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Paschold L, Gottschick C, Langer S, Klee B, Diexer S, Aksentijevich I, Schultheiß C, Purschke O, Riese P, Trittel S, Haase R, Dressler F, Eberl W, Hübner J, Strowig T, Guzman CA, Mikolajczyk R, Binder M. T cell repertoire breadth is associated with the number of acute respiratory infections in the LoewenKIDS birth cohort. Sci Rep 2023; 13:9516. [PMID: 37308563 DOI: 10.1038/s41598-023-36144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
We set out to gain insight into peripheral blood B and T cell repertoires from 120 infants of the LoewenKIDS birth cohort to investigate potential determinants of early life respiratory infections. Low antigen-dependent somatic hypermutation of B cell repertoires, as well as low T and B cell repertoire clonality, high diversity, and high richness especially in public T cell clonotypes reflected the immunological naivety at 12 months of age when high thymic and bone marrow output are associated with relatively few prior antigen encounters. Infants with inadequately low T cell repertoire diversity or high clonality showed higher numbers of acute respiratory infections over the first 4 years of life. No correlation of T or B cell repertoire metrics with other parameters such as sex, birth mode, older siblings, pets, the onset of daycare, or duration of breast feeding was noted. Together, this study supports that-regardless of T cell functionality-the breadth of the T cell repertoire is associated with the number of acute respiratory infections in the first 4 years of life. Moreover, this study provides a valuable resource of millions of T and B cell receptor sequences from infants with available metadata for researchers in the field.
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Affiliation(s)
- Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Cornelia Gottschick
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Susan Langer
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Bianca Klee
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Sophie Diexer
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christoph Schultheiß
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Oliver Purschke
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Peggy Riese
- Department Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, 38124, Braunschweig, Germany
| | - Stephanie Trittel
- Department Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, 38124, Braunschweig, Germany
| | - Roland Haase
- Department of Neonatology and Pediatric Intensive Care, Hospital St. Elisabeth und St. Barbara, 06110, Halle (Saale), Germany
| | - Frank Dressler
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, 30625, Hannover, Germany
| | - Wolfgang Eberl
- Department of Paediatrics, Hospital Braunschweig, 38118, Braunschweig, Germany
| | - Johannes Hübner
- Department of Paediatrics, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University Munich, 80337, Munich, Germany
| | - Till Strowig
- Department Microbial Immune Regulation, Helmholtz Centre for Infection Research, 38124, Braunschweig, Germany
| | - Carlos A Guzman
- Department Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, 38124, Braunschweig, Germany
| | - Rafael Mikolajczyk
- Interdisciplinary Center for Health Sciences, Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Medical School of the Martin-Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
- Division of Medical Oncology, University Hospital Basel, Petersgraben 4, 40314031, Basel, Switzerland.
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Time-Specific Factors Influencing the Development of Asthma in Children. Biomedicines 2022; 10:biomedicines10040758. [PMID: 35453508 PMCID: PMC9025817 DOI: 10.3390/biomedicines10040758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023] Open
Abstract
Susceptibility to asthma is complex and heterogeneous, as it involves both genetic and environmental insults (pre- and post-birth) acting in a critical window of development in early life. According to the Developmental Origins of Health and Disease, several factors, both harmful and protective, such as nutrition, diseases, drugs, microbiome, and stressors, interact with genotypic variation to change the capacity of the organism to successfully adapt and grow in later life. In this review, we aim to provide the latest evidence about predictive risk and protective factors for developing asthma in different stages of life, from the fetal period to adolescence, in order to develop strategic preventive and therapeutic interventions to predict and improve health later in life. Our study shows that for some risk factors, such as exposure to cigarette smoke, environmental pollutants, and family history of asthma, the evidence in favor of a strong association of those factors with the development of asthma is solid and widely shared. Similarly, the clear benefits of some protective factors were shown, providing new insights into primary prevention. On the contrary, further longitudinal studies are required, as some points in the literature remain controversial and a source of debate.
