomes of auricle subunits were simultaneously assessed by a senior physician pre- and postoperatively.

RESULTS

The mean duration of follow-up in this study was 8.73 months. The preoperative VAS satisfaction score was recorded as 2.26 ± 0.86, while the post-operative VAS score significantly increased to 7.86 ± 0.86. The preoperative auricle esthetic outcomes score was recorded as 9.95 ± 1.74, while the post-operative score significantly increased to 24.04 ± 2.16. The follow-up period did not present any cases of flap necrosis, hematoma, infection, or wound dehiscence.

CONCLUSION

The study demonstrates that comprehensive utilization of residual auricular tissue can lead to optimal outcomes in correcting polyotia with concha-type microtia. The utilization of residual ear tissue can be maximized to streamline the operation, minimize bodily harm, and enhance patient satisfaction.

Tragal remnant flap reconstruction method for congenital tragal malformation in children

OBJECTIVE

To explore the clinical effect of tragal remnant flap for congenital tragal malformation in children.

METHODS

The clinical data of 23 children with congenital tragal malformation hospitalized in our department from May 2017 to May 2021 were retrospectively reviewed.

RESULTS

Congenital tragal malformation has various names and clinical manifestations. It is a kind of rare congenital auricle malformation, which can exist alone or in combination with other malformations. About 78.3% of the children with congenital tragal malformation had a natural tragal remnant flap; The rest of the children without tragal remnant flap were repaired by skin flap＆cartilage reconstruction method (SFC-RM). For the depressed deformity around the tragus, the cartilage and fascia tissue around the tragus were used for filling. The overall effect was satisfactory.

CONCLUSIONS

Most children with congenital tragal malformation have natural tragal remnant flap. Tragal remnant flap reconstruction method (TRE-RM) not only has shorter operation time, less trauma, faster healing，fewer complications, but also can obtain more natural tragus appearance.

["Tragus flap" combined with "Z" modification method in the surgical correction of congenital tragal deformity in children and literature review]

Objective:To explore the clinical effect of "tragus flap" combined with "Z" modification method in the surgical correction of congenital tragal deformity in children. Methods:The clinical data of 36 children with congenital tragal deformity who were operated in Children's Hospital of Nanjing Medical University from June 2016 to June 2021 were retrospectively summarized, 30 children（35 ears）with congenital tragal malformation had a natural "tragus flap" structure. During the operation, "tragus flap" combined with "Z" modification method was used to reconstruct the tragus. For the depressed deformity around the tragus, the cartilage and fascia tissue around the tragus were used for filling.In the other 6 cases （8 ears）, because the natural "tragus flap" structure was not found, the tragus was reconstructed by other methods, and a relatively satisfactory tragus structure was obtained. The overall effect was satisfactory. Results:No obvious complications were observed during and after the operation. No obvious scar and cartilage hyperplasia were found during the follow-up of 1-12 months. The reconstructed tragus has a good three-dimensional shape, and the depression at the tragus has been well corrected, which is close to the healthy side. The children with bilateral tragus deformity basically achieve bilateral symmetrical tragus, which is satisfactory to the children and their parents. Conclusion:Although the clinical manifestations of congenital tragal malformation are various， "tragus flap" combined with "Z" modification method for tragus reconstruction can be used for most cases. The method not only has shorter operation time, less skin scar and fewer complications, but also can obtain more natural tragus structure.

Polyotia: the Confusing Auricular Malformation

OBJECTIVE

Polyotia is a very rare auricular malformation, and only few cases have been reported to date. Polyotia has been ambiguously defined, and due to the instability of its shape and condition, no uniform surgical technique has been established up to now. Thus, it is necessary to standardize the diagnosis and treatment of polyotia. The aim of the present study was to present a new set of objective diagnostic criteria for discussion, and introduce our surgical design for polyotia.

METHODS

A retrospective analysis was performed on 34 cases of polyotia, which were diagnosed and treated in our Plastic Surgery Department during a 3-year period from January 2016 to March 2019. The preoperative photographs, manifestations and operation records of these 34 cases were reviewed.

RESULTS

On the basis of the new set of objective diagnostic criteria, only 12 of 34 cases were diagnosed as polyotia, while the remaining 22 cases were diagnosed as accessory tragus. Polyotia was redefined as the presence of a broad-based accessory auricle in the tragus area along with accessory cavitas conchae similar to cavitas conchae. The new surgical design emphasized the use of cartilage and skin to fill up the concavity and reconstruct the tragus.

CONCLUSIONS

The diagnosis of polyotia was presented on the basis of a new set of objective criteria, which include an accessory auricle and accessory cavitas conchae. The use of cartilage and skin to fill up the concavity and reconstruct the tragus were the emphases.

Epidemiological Analysis and the Nomogram for Possible Risk Factors for Severe Microtia

BACKGROUND

Microtia is a severe congenital malformation of the external ear. This study aimed to explore the epidemiologic characteristics and the possible risk factors in patients with severe microtia in China, and integrate significant variables into a predictive nomogram.

