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Grunert M, Dorn C, Dopazo A, Sánchez-Cabo F, Vázquez J, Rickert-Sperling S, Lara-Pezzi E. Technologies to Study Genetics and Molecular Pathways. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1441:435-458. [PMID: 38884724 DOI: 10.1007/978-3-031-44087-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Over the last few decades, the study of congenital heart disease (CHD) has benefited from various model systems and the development of molecular biological techniques enabling the analysis of single gene as well as global effects. In this chapter, we first describe different models including CHD patients and their families, animal models ranging from invertebrates to mammals, and various cell culture systems. Moreover, techniques to experimentally manipulate these models are discussed. Second, we introduce cardiac phenotyping technologies comprising the analysis of mouse and cell culture models, live imaging of cardiogenesis, and histological methods for fixed hearts. Finally, the most important and latest molecular biotechniques are described. These include genotyping technologies, different applications of next-generation sequencing, and the analysis of transcriptome, epigenome, proteome, and metabolome. In summary, the models and technologies presented in this chapter are essential to study the function and development of the heart and to understand the molecular pathways underlying CHD.
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Affiliation(s)
- Marcel Grunert
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- DiNAQOR AG, Schlieren, Switzerland
| | - Cornelia Dorn
- Cardiovascular Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ana Dopazo
- Genomics Unit, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Fátima Sánchez-Cabo
- Bioinformatics Unit, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jésus Vázquez
- Proteomics Unit, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | | | - Enrique Lara-Pezzi
- Myocardial Homeostasis and Cardiac Injury Programme, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
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Andescavage NN, Pradhan S, Gimovsky AC, Kapse K, Donofrio MT, Cheng JJ, Sharker Y, Wessel D, du Plessis AJ, Limperopoulos C. Magnetic Resonance Spectroscopy of Brain Metabolism in Fetuses With Congenital Heart Disease. J Am Coll Cardiol 2023; 82:1614-1623. [PMID: 37821172 DOI: 10.1016/j.jacc.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) remains a significant risk factor for neurologic injury because altered fetal hemodynamics may be unable to support typical brain development during critical periods of growth and maturation. OBJECTIVES The primary objective was to assess differences in the cerebral biochemical profile between healthy fetuses and fetuses with complex CHD and to relate these with infant outcomes. METHODS Pregnant participants underwent fetal magnetic resonance imaging with cerebral proton magnetic resonance spectroscopy acquisitions as part of a prospective observational study. Cerebral metabolites of N-acetyl aspartate, creatine, choline, myo-inositol, scyllo-inositol, lactate, and relevant ratios were quantified using LCModel. RESULTS We acquired 503 proton magnetic resonance spectroscopy images (controls = 333; CHD = 170) from 333 participants (controls = 221; CHD = 112). Mean choline levels were higher in CHD compared with controls (CHD 2.47 IU [Institutional Units] ± 0.44 and Controls 2.35 IU ± 0.45; P = 0.02), whereas N-acetyl aspartate:choline ratios were lower among CHD fetuses compared with controls (CHD 1.34 ± 0.40 IU vs controls 1.44 ± 0.48 IU; P = 0.001). Cerebral lactate was detected in all cohorts but increased in fetuses with transposition of the great arteries and single-ventricle CHD (median: 1.63 [IQR: 0.56-3.27] in transposition of the great arteries and median: 1.28 [IQR: 0-2.42] in single-ventricle CHD) compared with 2-ventricle CHD (median: 0.79 [IQR: 0-1.45]). Cerebral lactate also was associated with increased odds of death before discharge (OR: 1.75; P = 0.04). CONCLUSIONS CHD is associated with altered cerebral metabolites in utero, particularly in the third trimester period of pregnancy, which is characterized by exponential brain growth and maturation, and is associated with survival to hospital discharge. The long-term neurodevelopmental consequences of these findings warrant further study.
