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Cissé YM, Montgomery KR, Zierden HC, Hill EM, Kane PJ, Huang W, Kane MA, Bale TL. Maternal preconception stress produces sex-specific effects at the maternal:fetal interface to impact offspring development and phenotypic outcomes†. Biol Reprod 2024; 110:339-354. [PMID: 37971364 PMCID: PMC10873277 DOI: 10.1093/biolre/ioad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Entering pregnancy with a history of adversity, including adverse childhood experiences and racial discrimination stress, is a predictor of negative maternal and fetal health outcomes. Little is known about the biological mechanisms by which preconception adverse experiences are stored and impact future offspring health outcomes. In our maternal preconception stress (MPS) model, female mice underwent chronic stress from postnatal days 28-70 and were mated 2 weeks post-stress. Maternal preconception stress dams blunted the pregnancy-induced shift in the circulating extracellular vesicle proteome and reduced glucose tolerance at mid-gestation, suggesting a shift in pregnancy adaptation. To investigate MPS effects at the maternal:fetal interface, we probed the mid-gestation placental, uterine, and fetal brain tissue transcriptome. Male and female placentas differentially regulated expression of genes involved in growth and metabolic signaling in response to gestation in an MPS dam. We also report novel offspring sex- and MPS-specific responses in the uterine tissue apposing these placentas. In the fetal compartment, MPS female offspring reduced expression of neurodevelopmental genes. Using a ribosome-tagging transgenic approach we detected a dramatic increase in genes involved in chromatin regulation in a PVN-enriched neuronal population in females at PN21. While MPS had an additive effect on high-fat-diet (HFD)-induced weight gain in male offspring, both MPS and HFD were necessary to induce significant weight gain in female offspring. These data highlight the preconception period as a determinant of maternal health in pregnancy and provides novel insights into mechanisms by which maternal stress history impacts offspring developmental programming.
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Affiliation(s)
- Yasmine M Cissé
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen R Montgomery
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hannah C Zierden
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth M Hill
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick J Kane
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Weiliang Huang
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Maureen A Kane
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Tracy L Bale
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
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Perla S, Kumar A. Epigenetic and transcriptional regulation of the human angiotensinogen gene by high salt. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.22.568343. [PMID: 38045346 PMCID: PMC10690268 DOI: 10.1101/2023.11.22.568343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Hypertension is caused by a combination of genetic and environmental factors. Angiotensinogen (AGT) is a component of RAAS, that regulates blood pressure. The human angiotensinogen (hAGT) gene has -6A/-6G polymorphism and -6A variant is associated with human hypertension. In this study, we have investigated the epigenetic regulation of the hAGT. To understand transcriptional regulation of the hAGT, we have made transgenic animals containing -6A. We show that HS affects DNA methylation and modulates transcriptional regulation of this gene in liver and kidney. High salt (HS) increases hAGT gene expression in -6A TG mice. We have observed that the number of CpG sites in the hAGT promoter is decreased after HS treatment. In the liver, seven CpG sites are methylated whereas after HS treatment, only three CpG sites remain methylated. In the kidney, five CpG sites are methylated, whereas after HS treatment, only three CpG sites remain methylated. These results suggest that HS promotes DNA demethylation and increasing AGT gene expression. RT-PCR and immunoblot analysis show that hAGT gene expression is increased by HS. Chip assay has shown that transcription factors bind strongly after HS treatment. RNA-Seq identified differentially expressed genes, novel target genes associated with hypertension, top canonical pathways, upstream regulators. One of the plausible mechanisms for HS induced up-regulation of the hAGT gene is through IL-6/JAK/STAT3/AGT axis.