METHODS

A total of 965 patients with microtia were included. This retrospective case study was conducted from July 2014 to July 2019 at Plastic Surgery Hospital in China. The detailed questionnaires concerning potential risk factors were completed and data were gathered. Chi-Square and Fisher tests were used to analyze the variables, and a multivariate logistic regression model was used to select variables related to severe microtia, and then construct a nomogram. The nomogram model was evaluated by the concordance index (C-index), calibration plot, and receiver operating characteristics (ROCs) curve. Bootstraps with 1000 resamples were applied to these analyses.

RESULTS

Of the 965 microtia patients, 629 (65.2%) were male and 867 (89.8%) were sporadic. The cases were observed more commonly in unilateral (83.1%) and right-sided (52.0%). And multiple malformations were observed in 392 (40.6%) cases. Multivariate logistic regression analysis showed that maternal age, miscarriage frequency, virus infection, anemia, using progesterone, paternal alcohol intake, and topography of living areas were associated with a higher risk of severe microtia. All the significant variables were combined into a predictive nomogram (C-index = 0.755,95% CI = 0.703-0.807). Higher prediction accuracy (adjusted C-index = 0.749) was further verified via bootstrap validation. The calibration plot showed good performance, and the ROCs curve analysis demonstrated high sensitivity and specificity.

CONCLUSIONS

Most microtia patients are male, sporadic, and accompanied by other malformations, which are similar to the phenotypic analysis results of other studies. A nomogram predicting severe microtia was constructed to provide scientific guidance for individualized prevention in clinical practice.

Administration of All-Trans Retinoic Acid to Pregnant Sows Improves the Developmental Defects of Hoxa1-/- Fetal Pigs

Hoxa1 mutation adversely affect fetal pig development, but whether all-trans retinoic acid (ATRA) administration to Hoxa1^+/− pregnant sows can improve Hoxa1^−/− fetal pig development defects has not been reported. A total of 24 healthy Hoxa1^+/− sows were mated with a healthy Hoxa1^+/− boar and randomly assigned to one control group and nine experiment groups. ATRA was orally administered to pregnant sows at the doses of 0, 4, 5, or 6 mg/kg maternal body weight on 12, 13, and 14 days post coitum (dpc), respectively, and a total of 146 live piglets were delivered including 37 Hoxa1^−/− piglets and 109 non-Hoxa1^−/− piglets. Results indicated that Hoxa1^−/− piglets delivered by sows in control group had bilateral microtia, canal atresia and ear's internal defects, and had lower birth liveweight and external ear score than non-Hoxa1^−/− neonatal piglets (P < 0.05). Maternal administration with ATRA can effectively correct the development defects of Hoxa1^−/− fetal pigs, Hoxa1^−/− neonatal piglets delivered by sows administered ATRA at a dose of 4 mg/kg body weight on 14 dpc had higher birth liveweight (P > 0.05) and higher scores of external ear (P < 0.05) compared to Hoxa1^−/− neonatal piglets from the control group, but had no significantly difference in terms of birth liveweight and external ear integrity than non-Hoxa1^−/− piglets from the control group (P > 0.05). The time of ATRA administration significantly affected Hoxa1^−/− fetal development (P < 0.05). Administration of ATRA to Hoxa1^+/− pregnant sows at 4 mg/kg body weight on 14 dpc can effectively improve the birth liveweight and ear defects of Hoxa1^−/− piglets.

Maternal risk factors for severe microtia/atresia in China: A case-control study

OBJECTIVE

Microtia/atresia is a severe malformation of the external ear. Previous studies have reported the potential risk factors on microtia, whereas few focused on severe microtia/atresia. The aim of the study was to investigate the effects of maternal exposure to environmental risk factors in patients with severe microtia/atresia in China.

METHODS

A case-control study was conducted. Cases were patients with severe microtia/atresia who presented to PUMCH between January 2014 and October 2017. A total of 322 patients with severe microtia/atresia were enrolled and 322 normal controls matched 1:1 with the patients by sex, age and nationality were enrolled. The designed questionnaires were completed and data were gathered. Odds ratios were estimated with logistic regression models along with 95% confidence intervals in severe microtia/atresia.

RESULTS

Most cases were males(68.6%), and the cases were observed more common in unilateral(80.7%), right-sided (54.0%). Multivariate logistic regression analysis showed that threatened abortion (OR 4.066,95% CI = 2.360-7.007), NSAIDs (OR 2.576,95% CI = 1.079-6.148), virus infection (OR 1.933,95% CI = 1.148-3.256), anemia (OR 1.902,95% CI = 1.026-3.526), miscarriages (OR 1.804,95% CI = 1.425-2.285), maternal age (OR 1.079,95% CI = 1.015-1.148) and paternal age (OR 1.061,95% CI = 1.003-1.122) were associated with a higher risk of severe microtia/atresia.

CONCLUSION

These results support that some maternal risk factors could be associated with severe microtia/atresia.

Seasonal Variations in Microtia of Chinese Population

BACKGROUND

Seasonality of congenital birth defect could help to identify environmental risk factors. Data concerning the seasonality of the prevalence of microtia are little. This article aims to determine whether births of microtia follow a certain pattern.

METHODS

Data were obtained from 2669 patients with microtia who were admitted to Second Ear Reconstruction Center of Plastic Surgery Hospital, Chinese Academy of Medical Science from January 2007 to December 2013. The controls consist of all living births from the Obstetric Department of the Haidian Maternal & Child Health Hospital during the same time. Seasonal variations in months of births were analyzed by using χ test.

