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Gigase FAJ, Suleri A, Isaevska E, Rommel AS, Boekhorst MGBM, Dmitrichenko O, El Marroun H, Steegers EAP, Hillegers MHJ, Muetzel RL, Lieb W, Cecil CAM, Pop V, Breen M, Bergink V, de Witte LD. Inflammatory markers in pregnancy - surprisingly stable. Mapping trajectories and drivers in four large cohorts. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.19.599718. [PMID: 38948713 PMCID: PMC11213028 DOI: 10.1101/2024.06.19.599718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Adaptations of the immune system throughout gestation have been proposed as important mechanisms regulating successful pregnancy. Dysregulation of the maternal immune system has been associated with adverse maternal and fetal outcomes. To translate findings from mechanistic preclinical studies to human pregnancies, studies of serum immune markers are the mainstay. The design and interpretation of human biomarker studies require additional insights in the trajectories and drivers of peripheral immune markers. The current study mapped maternal inflammatory markers (C-reactive protein (CRP), interleukin (IL)-1β, IL-6, IL-17A, IL-23, interferon- γ ) during pregnancy and investigated the impact of demographic, environmental and genetic drivers on maternal inflammatory marker levels in four multi-ethnic and socio-economically diverse population-based cohorts with more than 12,000 pregnant participants. Additionally, pregnancy inflammatory markers were compared to pre-pregnancy levels. Cytokines showed a high correlation with each other, but not with CRP. Inflammatory marker levels showed high variability between individuals, yet high concordance within an individual over time during and pre-pregnancy. Pre-pregnancy body mass index (BMI) explained more than 9.6% of the variance in CRP, but less than 1% of the variance in cytokines. The polygenic score of CRP was the best predictor of variance in CRP (>14.1%). Gestational age and previously identified inflammation drivers, including tobacco use and parity, explained less than 1% of variance in both cytokines and CRP. Our findings corroborate differential underlying regulatory mechanisms of CRP and cytokines and are suggestive of an individual inflammatory marker baseline which is, in part, genetically driven. While prior research has mainly focused on immune marker changes throughout pregnancy, our study suggests that this field could benefit from a focus on intra-individual factors, including metabolic and genetic components.
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2
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Nelson BN, Friedman JE. Developmental Programming of the Fetal Immune System by Maternal Western-Style Diet: Mechanisms and Implications for Disease Pathways in the Offspring. Int J Mol Sci 2024; 25:5951. [PMID: 38892139 PMCID: PMC11172957 DOI: 10.3390/ijms25115951] [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: 04/18/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Maternal obesity and over/undernutrition can have a long-lasting impact on offspring health during critical periods in the first 1000 days of life. Children born to mothers with obesity have reduced immune responses to stimuli which increase susceptibility to infections. Recently, maternal western-style diets (WSDs), high in fat and simple sugars, have been associated with skewing neonatal immune cell development, and recent evidence suggests that dysregulation of innate immunity in early life has long-term consequences on metabolic diseases and behavioral disorders in later life. Several factors contribute to abnormal innate immune tolerance or trained immunity, including changes in gut microbiota, metabolites, and epigenetic modifications. Critical knowledge gaps remain regarding the mechanisms whereby these factors impact fetal and postnatal immune cell development, especially in precursor stem cells in bone marrow and fetal liver. Components of the maternal microbiota that are transferred from mothers consuming a WSD to their offspring are understudied and identifying cause and effect on neonatal innate and adaptive immune development needs to be refined. Tools including single-cell RNA-sequencing, epigenetic analysis, and spatial location of specific immune cells in liver and bone marrow are critical for understanding immune system programming. Considering the vital role immune function plays in offspring health, it will be important to understand how maternal diets can control developmental programming of innate and adaptive immunity.
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Affiliation(s)
- Benjamin N. Nelson
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Jacob E. Friedman
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Department of Physiology and Biochemistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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3
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Layden AJ, Bertolet M, Parks WT, Adibi JJ, Roberts JM, Catov JM. Prepregnancy obesity and risk of placental inflammation at term: a selection bias analysis. Ann Epidemiol 2023; 86:25-33.e7. [PMID: 37302673 PMCID: PMC10546767 DOI: 10.1016/j.annepidem.2023.06.003] [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: 12/30/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE Placental histopathology is a resource for investigating obesity-associated pregnancy conditions. However, studies oversample adverse pregnancies, biasing findings. We examine the association between prepregnancy obesity (risk factor for inflammation) and histologic placental inflammation (correlated with impaired infant neurodevelopment) and how selection bias may influence the association. METHODS Singleton term deliveries between 2008 and 2012 from the Magee Obstetric Maternal and Infant database were analyzed. Prepregnancy body mass index (BMI) was categorized as underweight, lean (referent), overweight, and obese. Outcomes were diagnoses of acute (acute chorioamnionitis and fetal inflammation) and chronic placental inflammation (chronic villitis). Risk ratios for associations between BMI and placental inflammation were estimated using selection bias approaches: complete case, exclusion of pregnancy complications, multiple imputation, and inverse probability weighting. E-values approximated how susceptible estimates were to residual selection bias. RESULTS Across methods, obesity was associated with an 8-15% lower risk of acute chorioamnionitis, a 7%-14% lower risk of acute fetal inflammation, and a 12%-30% higher risk of chronic villitis relative to lean women. E-values indicated modest residual selection bias could explain away associations, though few measured indications of placental evaluations met this threshold. CONCLUSIONS Obesity may contribute to placental inflammation, and we highlight robust methods to analyze clinical data susceptible to selection bias.
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Affiliation(s)
| | - Marnie Bertolet
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA
| | - W Tony Parks
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, CA
| | - Jennifer J Adibi
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James M Roberts
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
| | - Janet M Catov
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA
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4
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Valencia-Ortega J, Solis-Paredes JM, Saucedo R, Estrada-Gutierrez G, Camacho-Arroyo I. Excessive Pregestational Weight and Maternal Obstetric Complications: The Role of Adipokines. Int J Mol Sci 2023; 24:14678. [PMID: 37834125 PMCID: PMC10572963 DOI: 10.3390/ijms241914678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
There is a high frequency of overweight and obesity in women of reproductive age. Women who start pregnancy with overweight or obesity have an increased risk of developing maternal obstetric complications such as gestational hypertension, pre-eclampsia, gestational diabetes mellitus, postpartum hemorrhage, and requiring C-section to resolve the pregnancy with a higher risk of C-section surgical site infection. Excessive weight in pregnancy is characterized by dysregulation of adipokines, the functions of which partly explain the predisposition of pregnant women with overweight or obesity to these maternal obstetric complications. This review compiles, organizes, and analyzes the most recent studies on adipokines in pregnant women with excess weight and the potential pathophysiological mechanisms favoring the development of maternal pregnancy complications.
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Affiliation(s)
- Jorge Valencia-Ortega
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, Mexico City 11000, Mexico;
| | - Juan Mario Solis-Paredes
- Department of Reproductive and Perinatal Health Research, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico;
| | - Renata Saucedo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico;
| | | | - Ignacio Camacho-Arroyo
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, Mexico City 11000, Mexico;
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Radford-Smith DE, Anthony DC. Mechanisms of Maternal Diet-Induced Obesity Affecting the Offspring Brain and Development of Affective Disorders. Metabolites 2023; 13:455. [PMID: 36984895 PMCID: PMC10053489 DOI: 10.3390/metabo13030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Depression and metabolic disease are common disorders that share a bidirectional relationship and continue to increase in prevalence. Maternal diet and maternal behaviour both profoundly influence the developmental trajectory of offspring during the perinatal period. At an epidemiological level, both maternal depression and obesity during pregnancy have been shown to increase the risk of neuropsychiatric disease in the subsequent generation. Considerable progress has been made to understand the mechanisms by which maternal obesity disrupts the developing offspring gut-brain axis, priming offspring for the development of affective disorders. This review outlines such mechanisms in detail, including altered maternal care, the maternal microbiome, inflammation, breast milk composition, and maternal and placental metabolites. Subsequently, offspring may be prone to developing gut-brain interaction disorders with concomitant changes to brain energy metabolism, neurotransmission, and behaviour, alongside gut dysbiosis. The gut microbiome may act as a key modifiable, and therefore treatable, feature of the relationship between maternal obesity and the offspring brain function. Further studies examining the relationship between maternal nutrition, the maternal microbiome and metabolites, and offspring neurodevelopment are warranted to identify novel therapeutic targets.
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Affiliation(s)
- Daniel E. Radford-Smith
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford OX37JX, UK
- Department of Chemistry, University of Oxford, Mansfield Road, Oxford OX13TA, UK
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX13QT, UK
| | - Daniel C. Anthony
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX13QT, UK
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6
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Resistin Modulates the Functional Activity of Colostral Macrophages from Mothers with Obesity and Diabetes. Biomedicines 2022; 10:biomedicines10102332. [DOI: 10.3390/biomedicines10102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Obesity and diabetes are major public health problems. Resistin is an adipokine that links the two diseases. There are few reports regarding colostrum cells and resistin from mothers with obesity and diabetes. Thus, this study aimed to determine the functional activity of macrophages present in the breast milk and colostrum of diabetic mothers with obesity and the effects of resistin on these cells. Methods: The women were divided according to BMI and glycemic status into normal weight non-diabetic, obese non-diabetic, normal weight type 2 diabetic, or obese type 2 diabetic groups. ELISA determined the resistin in colostrum. The cell subsets and apoptosis were determined by flow cytometry and the functional activity of cells by fluorescence microscopy. Results: The resistin levels were higher in the colostrum from diabetic mothers with obesity. The frequencies of CD14+ cells and cells expressing CD95+, independent of resistin treatment, were higher in the colostrum from diabetic mothers with obesity. The frequency of cells expressing CD14+CD95+ was higher in cells not treated with resistin in the colostrum from diabetic mothers with obesity. Apoptosis, irrespective of the presence of resistin, increased, whereas microbicidal activity decreased in cells from diabetic mothers with obesity. Conclusion: The data suggest that hyperglycemia associated with low-grade inflammation caused by obesity affects the percentage of cells expressing CD14+CD95+, death by apoptosis, and microbicidal indices; meanwhile, resistin restored the microbicidal activity of colostrum cells.