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Affiliation(s)
- Nickie N Andescavage
- Department of Neonatology, Children's National Hospital, Washington, DC, USA; Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Subechhya Pradhan
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Alexis C Gimovsky
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - Mary T Donofrio
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Jenhao Jacob Cheng
- Department of Biostatistics, Children's National Hospital, Washington, DC, USA
| | - Yushuf Sharker
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA
| | - David Wessel
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Adre J du Plessis
- Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Prenatal Pediatric Institute, Children's National Hospital, Washington, DC, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, Washington, DC, USA; Department of Pediatrics, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; Department of Radiology, Children's National Hospital, Washington, DC, USA; Department of Radiology, the George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
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Panigrahy A, Blüml S, Rajagopalan V. Altered In Utero Metabolic Brain Trajectories in CHD: Going Beyond Fetal Brain Structure and Physiology. J Am Coll Cardiol 2023; 82:1624-1627. [PMID: 37821173 PMCID: PMC11136159 DOI: 10.1016/j.jacc.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Ashok Panigrahy
- Department of Radiology, Bioengineering, Bioinformatics and Developmental Biology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Stefan Blüml
- Department of Radiology, Children's Hospital of Los Angeles, Keck School of Medicine and Biomedical Engineering, USC, Los Angeles, California, USA
| | - Vidya Rajagopalan
- Department of Pediatrics and Radiology, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Song JG, Sun C, Zhu M, Zhu JX, Zhang N, Wang GB, Zhao B. Regional changes in brain apparent diffusion coefficient in fetuses with complex congenital heart disease and normal pregnancy assessed using diffusion-weighted imaging. Front Neurol 2023; 14:1136633. [PMID: 37351264 PMCID: PMC10283352 DOI: 10.3389/fneur.2023.1136633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/19/2023] [Indexed: 06/24/2023] Open
Abstract
Objectives To explore changes in brain apparent diffusion coefficient (ADC) in normal fetuses and fetuses with complex congenital heart disease (CHD) during the second and early third trimesters. Methods This single-center prospective study was conducted from May 2019 through October 2021. We measured and compared the mean ADC values between 23 fetuses with CHD and 27 gestational age (GA)-matched controls using covariance analyses. ADC density plots and histograms were used to compare brain characteristics. False-discovery rates (FDR, α = 0.05) correction was used for multiple testing. Results The mean ADC in the frontal white matter, temporal white matter, parietal white matter, occipital white matter, cerebellar hemisphere, central area of the centrum semiovale, basal ganglia region, thalamus, and pons were not significantly different (all p > 0.05). Based on histogram analysis, there were no significant differences between the controls and fetuses with CHD after FDR correction. However, the ADC density plots showed significant heterogeneity between the controls and fetuses with CHD. Conclusion The mean ADC values and ADC histogram analysis did not differ between the CHD and normal groups. The ADC density plots may provide supplementary information and improve the sensitivity for detecting early brain changes in fetuses with CHD.
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Affiliation(s)
- Jia-Guang Song
- Department of Ultrasound, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Cong Sun
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Zhu
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jin-Xia Zhu
- MR Collaboration, Healthcare Siemens Ltd., Beijing, China
| | - Nan Zhang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Guang-Bin Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bin Zhao
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
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Schmithorst VJ, Adams PS, Badaly D, Lee VK, Wallace J, Beluk N, Votava-Smith JK, Weinberg JG, Beers SR, Detterich J, Wood JC, Lo CW, Panigrahy A. Impaired Neurovascular Function Underlies Poor Neurocognitive Outcomes and Is Associated with Nitric Oxide Bioavailability in Congenital Heart Disease. Metabolites 2022; 12:metabo12090882. [PMID: 36144286 PMCID: PMC9504090 DOI: 10.3390/metabo12090882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