RESULTS

A total of 2669 patients with microtia and 89,273 healthy living newborns were included in this study. Birth time peak of the patients occurred in autumn, especially in November, compared with the nadir in the spring, especially in April (P G 0.05). The birth time peak of male patients occurred in autumn, too, especially in October and November, While the valley occurred in spring (April, too). However, the seasonality in female patients is not so apparent with the peak occurred in the tail of summer and autumn, especially in August, November, and September orderly, while the valley occurred in March.

CONCLUSIONS

There is a possible seasonality in birth months and a difference between sexes of patients with microtia in this native Chinese population. This approach could be useful to study the etiology of microtia.

Seasonal variation in months of birth of patients with microtia in a Chinese population

OBJECTIVE

Seasonality in months of births has been found in many congenital deformities, but little data are available in microtia, especially in a Chinese population. The aim of this study was to determine whether births of patients with microtia follow a seasonal pattern in a Chinese population.

METHODS

Patients with microtia treated at the Plastic Surgery Hospital between 2009-03 and 2010-03 were investigated according to the months of births. Seasonal variations in months of births were analyzed by using χ(2) test.

RESULTS

A total of 693 patients with microtia were included in the study. Birth time peaks occurred in autumn and winter, especially in October and March, compared with the nadir in the summer (P<0.05). The birth time peaks of male occurred in autumn and winter, especially in October, January and September. The birth time peaks of female occurred in spring and summer, especially in March. There was statistical difference in birth distribution in different months (P<0.05) or four seasons (P<0.05) between the two genders. There was no statistical difference in birth distribution on a monthly or seasonal basis by sides.

CONCLUSIONS

The data indicate that there is a possible seasonality in months of births of patients with microtia in a Chinese population and a difference between the genders. This approach could be useful for the study of the etiology and pathogenesis of microtia.

Irreversible effects of retinoic acid pulse on Xenopus jaw morphogenesis: new insight into cranial neural crest specification

Jaws are formed by cephalic neural crest (CNCCs) and mesodermal cells migrating to the first pharyngeal arch (PA1). A complex signaling network involving different PA1 components then establishes the jaw morphogenetic program. To gather insight on this developmental process, in this study, we analyze the teratogenic effects of brief (1-15 min) pulses of low doses of retinoic acid (RA: 0.25-2 µM) or RA agonists administered to early Xenopus laevis (X.l.) embryos. We show that these brief pulses of RA cause permanent craniofacial defects specifically when treatments are performed during a 6-hr window (developmental stages NF15-NF23) that covers the period of CNCCs maintenance, migration, and specification. Earlier or later treatments have no effect. Similar treatments performed at slightly different developmental stages within this temporal window give rise to different spectra of malformations. The RA-dependent teratogenic effects observed in Xenopus can be partially rescued by folinic acid. We provide evidence suggesting that in Xenopus, as in the mouse, RA causes craniofacial malformations by perturbing signaling to CNCCs. Differently from the mouse, where RA affects CNCCs only at the end of their migration, in Xenopus, RA has an effect on CNCCs during all the period ranging from their exit from the neural tube until their arrival in the PA1. Our findings provide a conceptual framework to understand the origin of individual facial features and the evolution of different craniofacial morphotypes.

Epidemiological analysis of microtia: a retrospective study in 345 patients in China

OBJECTIVE

To study the epidemiologic characteristics of microtia in China and to investigate the possible risk factors with respect to the classification of microtia.

METHODS

A total of 345 patients with microtia were studied. All patients were taken an intentional physical examination and classified into five types. A detailed questionnaire concerning the maternal conditions during pregnancy was filled out by patient's mother. The frequencies of the relative factors were counted and the variables were statistically analyzed using Chi Square and Fisher's tests in the five types of microtia.

RESULTS

Most cases of microtia (88.12%) were sporadic and 72.75% of all cases occurred in males. It was more seen unilateral, especially affected on the right side (55.94%). A total of 195 patients (56.52%) were isolated microtia. In the rest of non-isolated microtia patients, 37.97% of the cases had hemifacial microsomia, which was the most common associated deformity. Thirty-four patients (9.86%) belonged to typical familial microtia. Three maternal factors showed significant differences in the five types of microtia, which were perinatal virus infection, high prior miscarriages and prevention treatments for threatened abortion.

CONCLUSIONS

The majority of microtia cases in China are sporadic and usually more common in males. Mothers who have prior miscarriages over 3 times or perinatal virus infection seem to be more likely to have severe microtia infants.

Environmental and genetic factors associated with congenital microtia: a case-control study in Jiangsu, China, 2004 to 2007

BACKGROUND

The objectives of this study were to filter out the environmental and genetic risk factors in microtia patients and to demonstrate the relationship between environmental and inherited factors in congenital microtia.

METHODS

A case-control study was carried out in 121 congenital microtia patients and 152 controls. Epidemiologic data related to environmental exposure were gathered through personal interviews with the target group. Polymerase chain reaction and DNA sequence analysis were performed to analyze the Gsc gene and BMP5 gene mutation in the case and control groups. The logistic regression model was used to analyze environmental and genetic risk factors and their relationships to microtia.