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Lin J, Yuan S, Dong B, Zhang J, Zhang L, Wu J, Chen J, Tang M, Zhang B, Wang H, Dai Y, Liu S, Hu Y, Qi X, Xu L, Zhao L, Yin Y. The Associations of Caesarean Delivery With Risk of Wheezing Diseases and Changes of T Cells in Children. Front Immunol 2022; 12:793762. [PMID: 34970272 PMCID: PMC8712489 DOI: 10.3389/fimmu.2021.793762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to assess the associations of caesarean delivery (CD) with risk of wheezing diseases and changes of immune cells in children. Design The cross-sectional study was conducted between May, 2020 and April, 2021. Setting and participants The study was conducted in Shanghai Children’s Medical Center, Shanghai, China. A total of 2079 children with a mean age of 36.97 ± 40.27 months and their guardians were included in the present study via face-to-face inquiry and physical examination by clinicians. Methods Logistic regression was applied to estimate odds ratio (ORs) and 95% confidence intervals (CIs) for the association between CD and first episode of wheezing (FEW) or asthma. Models were adjusted for premature or full-term delivery, exclusive breastfeeding (at least 4 months) or not. Results Among the 2079 children, 987 children (47.47%) were born by CD and 1092 (52.53%) by vaginal delivery (VD). Children delivered by caesarean had significantly lower gestational age (P<0.01) compared with those who delivered vaginally. Our results also showed that CD was related to increased risk of FEW by the age of 3(adjusted OR 1.50, 95%CI 1.06, 2.12) and increased tendency to develop asthma by the age of 4 (adjusted OR 3.16, 95%CI 1.25, 9.01). The subgroup analysis revealed that the negative effects of CD on asthma were more obvious in children without exclusive breastfeeding (adjusted OR 4.93, 95%CI 1.53, 21.96) or without postnatal smoking exposure (adjusted OR 3.58, 95%CI 1.20, 13.13). Furthermore, compared with children born through VD, a significant change of the T cells (increased proportion of CD4+ T cells and decreased number and proportion of CD8+ T cells) were observed before the age of one in the CD group. However, the changes were insignificant in children over 1 year old. Conclusions This study showed age-dependent associations of CD with asthma and FEW in offspring. Moreover, CD appeared to have an effect on the cellular immunity in infants, the disorder of which may contribute to the development of asthma in children.
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Affiliation(s)
- Jilei Lin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuhua Yuan
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Dong
- Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinhong Wu
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiande Chen
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mingyu Tang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Zhang
- Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Hansong Wang
- Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Yuanyuan Dai
- Department of Neonatology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinyi Qi
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liangye Xu
- Department of information, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liebin Zhao
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai, China
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Gürdeniz G, Ernst M, Rago D, Kim M, Courraud J, Stokholm J, Bønnelykke K, Björkbom A, Trivedi U, Sørensen SJ, Brix S, Hougaard D, Rasmussen M, Cohen AS, Bisgaard H, Chawes B. Neonatal metabolome of cesarean section and risk of childhood asthma. Eur Respir J 2021; 59:13993003.02406-2021. [PMID: 34887324 DOI: 10.1183/13993003.02406-2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/27/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Birth by cesarean section (CS) is linked to an increased risk of developing asthma, but the underlying mechanisms are unclear. OBJECTIVE To elucidate the link between birth by CS and asthma using newborn metabolomic profiles and integrating early life gut microbiome data and cord blood immunology. METHODS We investigated the influence of CS on liquid chromatography mass spectrometry (LC-MS) metabolomic profiles of dried blood spots from newborns of the two independent Copenhagen Prospective Studies on Asthma in Childhood cohorts, i.e. COPSAC2010 (n=677) and COPSAC2000 (n=387). We assessed the associations between the CS metabolic profile, age one-week gut microbiome data and frequency of cord blood Tregs. RESULTS In COPSAC2010, a partial least square-discriminant analysis (PLS-DA) model showed that children born by CS versus natural delivery had different metabolic profiles (AUC=0.77, p=2.2e-16), which was replicated in COPSAC2000 (AUC=0.66, p=1.2e-5). The metabolic profile of CS was significantly associated with an increased risk of asthma at school-age in both COPSAC2010 (p=0.03) and COPSAC2000 (p=0.005). CS was associated with lower abundance of tryptophan, bile acid and phenylalanine metabolites, indicative of a perturbed gut microbiota. Further, gut bacteria dominating after natural delivery, i.e. Bifidobacterium and Bacteroides were correlated with CS-discriminative microbial metabolites, suggesting maternal microbial transmission during birth regulating the newborn's metabolism. Finally, the CS metabolic profile was associated with frequency of cord blood Tregs. CONCLUSIONS These findings propose that CS is programming the risk of childhood asthma through perturbed immune responses and gut microbial colonization patterns reflected in the blood metabolome at birth.