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7
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Denizli M, Capitano ML, Kua KL. Maternal obesity and the impact of associated early-life inflammation on long-term health of offspring. Front Cell Infect Microbiol 2022; 12:940937. [PMID: 36189369 PMCID: PMC9523142 DOI: 10.3389/fcimb.2022.940937] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/23/2022] [Indexed: 12/02/2022] Open
Abstract
The prevalence of obesity is increasingly common in the United States, with ~25% of women of reproductive age being overweight or obese. Metaflammation, a chronic low grade inflammatory state caused by altered metabolism, is often present in pregnancies complicated by obesity. As a result, the fetuses of mothers who are obese are exposed to an in-utero environment that has altered nutrients and cytokines. Notably, both human and preclinical studies have shown that children born to mothers with obesity have higher risks of developing chronic illnesses affecting various organ systems. In this review, the authors sought to present the role of cytokines and inflammation during healthy pregnancy and determine how maternal obesity changes the inflammatory landscape of the mother, leading to fetal reprogramming. Next, the negative long-term impact on offspring’s health in numerous disease contexts, including offspring’s risk of developing neuropsychiatric disorders (autism, attention deficit and hyperactive disorder), metabolic diseases (obesity, type 2 diabetes), atopy, and malignancies will be discussed along with the potential of altered immune/inflammatory status in offspring as a contributor of these diseases. Finally, the authors will list critical knowledge gaps in the field of developmental programming of health and diseases in the context of offspring of mothers with obesity, particularly the understudied role of hematopoietic stem and progenitor cells.
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Affiliation(s)
- Merve Denizli
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis IN, United States
| | - Maegan L. Capitano
- Department of Microbiology & Immunology, Indiana University School of Medicine, Indianapolis IN, United States
| | - Kok Lim Kua
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis IN, United States
- *Correspondence: Kok Lim Kua,
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8
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Bryan EE, Chen X, Smith BS, Dilger RN, Dilger AC. Maternal Immune Activation and Dietary Soy Isoflavone Supplementation Influence Pig Immune Function but not Muscle Fiber Formation. J Anim Sci 2022; 100:6568979. [PMID: 35426431 PMCID: PMC9155173 DOI: 10.1093/jas/skac134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The goals of this study were to determine the impact of maternal PRRSV infection on offspring muscle and immune development and the potential of dietary soy isoflavones to mitigate those effects. Thirteen first-parity gilts (“gilts”) were randomly allotted into one of three treatments: not infected and fed a diet devoid of isoflavones (CON), infected with porcine reproductive and respiratory syndrome virus (PRRSV) and fed the control diet (POS) or that supplemented with 1,500 mg/kg soy-derived isoflavones (ISF). Gilts were inoculated with PRRSV intranasally on gestational day (GD) 70. After farrowing (GD 114 ± 2), 1-2 offspring (“pigs”) closest to the average litter weight were selected either at birth (3 ± 2 d of age) or weaning (21 ±2 d of age) to determine body, muscle, and organ weights as well as muscle cell number and size. Four weaned pigs of average body weight within each litter were selected for postnatal immune challenge. At PND 52, pigs were injected with 5 µg/kg BW lipopolysaccharide (LPS) intraperitoneally. Serum was collected at 0, 4, and 8 h following LPS administration to analyze tumor necrosis factor alpha (TNF-α). At PND 59, pigs were administered a novel vaccine to elicit an adaptive immune response. At PND 59, 66, and 73, peripheral blood mononuclear cells were isolated and T-cell populations determined by flow cytometry. Both POS and ISF pigs exhibited persistent PRRSV infections throughout the study (PND 1-73). At PND 3, whole body, muscle, and organ weights were not different (P > 0.22) between groups, with the exception of relative liver weight, which was increased (P < 0.05) in POS compared with CON pigs. At PND 21, ISF pigs had reduced (P ≤ 0.05) whole body and muscle weights, but greater (P < 0.05) kidney weight compared with CON, and greater (P < 0.05) relative liver weight compared with CON and POS. Muscle fiber number and size were not different (P > 0.39) between groups at birth or weaning. After LPS administration, TNF-α was greatest in ISF pigs (P < 0.05) at both 0 and 8 h post-challenge. At the peak time-point of 4 h post-challenge, ISF pigs had the greatest concentration of TNF-α and CON pigs had the lowest, with POS pigs being intermediate (P = 0.01). After vaccination, ISF offspring had shifts in T-cell populations indicating an impaired immune response. These data indicate that maternal PRRSV infection may impact offspring organ growth and immune function, particularly when the dam is supplemented with isoflavones.
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Affiliation(s)
- E E Bryan
- Department of Animal Sciences, University of Illinois, Urbana-Champaign, USA
| | - X Chen
- Department of Animal Sciences, University of Illinois, Urbana-Champaign, USA
| | - B S Smith
- Department of Animal Sciences, University of Illinois, Urbana-Champaign, USA
| | - R N Dilger
- Department of Animal Sciences, University of Illinois, Urbana-Champaign, USA
| | - A C Dilger
- Department of Animal Sciences, University of Illinois, Urbana-Champaign, USA
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9
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Ohashi M, Miura K, Takashima N, Kadota A, Saito Y, Tsuji S, Murakami T, Kadomatsu Y, Nagayoshi M, Hara M, Tanaka K, Tamura T, Hishida A, Takezaki T, Shimoshikiryo I, Ozaki E, Watanabe I, Suzuki S, Watanabe M, Kuriki K, Arisawa K, Katsuura-Kamano S, Yamasaki S, Ikezaki H, Oze I, Koyanagi YN, Mikami H, Nakamura Y, Takeuchi K, Kita Y, Wakai K. The association of reproductive history with hypertension and obesity according to menopausal status: the J-MICC Study. Hypertens Res 2022; 45:708-714. [PMID: 35031776 DOI: 10.1038/s41440-021-00820-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/08/2022]
Abstract
Previous studies have reported that the number of pregnancies and childbirths affected the risk of cardiovascular diseases (CVDs). However, the influence of reproductive history on hypertension and obesity, which are important risk factors for CVDs, is still unclear. Moreover, this association may vary depending on menopausal status. We evaluated the association of reproductive history with hypertension and obesity using a large cross-sectional dataset from the Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study). At the baseline survey, physical data, blood samples, and self-reported health questionnaires were collected. Participants with insufficient data were excluded, and 24,558 women from eight study regions were included in this study. Logistic regression analysis was conducted to evaluate the association of reproductive history with hypertension and obesity using multivariable-adjusted odds ratios. In premenopausal women, childbirth showed a generally protective effect on hypertension but not on obesity. In postmenopausal women, childbirth was positively associated with obesity and hypertension but not with hypertension after adjusting for BMI. In conclusion, reproductive history was associated with hypertension and obesity in a large Japanese population, and this association differed between premenopausal and postmenopausal women.
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Affiliation(s)
- Mizuki Ohashi
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan.
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Naoyuki Takashima
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Yoshino Saito
- Department of Health Science, Aino University, Osaka, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Yuka Kadomatsu
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiro Takezaki
- Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ippei Shimoshikiryo
- Department of International Island and Community Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Etsuko Ozaki
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Watanabe
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Miki Watanabe
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kiyonori Kuriki
- Laboratory of Public Health, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kokichi Arisawa
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Sakurako Katsuura-Kamano
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Sho Yamasaki
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroaki Ikezaki
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Comprehensive General Internal Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center, Nagoya, Japan
| | - Yuriko N Koyanagi
- Division of Cancer Information and Control, Aichi Cancer Center, Nagoya, Japan
| | - Haruo Mikami
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Yohko Nakamura
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Kenji Takeuchi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshikuni Kita
- Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Breuer S, Kasper P, Vohlen C, Janoschek R, Hoffmann T, Appel S, Müller-Limberger E, Mesaros A, Rose-John S, Garbers C, Müller S, Lackmann JW, Mahabir E, Dötsch J, Hucklenbruch-Rother E, Bae-Gartz I. Brain-Restricted Inhibition of IL-6 Trans-Signaling Mildly Affects Metabolic Consequences of Maternal Obesity in Male Offspring. Nutrients 2021; 13:3735. [PMID: 34835991 PMCID: PMC8618896 DOI: 10.3390/nu13113735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022] Open
Abstract
Maternal obesity greatly affects next generations, elevating obesity risk in the offspring through perinatal programming and flawed maternal and newborn nutrition. The exact underlying mechanisms are poorly understood. Interleukin-6 (IL-6) mediates its effects through a membrane-bound receptor or by trans-signaling (tS), which can be inhibited by the soluble form of the co-receptor gp130 (sgp130). As IL-6 tS mediates western-style diet (WSD) effects via chronic low-grade inflammation (LGI) and LGI is an important mediator in brain-adipose tissue communication, this study aims at determining the effects of maternal obesity in a transgenic mouse model of brain-restricted IL-6tS inhibition (GFAPsgp130) on offspring's short- and long-term body composition and epigonadal white adipose tissue (egWAT) metabolism. Female wild type (WT) or transgenic mice were fed either standard diet (SD) or WSD pregestationally, during gestation, and lactation. Male offspring received SD from postnatal day (P)21 to P56 and were metabolically challenged with WSD from P56 to P120. At P21, offspring from WT and transgenic dams that were fed WSD displayed increased body weight and egWAT mass, while glucose tolerance testing showed the strongest impairment in GFAPsgp130WSD offspring. Simultaneously, egWAT proteome reveals a characteristic egWAT expression pattern in offspring as a result of maternal conditions. IL-6tS inhibition in transgenic mice was in tendency associated with lower body weight in dams on SD and their respective offspring but blunted by the WSD. In conclusion, maternal nutrition affects offspring's body weight and egWAT metabolism predominantly independent of IL-6tS inhibition, emphasizing the importance of maternal and newborn nutrition for long-term offspring health.