RESULTS

The main risk factors were disease during pregnancy (odds ratio, 5.890; 95 percent CI, 2.358 to 14.715), toxicity exposure during pregnancy (odds ratio, 4.764; 95 percent CI, 1.659 to 13.680), and resident area (odds ratio, 5.114; 95 percent CI, 2.086 to 12.535). The synthetic attributable risks amount to 0.7185. As to the Gsc gene, six of these patients had a same-sense mutation C-->T on 197 bp in exon 2; a missense mutation on A-->G 125 bp in exon 3 occurred in two cases; and amino acid changes from glutamic acid to glutamine. A heterozygosity on 196 TTT-->ACA resulting in missense mutation was detected in four patients, causing the amino acid to change from phenylalanine to threonine in BMP5 maternal peptide gene. However, no mutations were detected in the control subjects.

CONCLUSIONS

The results suggested that both environmental and genetic factors contribute to congenital microtia. The Gsc gene and the BMP5 maternal peptide gene may act as the predisposing genes of microtia. Further research is needed to clarify the relationship between the risk factors and microtia.

Molecular dynamics of retinoic acid-induced craniofacial malformations: implications for the origin of gnathostome jaws

Background

Intake of retinoic acid (RA) or of its precursor, vitamin A, during early pregnancy is associated with increased incidence of craniofacial lesions. The origin of these teratogenic effects remains enigmatic as in cranial neural crest cells (CNCCs), which largely contribute to craniofacial structures, the RA-transduction pathway is not active. Recent results suggest that RA could act on the endoderm of the first pharyngeal arch (1stPA), through a RARß-dependent mechanism.

Methodology/Principal Findings

Here we show that RA provokes dramatically different craniofacial malformations when administered at slightly different developmental times within a narrow temporal interval corresponding to the colonization of the 1^st PA by CNCCs. We provide evidence showing that RA acts on the signalling epithelium of the 1^st PA, gradually reducing the expression of endothelin-1 and Fgf8. These two molecular signals are instrumental in activating Dlx genes in incoming CNCCs, thereby triggering the morphogenetic programs, which specify different jaw elements.

Conclusions/Significance

The anatomical series induced by RA-treatments at different developmental times parallels, at least in some instances, the supposed origin of modern jaws (e.g., the fate of the incus). Our results might provide a conceptual framework for the rise of jaw morphotypes characteristic of gnathostomes.

Platelet-derived growth factor C plays a role in the branchial arch malformations induced by retinoic acid

BACKGROUND

All-trans-retinoic acid (RA) can produce branchial arch abnormalities in postimplantation rodent embryos cultured in vitro. Platelet-derived growth factor C (PDGF-C) was recently identified as a member of the PDGF ligand family. Many members of the PDGF family are essential for branchial arch morphogenesis and can be regulated by RA. The roles of PDGF-C in branchial arch malformations induced by RA and possible mechanisms were investigated.

METHODS

In whole embryo culture (WEC), mouse embryos were exposed to RA at 0, 0.1, 0.4, 1.0, or 10.0 microM, PDGF-C at 25, 50, or 75 ng/mL, or PDGF-C at 25, 50, or 75 ng/mL containing 0.4 microM RA. After 48 h of culture, mouse embryos were examined for dysmorphogenesis, and whole-mount immunohistochemistry was applied to PDGF-C. In explant cultures, explants were exposed to the same doses of RA and PDGF-C as WEC. Semiquantitative RT-PCR, zymography, and reverse zymography were used to evaluate the expressions and activities of matrix metalloproteinase (MMP)-2, MMP-14, and tissue inhibitor of metalloproteinase (TIMP)-2.

RESULTS

PDGF-C was reduced by RA, and exogenous PDGF-C rescued the branchial arch malformations induced by RA. Moreover, PDGF-C prevented RA-induced inhibition of the migratory ability of mesenchymal cells in the first branchial arch, by regulating the expressions of MMP-2, MMP-14, and TIPM-2.

CONCLUSIONS

Our results suggest that RA exposure reduces the expression of PDGF-C. The branchial arch malformations resulting from fetal RA exposure are caused at least partially by loss of PDGF-C and subsequent misregulations of the expressions of MMP-2, MMP-14, and TIMP-2.

Antifungal triazole derivative triadimefon induces ectopic maxillary cartilage by altering the morphogenesis of the first branchial arch

BACKGROUND

The triazole derivative, triadimefon (FON), induces branchial arch abnormalities in post-implantation rat embryos cultured in vitro, and cranio-facial malformations in mouse fetuses. Ectopic maxillary cartilage has been also described as a typical FON-related malformation. This work studies the morphogenesis of the ectopic cartilage in rat embryos and fetuses exposed in vivo to FON during the early postimplantation period.

METHODS

Pregnant rats were treated with 0, 250, and 500 mg/kg FON on Day 9.5 of pregnancy (D9.5) and sacrificed at term (D20), during the early fetal period (D17) or at different embryogenetic periods (D10, D11, D12). The skeleton was examined after stain of bone and cartilage or of cartilage alone respectively at term or at D17. The neural crest cell (NCC) migration and compaction was investigated at D10 and D11 and the cranial nerve organization described at D12.