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Affiliation(s)
- Gözde Gürdeniz
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Madeleine Ernst
- Section for Clinical Mass Spectrometry, Department of Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Daniela Rago
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Min Kim
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Julie Courraud
- Section for Clinical Mass Spectrometry, Department of Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anders Björkbom
- Section for Clinical Mass Spectrometry, Department of Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Urvish Trivedi
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Søren J Sørensen
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - David Hougaard
- Section for Clinical Mass Spectrometry, Department of Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Morten Rasmussen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Chemometrics and Analytical Technologies, Department of Food Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Arieh S Cohen
- Section for Clinical Mass Spectrometry, Department of Congenital Disorders, Danish Center for Neonatal Screening, Statens Serum Institut, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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García-Serna AM, Martín-Orozco E, Hernández-Caselles T, Morales E. Prenatal and Perinatal Environmental Influences Shaping the Neonatal Immune System: A Focus on Asthma and Allergy Origins. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083962. [PMID: 33918723 PMCID: PMC8069583 DOI: 10.3390/ijerph18083962] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023]
Abstract
It is suggested that programming of the immune system starts before birth and is shaped by environmental influences acting during critical windows of susceptibility for human development. Prenatal and perinatal exposure to physiological, biological, physical, or chemical factors can trigger permanent, irreversible changes to the developing immune system, which may be reflected in cord blood of neonates. The aim of this narrative review is to summarize the evidence on the role of the prenatal and perinatal environment, including season of birth, mode of delivery, exposure to common allergens, a farming environment, pet ownership, and exposure to tobacco smoking and pollutants, in shaping the immune cell populations and cytokines at birth in humans. We also discuss how reported disruptions in the immune system at birth might contribute to the development of asthma and related allergic manifestations later in life.
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Affiliation(s)
- Azahara María García-Serna
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Biochemistry and Molecular Biology B and Immunology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
| | - Elena Martín-Orozco
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Biochemistry and Molecular Biology B and Immunology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
- Network of Asthma and Adverse and Allergic Reactions (ARADyAL), 28029 Madrid, Spain
| | - Trinidad Hernández-Caselles
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Biochemistry and Molecular Biology B and Immunology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
- Network of Asthma and Adverse and Allergic Reactions (ARADyAL), 28029 Madrid, Spain
| | - Eva Morales
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Public Health Sciences, University of Murcia, 30100 Murcia, Spain
- Correspondence: ; Tel.: +34-868883691
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Tanoey J, Gulati A, Patterson C, Becher H. Risk of Type 1 Diabetes in the Offspring Born through Elective or Non-elective Caesarean Section in Comparison to Vaginal Delivery: a Meta-Analysis of Observational Studies. Curr Diab Rep 2019; 19:124. [PMID: 31712908 DOI: 10.1007/s11892-019-1253-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Caesarean section (CS) has been associated with an increased risk of type 1 diabetes (T1D). The lack of exposure to maternal vaginal and anal microbiome and bypassing the labor process often observed in elective CS may affect neonatal immune system development. This study aims to summarize the effects of elective and non-elective CS on T1D risk in the offspring. METHODS A systematic literature search was conducted online for publications providing data on elective and non-elective CS with T1D diagnosis in children and young adults, followed by a meta-analysis from selected studies. Newcastle-Ottawa Scale and GRADEpro tool were applied for quality analysis. RESULTS Nine observational studies comprising over 5 million individuals fulfilled the inclusion criteria. Crude OR estimates showed a 12% increased T1D risk from elective CS compared to vaginal delivery with significant heterogeneity. Adjusted ORs from seven studies did not show T1D risk differences from either CS category, and heterogeneity was detected between studies. Separate analysis of cohort and case-control studies reduced the heterogeneity and revealed a slight increase in T1D risk associated with elective CS in cohort studies (adjusted OR = 1.12 (1.01-1.24)), and a higher increased risk associated with non-elective CS in case-control studies (adjusted OR = 1.19 (1.06-1.34)). CONCLUSION Summarized crude risk estimates showed a small increased T1D risk in children and young adults born through elective CS compared to vaginal delivery, but with significant heterogeneity. Adjusted risk estimates by study design indicated a slightly increased T1D risks associated with elective or non-elective CS.