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Affiliation(s)
- Saida Breuer
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Philipp Kasper
- Clinic for Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany;
| | - Christina Vohlen
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Ruth Janoschek
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Thorben Hoffmann
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Sarah Appel
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Elena Müller-Limberger
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Andrea Mesaros
- Department of Phenotyping, Max-Planck Institute for Biology of Aging, University of Cologne, D-50931 Cologne, Germany;
| | - Stefan Rose-John
- Department for Biochemistry, Christian-Albrechts-University zu Kiel, D-24098 Kiel, Germany;
| | - Christoph Garbers
- Department of Pathology, Medical Faculty, Otto-von-Guericke-University Magdeburg, D-39120 Magdeburg, Germany;
| | - Stefan Müller
- Center for Molecular Medicine (CMMC), Proteomics Facility, University of Cologne, D-50931 Cologne, Germany;
| | - Jan-Wilm Lackmann
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, D-50931 Cologne, Germany;
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, D-50937 Cologne, Germany;
| | - Jörg Dötsch
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Eva Hucklenbruch-Rother
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
| | - Inga Bae-Gartz
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, D-50937 Cologne, Germany; (S.B.); (C.V.); (R.J.); (T.H.); (S.A.); (E.M.-L.); (J.D.); (E.H.-R.)
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11
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Li Y, Pollock CA, Saad S. Aberrant DNA Methylation Mediates the Transgenerational Risk of Metabolic and Chronic Disease Due to Maternal Obesity and Overnutrition. Genes (Basel) 2021; 12:genes12111653. [PMID: 34828259 PMCID: PMC8624316 DOI: 10.3390/genes12111653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/02/2021] [Accepted: 10/17/2021] [Indexed: 12/13/2022] Open
Abstract
Maternal obesity is a rapidly evolving universal epidemic leading to acute and long-term medical and obstetric health issues, including increased maternal risks of gestational diabetes, hypertension and pre-eclampsia, and the future risks for offspring's predisposition to metabolic diseases. Epigenetic modification, in particular DNA methylation, represents a mechanism whereby environmental effects impact on the phenotypic expression of human disease. Maternal obesity or overnutrition contributes to the alterations in DNA methylation during early life which, through fetal programming, can predispose the offspring to many metabolic and chronic diseases, such as non-alcoholic fatty liver disease, obesity, diabetes, and chronic kidney disease. This review aims to summarize findings from human and animal studies, which support the role of maternal obesity in fetal programing and the potential benefit of altering DNA methylation to limit maternal obesity related disease in the offspring.
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Affiliation(s)
- Yan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China;
| | - Carol A. Pollock
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2065, Australia;
| | - Sonia Saad
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW 2065, Australia;
- Correspondence:
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12
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Jarmund AH, Giskeødegård GF, Ryssdal M, Steinkjer B, Stokkeland LMT, Madssen TS, Stafne SN, Stridsklev S, Moholdt T, Heimstad R, Vanky E, Iversen AC. Cytokine Patterns in Maternal Serum From First Trimester to Term and Beyond. Front Immunol 2021; 12:752660. [PMID: 34721426 PMCID: PMC8552528 DOI: 10.3389/fimmu.2021.752660] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022] Open
Abstract
Pregnancy implies delicate immunological balance between two individuals, with constant changes and adaptions in response to maternal capacity and fetal demands. We performed cytokine profiling of 1149 longitudinal serum samples from 707 pregnant women to map immunological changes from first trimester to term and beyond. The serum levels of 22 cytokines and C-reactive protein (CRP) followed diverse but characteristic trajectories throughout pregnancy, consistent with staged immunological adaptions. Eotaxin showed a particularly robust decrease throughout pregnancy. A strong surge in cytokine levels developed when pregnancies progressed beyond term and the increase was amplified as labor approached. Maternal obesity, smoking and pregnancies with large fetuses showed sustained increase in distinct cytokines throughout pregnancy. Multiparous women had increased cytokine levels in the first trimester compared to nulliparous women with higher cytokine levels in the third trimester. Fetal sex affected first trimester cytokine levels with increased levels in pregnancies with a female fetus. These findings unravel important immunological dynamics of pregnancy, demonstrate how both maternal and fetal factors influence maternal systemic cytokines, and serve as a comprehensive reference for cytokine profiles in normal pregnancies.
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Affiliation(s)
- Anders Hagen Jarmund
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Guro Fanneløb Giskeødegård
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mariell Ryssdal
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bjørg Steinkjer
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Live Marie Tobiesen Stokkeland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torfinn Støve Madssen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Signe Nilssen Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Solhild Stridsklev
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Women’s Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Runa Heimstad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ann-Charlotte Iversen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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13
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Wawer AA, Hodyl NA, Fairweather-Tait S, Froessler B. Are Pregnant Women Who Are Living with Overweight or Obesity at Greater Risk of Developing Iron Deficiency/Anaemia? Nutrients 2021; 13:1572. [PMID: 34067098 PMCID: PMC8151407 DOI: 10.3390/nu13051572] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022] Open
Abstract
Low-grade inflammation is often present in people living with obesity. Inflammation can impact iron uptake and metabolism through elevation of hepcidin levels. Obesity is a major public health issue globally, with pregnant women often affected by the condition. Maternal obesity is associated with increased pregnancy risks including iron deficiency (ID) and iron-deficiency anaemia (IDA)-conditions already highly prevalent in pregnant women and their newborns. This comprehensive review assesses whether the inflammatory state induced by obesity could contribute to an increased incidence of ID/IDA in pregnant women and their children. We discuss the challenges in accurate measurement of iron status in the presence of inflammation, and available iron repletion strategies and their effectiveness in pregnant women living with obesity. We suggest that pre-pregnancy obesity and overweight/obese pregnancies carry a greater risk of ID/IDA for the mother during pregnancy and postpartum period, as well as for the baby. We propose iron status and weight gain during pregnancy should be monitored more closely in women who are living with overweight or obesity.
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Affiliation(s)
- Anna A. Wawer
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia;
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Nicolette A. Hodyl
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Susan Fairweather-Tait
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia;
- Discipline of Acute Care Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
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14
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Munro SK, Balakrishnan B, Lissaman AC, Gujral P, Ponnampalam AP. Cytokines and pregnancy: Potential regulation by histone deacetylases. Mol Reprod Dev 2021; 88:321-337. [PMID: 33904218 DOI: 10.1002/mrd.23430] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 12/26/2022]
Abstract
Cytokines are important regulators of pregnancy and parturition. Aberrant expression of proinflammatory cytokines during pregnancy contributes towards preterm labor, pre-eclampsia, and gestational diabetes mellitus. The regulation of cytokine expression in human cells is highly complex, involving interactions between environment, transcription factors, and feedback mechanisms. Recent developments in epigenetic research have made tremendous advancements in exploring histone modifications as a key epigenetic regulator of cytokine expression and the effect of their signaling molecules on various organ systems in the human body. Histone acetylation and subsequent deacetylation by histone deacetylases (HDACs) are major epigenetic regulators of protein expression in the human body. The expression of various proinflammatory cytokines, their role in normal and abnormal pregnancy, and their epigenetic regulation via HDACs will be discussed in this review.
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Affiliation(s)
- Sheryl K Munro
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Biju Balakrishnan
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Abbey C Lissaman
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Palak Gujral
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Anna P Ponnampalam
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Department of Physiology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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15
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Davis J, Mire E. Maternal obesity and developmental programming of neuropsychiatric disorders: An inflammatory hypothesis. Brain Neurosci Adv 2021; 5:23982128211003484. [PMID: 33889757 PMCID: PMC8040564 DOI: 10.1177/23982128211003484] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Maternal obesity is associated with the development of a variety of neuropsychiatric disorders; however, the mechanisms behind this association are not fully understood. Comparison between maternal immune activation and maternal obesity reveals similarities in associated impairments and maternal cytokine profile. Here, we present a summary of recent evidence describing how inflammatory processes contribute towards the development of neuropsychiatric disorders in the offspring of obese mothers. This includes discussion on how maternal cytokine levels, fatty acids and placental inflammation may interact with foetal neurodevelopment through changes to microglial behaviour and epigenetic modification. We also propose an exosome-mediated mechanism for the disruption of brain development under maternal obesity and discuss potential intervention strategies.