RESULTS

Triadimefon is teratogenic in rats under the chosen experimental conditions. The malformations were at the level of the cranio-facial and axial skeleton at term and of the hindbrain nerves in embryos. A NCC abnormal migration and compaction was observed at the level of the first branchial arch: in FON-exposed embryos NCC were detected at the level of both maxillary and mandibular processes, whereas control embryos showed the immunostained tissue only at the level of the mandibular bud.

CONCLUSIONS

The pathogenic pathway, proposed to explain the ectopic cartilage, is the displacement of part of the NCC-derived tissues at the maxillary region of the first branchial arch.

Mirror ear: A reconstructive technique for substantial tragal anomalies or polyotia

Polyotia (mirror ear) is an extremely rarely reported congenital anomaly of the external ear. The aetiology of this condition is unclear, and there are few descriptions of surgical techniques used. We aimed to review our experience with this condition by performing a retrospective review of the cases treated in our unit. Eight cases of polyotia treated at a referral centre for ear reconstruction in a 12 year period (1992-2004) were reviewed. Patient demographic data and associated syndromes were recorded. Operative techniques used in the cases were studied. There was an equal number of males and females. Four patients had abnormal contralateral ears and two patients were formally diagnosed as suffering from a congenital developmental syndrome. Five main components of surgical technique were found to be particularly relevant to these cases. These relate to deconstruction of the defect, management of extra cartilage, management of skin, proximity of the facial nerve and the timing of surgery. The authors conclude that a structured surgical approach can lead to successful reconstruction of these difficult abnormalities.

Retinoid signaling in inner ear development

The inner ear originates from an embryonic ectodermal placode and rapidly develops into a three-dimensional structure (the otocyst) through complex molecular and cellular interactions. Many genes and their products are involved in inner ear induction, organogenesis, and cell differentiation. Retinoic acid (RA) is an endogenous signaling molecule that may play a role during different phases of inner ear development, as shown from pathological observations. To gain insight into the function of RA during inner ear development, we have investigated the spatio-temporal expression patterns of major components of RA signaling pathway, including cellular retinoic acid binding proteins (CRABPs), cellular retinoid binding proteins (CRBPs), retinaldehyde dehydrogenases (RALDHs), catabolic enzymes (CYP26s), and nuclear receptors (RARs). Although the CrbpI, CrabpI, and -II genes are specifically expressed in the inner ear throughout development, loss-of-function studies have revealed that these proteins are dispensable for inner development and function. Several Raldh and Cyp26 gene transcripts are expressed at embryological day (E) 9.0-9.5 in the otocyst and show mainly complementary distributions in the otic epithelium and mesenchyme during following stages. From Western blot, RT-PCR, and in situ hybridization analysis, there is a low expression of Raldhs in the early otocyst at E9, while Cyp26s are strongly expressed. During the following days, there is an up-regulation of Raldhs and a down-regulation for Cyp26s. Specific RA receptor (Rar and Rxr) genes are expressed in the otocyst and during further development of the inner ear. At the otocyst stage, most of the components of the retinoid pathway are present, suggesting that the embryonic inner ear might act as an autocrine system, which is able to synthesize and metabolize RA necessary for its development. We propose a model in which two RA-dependent pathways may control inner ear ontogenesis: one indirect with RA from somitic mesoderm acting to regulate gene expression within the hindbrain neuroepithelium, and another with RA acting directly on the otocyst. Current evidence suggests that RA may regulate several genes involved in mesenchyme-epithelial interactions, thereby controlling inner ear morphogenesis. Our investigations suggest that RA signaling is a critical component not only of embryonic development, but also of postnatal maintenance of the inner ear.

Study on the common teratogenic pathway elicited by the fungicides triazole-derivatives

Triazole-derivatives alter the pharyngeal apparatus morphogenesis of rodent embryos cultured in vitro. The hindbrain segmentation and the rhombencephalic neural crest cell (NCCs) migration are altered by Fluconazole exposure in vitro. The aim of the present work is to identify if a common pathogenic pathway is detectable also for other molecules of this class of compounds. 9.5 days post coitum (d.p.c.) old rat embryos were exposed in vitro to the teratogenic concentrations of Flusilazole, Triadimefon and Triadimenol and cultured for 24, 48 or 60 h. The expression and localisation of Hox-b1 and Krox-20 proteins (used as markers for hindbrain segmentation) were evaluated after 24 h of culture. The localisation and distribution of NCC was evaluated after 24, 30 and 48 h of culture. The morphology of the embryos was analysed after 48 h, while the branchial nerve structures were evaluated after 60 h of culture. Hindbrain segmentation and NCC migration alteration as well as pharyngeal arch and cranial nerve abnormalities were detected after exposure of the tested molecules. A common severe teratogenic intrinsic property for the tested molecules of this chemical class has been found, acting through alteration of the normal hindbrain developmental pattern.

Epidemiologic characteristics of anotia and microtia in California, 1989-1997

BACKGROUND

There is a paucity of epidemiologic information about the external ear malformations anotia and microtia.

METHODS

Using data from a large population-based registry, we explored prevalences and maternal/infant characteristics associated with anotia and microtia. Data were derived from the California Birth Defects Monitoring Program, a population-based active surveillance system for collecting information on infants and fetuses with congenital malformations using multiple source ascertainment. Approximately 2.5 million births (live-born and stillborn) occurred during the ascertainment period, 1989-1997. Information on maternal and infant/fetal characteristics was obtained from California birth certificate and fetal death files.