We use a non-invasive MRI proxy of neurovascular function (pnvf) to assess the ability of the vasculature to supply baseline metabolic demand, to compare pediatric and young adult congenital heart disease (CHD) patients to normal referents and relate the proxy to neurocognitive outcomes and nitric oxide bioavailability. In a prospective single-center study, resting-state blood-oxygen-level-dependent (BOLD) and arterial spin labeling (ASL) MRI scans were successfully obtained from 24 CHD patients (age = 15.4 ± 4.06 years) and 63 normal referents (age = 14.1 ± 3.49) years. Pnvf was computed on a voxelwise basis as the negative of the ratio of functional connectivity strength (FCS) estimated from the resting-state BOLD acquisition to regional cerebral blood flow (rCBF) as estimated from the ASL acquisition. Pnvf was used to predict end-tidal CO2 (PETCO2) levels and compared to those estimated from the BOLD data. Nitric oxide availability was obtained via nasal measurements (nNO). Pnvf was compared on a voxelwise basis between CHD patients and normal referents and correlated with nitric oxide availability and neurocognitive outcomes as assessed via the NIH Toolbox. Pnvf was shown as highly predictive of PETCO2 using theoretical modeling. Pnvf was found to be significantly reduced in CHD patients in default mode network (DMN, comprising the ventromedial prefrontal cortex and posterior cingulate/precuneus), salience network (SN, comprising the insula and dorsal anterior cingulate), and central executive network (CEN, comprising posterior parietal and dorsolateral prefrontal cortex) regions with similar findings noted in single cardiac ventricle patients. Positive correlations of Pnvf in these brain regions, as well as the hippocampus, were found with neurocognitive outcomes. Similarly, positive correlations between Pnvf and nitric oxide availability were found in frontal DMN and CEN regions, with particularly strong correlations in subcortical regions (putamen). Reduced Pnvf in CHD patients was found to be mediated by nNO. Mediation analyses further supported that reduced Pnvf in these regions underlies worse neurocognitive outcome in CHD patients and is associated with nitric oxide bioavailability. Impaired neuro-vascular function, which may be non-invasively estimated via combined arterial-spin label and BOLD MR imaging, is a nitric oxide bioavailability dependent factor implicated in adverse neurocognitive outcomes in pediatric and young adult CHD.
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Affiliation(s)
| | - Phillip S. Adams
- Department of Pediatric Anesthesiology, UPMC Children’s Hospital, Pittsburgh, PA 15224, USA
| | - Daryaneh Badaly
- Learning and Development Center, Child Mind Institute, New York, NY 10022, USA
| | - Vincent K. Lee
- Department of Pediatric Radiology, UPMC Children’s Hospital, Pittsburgh, PA 15224, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Julia Wallace
- Department of Pediatric Radiology, UPMC Children’s Hospital, Pittsburgh, PA 15224, USA
| | - Nancy Beluk
- Department of Pediatric Radiology, UPMC Children’s Hospital, Pittsburgh, PA 15224, USA
| | | | | | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Jon Detterich
- Heart Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - John C. Wood
- Heart Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Cecilia W. Lo
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Ashok Panigrahy
- Department of Pediatric Radiology, UPMC Children’s Hospital, Pittsburgh, PA 15224, USA
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Correspondence: ; Tel.: +1-412-692-5510; Fax: +1-412-692-6929
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Reduced Cerebellar Volume in Term Infants with Complex Congenital Heart Disease: Correlation with Postnatal Growth Measurements. Diagnostics (Basel) 2022; 12:diagnostics12071644. [PMID: 35885549 PMCID: PMC9321214 DOI: 10.3390/diagnostics12071644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 11/16/2022] Open
Abstract
Aberrant cerebellar development and the associated neurocognitive deficits has been postulated in infants with congenital heart disease (CHD). Our objective is to investigate the effect of postnatal head and somatic growth on cerebellar development in neonates with CHD. We compared term-born neonates with a history of CHD with a cohort of preterm-born neonates, two cohorts at similar risk for neurodevelopment impairment, in order to determine if they are similarly affected in the early developmental period. Study Design: 51 preterms-born healthy neonates, 62 term-born CHD neonates, and 54 term-born healthy neonates underwent a brain MRI with volumetric imaging. Cerebellar volumes were extracted through an automated segmentation pipeline that was developed in-house. Volumes were correlated with clinical growth parameters at both the birth and time of MRI. Results: The CHD cohort showed significantly lower cerebellar volumes when compared with both the control (p < 0.015) and preterm (p < 0.004) groups. Change in weight from birth to time of MRI showed a moderately strong correlation with cerebellar volume at time of MRI (r = 0.437, p < 0.002) in the preterms, but not in the CHD neonates (r = 0.205, p < 0.116). Changes in birth length and head circumference showed no significant correlation with cerebellar volume at time of MRI in either cohort. Conclusions: Cerebellar development in premature-born infants is associated with change in birth weight in the early post-natal period. This association is not observed in term-born neonates with CHD, suggesting differential mechanisms of aberrant cerebellar development in these perinatal at-risk populations.