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Affiliation(s)
- Justine Tanoey
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Amit Gulati
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Chris Patterson
- Centre for Public Health, University of Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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7
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Collier F, Ponsonby A, O'Hely M, Tang ML, Saffery R, Molloy J, Gray LE, Ranganathan S, Burgner D, Allen KJ, Brix S, Vuillermin PJ, Sly P, Harrison LC, Dwyer T. Naïve regulatory T cells in infancy: Associations with perinatal factors and development of food allergy. Allergy 2019; 74:1760-1768. [PMID: 30972786 DOI: 10.1111/all.13822] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND In previous studies, deficits in regulatory T-cell (Treg) number and function at birth have been linked with subsequent allergic disease. However, longitudinal studies that account for relevant perinatal factors are required. The aim of this study was to investigate the relationship between perinatal factors, naïve Treg (nTreg) over the first postnatal year and development of food allergy. METHODS In a birth cohort (n = 1074), the proportion of nTreg in the CD4+ T-cell compartment was measured by flow cytometry at birth (n = 463), 6 (n = 600) and 12 (n = 675) months. IgE-mediated food allergy was determined by food challenge at 1 year. Associations between perinatal factors (gestation, labour, sex, birth size), nTreg at each time point and food allergy at 1 year were examined by linear regression. RESULTS A higher proportion of nTreg at birth, larger birth size and male sex was each associated with higher nTreg in infancy. Exposure to labour, as compared to delivery by prelabour Caesarean section, was associated with a transient decrease nTreg. Infants that developed food allergy had decreased nTreg at birth, and the labour-associated decrease in nTreg at birth was more evident among infants with subsequent food allergy. Mode of birth was not associated with risk of food allergy, and there was no evidence that nTreg at either 6 or 12 months were related to food allergy. CONCLUSION The proportion of nTreg at birth is a major determinant of the proportion present throughout infancy, highlighting the importance of prenatal immune development. Exposure to the inflammatory stimulus of labour appears to reveal differences in immune function among infants at risk of food allergy.
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Affiliation(s)
- Fiona Collier
- Barwon Health Geelong Victoria Australia
- Deakin University Waurn Ponds Victoria Australia
- Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Anne‐Louise Ponsonby
- Murdoch Children’s Research Institute Parkville Victoria Australia
- University of Melbourne Parkville Victoria Australia
| | - Martin O'Hely
- Deakin University Waurn Ponds Victoria Australia
- Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Mimi L.K. Tang
- Murdoch Children’s Research Institute Parkville Victoria Australia
- University of Melbourne Parkville Victoria Australia
- The Royal Children’s Hospital Parkville Victoria Australia
| | - Richard Saffery
- Murdoch Children’s Research Institute Parkville Victoria Australia
- University of Melbourne Parkville Victoria Australia
| | - John Molloy
- Deakin University Waurn Ponds Victoria Australia
- Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Lawrence E. Gray
- Barwon Health Geelong Victoria Australia
- Deakin University Waurn Ponds Victoria Australia
| | - Sarath Ranganathan
- Murdoch Children’s Research Institute Parkville Victoria Australia
- University of Melbourne Parkville Victoria Australia
- The Royal Children’s Hospital Parkville Victoria Australia
| | - David Burgner
- Murdoch Children’s Research Institute Parkville Victoria Australia
- University of Melbourne Parkville Victoria Australia
- The Royal Children’s Hospital Parkville Victoria Australia
| | - Katrina J. Allen
- Murdoch Children’s Research Institute Parkville Victoria Australia
- University of Melbourne Parkville Victoria Australia
- The Royal Children’s Hospital Parkville Victoria Australia
| | - Susanne Brix
- Technical University of Denmark Kongens Lyngby Denmark
| | - Peter J. Vuillermin
- Barwon Health Geelong Victoria Australia
- Deakin University Waurn Ponds Victoria Australia
- Murdoch Children’s Research Institute Parkville Victoria Australia
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Thompson AL, Houck KM, Jahnke JR. Pathways linking caesarean delivery to early health in a dual burden context: Immune development and the gut microbiome in infants and children from Galápagos, Ecuador. Am J Hum Biol 2019; 31:e23219. [PMID: 30693586 PMCID: PMC6661198 DOI: 10.1002/ajhb.23219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/29/2018] [Accepted: 12/28/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Global increases in caesarean deliveries are exposing more infants to perinatal environments that are evolutionarily novel and potentially increasing their risks for inflammatory conditions. Yet, the pathways linking caesareans to later health outcomes are not well understood, particularly in dual burden contexts. We test two of the hypothesized pathways, altered immune function and gut microbiota, which may link delivery mode to later health outcomes and test whether these associations persist when controlling for postnatal nutritional and pathogenic exposures. METHODS Data come from infants, aged 0 to 2 (n = 41), and young children, aged 2 to 11 (n = 135), from the Galápagos, Ecuador. Differences in morbidity, C-reactive protein (CRP), and gut microbiota by delivery type were tested using linear and logistic regression models adjusted for nutritional and pathogenic exposures and infant age. RESULTS Over half of infants and over 40% of children were delivered by caesarean. Morbidity and CRP did not differ between infants or children born by caesarean or vaginally. Microbial taxa abundance differed by delivery mode. Infants born by caesarean had a higher abundance of Firmicutes and a lower relative abundance of Bacteroidales. Children born by caesarean had a higher abundance of Proteobacteria and Enterobacteriales. These differences remained after adjustment for environmental exposure. CONCLUSIONS Caesarean delivery is associated with differences in gut microbiota across childhood even in this dual burden context. Our results highlight the importance of examining caesarean delivery across diverse contexts to better understand the impact of perinatal interventions on short- and longer-term health outcomes.