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Affiliation(s)
- Jonathan Davis
- Hodge Centre for Neuropsychiatric Immunology, Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Erik Mire
- Hodge Centre for Neuropsychiatric Immunology, Neuroscience and Mental Health Research Institute, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
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16
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Yuliana ND, Hunaefi D, Goto M, Ishikawa YT, Verpoorte R. Measuring the health effects of food by metabolomics. Crit Rev Food Sci Nutr 2021; 62:6359-6373. [PMID: 33749380 DOI: 10.1080/10408398.2021.1901256] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Metabolomics of human biological fluids or tissues is used to discover markers for diseases by comparing the metabolome of the patients against healthy individuals. Ultimately, these markers can be used in drug discovery to determine how medications normalize (at least in part) the human metabolome at specific disease stages to homeostatic. Likewise, the health effects of food can be studied. Even metabolomics of the food can be combined with metabolomics of the treated patients to correlate compounds from food with measurable health effects from clinical studies. Various chemometric analyses of these metabolomics data are used to identify markers for diseases and to obtain evidence for health effects. This review discusses recent researches (published from 2013 to 2021) on whether specific dietary intervention to humans suffering from metabolic disorders may improve their pathological status. The scope is limited to those associated with major lifestyle diseases such as diabetes, obesity, and cardiovascular diseases, for which food is thought may have detrimental as well as beneficial effects on human health. It includes metabolites characterization of different biological samples such as the human serum/plasma, urine, saliva, feces, or ileal fluid. Whether the study results supported the claimed health benefits and whether the research was conducted with appropriate study design, was criticized.
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Affiliation(s)
- Nancy Dewi Yuliana
- Department of Food Science and Technology, IPB University, IPB Darmaga Campus, Bogor, Indonesia.,Halal Science Center IPB University, IPB Baranangsiang Campus, Bogor, Indonesia
| | - Dase Hunaefi
- Department of Food Science and Technology, IPB University, IPB Darmaga Campus, Bogor, Indonesia.,Halal Science Center IPB University, IPB Baranangsiang Campus, Bogor, Indonesia
| | - Masao Goto
- Functionality Evaluation Unit, Food Function Division, Food Research Institute, NARO, Tsukuba-Ibaraki, Japan
| | - Yuko Takano Ishikawa
- Functionality Evaluation Unit, Food Function Division, Food Research Institute, NARO, Tsukuba-Ibaraki, Japan
| | - Robert Verpoorte
- Natural Products Laboratory, Institute of Biology, Leiden University, Leiden, RA, The Netherlands
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17
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Wallace MK, Shivappa N, Wirth MD, Hébert JR, Huston-Gordesky L, Alvarado F, Mouzon SHD, Catalano PM. Longitudinal Assessment of Relationships Between Health Behaviors and IL-6 in Overweight and Obese Pregnancy. Biol Res Nurs 2021; 23:481-487. [PMID: 33511855 DOI: 10.1177/1099800420985615] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inflammation is a common factor in adverse pregnancy outcomes (APOs). Behavioral factors influence inflammatory markers and APOs but rarely have been investigated simultaneously in pregnancy. Our purpose was to determine how diet, physical activity, and obesity are associated with interleukin (IL)-6 in early and late pregnancy. METHODS We conducted a secondary analysis of 49 overweight/obese pregnant women. Health behavior data, including diet quality using the Dietary Inflammatory Index (DII®); physical activity (Leisure Time Physical Activity scale); body mass index (BMI); and plasma IL-6 concentrations were collected at 13-16 weeks (early pregnancy) and 34-36 weeks (late pregnancy) gestation. Multiple linear regression analyses were used to determine the amount of variance explained in early and late pregnancy IL-6 concentrations by early and late pregnancy diet, physical activity, and BMI. RESULTS Early diet and early BMI were the strongest predictors of early IL-6 concentrations (R2 = 0.43; p < .001) and late IL-6 concentrations (R2 = 0.30; p < .001). Late BMI predicted late IL-6 (R2 = .11; p = .02). Change in diet over pregnancy predicted late IL-6 (R2 = 0.17; p = .03). CONCLUSION These findings suggest that maternal diet and BMI in early pregnancy, which likely reflects prepregnancy status, may have a greater impact on inflammatory processes than factors later in pregnancy. Future work should assess if behavioral factors before pregnancy produce similar relationships to those reported here, which may clarify the timing and type of lifestyle interventions to effectively reduce APOs.
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Affiliation(s)
- McKenzie K Wallace
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics, 49112Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Connection Health Innovations, LLC, Columbia, SC, USA
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, 49112Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Connection Health Innovations, LLC, Columbia, SC, USA
- College of Nursing, 49112University of South Carolina, Columbia, SC, USA
| | - James R Hébert
- Department of Epidemiology and Biostatistics, 49112Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Connection Health Innovations, LLC, Columbia, SC, USA
| | | | - Fernanda Alvarado
- Mother Infant Research Institute, 1867Tufts Medical Center, Boston, MA, USA
| | | | - Patrick M Catalano
- 2559MetroHealth Medical Center, Cleveland, OH, USA
- 12304School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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18
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Beneventi F, Locatelli E, De Amici M, Cavagnoli C, Bellingeri C, De Maggio I, Ruspini B, Spinillo A. Maternal and fetal Leptin and interleukin 33 concentrations in pregnancy complicated by obesity and preeclampsia. J Matern Fetal Neonatal Med 2020; 33:3942-3948. [PMID: 30856361 DOI: 10.1080/14767058.2019.1593359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: To evaluate maternal and fetal Leptin and IL33 concentrations in pregnancy complicated by obesity and preeclampsia.Study design: A case-control study including 35 subjects with obesity (18 normotensive and 17 preeclamptic) and 47 normal weight controls (42 normotensive and 5 preeclamptic).Main outcome measures: Leptin and IL33 concentrations in maternal serum during pregnancy and in cord blood; uterine artery and umbilical artery Doppler velocimetry.Results: Subjects with obesity who developed preeclampsia had higher first trimester maternal (41.5, interquartile range (IQR) = 15.7-65.1 ng/ml) Leptin concentrations compared to either normal weight with (25, IQR = 20.4-25.8 ng/ml) and without hypertension (14.26, IQR = 8.2-22.8) (p < .05) or normotensive subjects with obesity (30.3, IQR = 10.4-38.4) (p < .05). Subjects with obesity who developed preeclampsia (2.4, IQR = 1.7-3.2 pg/ml) or not (1.4, IQR = 0.8-2 pg/ml) had lower first trimester maternal IL33 levels when compared to controls without hypertension (4.8, IQR = 2.9-5.9 pg/ml) (p < .001). Cord blood Leptin and IL33 concentrations were significantly correlated to third trimester maternal concentrations (Spearman rho = 0.51, p < .001 and Spearman rho = 0.68, p < .001, respectively). Uterine artery pulsatility index (PI) were significantly and directly correlated with maternal Leptin levels (p < .002) and inversely and statistically correlated with maternal IL33 concentrations (p < .001).Conclusions: Compared to lean controls, pregnant subjects with obesity had higher serum Leptin and lower IL33 concentrations at first trimester and during pregnancy. This difference persisted also for those who later developed preeclampsia. The relationship between maternal serum levels of Leptin and IL33 with uterine artery Doppler pulsatility index strongly suggests a role of these two markers in early placentation.
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Affiliation(s)
- Fausta Beneventi
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Elena Locatelli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Mara De Amici
- Department of Pediatrics, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Chiara Cavagnoli
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Camilla Bellingeri
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Irene De Maggio
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Beatrice Ruspini
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
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19
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Janbakhishov T, Çağlayan E, Acet F, Altunyurt S, Özer E. Effect of vascular endothelial growth factor on fetal vessels among obese pregnant women. Int J Gynaecol Obstet 2020; 151:231-236. [PMID: 32790905 DOI: 10.1002/ijgo.13346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/11/2020] [Accepted: 08/11/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the role of vascular endothelial growth factor (VEGF) in placental hypoperfusion in obesity. METHODS The prospective study enrolled women with a first-trimester singleton pregnancy in Izmir, Turkey, between January and April 2011. Participants were divided into three groups: obese (body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] >30) with cesarean delivery; normal weight (BMI <30) with vaginal delivery (NVD); and healthy controls (BMI <30) with cesarean delivery. Before delivery, serum C-reactive protein (CRP), and uterine and fetal Doppler measurements were taken. VEGF was evaluated immunohistochemically from the umbilical cord. RESULTS Overall, 109 women completed the study: obesity group (n=13, 11.9%), NVD group (n=50, 45.9%), and control group (n=46, 42.2%). Serum CRP was higher in the obesity group than in the control or NVD groups (P=0.009). VEGF score was highest in the NVD group (9.39 ± 3.11), and lowest in the obesity group (4.58 ± 2.78) (P<0.001). VEGF score decreased by 0.81 for each increase in BMI of 1 (P=0.002). CONCLUSIONS Maternal obesity was related to decreased VEGF expression. Although not supported by Doppler findings, decreased VEGF expression owing to maternal obesity might trigger endothelial dysfunction and inflammation.