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Genetic regulation and variation of expression of miRNA and mRNA transcripts in fetal muscle tissue in the context of sex, dam and variable fetal weight. Biol Sex Differ 2022; 13:24. [PMID: 35550009 PMCID: PMC9103043 DOI: 10.1186/s13293-022-00433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/25/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Impaired skeletal muscle growth in utero can result in reduced birth weight and pathogenesis of intrauterine growth restriction. Fetal and placental growth is influenced by many factors including genetic, epigenetic and environmental factors. In fact, the sex and genotype of the fetus itself, as well as the mother providing it with a suitable environment, influence the growth of the fetus. Hence, our goal was to decipher and elucidate the molecular pathways of developmental processes mediated by miRNAs and mRNAs in fetal muscle tissue in the context of sex, dam, and fetal weight. Therefore, we analyse the variation of miRNA and mRNA expression in relation to these factors. In addition, the coincidence of genetic regulation of these mRNAs and miRNAs, as revealed by expression quantitative trait loci (eQTL) analyses, with sex-, mother- and weight-associated expression was investigated. METHODS A three-generation pig F2 population (n = 118) based on reciprocal crossing of German Landrace (DL) and Pietrain (Pi) was used. Genotype information and transcriptomic data (mRNA and miRNA) from longissimus dorsi muscle (LDM) of pig fetuses sampled at 63 days post-conception (dpc) were used for eQTL analyses. RESULTS The transcript abundances of 13, 853, and 275 probe-sets were influenced by sex, dam and fetal weight at 63 dpc, respectively (FDR < 5%). Most of significant transcripts affected by sex were located on the sex chromosomes including KDM6A and ANOS1 or autosomes including ANKS1B, LOC100155138 and miR-153. The fetal muscle transcripts associated with fetal weight indicated clearer metabolic directions than maternally influenced fetal muscle transcripts. Moreover, coincidence of genetic regulation (eQTL) and variation in transcript abundance due to sex, dam and fetal weight were identified. CONCLUSIONS Integrating information on eQTL, sex-, dam- and weight-associated differential expression and QTL for fetal weight allowed us to identify molecular pathways and shed light on the basic biological processes associated with differential muscle development in males and females, with implications for adaptive fetal programming.
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Deng YD, Peng XB, Zhao RR, Ma CQ, Li JN, Yao LQ. The intestinal microbial community dissimilarity in hepatitis B virus-related liver cirrhosis patients with and without at alcohol consumption. Gut Pathog 2019; 11:58. [PMID: 31788031 PMCID: PMC6878713 DOI: 10.1186/s13099-019-0337-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Chronic hepatitis B virus (HBV) infection-reduced liver functions are associated with intestinal microbial community dissimilarity. This study aimed to investigate the microbial community dissimilarity in patients with different grades of HBV-related liver cirrhosis. Results Serum endotoxin was increased with Child–Pugh (CP) class (A, B, and C). Veillonellaceae and Lachnospiraceae families were reduced in patients compared with controls. Megamonas and Veillonella genus was reduced and increased in patients compared with controls, respectively, especially in CPB and CPC groups. Correlation analysis showed that endotoxin content was significantly correlated with alcohol consumption (95% CI 0.100, 0.493), CP class (95% CI 0.289, 0.687) and Lachnospiraceae family level (95% CI − 0.539, − 0.122). Firmicutes/Bacteroidetes ratio was correlated with the level of Lachnospiraceae family (95% CI 0.013, 0.481), Veillonellaceae family (95% CI 0.284, 0.696), Megamonas genus (95% CI 0.101, 0.518) and Veillonella genus (95% CI 0.134, 0.545). All aforementioned bacteria were independent risk or protective factors for hepatitis. Alcohol consumption changed microbial community. Conclusions Our study demonstrated that elevated Firmicutes/Bacteroidetes ratio, reduced Megamonas genus level and increased Veillonella genus level were indicators for HBV-related liver cirrhosis. Alcohol-related pathogenesis was associated with the changed microbial community.