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Affiliation(s)
- Amanda L. Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelly M Houck
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Johanna R. Jahnke
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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9
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Caesarean delivery, immune function and inflammation in early life among Ecuadorian infants and young children. J Dev Orig Health Dis 2019; 10:555-562. [PMID: 30728087 DOI: 10.1017/s2040174419000047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Caesarean delivery has been linked to a number of inflammatory conditions in childhood and adolescence. Yet the mechanisms underlying these associations and their generalizability across contexts with different postnatal feeding and pathogenic exposures remain unclear. This study tests the association between delivery type and three measures of immune function, inflammation, morbidity and leukocyte proportions, in Ecuadorian infants and children aged 6 months to 2 years. Data were collected from mother-child pairs participating in a nationally representative health and nutrition survey Encuesta Nacional de Salud y Nutricion (ENSANUT-ECU) conducted in 2012. The analytic sample includes 828 mothers and infants with delivery information and measured biomarkers. Poisson regression models were used to examine the association between delivery type and markers of immune function, controlling for maternal and infant characteristics, including age, sex, sociodemographic characteristics and medical indications. 40.8% (n=338) of sample infants and children were delivered by caesarean. Compared to those born vaginally, infants born by caesarean were less likely to have elevated C-reactive protein (CRP) [CRP>2 mg/l; risk ratio (RR): 0.76, 95% confidence interval (CI): 0.58-1.00] and more likely to have illness symptoms (RR: 1.22, 95% CI: 1.01-1.46) and elevated basophils (RR: 1.83, 95% CI: 1.03-3.25). No other immune cell proportions differed by delivery type. The results suggest that differences in the perinatal exposures accompanying caesarean delivery may alter immune development and function, particularly in the inflammatory response to infection and in cells involved in the allergic response, across infancy and early childhood. Understanding the pathways linking perinatal exposures to immune development is important for preventing the development of inflammatory conditions.
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Tribe RM, Taylor PD, Kelly NM, Rees D, Sandall J, Kennedy HP. Parturition and the perinatal period: can mode of delivery impact on the future health of the neonate? J Physiol 2018; 596:5709-5722. [PMID: 29533463 PMCID: PMC6265543 DOI: 10.1113/jp275429] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/25/2018] [Indexed: 12/21/2022] Open
Abstract
Caesarean section and instrumental delivery rates are increasing in many parts of the world for a range of cultural and medical reasons, with limited consideration as to how 'mode of delivery' may impact on childhood and long-term health. However, babies born particularly by pre-labour caesarean section appear to have a subtly different physiology from those born by normal vaginal delivery, with both acute and chronic complications such as respiratory and cardio-metabolic morbidities being apparent. It has been hypothesized that inherent mechanisms within the process of labour and vaginal delivery, far from being a passive mechanical process by which the fetus and placenta are expelled from the birth canal, may trigger certain protective developmental processes permissive for normal immunological and physiological development of the fetus postnatally. Traditionally the primary candidate mechanism has been the hormonal surges or stress response associated with labour and vaginal delivery, but there is increasing awareness that transfer of the maternal microbiome to the infant during parturition. Transgenerational transmission of disease traits through epigenetics are also likely to be important. Interventions such as probiotics, neonatal gut seeding and different approaches to clinical care have potential to influence parturition physiology and improve outcomes for infants.
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Affiliation(s)
- R. M. Tribe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - P. D. Taylor
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - N. M. Kelly
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - D. Rees
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - J. Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, St Thomas’ Hospital CampusKing's College LondonLondon SE1 7EHUK
| | - H. P. Kennedy
- Yale School of Nursing400 West Campus DriveWest HavenCT 06516USA
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Entz R, Rai U, Rycroft J, Chari RS, Kozyrskyj AL. Regional Caesarean Delivery Practices, the Maternal-Infant Microbiome, and Risk for Asthma. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1061-1065. [PMID: 29887361 DOI: 10.1016/j.jogc.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 01/14/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Rebecca Entz
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Usha Rai
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Jordan Rycroft
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Radha S Chari
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB
| | - Anita L Kozyrskyj
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB; Department of Pediatrics, University of Alberta, Edmonton, AB.