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Affiliation(s)
- Turab Janbakhishov
- Department of Obstetrics & Gynecology, Azerbaijan Medical School of Medicine, Educational Surgical Hospital, Baku, Azerbaijan
| | - Erkan Çağlayan
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ferruh Acet
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Sabahattin Altunyurt
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Erdener Özer
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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20
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Salarzadeh Jenatabadi H, Bt Wan Mohamed Radzi CWJ, Samsudin N. Associations of Body Mass Index with Demographics, Lifestyle, Food Intake, and Mental Health among Postpartum Women: A Structural Equation Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5201. [PMID: 32708480 PMCID: PMC7400682 DOI: 10.3390/ijerph17145201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022]
Abstract
As postpartum obesity is becoming a global public health challenge, there is a need to apply postpartum obesity modeling to determine the indicators of postpartum obesity using an appropriate statistical technique. This research comprised two phases, namely: (i) development of a previously created postpartum obesity modeling; (ii) construction of a statistical comparison model and introduction of a better estimator for the research framework. The research model displayed the associations and interactions between the variables that were analyzed using the Structural Equation Modeling (SEM) method to determine the body mass index (BMI) levels related to postpartum obesity. The most significant correlations obtained were between BMI and other substantial variables in the SEM analysis. The research framework included two categories of data related to postpartum women: living in urban and rural areas in Iran. The SEM output with the Bayesian estimator was 81.1%, with variations in the postpartum women's BMI, which is related to their demographics, lifestyle, food intake, and mental health. Meanwhile, the variation based on SEM with partial least squares estimator was equal to 70.2%, and SEM with a maximum likelihood estimator was equal to 76.8%. On the other hand, the output of the root mean square error (RMSE), mean absolute error (MSE) and mean absolute percentage error (MPE) for the Bayesian estimator is lower than the maximum likelihood and partial least square estimators. Thus, the predicted values of the SEM with Bayesian estimator are closer to the observed value compared to maximum likelihood and partial least square. In conclusion, the higher values of R-square and lower values of MPE, RMSE, and MSE will produce better goodness of fit for SEM with Bayesian estimators.
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Affiliation(s)
- Hashem Salarzadeh Jenatabadi
- Department of Science and Technology Studies, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia; (C.W.J.B.W.M.R.); (N.S.)
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21
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Majali-Martinez A, Hoch D, Tam-Amersdorfer C, Pollheimer J, Glasner A, Ghaffari-Tabrizi-Wizsy N, Beristain AG, Hiden U, Dieber-Rotheneder M, Desoye G. Matrix metalloproteinase 15 plays a pivotal role in human first trimester cytotrophoblast invasion and is not altered by maternal obesity. FASEB J 2020; 34:10720-10730. [PMID: 32614494 PMCID: PMC7496590 DOI: 10.1096/fj.202000773r] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 01/13/2023]
Abstract
Adequate anchoring of the placenta in the uterus through invasion of first trimester cytotrophoblasts (CTB) is required for a successful pregnancy. This process is mediated by matrix metalloproteinases (MMPs) and regulated by the maternal environment. Obesity is known to alter the intrauterine milieu and has been related to impaired invasion. We hypothesized that placental MMP15, a novel membrane‐type MMP, is involved in CTB invasion and regulated by maternal obesity in early pregnancy. Thus, in this study MMP15 was immunolocalized to invasive extravillous and interstitial CTB. MMP15 silencing in chorionic villous explants using two different siRNAs reduced trophoblast outgrowth length (−35%, P ≤ .001 and −26%, P < .05) and area (−43%, P ≤ .001 and −36%, P ≤ .01) without altering trophoblast proliferation or apoptosis. Short‐term treatment of primary first trimester trophoblasts with IL‐6 (10 ng/mL), interleukin 10 (IL‐10) (50 ng/mL), and tumor necrosis factor α (TNF‐α) (10 ng/mL) did not affect MMP15 protein levels. Likewise, MMP15 mRNA and protein levels were unaltered between human first trimester placentas from control pregnancies vs those complicated with maternal obesity. Overall, our results suggest that the role of MMP15 in placental development and function in early pregnancy is limited to CTB invasion without being affected by short‐ and long‐term inflammation.
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Affiliation(s)
| | - Denise Hoch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Carmen Tam-Amersdorfer
- Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Jürgen Pollheimer
- Department of Obstetrics and Fetal-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | - Alexander G Beristain
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ursula Hiden
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Hoch D, Bachbauer M, Pöchlauer C, Algaba-Chueca F, Tandl V, Novakovic B, Megia A, Gauster M, Saffery R, Glasner A, Desoye G, Majali-Martinez A. Maternal Obesity Alters Placental Cell Cycle Regulators in the First Trimester of Human Pregnancy: New Insights for BRCA1. Int J Mol Sci 2020; 21:E468. [PMID: 31940810 PMCID: PMC7014057 DOI: 10.3390/ijms21020468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
In the first trimester of pregnancy, placental development involves a wide range of cellular processes. These include trophoblast proliferation, fusion, and differentiation, which are dependent on tight cell cycle control. The intrauterine environment affects placental development, which also includes the trophoblast cell cycle. In this work, we focus on maternal obesity to assess whether an altered intrauterine milieu modulates expression and protein levels of placental cell cycle regulators in early human pregnancy. For this purpose, we use first trimester placental tissue from lean and obese women (gestational week 5+0-11+6, n = 58). Using a PCR panel, a cell cycle protein array, and STRING database analysis, we identify a network of cell cycle regulators increased by maternal obesity in which breast cancer 1 (BRCA1) is a central player. Immunostaining localizes BRCA1 predominantly to the villous and the extravillous cytotrophoblast. Obesity-driven BRCA1 upregulation is not able to be explained by DNA methylation (EPIC array) or by short-term treatment of chorionic villous explants at 2.5% oxygen with tumor necrosis factor α (TNF-α) (50 mg/mL), leptin (100 mg/mL), interleukin 6 (IL-6) (100 mg/mL), or high glucose (25 nM). Oxygen tension rises during the first trimester, but this change in vitro has no effect on BRCA1 (2.5% and 6.5% O2). We conclude that maternal obesity affects placental cell cycle regulation and speculate this may alter placental development.
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Affiliation(s)
- Denise Hoch
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (D.H.); (M.B.); (C.P.); (V.T.); (A.M.-M.)
| | - Martina Bachbauer
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (D.H.); (M.B.); (C.P.); (V.T.); (A.M.-M.)
| | - Caroline Pöchlauer
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (D.H.); (M.B.); (C.P.); (V.T.); (A.M.-M.)
| | - Francisco Algaba-Chueca
- Department of Endocrinology and Nutrition Research Unit, University Hospital of Tarragona Joan XXIII-Institut d´Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain; (F.A.-C.); (A.M.)
| | - Veronika Tandl
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (D.H.); (M.B.); (C.P.); (V.T.); (A.M.-M.)
| | - Boris Novakovic
- Murdoch Children’s Research Institute, Royal Children’s Hospital, 3052 Melbourne, Australia; (B.N.); (R.S.)
| | - Ana Megia
- Department of Endocrinology and Nutrition Research Unit, University Hospital of Tarragona Joan XXIII-Institut d´Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain; (F.A.-C.); (A.M.)
| | - Martin Gauster
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre for Cell Signaling, Metabolism and Ageing, Medical University of Graz, 8036 Graz, Austria;
| | - Richard Saffery
- Murdoch Children’s Research Institute, Royal Children’s Hospital, 3052 Melbourne, Australia; (B.N.); (R.S.)
| | | | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (D.H.); (M.B.); (C.P.); (V.T.); (A.M.-M.)
| | - Alejandro Majali-Martinez
- Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (D.H.); (M.B.); (C.P.); (V.T.); (A.M.-M.)
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Cheng C, Wu X, Zhang X, Zhang X, Peng J. Obesity of Sows at Late Pregnancy Aggravates Metabolic Disorder of Perinatal Sows and Affects Performance and Intestinal Health of Piglets. Animals (Basel) 2019; 10:ani10010049. [PMID: 31881697 PMCID: PMC7023453 DOI: 10.3390/ani10010049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 01/14/2023] Open
Abstract
Simple Summary Our novel findings suggest that excessive backfat thickness of sows at days 109 of gestation exacerbates the metabolic disorder of perinatal sows, reduces the number and litter weight of piglets born alive, and adversely affects the intestinal health of sows and their offspring piglets. Moreover, the current study also provides an important theoretical reference for strengthening the control of body condition in sows during reproductive cycle. Abstract This study explored the effect of obesity of sows in late pregnancy on metabolic status of perinatal sows and performance, intestinal health, and immune system of offspring piglets. Sixty multiparous Landrance × Large White sows were selected in this study. Sows were divided into two groups according to backfat thickness (normal backfat thickness group, =17 mm; excessive backfat thickness group, ≥21 mm) at days 109 of gestation. The excessive backfat thickness of sows during late pregnancy decreased the total number and litter weight of piglets born alive. Compared with normal backfat thickness sows, the excessive backfat thickness sows had increased levels of plasma glucose, IL-6, and TNF-α and homeostasis model assessment insulin resistance values. The excessive backfat thickness also reduced total superoxide dismutase but increased thiobarbituric acid reactive substances in plasma of perinatal sows. Additionally, the fecal levels of TNF-α were increased but those of IL-10 were decreased in piglets from excessive backfat thickness sow. These findings indicate that the obesity of sows during late pregnancy aggravates the metabolic disorder of perinatal sows, reduces the number of piglets born alive, and adversely affects the intestinal health of sows and their offspring piglets.