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Asschenfeldt B, Evald L, Salvig C, Heiberg J, Østergaard L, Eskildsen SF, Hjortdal VE. Altered Cerebral Microstructure in Adults With Atrial Septal Defect and Ventricular Septal Defect Repaired in Childhood. J Am Heart Assoc 2022; 11:e020915. [PMID: 35699183 PMCID: PMC9238637 DOI: 10.1161/jaha.121.020915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Delayed brain development, brain injury, and neurodevelopmental disabilities are commonly observed in infants operated for complex congenital heart defect. Our previous findings of poorer neurodevelopmental outcomes in individuals operated for simple congenital heart defects calls for further etiological clarification. Hence, we examined the microstructural tissue composition in cerebral cortex and subcortical structures in comparison to healthy controls and whether differences were associated with neurodevelopmental outcomes. Methods and Results Adults (n=62) who underwent surgical closure of an atrial septal defect (n=33) or a ventricular septal defect (n=29) in childhood and a group of healthy, matched controls (n=38) were enrolled. Brain diffusional kurtosis imaging and neuropsychological assessment were performed. Cortical and subcortical tissue microstructure were assessed using mean kurtosis tensor and mean diffusivity and compared between groups and tested for associations with neuropsychological outcomes. Alterations in microstructural tissue composition were found in the parietal, temporal, and occipital lobes in the congenital heart defects, with distinct mean kurtosis tensor cluster‐specific changes in the right visual cortex (pericalcarine gyrus, P=0.002; occipital part of fusiform and lingual gyri, P=0.019). Altered microstructural tissue composition in the subcortical structures was uncovered in atrial septal defects but not in ventricular septal defects. Associations were found between altered cerebral microstructure and social recognition and executive function. Conclusions Children operated for simple congenital heart defects demonstrated altered microstructural tissue composition in the cerebral cortex and subcortical structures during adulthood when compared with healthy peers. Alterations in cerebral microstructural tissue composition were associated with poorer neuropsychological performance. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03871881.
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Affiliation(s)
- Benjamin Asschenfeldt
- Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Denmark.,Department of Clinical Medicine Aarhus University Denmark
| | - Lars Evald
- Department of Clinical Medicine Aarhus University Denmark.,Hammel Neurorehabilitation Centre and University Research Clinic Denmark
| | - Camilla Salvig
- Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Denmark
| | - Johan Heiberg
- Department of Cardiothoracic & Vascular Surgery Aarhus University Hospital Denmark.,Department of Clinical Medicine Aarhus University Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience Aarhus University Denmark.,Department of Clinical Medicine Aarhus University Denmark.,Neuroradiology Research Unit, Department of Radiology Aarhus University Hospital Denmark
| | - Simon Fristed Eskildsen
- Center of Functionally Integrative Neuroscience Aarhus University Denmark.,Department of Clinical Medicine Aarhus University Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Clinical Medicine Aarhus University Denmark.,Department of Cardiothoracic Surgery, Rigshospitalet and Institute of Clinical Medicine University of Copenhagen Denmark
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Wu Y, Lu YC, Kapse K, Jacobs M, Andescavage N, Donofrio MT, Lopez C, Quistorff JL, Vezina G, Krishnan A, du Plessis AJ, Limperopoulos C. In Utero MRI Identifies Impaired Second Trimester Subplate Growth in Fetuses with Congenital Heart Disease. Cereb Cortex 2022; 32:2858-2867. [PMID: 34882775 PMCID: PMC9247421 DOI: 10.1093/cercor/bhab386] [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] [Received: 04/15/2021] [Revised: 09/10/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
The subplate is a transient brain structure which plays a key role in the maturation of the cerebral cortex. Altered brain growth and cortical development have been suggested in fetuses with complex congenital heart disease (CHD) in the third trimester. However, at an earlier gestation, the putative role of the subplate in altered brain development in CHD fetuses is poorly understood. This study aims to examine subplate growth (i.e., volume and thickness) and its relationship to cortical sulcal development in CHD fetuses compared with healthy fetuses by using 3D reconstructed fetal magnetic resonance imaging. We studied 260 fetuses, including 100 CHD fetuses (22.3-32 gestational weeks) and 160 healthy fetuses (19.6-31.9 gestational weeks). Compared with healthy fetuses, CHD fetuses had 1) decreased global and regional subplate volumes and 2) decreased subplate thickness in the right hemisphere overall, in frontal and temporal lobes, and insula. Compared with fetuses with two-ventricle CHD, those with single-ventricle CHD had reduced subplate volume and thickness in right occipital and temporal lobes. Finally, impaired subplate growth was associated with disturbances in cortical sulcal development in CHD fetuses. These findings suggested a potential mechanistic pathway and early biomarker for the third-trimester failure of brain development in fetuses with complex CHD. SIGNIFICANCE STATEMENT Our findings provide an early biomarker for brain maturational failure in fetuses with congenital heart disease, which may guide the development of future prenatal interventions aimed at reducing neurological compromise of prenatal origin in this high-risk population.