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Koletzko S, Lee HS, Beyerlein A, Aronsson CA, Hummel M, Liu E, Simell V, Kurppa K, Lernmark Å, Hagopian W, Rewers M, She JX, Simell O, Toppari J, Ziegler AG, Krischer J, Agardh D. Cesarean Section on the Risk of Celiac Disease in the Offspring: The Teddy Study. J Pediatr Gastroenterol Nutr 2018; 66:417-424. [PMID: 28753178 PMCID: PMC5787038 DOI: 10.1097/mpg.0000000000001682] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cesarean section (C-section) is associated with various immune-mediated diseases in the offspring. We investigated the relationship between mode of delivery and celiac disease (CD) and CD autoimmunity (CDA) in a multinational birth cohort. METHODS From 2004 to 2010, infants from the general population who tested positive for HLA DR3-DQ2 or DR4-DQ8 were enrolled in The Environmental Determinants for Diabetes in the Young (TEDDY) study. Children were annually screened for transglutaminase autoantibodies, if positive, they are retested after 3 to 6 months and those persistently positive defined as CDA. Associations of C-section with maternal (age, education level, parity, pre-pregnancy weight, diabetes, smoking, weight gain during pregnancy) and child characteristics (gestational age, birth weight) were examined by Fisher exact test or Wilcoxon rank-sum test. Hazard ratios (HRs) for CDA or CD were calculated by Cox proportional hazard regression models. RESULTS Of 6087 analyzed singletons, 1600 (26%) were born by C-section (Germany 38%, United States 37%, Finland 18%, Sweden 16%), and the remaining were born vaginally without instrumental support; 979 (16%) had developed CDA and 343 (6%) developed CD. C-section was associated with lower risk for CDA (hazard ratio [HR] = 0.85; 95% confidence interval [CI] 0.73, 0.99 P = 0.032) and CD (HR = 0.75; 95% CI 0.58, 0.98; P = 0.034). After adjusting for country, sex, HLA-genotype, CD in family, maternal education, and breast-feeding duration, significance was lost for CDA (HR = 0.91; 95% CI 0.78, 1.06; P = 0.20) and CD (HR = 0.85; 95% CI 0.65, 1.11; P = 0.24). Presurgical ruptured membranes had no influence on CDA or CD development. CONCLUSION C-section is not associated with increased risk for CDA or CD in the offspring.
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Affiliation(s)
- Sibylle Koletzko
- Dr. v. Hauner Children’s Hospital, University Munich Medical Center, Munich, Germany
| | - Hye-Seung Lee
- Health Informatics Institute, Department of Paediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Andreas Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Carin A. Aronsson
- Department of Clinical Sciences, Lund University, Skane University Hosptial, Malmo, Sweden
| | - Michael Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Edwin Liu
- Digestive Health Institute, University of Colorado, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ville Simell
- Medicity Laboratory, University of Turku, Turku, Finland
| | - Kalle Kurppa
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skane University Hosptial, Malmo, Sweden
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora CO, USA
| | - Jin-Xiong She
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta GA, USA
| | - Olli Simell
- Department of Paediatrics, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Department of Paediatrics, Turku University Hospital, Turku, Finland
- Departments of Physiology, University of Turku, Turku, Finland
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V., Neuherberg, Germany
| | - Jeffrey Krischer
- Health Informatics Institute, Department of Paediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Daniel Agardh
- Department of Clinical Sciences, Lund University, Skane University Hosptial, Malmo, Sweden
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13
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Abstract
Celiac disease (CD) is a common autoimmune disorder induced by ingestion of gluten in genetically susceptible individuals. Despite the prerequisite for a genetic predisposition, only a minority of the 40% of the Caucasian population that has this genetic predisposition develops the disease. Thus, environmental and/or lifestyle factors play a causal role in the development of CD. The incidence of CD has increased over the last half-century, resulting in rising interest in identifying risk factors for CD to enable primary prevention. Early infant feeding practices have been suggested as one of the factors influencing the risk of CD in genetically susceptible individuals. However, recent large prospective studies have shown that neither the timing of gluten introduction nor the duration or maintenance of breastfeeding influence the risk of CD. Also, other environmental influences have been investigated as potential risk factors, but have not led to primary prevention strategies. Secondary prevention is possible through early diagnosis and treatment. Since CD is significantly underdiagnosed and a large proportion of CD patients are asymptomatic at the time of diagnosis, secondary prevention will not identify all CD patients, as long as mass screening has not been introduced. As following a gluten-free diet is a major challenge, tertiary prevention strategies are discussed as well.