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Affiliation(s)
- Chuanshang Cheng
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan 430070, China; (C.C.); (X.W.); (X.Z.)
- Key Laboratory of Animal Nutrition and Feed Science, Ministry of Agriculture and Rural Affairs, WENS Research Institute (Technology Center), Yunfu 527300, China
| | - Xiaoyu Wu
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan 430070, China; (C.C.); (X.W.); (X.Z.)
| | - Xiaofeng Zhang
- College of Life Sciences, Zhaoqing University, Zhaoqing 526061, China;
| | - Xiu Zhang
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan 430070, China; (C.C.); (X.W.); (X.Z.)
| | - Jian Peng
- Department of Animal Nutrition and Feed Science, College of Animal Science and Technology, Huazhong Agricultural University, Wuhan 430070, China; (C.C.); (X.W.); (X.Z.)
- The Cooperative Innovation Centre for Sustainable Pig Production, Wuhan 430070, China
- Correspondence:
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Brodowski L, Büter W, Kohls F, Hillemanns P, von Kaisenberg C, Dammann O. Maternal Overweight, Inflammation and Neurological Consequences for the Preterm Child: Results of the ELGAN Study. Geburtshilfe Frauenheilkd 2019; 79:1176-1182. [PMID: 31736506 PMCID: PMC6846733 DOI: 10.1055/a-0960-0939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/25/2019] [Accepted: 06/21/2019] [Indexed: 12/16/2022] Open
Abstract
Maternal overweight and obesity are prenatal risk factors for obstetrical complications, preterm birth, neonatal morbidity as well as cognitive and behavioural developmental disorders in children. Paediatric morbidity and mortality as well as child development disorders are significantly associated with maternal obesity. Particularly in the neurodevelopmental and psychiatric area, it is becoming increasingly clear that, in children of mothers with an increased body mass index (BMI), there is a high correlation with childhood cognitive disabilities, attention disorders, and diseases on the autistic spectrum. The ELGAN (Extremely Low Gestational Age Newborn) study is a multicentre study which has been supported since 2000 by the National Institutes of Health (NIH) and whose objective is to research predictors for neonatal brain damage and neurological-cognitive sequelae in premature infants. The areas of focus are the connection between maternal overweight and obesity and pregnancy complications, APGAR scores and systemic inflammatory markers. In this overview, our aim is to summarise the work in this area and discuss it critically on the basis of current literature. We will examine the hypothesis whether maternal overweight and obesity in terms of a chronic inflammatory state is associated with neonatal inflammation which in turn is associated with an unfavourable development prognosis.
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Affiliation(s)
- Lars Brodowski
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfgang Büter
- Kinderklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Fabian Kohls
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Peter Hillemanns
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Olaf Dammann
- Frauenklinik, Medizinische Hochschule Hannover, Hannover, Germany
- Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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25
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Sureshchandra S, Marshall NE, Messaoudi I. Impact of pregravid obesity on maternal and fetal immunity: Fertile grounds for reprogramming. J Leukoc Biol 2019; 106:1035-1050. [PMID: 31483523 DOI: 10.1002/jlb.3ri0619-181r] [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: 06/05/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022] Open
Abstract
Maternal pregravid obesity results in several adverse health outcomes during pregnancy, including increased risk of gestational diabetes, preeclampsia, placental abruption, and complications at delivery. Additionally, pregravid obesity and in utero exposure to high fat diet have been shown to have detrimental effects on fetal programming, predisposing the offspring to adverse cardiometabolic, endocrine, and neurodevelopmental outcomes. More recently, a deeper appreciation for the modulation of offspring immunity and infectious disease-related outcomes by maternal pregravid obesity has emerged. This review will describe currently available animal models for studying the impact of maternal pregravid obesity on fetal immunity and review the data from clinical and animal model studies. We also examine the burden of pregravid obesity on the maternal-fetal interface and the link between placental and systemic inflammation. Finally, we discuss future studies needed to identify key mechanistic underpinnings that link maternal inflammatory changes and fetal cellular reprogramming events.
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Affiliation(s)
- Suhas Sureshchandra
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Nicole E Marshall
- Maternal-Fetal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Ilhem Messaoudi
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
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26
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Nicklas JM, Rosner BA, Zera CA, Seely EW. Association Between Changes in Postpartum Weight and Waist Circumference and Changes in Cardiometabolic Risk Factors Among Women With Recent Gestational Diabetes. Prev Chronic Dis 2019; 16:E47. [PMID: 31002638 PMCID: PMC6513485 DOI: 10.5888/pcd16.180308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Women with gestational diabetes mellitus (GDM) have a 30% to 70% risk for developing type 2 diabetes and are at increased risk for cardiovascular disease. Little is known about how anthropometric changes in the first postpartum year modify cardiometabolic risk factors. METHODS We randomly assigned women in the Balance After Baby study to an intervention group consisting of participation in a web-based lifestyle program or to a control group in which no program was offered. We measured weight, height, waist circumference, blood pressure, lipids, insulin, adiponectin, interleukin-6, and high-sensitivity C-reactive protein, and we conducted 2-hour oral glucose tolerance tests at 6 weeks, 6 months, and 12 months postpartum. We evaluated whether women assigned to the intervention had improved cardiometabolic risk markers compared with the control group. We then conducted a post-hoc analysis, pooling the 2 groups to compare changes in weight and waist circumference with changes in cardiometabolic risk factors. RESULTS Women in the intervention group did not significantly improve cardiometabolic risk markers compared with women in the control group. We noted a large overlap of weight change and change in waist circumference between groups. In our post-hoc analysis pooling groups, changes in diabetes and cardiovascular risk factors were significantly correlated with changes in weight and waist circumference. The strongest associations were observed for fasting insulin, HOMA, and fasting glucose. CONCLUSION Anthropometric changes in weight and waist circumference in women with recent GDM may affect cardiometabolic risk factors, even in the first postpartum year. Our study demonstrates the importance of the postpartum year as an opportunity to decrease future risk for diabetes and cardiovascular disease in women with a history of GDM.
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Affiliation(s)
- Jacinda M Nicklas
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045.
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Chloe A Zera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital Boston, Massachusetts
| | - Ellen W Seely
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
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Stokkeland LMT, Giskeødegård GF, Stridsklev S, Ryan L, Steinkjer B, Tangerås LH, Vanky E, Iversen AC. Serum cytokine patterns in first half of pregnancy. Cytokine 2019; 119:188-196. [PMID: 30954016 DOI: 10.1016/j.cyto.2019.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Human pregnancy is a state of elevated maternal systemic inflammation, and pregnancy complications are often associated with a dysfunctional immune response. The network of cytokines reflects this complex immune activity, and broad serum cytokine profiling provides a new tool to understand the changes in immune status during pregnancy. OBJECTIVE This study aimed to determine how maternal serum cytokine patterns change during the first half of pregnancy. METHODS Maternal peripheral serum samples collected at a mean gestation of 10, 13, 18 and 24 weeks were included from a prospective clinical study of healthy women (n = 110) in first half of normal pregnancy. The serum samples were analysed for 27 different cytokines using multiplex magnetic bead-based immunoassays, and high sensitivity C-reactive protein (CRP) was analysed by ELISA. Serum cytokine and CRP patterns were explored with linear mixed effects models (LMM) and multilevel partial least squares discriminant analysis (PLS-DA). RESULTS Serum cytokine profiling provided partial overview of the maternal immune status and corresponding reference values for serum cytokine levels during the first half of pregnancy. Several cytokines decreased in concentration from first to second trimester. Cytokine pattern analysis revealed that chemokines provided the most sensitive measurement of variation with gestational age in normal pregnancies. The nine inflammatory cytokines showed the highest intra-group correlation during pregnancy, while CRP levels did not correlate with changes in the inflammatory cytokines. CONCLUSION Chemokines showed the greatest gestational variation and inflammatory cytokines showed a strong intra-group correlation during the first half of pregnancy.
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Affiliation(s)
- Live Marie T Stokkeland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway.
| | - Guro F Giskeødegård
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Solhild Stridsklev
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Liv Ryan
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Bjørg Steinkjer
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Line H Tangerås
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ann-Charlotte Iversen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
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Miller ES, Hoxha D, Pinheiro E, Grobman WA, Wisner KL. The association of serum C-reactive protein with the occurrence and course of postpartum depression. Arch Womens Ment Health 2019; 22:129-132. [PMID: 29654412 PMCID: PMC6186200 DOI: 10.1007/s00737-018-0841-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/22/2018] [Indexed: 01/05/2023]
Abstract
CRP has been positively correlated with depressive symptomatology but this has received less study in postpartum depression (PPD). In this secondary analysis of a trial of PPD treatment, depressive symptoms (Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms (SIGH-ADS29)) and serum CRP levels were assessed and associations between CRP and SIGH-ADS29 scores evaluated. The associations between baseline log CRP and depression response and remission were also assessed. Of the 35 women included, neither baseline log CRP nor exit log CRP was significantly associated with SIGH-ADS29 score. Baseline CRP was not associated with response or remission. In this sample of women with PPD, CRP was not associated with depressive symptoms nor response to treatment.