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Affiliation(s)
- Yao Wu
- Developing Brain Institute, Children’s National Hospital, Washington, DC 20010, USA
| | - Yuan-Chiao Lu
- Developing Brain Institute, Children’s National Hospital, Washington, DC 20010, USA
| | - Kushal Kapse
- Developing Brain Institute, Children’s National Hospital, Washington, DC 20010, USA
| | - Marni Jacobs
- School of Health Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Nickie Andescavage
- Division of Neonatology, Children’s National Hospital, Washington, DC 20010, USA
| | - Mary T Donofrio
- Division of Cardiology, Children’s National Hospital, Washington, DC 20010, USA
| | - Catherine Lopez
- Developing Brain Institute, Children’s National Hospital, Washington, DC 20010, USA
| | | | - Gilbert Vezina
- Department of Diagnostic Imaging and Radiology, Children’s National Hospital, Washington, DC 20010, USA
| | - Anita Krishnan
- Division of Cardiology, Children’s National Hospital, Washington, DC 20010, USA
| | - Adré J du Plessis
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA
| | - Catherine Limperopoulos
- Address correspondence to Catherine Limperopoulos, Developing Brain Institute, Children's National Hospital, Washington, DC 20010, USA.
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Bonthrone AF, Dimitrova R, Chew A, Kelly CJ, Cordero-Grande L, Carney O, Egloff A, Hughes E, Vecchiato K, Simpson J, Hajnal JV, Pushparajah K, Victor S, Nosarti C, Rutherford MA, Edwards AD, O’Muircheartaigh J, Counsell SJ. Individualized brain development and cognitive outcome in infants with congenital heart disease. Brain Commun 2021; 3:fcab046. [PMID: 33860226 PMCID: PMC8032964 DOI: 10.1093/braincomms/fcab046] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Infants with congenital heart disease are at risk of neurodevelopmental impairments, the origins of which are currently unclear. This study aimed to characterize the relationship between neonatal brain development, cerebral oxygen delivery and neurodevelopmental outcome in infants with congenital heart disease. A cohort of infants with serious or critical congenital heart disease (N = 66; N = 62 born ≥37 weeks) underwent brain MRI before surgery on a 3T scanner situated on the neonatal unit. T2-weighted images were segmented into brain regions using a neonatal-specific algorithm. We generated normative curves of typical volumetric brain development using a data-driven technique applied to 219 healthy infants from the Developing Human Connectome Project (dHCP). Atypicality indices, representing the degree of positive or negative deviation of a regional volume from the normative mean for a given gestational age, sex and postnatal age, were calculated for each infant with congenital heart disease. Phase contrast angiography was acquired in 53 infants with congenital heart disease and cerebral oxygen delivery was calculated. Cognitive and motor abilities were assessed at 22 months (N = 46) using the Bayley scales of Infant and Toddler Development-Third Edition. We assessed the relationship between atypicality indices, cerebral oxygen delivery and cognitive and motor outcome. Additionally, we examined whether cerebral oxygen delivery was associated with neurodevelopmental outcome through the mediating effect of brain volume. Negative atypicality indices in deep grey matter were associated with both reduced neonatal cerebral oxygen delivery and poorer cognitive abilities at 22 months across the whole sample. In infants with congenital heart disease born ≥37 weeks, negative cortical grey matter and total tissue volume atypicality indices, in addition to deep grey matter structures, were associated with poorer cognition. There was a significant indirect relationship between cerebral oxygen delivery and cognition through the mediating effect of negative deep grey matter atypicality indices across the whole sample. In infants born ≥37 weeks, cortical grey matter and total tissue volume atypicality indices were also mediators of this relationship. In summary, lower cognitive abilities in toddlers with congenital heart disease were associated with smaller grey matter volumes before cardiac surgery. The aetiology of poor cognition may encompass poor cerebral oxygen delivery leading to impaired grey matter growth. Interventions to improve cerebral oxygen delivery may promote early brain growth and improve cognitive outcomes in infants with congenital heart disease.