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Affiliation(s)
- Caroline Meijer
- Deptartment of Pediatrics, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden, Netherlands
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Luisa Mearin
- Deptartment of Pediatrics, Leiden University Medical Center, Willem Alexander Children's Hospital, Leiden, Netherlands
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Sakwinska O, Foata F, Berger B, Brüssow H, Combremont S, Mercenier A, Dogra S, Soh SE, Yen JCK, Heong GYS, Lee YS, Yap F, Meaney MJ, Chong YS, Godfrey KM, Holbrook JD. Does the maternal vaginal microbiota play a role in seeding the microbiota of neonatal gut and nose? Benef Microbes 2017; 8:763-778. [PMID: 29022384 DOI: 10.3920/bm2017.0064] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The acquisition and early maturation of infant microbiota is not well understood despite its likely influence on later health. We investigated the contribution of the maternal microbiota to the microbiota of infant gut and nose in the context of mode of delivery and feeding. Using 16S rRNA sequencing and specific qPCR, we profiled microbiota of 42 mother-infant pairs from the GUSTO birth cohort, at body sites including maternal vagina, rectum and skin; and infant stool and nose. In our study, overlap between maternal vaginal microbiota and infant faecal microbiota was minimal, while the similarity between maternal rectal microbiota and infant microbiota was more pronounced. However, an infant's nasal and gut microbiota were no more similar to that of its own mother, than to that of unrelated mothers. These findings were independent of delivery mode. We conclude that the transfer of maternal vaginal microbes play a minor role in seeding infant stool microbiota. Transfer of maternal rectal microbiota could play a larger role in seeding infant stool microbiota, but approaches other than the generally used analyses of community similarity measures are likely to be needed to quantify bacterial transmission. We confirmed the clear difference between microbiota of infants born by Caesarean section compared to vaginally delivered infants and the impact of feeding mode on infant gut microbiota. Only vaginally delivered, fully breastfed infants had gut microbiota dominated by Bifidobacteria. Our data suggest that reduced transfer of maternal vaginal microbial is not the main mechanism underlying the differential infant microbiota composition associated with Caesarean delivery. The sources of a large proportion of infant microbiota could not be identified in maternal microbiota, and the sources of seeding of infant gut and nasal microbiota remain to be elucidated.
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Affiliation(s)
- O Sakwinska
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - F Foata
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - B Berger
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - H Brüssow
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - S Combremont
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - A Mercenier
- 1 Nestlé Research Center, Vers-Chez-Les-Blanc, 1000 Lausanne, Switzerland
| | - S Dogra
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, 119228 Singapore
| | - S-E Soh
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,4 Vishuo BioMedical Pte Ltd, 03-33/35A, Teletech Park, 2O Science Park Road, Singapore
| | - J C K Yen
- 5 Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore
| | - G Y S Heong
- 6 Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore.,7 Duke-NUS Medical School, 8 College Road, 169857 Singapore.,8 Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, 119228 Singapore
| | - Y S Lee
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,3 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, 119228 Singapore.,9 Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat - National University Children's Medical Institute, National University Health System, 1E Kent Ridge Road, 119228 Singapore
| | - F Yap
- 10 Department of Paediatric Endocrinology, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899 Singapore
| | - M J Meaney
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,11 Ludmer Centre for Neuroinformatics and Mental Health, Douglas University Mental Health Institute, McGill University, 3755 Côte-Ste-Catherine Montreal, QC H3T 1E2 Canada
| | - Y-S Chong
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,8 Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 1E Kent Ridge Road, 119228 Singapore
| | - K M Godfrey
- 12 MRC Lifecourse Epidemiology Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.,13 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, MP 218 Tremona Road, SO16 6YD Southampton, United Kingdom
| | - J D Holbrook
- 2 Singapore Institute for Clinical Sciences (SICS), Agency for Science and Technology Research (A*STAR), 30 Medical Drive, 117609 Singapore.,13 NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, MP 218 Tremona Road, SO16 6YD Southampton, United Kingdom
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15
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Clausen TD, Bergholt T, Bouaziz O, Arpi M, Eriksson F, Rasmussen S, Keiding N, Løkkegaard EC. Broad-Spectrum Antibiotic Treatment and Subsequent Childhood Type 1 Diabetes: A Nationwide Danish Cohort Study. PLoS One 2016; 11:e0161654. [PMID: 27560963 PMCID: PMC4999141 DOI: 10.1371/journal.pone.0161654] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022] Open
Abstract
Background Studies link antibiotic treatment and delivery by cesarean section with increased risk of chronic diseases through changes of the gut-microbiota. We aimed to evaluate the association of broad-spectrum antibiotic treatment during the first two years of life with subsequent onset of childhood type 1 diabetes and the potential effect-modification by mode of delivery. Materials and Methods A Danish nationwide cohort study including all singletons born during 1997–2010. End of follow-up by December 2012. Four national registers provided information on antibiotic redemptions, outcome and confounders. Redemptions of antibiotic prescriptions during the first two years of life was classified into narrow-spectrum or broad-spectrum antibiotics. Children were followed from age two to fourteen, both inclusive. The risk of type 1 diabetes with onset before the age of 15 years was assessed by Cox regression. A total of 858,201 singletons contributed 5,906,069 person-years, during which 1,503 children developed type 1 diabetes. Results Redemption of broad-spectrum antibiotics during the first two years of life was associated with an increased rate of type 1 diabetes during the following 13 years of life (HR 1.13; 95% CI 1.02 to 1.25), however, the rate was modified by mode of delivery. Broad-spectrum antibiotics were associated with an increased rate of type 1 diabetes in children delivered by either intrapartum cesarean section (HR 1.70; 95% CI 1.15 to 2.51) or prelabor cesarean section (HR 1.63; 95% CI 1.11 to 2.39), but not in vaginally delivered children. Number needed to harm was 433 and 562, respectively. The association with broad-spectrum antibiotics was not modified by parity, genetic predisposition or maternal redemption of antibiotics during pregnancy or lactation. Conclusions Redemption of broad-spectrum antibiotics during infancy is associated with an increased risk of childhood type 1 diabetes in children delivered by cesarean section.