RESULTS

The prevalence of anotia/microtia was 2.50 per 10,000 live births and stillbirths. Isolated cases, i.e., those live births and stillbirths with no other accompanying anomaly diagnoses, revealed a prevalence of 0.63 per 10,000, whereas among nonisolated cases, the prevalence was 1.53 per 10,000 live births and stillbirths. Prevalences of isolated anotia/microtia were substantially higher among U.S.-born Hispanics, foreign-born Hispanics, and Asians compared to non-Hispanic whites, with relative risks ranging from three- to seven-fold. Similar prevalences for maternal race/ethnicity (except for Asians) were observed for live births and stillbirths with nonisolated cases of anotia/microtia, but the magnitude of risks were lower than those observed for isolated cases. Prevalence of nonisolated anotia/microtia was substantially lower among women whose education was 12 years or more.

CONCLUSIONS

These data reveal descriptive epidemiologic features of anotia/microtia most notably substantial risks associated with race/ethnic groups and lower maternal education. Additional study for factors associated with these characteristics could reveal clues for the etiology of these ear anomalies.

The external ear: More attention to detail may aid syndrome diagnosis and contribute answers to embryological questions

The human pinna has a complex shape and yet the basic components of normal structure are remarkably constant between individuals. It is precocious in its appearance during embryogenesis and it has been subject to many developmental and surgical studies, yet questions remain as to its primary embryogenesis and the causes of its malformations. Unfortunately, the vast majority of clinical reports of syndromes and of individuals with dysmorphic signs provide limited and inadequate description of the external ear. Given the intricate pattern of the pinna, and hence its potential for morphological variation, we think that more attention to the specific description of ear anomalies may lead to a better appreciation of the etiology and embryology of the malformations. Furthermore, in some cases correlation with specific syndromes may provide an aid to diagnosis. Towards those ends this paper reviews some of the controversy concerning the embryology of the pinna, and discusses a number of the better-defined anomalies of the external ear. Although it has been suggested that anomalies of the insertion and orientation of intrinsic muscles of the pinna may be responsible for variations in external ear morphology, we think it likely that in many cases the anomalous insertions may be secondary.

Craniofacial and axial skeletal defects induced by the fungicide triadimefon in the mouse

BACKGROUND

Triadimefon is an antifungal derived from triazole. In in vitro whole-rodent embryo cultures, triazole-derivatives showed specific teratogenic effects at the branchial apparatus. The aim of the present work was to test in vivo triadimefon (FON), in order to verify a relationship between triazole exposure, embryonic abnormalities, and/or fetal malformations.

METHODS

Pregnant CD-1 mice were treated with 0-300 mg/kg FON by gavage on day 8 post coitum (p.c.) at 10:00 AM, and sacrificed on day 8 p.c. at 1:00 PM, on day 9 p.c. at 10:00 AM, on day 10 p.c. at 10:00 AM, and at term of gestation (day 18 p.c.). At midgestation, the embryos were processed for specific immunostainings to visualize the hindbrain segmentation (day 8 p.c.) and the neural crest cell migration (days 8 and 9 p.c.). Fetuses explanted at term were all processed for skeletal examination after double-staining of osseous and cartilaginous tissues.

RESULTS

At midgestation, the immunostaining of rhombomeres 3 and 5 showed a light scattering of the immunostained areas; the neural crest cell migration was unaffected, but their localization at the branchial arch level was abnormal. At term, several severe malformations were observed at the craniofacial and at the axial skeletal level. Ectopic cartilage was observed at the upper jaw.

CONCLUSIONS

Triadimefon is teratogenic. The observed craniofacial malformations could be explained by an alteration of the rhombomeric organization and neural crest migration to the branchial arches; the axial abnormalities could be explained by the abnormal segmental identity specification.

Relationship between hindbrain segmentation, neural crest cell migration and branchial arch abnormalities in rat embryos exposed to fluconazole and retinoic acid in vitro

Fluconazole (FLUCO) and retinoic acid (RA) can perturb morphogenesis of the branchial apparatus in rodent embryos exposed in vitro. The aim of the present study was to compare the effects induced by in vitro exposure to FLUCO or to RA on rhombomere organisation, neural crest cell (NCC) migration and cranial nerve differentiation using specific antibodies. For this purpose 9.5 d.p.c. rat embryos were exposed to teratogenic concentrations of FLUCO or RA; another group was exposed to no-effect concentrations of both agents. Expression of Hox-b1 and Krox20 (markers of specific rhombomeres) was altered after FLUCO and RA exposure. Furthermore, FLUCO and RA showed a synergistic effect. These results suggest that the observed branchial abnormalities are due to anomalous NCC migration related to incorrect organisation of specific rhombomeres.