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Affiliation(s)
- Alexandra F Bonthrone
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Ralica Dimitrova
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Christopher J Kelly
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, 28040 Madrid, Spain
| | - Olivia Carney
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - John Simpson
- Paediatric Cardiology Department, Evelina London Children’s Healthcare, London SE1 7EH, UK
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Kuberan Pushparajah
- Paediatric Cardiology Department, Evelina London Children’s Healthcare, London SE1 7EH, UK
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
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10
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Williamson JB, Lamb DG, Porges EC, Bottari S, Woods AJ, Datta S, Langer K, Cohen RA. Cerebral Metabolite Concentrations Are Associated With Cortical and Subcortical Volumes and Cognition in Older Adults. Front Aging Neurosci 2021; 12:587104. [PMID: 33613261 PMCID: PMC7886995 DOI: 10.3389/fnagi.2020.587104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
Background Cerebral metabolites are associated with different physiological processes in brain aging. Cortical and limbic structures play important roles in cognitive aging; however, the relationship between these structures and age remains unclear with respect to physiological underpinnings. Regional differences in metabolite levels may be related to different structural and cognitive changes in aging. Methods Magnetic resonance imaging and spectroscopy were obtained from 117 cognitively healthy older adults. Limbic and other key structural volumes were measured. Concentrations of N-acetylaspartate (NAA) and choline-containing compounds (Cho) were measured in frontal and parietal regions. Neuropsychological testing was performed including measures of crystallized and fluid intelligence and memory. Results NAA in the frontal voxel was associated with limbic and cortical volumes, whereas Cho in parietal cortex was negatively associated with hippocampal and other regional volumes. Hippocampal volume was associated with forgetting, independent of age. Further, parietal Cho and hippocampal volume contributed independent variance to age corrected discrepancy between fluid and crystallized abilities. Conclusion These findings suggest that physiological changes with age in the frontal and parietal cortices may be linked to structural changes in other connected brain regions. These changes are differentially associated with cognitive performance, suggesting potentially divergent mechanisms.