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Affiliation(s)
- Yong-Dong Deng
- 1Department of Infection, First Hospital of Lanzhou University, #1 Donggang West Road, Lanzhou, 730000 Gansu China
| | - Xue-Bin Peng
- 1Department of Infection, First Hospital of Lanzhou University, #1 Donggang West Road, Lanzhou, 730000 Gansu China
| | - Rong-Rong Zhao
- 1Department of Infection, First Hospital of Lanzhou University, #1 Donggang West Road, Lanzhou, 730000 Gansu China
| | - Chao-Qun Ma
- 2First Clinical Medicine of Lanzhou University, Medical College of Lanzhou University, #199 Donggang West Road, Lanzhou, 730000 Gansu China
| | - Jian-Ning Li
- 1Department of Infection, First Hospital of Lanzhou University, #1 Donggang West Road, Lanzhou, 730000 Gansu China
| | - Li-Qiong Yao
- 3Department of Laboratory, First Hospital of Lanzhou University, #1 Donggang West Road, Lanzhou, 730000 Gansu China
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Pillay P, Vatish M, Duarte R, Moodley J, Mackraj I. Exosomal microRNA profiling in early and late onset preeclamptic pregnant women reflects pathophysiology. Int J Nanomedicine 2019; 14:5637-5657. [PMID: 31413567 PMCID: PMC6661992 DOI: 10.2147/ijn.s208865] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/30/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Preeclampsia is the leading cause of maternal and fetal mortality due to the inability to diagnose and treat the disorder early in pregnancy. This is attributed to the complex pathophysiology and unknown etiology of the disorder, which is modulated by several known and unknown factors. Exosomes have recently been implicated as possible mediators of the pathogenesis of preeclampsia, with, however, no evidence linking these nanovesicles to the pathophysiology of preeclampsia and its subtypes. Methods: To better understand the pathophysiological role of exosomes in preeclampsia, we have analyzed the exosomal microRNA in early and late onset preeclamptic women in comparison to their gestationally matched normotensive controls using Digital Direct Detection (NanoString Technologies). Results: For the first time, distinct exosomal microRNA signatures in early and late onset preeclampsia have been identified. Moreover, these signatures indicate that exosomes are involved in key pathological features associated with preeclampsia and differentiate between the subtypes. Conclusion: This study forms the basis for the diagnostic and functional validation of the identified signatures as biomarkers of preeclampsia and its subtypes.
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Affiliation(s)
- Preenan Pillay
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Manu Vatish
- Nuffield Department of Women's and Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Raquel Duarte
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jack Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, University of Kwazulu-Natal, Durban, South Africa
| | - Irene Mackraj
- School of Laboratory Medicine and Medical Sciences, University of Kwazulu-Natal, Durban, South Africa
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Gupta V, Saxena R, Walia GK, Agarwal T, Vats H, Dunn W, Relton C, Sovio U, Papageorghiou A, Davey Smith G, Khadgawat R, Sachdeva MP. Gestational route to healthy birth (GaRBH): protocol for an Indian prospective cohort study. BMJ Open 2019; 9:e025395. [PMID: 31048433 PMCID: PMC6501957 DOI: 10.1136/bmjopen-2018-025395] [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] [Received: 07/12/2018] [Revised: 10/17/2018] [Accepted: 03/12/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Pregnancy is characterised by a high rate of metabolic shifts from early to late phases of gestation in order to meet the raised physiological and metabolic needs. This change in levels of metabolites is influenced by gestational weight gain (GWG), which is an important characteristic of healthy pregnancy. Inadequate/excessive GWG has short-term and long-term implications on maternal and child health. Exploration of gestational metabolism is required for understanding the quantitative changes in metabolite levels during the course of pregnancy. Therefore, our aim is to study trimester-specific variation in levels of metabolites in relation to GWG and its influence on fetal growth and newborn anthropometric traits at birth. METHODS AND ANALYSIS A prospective longitudinal study is planned (start date: February 2018; end date: March 2023) on pregnant women that are being recruited in the first trimester and followed in subsequent trimesters and at the time of delivery (total 3 follow-ups). The study is being conducted in a hospital located in Bikaner district (66% rural population), Rajasthan, India. The estimated sample size is of 1000 mother-offspring pairs. Information on gynaecological and obstetric history, socioeconomic position, diet, physical activity, tobacco and alcohol consumption, depression, anthropometric measurements and blood samples is being collected for metabolic assays in each trimester using standardised methods. Mixed effects regression models will be used to assess the role of gestational weight in influencing metabolite levels in each trimester. The association of maternal levels of metabolites with fetal growth, offspring's weight and body composition at birth will be investigated using regression modelling. ETHICS AND DISSEMINATION The study has been approved by the ethics committees of the Department of Anthropology, University of Delhi and Sardar Patel Medical College, Rajasthan. We are taking written informed consent after discussing the various aspects of the study with the participants in the local language.