Limb reduction defects in the first generation and deafness in the second generation of intrauterine exposed fetuses to diethylstilbestrol

Maternal treatment with diethylstilbestrol (DES) during pregnancy can produce vaginal adenocarcinoma and other abnormalities of the vagina in her daughters when they reach adolescence or adulthood, miscarriages and absence of full term infants. Concerning malformations in newborns whose mothers were treated with DES, clitoromegaly and malformations of the uterus were reported in females and genital lesions in males. However, the frequencies of major congenital anomalies were not greater than expected. We report three cases of limb reduction defects (LRD) in the first generation of children whose mothers were treated with DES during pregnancy, and two children (one male, one female) with deafness in the second generation after intrauterine exposure to DES. The LRD were not associated with other congenital anomalies. The malformed children with LRD were born between 1965 and 1973. The deafness was also isolated. The two mothers who have no hearing problems and who are healthy were exposed in utero to DES in 1963 and 1965, respectively. Their children were born in 1989 and 1994, respectively. In conclusion, the association of LRD and hearing loss with intrauterine exposure to DES could be coincidental. However, some hypothesis may explain these associations. Congenital hearing loss in the second generation may suggest a transgenerational effect.

Effects of gestational exposure to ethane dimethanesulfonate in CD-1 mice: Microtia and preliminary hearing tests

BACKGROUND

Microtia is a reduction in pinna size, usually seen in humans in conjunction with other medical conditions. We report microtia in CD-1 mice after gestational exposure to ethane dimethanesulfonate (EDS), an alkylating agent and adult rat Leydig cell toxicant.

METHODS

Time-pregnant CD-1 mice were administered 0, 80, or 160 mg EDS/kg on gestation days (GD) 11-17, or 0 or 160 mg EDS/kg on GD 11-13, GD 13-15 or GD 15-17. Pinnae were measured on postnatal days (PND) 4, 8, 18, and 28; and were observed for detachment from birth through PND 8. Branchial-arch derived skeletal structures and histology of the pinna was examined on PND 4 and 24. Brainstem auditory evoked response (BAER) tests were carried out at approximately PND 160 to determine possible effects on hearing.

RESULTS

All offspring of EDS-treated dams exhibited bilateral, dose-related decreases in pinna size. Gestational exposure during GD 11-13 produced smaller ears than during GD 13-15 or 15-17, but not as small as the GD 11-17 regimen. Ossification of other pharyngeal arch derivatives was delayed whereas histology was unremarkable. BAER analysis showed a decrease in the proportion of adult offspring producing a quantifiable response to varied auditory stimuli among EDS-treated litters.

CONCLUSIONS

Gestational exposure to EDS affects pinna development in the mouse, with a broad period of sensitivity during the second half of gestation. Microtia induced by EDS may be associated with hearing deficits, suggesting functional importance of pinna size or additional effects of EDS on ear development not detected by morphological examination.

Retinoic acid-induced developmental defects are mediated by RARbeta/RXR heterodimers in the pharyngeal endoderm

Fusion and hypoplasia of the first two branchial arches, a defect typically observed in retinoic acid (RA) embryopathy, is generated in cultured mouse embryos upon treatment with BMS453, a synthetic compound that exhibits retinoic acid receptor beta (RARbeta) agonistic properties in transfected cells. By contrast, no branchial arch defects are observed following treatment with synthetic retinoids that exhibit RARalpha or RARgamma agonistic properties. The BMS453-induced branchial arch defects are mediated through RAR activation, as they are similar to those generated by a selective pan-RAR agonist, are prevented by a selective pan-RAR antagonist and cannot be mimicked by exposure to a pan-RXR agonist alone. They are enhanced in the presence of a pan-RXR agonist, and cannot be generated in Rarb-null embryos. Furthermore, they are accompanied, in the morphologically altered region, by ectopic expression of Rarb and of several other direct RA target genes. Therefore, craniofacial abnormalities characteristic of the RA embryopathy are mediated through ectopic activation of RARbeta/RXR heterodimers, in which the ligand-dependent activity of RXR is subordinated to that of RARbeta. Endodermal cells lining the first two branchial arches respond to treatment with the RARbeta agonist, in contrast to neural crest cells and ectoderm, which suggests that a faulty endodermal regionalization is directly responsible for RA-induced branchial arch dysmorphologies. Additionally, we provide the first in vivo evidence that the synthetic RARbeta agonist BMS453 exhibits an antagonistic activity on the two other RAR isotypes.

Pathogenic pathways in fluconazole-induced branchial arch malformations

BACKGROUND

A widely-used antimycotic agent, bis-triazole fluconazole (FLUCO), is able to produce abnormalities to the branchial apparatus (hypoplasia, agenesis, and fusion) in postimplantation rodent embryos cultured in vitro. The branchial apparatus is a complex and transient structure in vertebrate embryos and is essential for the development of the face skeleton. Branchial arch mesenchyme is formed by two different cellular populations: paraxial mesenchyme and ectomesenchyme, which originate from rhombencephalic neural crest cell (NCC) migration. We investigated the possible pathogenic pathways involved in FLUCO-related branchial arch abnormalities. Perturbations in physiological apoptosis, cell proliferation, NCC migration and branchial mesenchyme induction have been considered.

METHODS

Rat embryos (9.5-day postcoitum; 1-3 somites) were exposed in vitro to 0 or 500 microM FLUCO. After 24, 36, or 48 hr of culture, embryos were examined for apoptosis (acridine orange method) and cell proliferation (BrdU incorporation and detection method). Rhombencephalic NCC migration was analyzed using immunostaining of NCC (using anti-CRABP antibodies) and the extracellular matrix (using anti-fibronectin antibodies). The differentiative capability of the branchial mesenchymes was investigated using anti-endothelin and anti-endothelin-receptor antibodies.