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Affiliation(s)
- John B Williamson
- Center for Cognitive Aging and Memory, Clinical Translational Research Program, College of Medicine, University of Florida, Gainesville, FL, United States.,Center for OCD and Anxiety Related Disorders, Department of Psychiatry, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Damon G Lamb
- Center for Cognitive Aging and Memory, Clinical Translational Research Program, College of Medicine, University of Florida, Gainesville, FL, United States.,Center for OCD and Anxiety Related Disorders, Department of Psychiatry, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Eric C Porges
- Center for Cognitive Aging and Memory, Clinical Translational Research Program, College of Medicine, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Sarah Bottari
- Center for OCD and Anxiety Related Disorders, Department of Psychiatry, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Adam J Woods
- Center for Cognitive Aging and Memory, Clinical Translational Research Program, College of Medicine, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Somnath Datta
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Kailey Langer
- Center for Cognitive Aging and Memory, Clinical Translational Research Program, College of Medicine, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Ronald A Cohen
- Center for Cognitive Aging and Memory, Clinical Translational Research Program, College of Medicine, University of Florida, Gainesville, FL, United States.,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
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11
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Barkhuizen M, Abella R, Vles JSH, Zimmermann LJI, Gazzolo D, Gavilanes AWD. Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease. Pediatr Cardiol 2021; 42:1-18. [PMID: 33373013 PMCID: PMC7864813 DOI: 10.1007/s00246-020-02440-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/17/2020] [Indexed: 12/01/2022]
Abstract
Congenital heart defects (CHD) is one of the most common types of birth defects. Thanks to advances in surgical techniques and intensive care, the majority of children with severe forms of CHD survive into adulthood. However, this increase in survival comes with a cost. CHD survivors have neurological functioning at the bottom of the normal range. A large spectrum of central nervous system dysmaturation leads to the deficits seen in critical CHD. The heart develops early during gestation, and CHD has a profound effect on fetal brain development for the remainder of gestation. Term infants with critical CHD are born with an immature brain, which is highly susceptible to hypoxic-ischemic injuries. Perioperative blood flow disturbances due to the CHD and the use of cardiopulmonary bypass or circulatory arrest during surgery cause additional neurological injuries. Innate patient factors, such as genetic syndromes and preterm birth, and postoperative complications play a larger role in neurological injury than perioperative factors. Strategies to reduce the disability burden in critical CHD survivors are urgently needed.
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Affiliation(s)
- Melinda Barkhuizen
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Raul Abella
- Department of Pediatric Cardiac Surgery, University of Barcelona, Vall d'Hebron, Spain
| | - J S Hans Vles
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Luc J I Zimmermann
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diego Gazzolo
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Fetal, Maternal and Neonatal Health, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Antonio W D Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
- Instituto de Investigación e Innovación de Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Guayaquil, Guayaquil, Ecuador.
- Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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12
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Zhu S, Sai X, Lin J, Deng G, Zhao M, Nasser MI, Zhu P. Mechanisms of perioperative brain damage in children with congenital heart disease. Biomed Pharmacother 2020; 132:110957. [PMID: 33254442 DOI: 10.1016/j.biopha.2020.110957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022] Open
Abstract
Congenital heart disease, particularly cyanotic congenital heart disease (CCHD), may lead to a neurodevelopmental delay through central nervous system injury, more unstable central nervous system development, and increased vulnerability of the nervous system. Neurodevelopmental disease is the most serious disorder of childhood, affecting the quality of life of children and their families. Therefore, the monitoring and optimization of nerve damage treatments are important. The factors contributing to neurodevelopmental disease are primarily related to preoperative, intraoperative, postoperative, genetic, and environmental causes, with intraoperative causes being the most influential. Nevertheless, few studies have examined these factors, particularly the influencing factors during early postoperative care. Children with congenital heart disease may experience brain damage during early heart intensive care due to unstable haemodynamics and total body oxygen transfer, particularly early postoperative inflammatory reactions in the brain, blood glucose levels, and other factors that potentially influence long-term neural development. This study analyses the forms of structural and functional brain damage in the early postoperative period, along with the recent evolution of research on its contributing factors.
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Affiliation(s)
- Shuoji Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Xiyalatu Sai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianxin Lin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Gang Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China
| | - Mingyi Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
| | - M I Nasser
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510100, China.
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13
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Hodge SM, Haselgrove C, Honor L, Kennedy DN, Frazier JA. An assessment of the autism neuroimaging literature for the prospects of re-executability. F1000Res 2020; 9:1031. [PMID: 33796274 PMCID: PMC7968525 DOI: 10.12688/f1000research.25306.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The degree of reproducibility of the neuroimaging literature in psychiatric application areas has been called into question and the issues that relate to this reproducibility are extremely complex. Some of these complexities have to do with the underlying biology of the disorders that we study and others arise due to the technology we apply to the analysis of the data we collect. Ultimately, the observations we make get communicated to the rest of the community through publications in the scientific literature. Methods: We sought to perform a 're-executability survey' to evaluate the recent neuroimaging literature with an eye toward seeing if the technical aspects of our publication practices are helping or hindering the overall quest for a more reproducible understanding of brain development and aging. The topic areas examined include availability of the data, the precision of the imaging method description and the reporting of the statistical analytic approach, and the availability of the complete results. We applied the survey to 50 publications in the autism neuroimaging literature that were published between September 16, 2017 to October 1, 2018. Results: The results of the survey indicate that for the literature examined, data that is not already part of a public repository is rarely available, software tools are usually named but versions and operating system are not, it is expected that reasonably skilled analysts could approximately perform the analyses described, and the complete results of the studies are rarely available. Conclusions: We have identified that there is ample room for improvement in research publication practices. We hope exposing these issues in the retrospective literature can provide guidance and motivation for improving this aspect of our reporting practices in the future.