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Affiliation(s)
- Vipin Gupta
- Department of Anthropology, University of Delhi, Delhi, India
| | - Ruchi Saxena
- Department of Obstetrics and Gynaecology, Sardar Patel Medical College, Bikaner, Rajasthan, India
| | | | | | - Harsh Vats
- Department of Anthropology, University of Delhi, Delhi, India
| | - Warwick Dunn
- School of Biosciences, Phenome Centre Birmingham and Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Caroline Relton
- MRC Integrative Epidemiology Unit and Bristol Medical School, University of Bristol, Bristol, UK
| | - Ulla Sovio
- Obstetrics and Gyneacology, University of Cambridge, Cambridge, UK
| | - Aris Papageorghiou
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit and Bristol Medical School, University of Bristol, Bristol, UK
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Tang Y, Ye W, Liu X, Lv Y, Yao C, Wei J. VEGF and sFLT-1 in serum of PIH patients and effects on the foetus. Exp Ther Med 2019; 17:2123-2128. [PMID: 30867699 PMCID: PMC6396009 DOI: 10.3892/etm.2019.7184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/14/2019] [Indexed: 01/15/2023] Open
Abstract
The expression of vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFLT-1) in the serum of patients with pregnancy induced hypertension (PIH) syndrome and its effects on the foetus was explored. A total of 105 cases of PIH pregnant women admitted to The First People's Hospital of Changzhou from March 2015 to February 2018 were divided into 3 groups according to the severity of the patients condition. Group A (n=35) was hypertension complicating pregnancy, group B (n=46) was mild preeclampsia and group C (n=24) was severe preeclampsia. In addition, 35 healthy pregnant women were selected as the control group. VEGF and sFLT-1 levels in serum were detected by enzyme linked immunosorbent assay, and the correlations between levels of VEGF and sFLT-1, neonatal weight and Apgar score were analyzed. Compared with group A, the level of serum VEGF was lower, while the level of sFLT-1 was higher in groups B and C (P<0.05). Compared with group B, the serum VEGF level in group C decreased significantly (P<0.05), while the serum level of sFLT-1 increased significantly (P<0.05). Compared with group A, neonatal weight and Apgar score in group C was significantly lower (P<0.05). There was a positive correlation between the serum VEGF level and neonatal weight and Apgar score (r=0.435, P<0.001. r=0.357, P<0.001). There was a negative correlation between the serum sFLT-1 level and neonatal weight and Apgar score (r=−0.351, P<0.001. r=−0.422, P<0.001). Therefore, we concluded that VEGF and sFlt-1 may be involved in the occurrence and development of PIH. The decrease of serum VEGF level and the increase of sFlt-1 level may be related to the inhibited fetal growth and development, which is of great significance in the clinical detection of PIH patients.