RESULTS

During the whole culture period, no alterations in physiological apoptosis, cell proliferation, and mesenchymal cell induction were observed in FLUCO-exposed embryos in comparison to controls. On the contrary, severe alterations in NCC migration pathways were observed in FLUCO-exposed embryos.

CONCLUSIONS

The findings suggest that FLUCO produces teratogenic effects by interfering with the cellular and molecular mechanisms that control NCC migration.

Exposure of cynomolgus monkey embryos to retinoic acid causes thymic defects: effects on peripheral lymphoid organ development

We have previously reported that exposure of monkey embryos to 13-cis-retinoic acid (cRA) results in thymic defects. In this study, we analyzed lymphocyte and antigen-presenting cell populations at gestational days (GDs) 80-100 in the thymus, spleen, mesenteric lymph nodes, and gut-associated lymphoid tissue following a teratogenic dosing regimen of cRA (2.5 and 5 mg/kg) at GD14-27. Tissue sections were immunostained for T-cells (anti-CD3), B-cells (anti-CD20), dendritic cells (p55), and major histocompatibility class II (anti-HLA-DR). Digital images of spleen sections were analyzed to obtain the relative area occupied by the cell subsets within the white pulp (WP). Compared with controls, the T-cell dependent compartment of the spleen WP in specimens with perturbed thymic development (aplasia and severe hypoplasia) showed a reduction in size and proportion of CD3(+) T cells. Our findings indicate that cRA-induced thymic defects result in disrupted development of the splenic T-cell dependent compartment.

Cadherins and catenins, Wnts and SOXs: embryonic patterning in Xenopus

Wnt signaling plays a critical role in a wide range of developmental and oncogenic processes. Altered gene regulation by the canonical Wnt signaling pathway involves the cytoplasmic stabilization of beta-catenin, a protein critical to the assembly of cadherin-based cell-cell adherence junctions. In addition to binding to cadherins, beta-catenin also interacts with transcription factors of the TCF-subfamily of HMG box proteins and regulates their activity. The Xenopus embryo has proven to be a particularly powerful experimental system in which to study the role of Wnt signaling components in development and differentiation. We review this literature, focusing on the role of Wnt signaling and interacting components in establishing patterns within the early embryo.

13-cis-retinoic acid causes patterning defects in the early embryonic rostral hindbrain and abnormal development of the cerebellum in the macaque

BACKGROUND

We have previously reported that exposure of embryos to 13-cis-retinoic acid (cRA) results in an abnormal phenotype of the fetal cerebellum. In this study, we analyzed early changes in the cerebellar anlagen (midbrain-hindbrain junction) as well as lesions of the fetal cerebellar vermis after a teratogenic dosing regimen of cRA in the macaque model.

METHODS

We examined embryo coronal sections of the midbrain-hindbrain junction immunostained for Pax-2, Engrailed-2 (En-2) and Krox-20. To characterize the cerebellum foliation and fissure formation processes, we analyzed vermal cortical cell layer development and the number and depth of the major fissures on sagittal sections of fetal vermis. We also examined Purkinje cell development in vermal sections immunostained for CD3.

RESULTS

Compared with controls, there was a consistent truncation of the midbrain-hindbrain region of early embryos exposed to cRA. The cRA-induced fetal vermis lesions included inhibition in its anteroposterior growth, altered folial patterning, a general loss of prominence of the fissures accompanied by a total loss of sublobular fissures, and changes in cortical cell layer development. CD3(+) Purkinje cells were abnormally dispersed deep into the molecular layer in the vermis.

CONCLUSIONS

Our findings indicate that the effects of cRA on the developing cerebellum involve interference with the hierarchy of complex cellular and genetic interactions that lead to the growth and subdivision of the cerebellum into smaller units. The regional vermal defects may be related to early postnatal functional deficits.

Vitamin A teratogenicity and risk assessment in the macaque retinoid model

Studies were performed in the cynomolgus monkey (Macaca fascicularis) to provide risk assessment information on safe dose levels of Vitamin A during human pregnancy. Vitamin A palmitate was orally administered at 7500 IU/kg (2.25 mg/kg) to 80 000 IU/kg (24 mg/kg) body weight during early pregnancy (gestation day [GD] 16-27). The results indicated a dose-related increase in exposure (AUC) to retinyl esters and retinoic acids (RA) (all-trans-RA, all-trans-4-oxo-RA, 13-cis-RA, 13-cis-4-oxo-RA). There was also a dose-related increase in abortion and malformation that affected typical retinoid target tissues in the embryo, including the craniofacial region, heart, and thymus. The NOAEL and LOAEL for structural malformations were 7500 IU/kg and 20 000 IU/kg (6 mg/kg), respectively. A companion study involving oral administration of 13-cis-RA during the same gestational period established the NOAEL for malformations at 0.5 mg/kg/day, which is close to the human therapeutic dose range (0.5 to 1.5 mg/kg/day) associated with retinoid embryopathy. Based on the known similarities in teratogenic susceptibility to 13-cis-RA, the monkey NOAEL for Vitamin A (7500 IU/kg) was used to estimate safe levels of this nutrient in humans applying a safety factor of 10. This approach yielded safe levels of Vitamin A during human pregnancy in the range of approximately 25 000 to 37 000 IU/day.