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Cummings KJ, Leiter JC, Trachtenberg FL, Okaty BW, Darnall RA, Haas EA, Harper RM, Nattie EE, Krous HF, Mena OJ, Richerson GB, Dymecki SM, Kinney HC, Haynes RL. Altered 5-HT2A/C receptor binding in the medulla oblongata in the sudden infant death syndrome (SIDS): Part II. Age-associated alterations in serotonin receptor binding profiles within medullary nuclei supporting cardiorespiratory homeostasis. J Neuropathol Exp Neurol 2024; 83:144-160. [PMID: 38323418 PMCID: PMC10880067 DOI: 10.1093/jnen/nlae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
The failure of chemoreflexes, arousal, and/or autoresuscitation to asphyxia may underlie some sudden infant death syndrome (SIDS) cases. In Part I, we showed that some SIDS infants had altered 5-hydroxytryptamine (5-HT)2A/C receptor binding in medullary nuclei supporting chemoreflexes, arousal, and autoresuscitation. Here, using the same dataset, we tested the hypotheses that the prevalence of low 5-HT1A and/or 5-HT2A/C receptor binding (defined as levels below the 95% confidence interval of controls-a new approach), and the percentages of nuclei affected are greater in SIDS versus controls, and that the distribution of low binding varied with age of death. The prevalence and percentage of nuclei with low 5-HT1A and 5-HT2A/C binding in SIDS were twice that of controls. The percentage of nuclei with low 5-HT2A/C binding was greater in older SIDS infants. In >80% of older SIDS infants, low 5-HT2A/C binding characterized the hypoglossal nucleus, vagal dorsal nucleus, nucleus of solitary tract, and nuclei of the olivocerebellar subnetwork (important for blood pressure regulation). Together, our findings from SIDS infants and from animal models of serotonergic dysfunction suggest that some SIDS cases represent a serotonopathy. We present new hypotheses, yet to be tested, about how defects within serotonergic subnetworks may lead to SIDS.
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Affiliation(s)
- Kevin J Cummings
- Department of Biomedical Sciences, Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri, USA
| | - James C Leiter
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Benjamin W Okaty
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert A Darnall
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Elisabeth A Haas
- Department of Research, Rady’s Children’s Hospital, San Diego, California, USA
| | - Ronald M Harper
- Department of Neurobiology and the Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Eugene E Nattie
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Henry F Krous
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
- Departments of Pathology and Pediatrics, Rady Children’s Hospital, San Diego, California, USA
| | - Othon J Mena
- San Diego County Medical Examiner Office, San Diego, California, USA
| | - George B Richerson
- Departments of Neurology and Molecular Physiology & Biophysics, University of Iowa, Iowa City, Iowa, USA
| | - Susan M Dymecki
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah C Kinney
- Department of Pathology, CJ Murphy Laboratory for SIDS Research, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robin L Haynes
- Department of Pathology, CJ Murphy Laboratory for SIDS Research, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Bandoli G, Delker E, Schumacher BT, Baer RJ, Kelly AE, Chambers CD. Prenatal cannabis use disorder and infant hospitalization and death in the first year of life. Drug Alcohol Depend 2023; 242:109728. [PMID: 36516553 PMCID: PMC10363398 DOI: 10.1016/j.drugalcdep.2022.109728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether maternal cannabis use disorder is associated with infant hospitalization or death in the first year of life. METHODS We queried an administrative birth cohort derived from the hospital discharge database maintained by the California Office of Statewide Health Planning and Development and linked with vital statistics files. We included singleton, live-birth deliveries between 2011 and 2018. Pregnancies with cannabis use disorder were classified from International Classification of Disease codes. Outcomes included infant emergency department visits and hospital admissions identified from health records, and infant deaths identified from death records. Models were adjusted for sociodemographic variables, psychiatric comorbidities and other substance use disorders. RESULTS There were 34,544 births (1.0 %) with a cannabis use disorder diagnosis in pregnancy, with increasing prevalence over the study period. The incidence of infant death in the first year of life was greater among those with a maternal cannabis use disorder diagnosis than those without (1.0 % vs 0.4 %; adjusted risk ratio 1.4 95 % CI: 1.2-1.6). When examining specific causes of death, the increased risk estimates were attributable to perinatal conditions and sudden unexpected infant death. After adjustment, there was no increased risk of infant hospitalizations or emergency department visits. CONCLUSIONS These findings warrant further investigation into the underlying mechanisms of maternal prenatal CUD on infant outcomes, and add to a rapidly expanding body of literature supporting the need for effective treatment options for pregnant individuals with cannabis use disorders.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA.
| | - Erin Delker
- Department of Pediatrics, University of California San Diego, USA
| | - Benjamin T Schumacher
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA; Department of Epidemiology, School of Public Health, University of Pittsburgh, USA
| | - Rebecca J Baer
- Department of Pediatrics, University of California San Diego, USA
| | - Ann E Kelly
- Department of Pediatrics, University of California San Diego, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, USA
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Cummings KJ, Leiter JC. Take a deep breath and wake up: The protean role of serotonin preventing sudden death in infancy. Exp Neurol 2020; 326:113165. [PMID: 31887304 PMCID: PMC6956249 DOI: 10.1016/j.expneurol.2019.113165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/14/2019] [Accepted: 12/26/2019] [Indexed: 01/24/2023]
Abstract
Recordings from infants who died suddenly and unexpectedly demonstrate the occurrence of recurring apneas, ineffective gasping, and finally, failure to restore eupnea and arouse prior to death. Immunohistochemical and autoradiographic data demonstrate a constellation of serotonergic defects in the caudal raphe nuclei in infants who died of Sudden Infant Death Syndrome (SIDS). The purpose of this review is to synthesize what is known about adaptive responses of the infant to severely hypoxic conditions, which unleash a flood of neuromodulators that inhibit cardiorespiratory function, thermogenesis, and arousal and the emerging role of serotonin, which combats this cardiorespiratory inhibition to foster autoresuscitation, eupnea, and arousal to ensure survival following an hypoxic episode. The laryngeal and carotid body chemoreflexes are potent in newborns and infants, and both reflexes can induce apnea and bradycardia, which may be adaptive initially, but must be terminated if an infant is to survive. Serotonin has a unique ability to touch on each of the processes that may be required to recover from hypoxic reflex apnea: gasping, the restoration of heart rate and blood pressure, termination of apneas and, eventually, stimulation of eupnea and arousal. Recurrent apneic events, bradycardia, ineffective gasping and a failure to terminate apneas and restore eupnea are observed in animals harboring defects in the caudal serotonergic system models - all of these phenotypes are reminiscent of and compatible with the cardiorespiratory recordings made in infants who subsequently died of SIDS. The caudal serotonergic system provides an organized, multi-pronged defense against reflex cardiorespiratory inhibition and the hypoxia that accompanies prolonged apnea, bradycardia and hypotension, and any deficiency of caudal serotonergic function will increase the propensity for sudden unexplained infant death.
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Affiliation(s)
- Kevin J Cummings
- Department of Biomedical Sciences, University of Missouri-Columbia, Dalton Cardiovascular Research Center, 134 Research Park Drive, Columbia, MO 65203, USA
| | - James C Leiter
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, One Rope Ferry Road, Hanover, NH 03755, USA.
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