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Affiliation(s)
- Emily S. Miller
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | | | - Emily Pinheiro
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William A. Grobman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University, Chicago, IL, USA
| | - Katherine L. Wisner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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29
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Lobo TF, Torloni MR, Mattar R, Nakamura MU, Alexandre SM, Daher S. Adipokine levels in overweight women with early-onset gestational diabetes mellitus. J Endocrinol Invest 2019; 42:149-156. [PMID: 29696612 DOI: 10.1007/s40618-018-0894-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/19/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The study of adipokines in overweight women with early-onset (diagnosed before 20 weeks) gestational diabetes mellitus (GDM) could help to understand the ethiopathological mechanisms of this disorder. Our aim was to assess adipokine levels in overweight pregnant women with early-onset GDM compared to patients with standard-onset (diagnosed at 24-28 weeks) GDM and to glucose-tolerant women at the same gestational ages. METHODS This nested case-control study included 133 overweight pregnant women: 33 with early-onset (diagnosed < 20 weeks) GDM; 40 with standard-onset (diagnosed ≥ 24 weeks) GDM and 60 glucose-tolerant (normal oral glucose tolerance tests < 20 and ≥ 24 weeks). Adiponectin, leptin, resistin, visfatin and ghrelin serum levels were measured by ELISA. RESULTS Adiponectin serum levels were significantly lower in early-onset GDM women than in standard-onset GDM patients or controls matched for gestational age. Leptin serum levels were significantly higher in women with early-onset GDM than in controls. Women with early-onset GDM had lower adiponectin/leptin ratio than those with standard-onset GDM. There were no significant differences in resistin, ghrelin and visfatin serum levels among the participants. CONCLUSIONS Our results suggest that, compared to overweight glucose-tolerant women and patients with standard-onset GDM, overweight women with early-onset GDM have unbalanced adipokine levels, suggesting that they have a more inflammatory profile.
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Affiliation(s)
- T F Lobo
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M R Torloni
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - R Mattar
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M U Nakamura
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S M Alexandre
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Daher
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil.
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Mhatre M, Adeli S, Norwitz E, Craigo S, Phillippe M, Edlow A. The Effect of Maternal Obesity on Placental Cell-Free DNA Release in a Mouse Model. Reprod Sci 2018; 26:1218-1224. [PMID: 30453834 DOI: 10.1177/1933719118811647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The fetal fraction of cell-free DNA (cfDNA) in maternal plasma is decreased in obese women. The underlying mechanism is not well understood. The amount of cfDNA released from the placenta has not been directly examined in maternal obesity. OBJECTIVE We sought to quantify release of cfDNA from the placenta and fetal membranes in maternal diet-induced obesity using explant cultures in an established mouse model. STUDY DESIGN C57BL6/J females were fed either 60% high-fat diet or 10% fat-matched control diet for 14 weeks prepregnancy and throughout gestation. Placentas and fetal membranes were collected on e18 and randomly allocated to time 0-, 1-, or 6-hour culture times. The CfDNA was isolated from culture media, quantified, and normalized to tissue weight. RESULTS Placentas from obese dams released significantly less cfDNA compared to those of lean dams at time 0 (45.8 ± 4.3 ng/mg vs 65.6 ± 7.9 ng/mg, P = .02). Absolute cfDNA levels increased with longer placental culture, with no significant differences between obese and lean dams at 1 and 6 hours. Membranes released significantly less cfDNA than did placentas at every time point. CONCLUSIONS Maternal obesity is associated with decreased release of cfDNA from the placenta compared to lean controls immediately after tissue harvest. This may provide an alternative explanation for the lower fetal fraction of cfDNA noted in maternal obesity.
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Affiliation(s)
- Mohak Mhatre
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA
| | - Sharareh Adeli
- 2 Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Errol Norwitz
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA.,3 Tufts University School of Medicine, Boston, MA, USA
| | - Sabrina Craigo
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA.,3 Tufts University School of Medicine, Boston, MA, USA
| | - Mark Phillippe
- 2 Vincent Center for Reproductive Biology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.,4 Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. Edlow is now with Vincent Center for Reproductive Biology and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA, and Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Andrea Edlow
- 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA.,3 Tufts University School of Medicine, Boston, MA, USA
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Yockey LJ, Iwasaki A. Interferons and Proinflammatory Cytokines in Pregnancy and Fetal Development. Immunity 2018; 49:397-412. [PMID: 30231982 PMCID: PMC6152841 DOI: 10.1016/j.immuni.2018.07.017] [Citation(s) in RCA: 296] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/13/2018] [Accepted: 07/26/2018] [Indexed: 12/15/2022]
Abstract
Successful pregnancy requires carefully-coordinated communications between the mother and fetus. Immune cells and cytokine signaling pathways participate as mediators of these communications to promote healthy pregnancy. At the same time, certain infections or inflammatory conditions in pregnant mothers cause severe disease and have detrimental impacts on the developing fetus. In this review, we examine evidence for the role of maternal and fetal immune responses affecting pregnancy and fetal development, both under homeostasis and following infection. We discuss immune responses that are necessary to promote healthy pregnancy and those that lead to congenital disorders and pregnancy complications, with a particular emphasis on the role of interferons and cytokines. Understanding the contributions of the immune system in pregnancy and fetal development provides important insights into the pathogenesis underlying maternal and fetal diseases and sheds insights on possible targets for therapy.
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Affiliation(s)
- Laura J Yockey
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
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32
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Zacarías MF, Collado MC, Gómez-Gallego C, Flinck H, Aittoniemi J, Isolauri E, Salminen S. Pregestational overweight and obesity are associated with differences in gut microbiota composition and systemic inflammation in the third trimester. PLoS One 2018; 13:e0200305. [PMID: 30005082 PMCID: PMC6044541 DOI: 10.1371/journal.pone.0200305] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022] Open
Abstract
The obesity epidemic is a global challenge, and the velocity of propagation is high in the population at reproductive age. Overweight and obesity during pregnancy have been associated with high birth weight and an increased risk of childhood obesity, reinforcing the risk of other non-communicable diseases. Obesity involves chronic low-grade systemic inflammation. New biomarkers for early detection of obesity risk are urgently required. The aim of this study was to identify the connection between pregestational BMI (pre-BMI) status and inflammatory biomarkers during the third trimester of pregnancy and their association with intestinal microbiota composition. Fifty-four pregnant women were classified according to pre-pregnancy BMI as normoweight, overweight, or obese. Weight gain, inflammatory biomarkers (hs_CRP, haptoglobin, and suPAR), and microbiota composition were assessed during the third trimester. A significant lower weight gain for obese mothers and a positive correlation between pre-BMI and inflammatory biomarkers were detected (Spearman’s correlation). Haptoglobin levels were significantly higher in overweight and obese mothers. Higher Firmicutes levels and a higher ratio Firmicutes/Bacteroidetes were observed in the overweight and obese subjects. High hs_CRP and haptoglobin levels were also correlated with decreased microbiota diversity (Shannon index), whereas haptoglobin and hs_CRP values were correlated with several microbiota components, such as Ruminococcus gnavus and Faecalibacterium, and with specific phyla in the normoweight and overweight mothers; no significant associations with microbiota were found for suPAR. In conclusion, haptoglobin and hs_CRP reflected pregestational BMI status and related microbiota components, but haptoglobin was a better biomarker for microbiota associated with overweight. suPAR was associated with low grade inflammation dependent on pre-pregnancy BMI, but it was not related to deviated microbiota profiles.
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Affiliation(s)
| | - María Carmen Collado
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
- Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), Department of Biotechnology, Valencia, Spain
| | - Carlos Gómez-Gallego
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Heini Flinck
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab Laboratories, Tampere, Finland
| | - Erika Isolauri
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Sciences, Faculty of Medicine, University of Turku, Turku, Finland
| | - Seppo Salminen
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
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33
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Magnus MC, Olsen SF, Granstrom C, Lund-Blix NA, Svensson J, Johannesen J, Fraser A, Skrivarhaug T, Joner G, Njølstad PR, Størdal K, Stene LC. Paternal and maternal obesity but not gestational weight gain is associated with type 1 diabetes. Int J Epidemiol 2018; 47:417-426. [PMID: 29415279 PMCID: PMC5913633 DOI: 10.1093/ije/dyx266] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/23/2017] [Accepted: 12/06/2017] [Indexed: 01/10/2023] Open
Abstract
Background Our objective was to examine the associations of parental body mass index (BMI) and maternal gestational weight gain with childhood-onset type 1 diabetes. Comparing the associations of maternal and paternal BMI with type 1 diabetes in the offspring will provide further insight into the role of unmeasured confounding by characteristics linked to BMI in both parents. Methods We studied 132 331 children participating in the Norwegian Mother and Child Cohort Study (MoBa) and the Danish National Birth Cohort (DNBC) who were born between February 1998 and July 2009. Exposures of interest included parental BMI and maternal gestational weight gain obtained by maternal report. We used Cox-proportional hazards regression to examine the risk of type 1 diabetes (n=499 cases), which was ascertained by national childhood diabetes registers. Results The incidence of type 1 diabetes was 32.7 per 100 000 person-years in MoBa and 28.5 per 100 000 person-years in DNBC. Both maternal pre-pregnancy obesity, adjusted hazard ratio (HR) 1.41 [95% confidence interval (CI): 1.06, 1.89] and paternal obesity, adjusted HR 1.51 (95% CI: 1.11, 2.04), were associated with childhood-onset type 1 diabetes. The associations were similar after mutual adjustment. In contrast, maternal total gestational weight gain was not associated with childhood-onset type 1 diabetes, adjusted HR 1.00 (95% CI: 0.99, 1.02) per kilogram increase. Conclusions Our study suggests that the association between maternal obesity and childhood-onset type 1 diabetes is not likely explained by intrauterine mechanisms, but possibly rather by unknown environmental factors influencing BMI in the family.