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Affiliation(s)
- Yanhong Tang
- Department of Gynaecology and Obstetrics, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China
| | - Wenfeng Ye
- Department of Gynaecology and Obstetrics, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China
| | - Xia Liu
- Department of Gynaecology and Obstetrics, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China
| | - Yan Lv
- Department of Gynaecology and Obstetrics, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China
| | - Changfang Yao
- Department of Gynaecology and Obstetrics, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China
| | - Jiang Wei
- Department of Comprehensive Laboratory, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213000, P.R. China
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Prats-Puig A, Carreras-Badosa G, Bassols J, Cavelier P, Magret A, Sabench C, de Zegher F, Ibáñez L, Feil R, López-Bermejo A. The placental imprinted DLK1-DIO3 domain: a new link to prenatal and postnatal growth in humans. Am J Obstet Gynecol 2017; 217:350.e1-350.e13. [PMID: 28502757 DOI: 10.1016/j.ajog.2017.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/22/2017] [Accepted: 05/04/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The developmentally important DLK1-DIO3 imprinted domain on human chromosome 14 is regulated by 2 differentially methylated regions, the intergenic differentially methylated region and the MEG3 differentially methylated region. OBJECTIVE The aim was to determine the natural variation in DNA methylation at these differentially methylated regions in human placentas, and to determine its link to gene expression levels at the domain. The second goal was to explore whether the domain's methylation and gene expression correlate with prenatal and early postnatal growth of the conceptus. STUDY DESIGN Using pyrosequencing, we determined methylation levels at CpG dinucleotides across the 2 regulatory differentially methylated regions in placentas from 91 healthy mothers. At birth, placentas and infants were weighed (gestational age 39 ± 1 weeks; birthweight SD score 0.1 ± 0.8) and placental biopsies were collected. RNA expression was quantitated by real-time polymerase chain reaction. Infants' weights and lengths were followed up monthly during the first year. RESULTS Methylation levels at the 2 regulatory differentially methylated regions were linked and varied considerably between placentas. MEG3 promoter differentially methylated region methylation correlated negatively with weight increase (β = -0.406, P = .001, R2 = 0.206) and length increase (β = -0.363, P = .002, R2 = 0.230) during the first postnatal year. The methylation level of the intergenic differentially methylated region correlated with DIO3 expression (β = 0.313, P = .032, R2 = 0.152). Furthermore, the expression of both DIO3 and RTL1 (both imprinted genes within the DLK1-DIO3 domain) was negatively associated with birthweight (β = -0.331, P = .002, R2 = 0.165; and β = -0.307, P = .005, R2 = 0.159, respectively). RTL1 expression, in addition, was negatively linked to birth length (β = -0.306, P = .007, R2 = 0.162). CONCLUSION Our combined findings strongly suggest that placental DNA methylation at the DLK1-DIO3 domain's intergenic differentially methylated region and MEG3 promoter differentially methylated region relates to measures of early human growth, and may thus contribute to its control.
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Wei Y, Shi Q, Wang Z, Zhang R, Su L, Quamruzzaman Q, Rahman M, Chen F, Christiani DC. Maternal/fetal metabolomes appear to mediate the impact of arsenic exposure on birth weight: A pilot study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:313-319. [PMID: 27966664 PMCID: PMC5972365 DOI: 10.1038/jes.2016.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 05/19/2023]
Abstract
Arsenic exposure has been associated with low birth weight. However, the underlying mechanisms are not well understood. Alterations to metabolites may act as causal mediators of the effect of arsenic exposure on low birth weight. This pilot study aimed to explore the role of metabolites in mediating the association of arsenic exposure on infant birth weight. Study samples were selected from a well-established prospectively enrolled cohort in Bangladesh comprising 35 newborns and a subset of 20 matched mothers. Metabolomics profiling was performed on 35 cord blood samples and 20 maternal peripheral blood samples collected during the second trimester of pregnancy. Inorganic arsenic (iAs) exposure was evaluated via cord blood samples and maternal toenail samples collected during the first trimester. Multiple linear regression and mediation analyses were used to explore the relationship between iAs exposure, metabolite alterations, and low birth weight. Cord blood arsenic level was correlated with elevated levels of 17-methylstearate, laurate (12:0) and 4-vinylphenol sulfate along with lower birth weight. Prenatal maternal toenail iAs level was associated with two peripheral blood metabolites (butyrylqlycine and tartarate), which likely contributed to higher cord blood iAs levels both independently and interactively. Findings of this pilot study indicate that both intrauterine and maternal peripheral blood metabolites appear to influence the toxic effect of inorganic arsenic exposure on low birth weight.
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Affiliation(s)
- Yongyue Wei
- Department of Biostatistics, Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
- Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China
| | - Qianwen Shi
- Department of Biostatistics, Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhaoxi Wang
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Ruyang Zhang
- Department of Biostatistics, Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
- Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China
| | - Li Su
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | | | | | - Feng Chen
- Department of Biostatistics, Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
- Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China
| | - David C. Christiani
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
- Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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