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Affiliation(s)
- Steven M. Hodge
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - Christian Haselgrove
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - Leah Honor
- Lamar Soutter Library, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - David N. Kennedy
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - Jean A. Frazier
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
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14
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Hodge SM, Haselgrove C, Honor L, Kennedy DN, Frazier JA. An assessment of the autism neuroimaging literature for the prospects of re-executability. F1000Res 2020; 9:1031. [PMID: 33796274 PMCID: PMC7968525 DOI: 10.12688/f1000research.25306.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 05/04/2024] Open
Abstract
Background: The degree of reproducibility of the neuroimaging literature in psychiatric application areas has been called into question and the issues that relate to this reproducibility are extremely complex. Some of these complexities have to do with the underlying biology of the disorders that we study and others arise due to the technology we apply to the analysis of the data we collect. Ultimately, the observations we make get communicated to the rest of the community through publications in the scientific literature. Methods: We sought to perform a 're-executability survey' to evaluate the recent neuroimaging literature with an eye toward seeing if our publication practices are helping or hindering the overall quest for a more reproducible understanding of brain development and aging. The topic areas examined include availability of the data, the precision of the imaging method description and the reporting of the statistical analytic approach, and the availability of the complete results. We applied the survey to 50 publications in the autism neuroimaging literature that were published between September 16, 2017 to October 1, 2018. Results: The results of the survey indicate that for the literature examined, data that is not already part of a public repository is rarely available, software tools are usually named but versions and operating system are not, it is expected that reasonably skilled analysts could approximately perform the analyses described, and the complete results of the studies are rarely available. Conclusions: We have identified that there is ample room for improvement in research publication practices. We hope exposing these issues in the retrospective literature can provide guidance and motivation for improving this aspect of our reporting practices in the future.
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Affiliation(s)
- Steven M. Hodge
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - Christian Haselgrove
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - Leah Honor
- Lamar Soutter Library, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - David N. Kennedy
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
| | - Jean A. Frazier
- Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, 01655, USA
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15
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Thomason ME. Development of Brain Networks In Utero: Relevance for Common Neural Disorders. Biol Psychiatry 2020; 88:40-50. [PMID: 32305217 PMCID: PMC7808399 DOI: 10.1016/j.biopsych.2020.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/05/2020] [Accepted: 02/05/2020] [Indexed: 01/27/2023]
Abstract
Magnetic resonance imaging, histological, and gene analysis approaches in living and nonliving human fetuses and in prematurely born neonates have provided insight into the staged processes of prenatal brain development. Increased understanding of micro- and macroscale brain network development before birth has spurred interest in understanding the relevance of prenatal brain development to common neurological diseases. Questions abound as to the sensitivity of the intrauterine brain to environmental programming, to windows of plasticity, and to the prenatal origin of disorders of childhood that involve disruptions in large-scale network connectivity. Much of the available literature on human prenatal neural development comes from cross-sectional or case studies that are not able to resolve the longitudinal consequences of individual variation in brain development before birth. This review will 1) detail specific methodologies for studying the human prenatal brain, 2) summarize large-scale human prenatal neural network development, integrating findings from across a variety of experimental approaches, 3) explore the plasticity of the early developing brain as well as potential sex differences in prenatal susceptibility, and 4) evaluate opportunities to link specific prenatal brain developmental processes to the forms of aberrant neural connectivity that underlie common neurological disorders of childhood.
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Affiliation(s)
- Moriah E Thomason
- Department of Child and Adolescent Psychiatry, Department of Population Health, and Neuroscience Institute, New York University Langone Health, New York, New York.
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