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Affiliation(s)
- Tine D. Clausen
- Department of Gynecology and Obstetrics, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
- * E-mail:
| | - Thomas Bergholt
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen OE, Denmark
| | - Olivier Bouaziz
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
- Laboratory MAP5, University Paris Descartes and CNRS, Sorbonne Paris Cité, Paris, France
| | - Magnus Arpi
- Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Frank Eriksson
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Steen Rasmussen
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Niels Keiding
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Ellen C. Løkkegaard
- Department of Gynecology and Obstetrics, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
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Smits HH, van der Vlugt LE, von Mutius E, Hiemstra PS. Childhood allergies and asthma: New insights on environmental exposures and local immunity at the lung barrier. Curr Opin Immunol 2016; 42:41-47. [PMID: 27254380 DOI: 10.1016/j.coi.2016.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 12/11/2022]
Abstract
While certain bacteria and respiratory viruses promote local inflammation and disease onset, a more diverse colonization of the different species in the (gut) microbiome may be linked to more regulatory responses and protection against asthma and allergies. These processes are also influenced in part by food intake, both targeting the composition of the gut microbiome and influencing the immune system via metabolites. Early life environmental microbial exposure also contributes to protection against asthma and allergy and is linked with an early activation of the innate immune system and the development of regulatory immune responses. Although greater mechanistic insight is needed, it is tempting to speculate that part of the environmental effect can be explained by modulation of the microbiome composition at mucosal surfaces, epithelial barrier function and/or local immunity. A review of the latest studies is provided.
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Affiliation(s)
- Hermelijn H Smits
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Luciën Epm van der Vlugt
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Center for Lung Research, Germany
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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Influence of the delivery modus on subpopulations and replication of lymphocytes in mothers and newborns. Early Hum Dev 2015; 91:663-70. [PMID: 26513626 DOI: 10.1016/j.earlhumdev.2015.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several studies reported that the mode of delivery may induce changes to the immune system. Our hypothesis was that the delivery mode may influence mainly the naive T cell subpopulation. AIMS Particular focus was set on the proportions and peripheral replicative history of naive T cells and cord blood serum concentrations of IL-7, a cytokine involved in peripheral naive T cell homeostasis. STUDY DESIGN, SUBJECTS AND OUTCOME MEASURES In a prospective cohort study, proportions of lymphocyte populations were measured in mothers and newborns delivered by spontaneous vaginal delivery (SD), vacuum extraction (VE), primary (PCS) and secondary Cesarean sections (SCS) by flow cytometry. T-cell-receptor-excision-circles (TRECs) and relative telomere lengths (RTLs) were used to estimate the replicative history of peripheral naive T cells. The cytokine profile was assessed by ELISA. RESULTS The study demonstrated that leukocytes, neutrophils and NK cells were increased in spontaneously delivered newborns compared to PCS, whereas circulating T cells were relatively lower. TRECs and RTLs were not significantly influenced by the delivery mode. IL-2, IL-8 and IFN-γ were increased in VD. IL-7 production tends to be increased in more stress-associated delivery modes, such as VE and SCS. CONCLUSIONS Our results demonstrate proportional changes in newborns delivered by PCS and diminished cytokine production. It has to be proven whether these alterations may be of disadvantage regarding early defense of infectious diseases. Understanding the physiological role of these changes may help to find preventive strategies for neonatal infectious risks and the development of atopy or other immune diseases.
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