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Affiliation(s)
- Maria C Magnus
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Sjurdur F Olsen
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Charlotta Granstrom
- Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Nicolai A Lund-Blix
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Jannet Svensson
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Jesper Johannesen
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre at the University Hospitals Bristol, NHS Foundation Trust and the University of Bristol, Bristol, UK
| | | | - Geir Joner
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål R Njølstad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ketil Størdal
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pediatrics, Ostfold Hospital Trust, Fredrikstad, Norway
| | - Lars C Stene
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Gomez-Arango LF, Barrett HL, Wilkinson SA, Callaway LK, McIntyre HD, Morrison M, Dekker Nitert M. Low dietary fiber intake increases Collinsella abundance in the gut microbiota of overweight and obese pregnant women. Gut Microbes 2018; 9:189-201. [PMID: 29144833 PMCID: PMC6219589 DOI: 10.1080/19490976.2017.1406584] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED The gut microbiota contributes to the regulation of glucose metabolism in pregnancy. Abundance of the genus Collinsella is positively correlated with circulating insulin; however, it is unclear what determines Collinsella abundance. This study aims to validate the correlation between Collinsella and insulin and to elucidate if macronutrient intake alters Collinsella abundance and gut microbiota composition. Gut microbiota profiles were assessed by 16S rRNA sequencing in 57 overweight and 73 obese pregnant women from the SPRING (Study of PRobiotics IN Gestational diabetes) trial at 16 weeks gestation and correlated with metabolic hormone levels and macronutrient intake. Gut microbiota composition in the top and bottom 10% of dietary fiber intake was evaluated through network analysis. Collinsella abundance correlated positively with circulating insulin (rho = 0.30, p = 0.0006), independent of maternal BMI, but negatively with dietary fiber intake (rho = -0.20, p = 0.025) in this cohort. Low dietary fiber intake was associated with a gut microbiota favoring lactate fermentation while high fiber intake promotes short-chain fatty acid-producing bacteria. Low dietary fiber may enable overgrowth of Collinsella and alter the overall fermentation pattern in gut microbiota. This suggests that dietary choices during pregnancy can modify the nutritional ecology of the gut microbiota, with potential deleterious effects on the metabolic and inflammatory health of the host. TRIAL REGISTRATION ANZCTR 12611001208998, registered 23/11/2011.
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Affiliation(s)
- Luisa F. Gomez-Arango
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Helen L. Barrett
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia,Faculty of Medicine, The University of Queensland, Brisbane, Australia,Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Shelley A. Wilkinson
- Mater Health Services, Nutrition and Dietetics, Mater Hospital, Brisbane, Australia,Mater Research Institute –University of Queensland, Brisbane, Australia
| | - Leonie K. Callaway
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia,Faculty of Medicine, The University of Queensland, Brisbane, Australia,Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - H. David McIntyre
- Faculty of Medicine, The University of Queensland, Brisbane, Australia,Mater Research Institute –University of Queensland, Brisbane, Australia
| | - Mark Morrison
- Faculty of Medicine, The University of Queensland, Brisbane, Australia,Diamantina Institute, The University of Queensland, Brisbane, Australia,School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Marloes Dekker Nitert
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia,Diamantina Institute, The University of Queensland, Brisbane, Australia,CONTACT: Marloes Dekker Nitert School of Chemistry and Molecular Biosciences, Building 76–452. The University of Queensland Brisbane, QLD 4072, Australia
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35
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Durnwald CP, Downes K, Leite R, Elovitz M, Parry S. Predicting persistent impaired glucose tolerance in patients with gestational diabetes: The role of high sensitivity CRP and adiponectin. Diabetes Metab Res Rev 2018; 34. [PMID: 29078256 DOI: 10.1002/dmrr.2958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND To evaluate whether maternal serum adiponectin and high-sensitivity C-reactive protein (hsCRP) levels at the time of gestational diabetes mellitus (GDM) diagnosis are associated with persistent glucose intolerance in GDM women at 6 to 12 weeks postpartum. METHODS This is a secondary analysis of prospective randomized trial of GDM women enrolled in a behaviour education programme. Women with a GDM diagnosis ≥20 weeks were included. At the time of randomization, serum adiponectin and hsCRP levels were drawn. After delivery, women underwent a 2-hour 75-g oral glucose tolerance test at 6 to 12 weeks postpartum. Persistent impaired glucose tolerance (P-IGT) was defined as impaired fasting glucose, impaired glucose tolerance, or a diagnosis of type 2 diabetes mellitus. Regression models and receiver operator curves were used to evaluate the association between midpregnancy adiponectin and hsCRP and persistent impaired glucose tolerance. RESULTS Of 100 women in the trial, 63 completed postpartum glucose testing. Twenty (31.7%) of the women had P-IGT. Median hsCRP levels were higher at randomization (22-34 wk) in women with persistent impaired glucose tolerance compared with women with normal glucose tolerance (5.1 vs 3.8, P = .01). After adjustment for the original study intervention, the association between hsCRP and P-IGT persisted (odds ratio, 3.45; 95% confidence interval, 1.34-8.92; P = .01) and had good diagnostic performance with an area under the curve of 0.73. There was no difference in median adiponectin levels between groups (44.8 vs 52.0, P = .57) or in odds of P-IGT (odds ratio, 0.81; 95% confidence interval, 0.33-1.99; P = .65), and area under the curve = 0.54. CONCLUSIONS Midpregnancy high sensitivity CRP is a potential predictor of persistent impaired glucose tolerance diagnosed on the postpartum 2-hour 75-g oral glucose tolerance test in GDM women in the immediate postpartum period. Further investigation is needed in a larger population of women prior to using specific cut-offs for diagnostic purposes. High-sensitivity C-reactive protein levels in the immediate postpartum period should be seen as an adjunct, not a replacement, for the standard long-term screening of women with a history of a GDM pregnancy.
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Affiliation(s)
- Celeste P Durnwald
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katheryne Downes
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rita Leite
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michal Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel Parry
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Lobo TF, Borges CDM, Mattar R, Gomes CP, de Angelo AGS, Pendeloski KPT, Daher S. Impaired Treg and NK cells profile in overweight women with gestational diabetes mellitus. Am J Reprod Immunol 2018; 79. [PMID: 29315988 DOI: 10.1111/aji.12810] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/07/2017] [Indexed: 12/16/2022] Open
Abstract
PROBLEM Maternal obesity is frequently associated with gestational diabetes mellitus (GDM), and immunological mechanisms seem to be involved in the physiopathology of these conditions. The aim of this study was to characterize the profile of immune cells in peripheral blood of overweight women with GDM. METHOD OF STUDY This case-control study included 27 glucose-tolerant (controls) and 31 GDM overweight pregnant women. Flow cytometry was used to assess the number of regulatory T cells (Treg) and natural killer (NK) cells in the peripheral blood. In addition, the expression of IL-10, TGF-B, and TNF-A in Treg and expression of IFN-G, TNF-A, granzyme, and perforin in NK cells were analyzed. RESULTS GDM patients had significantly lower frequency of TCD4+ CD25bright and TCD4+ CD25+ FOXP3high cells, higher production of TNF-A by Treg cells and higher percentage of NKCD16+ 56dim cells than the controls. CONCLUSION The association between obesity and GDM is a condition where it is observed impaired Treg and NK cells profile, findings that seem to be related with the development of IR and inflammation.
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Affiliation(s)
| | | | - Rosiane Mattar
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Caio Perez Gomes
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Silvia Daher
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
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Solis-Paredes M, Estrada-Gutierrez G, Perichart-Perera O, Montoya-Estrada A, Guzmán-Huerta M, Borboa-Olivares H, Bravo-Flores E, Cardona-Pérez A, Zaga-Clavellina V, Garcia-Latorre E, Gonzalez-Perez G, Hernández-Pérez JA, Irles C. Key Clinical Factors Predicting Adipokine and Oxidative Stress Marker Concentrations among Normal, Overweight and Obese Pregnant Women Using Artificial Neural Networks. Int J Mol Sci 2017; 19:ijms19010086. [PMID: 29283404 PMCID: PMC5796036 DOI: 10.3390/ijms19010086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Maternal obesity has been related to adverse neonatal outcomes and fetal programming. Oxidative stress and adipokines are potential biomarkers in such pregnancies; thus, the measurement of these molecules has been considered critical. Therefore, we developed artificial neural network (ANN) models based on maternal weight status and clinical data to predict reliable maternal blood concentrations of these biomarkers at the end of pregnancy. Adipokines (adiponectin, leptin, and resistin), and DNA, lipid and protein oxidative markers (8-oxo-2′-deoxyguanosine, malondialdehyde and carbonylated proteins, respectively) were assessed in blood of normal weight, overweight and obese women in the third trimester of pregnancy. A Back-propagation algorithm was used to train ANN models with four input variables (age, pre-gestational body mass index (p-BMI), weight status and gestational age). ANN models were able to accurately predict all biomarkers with regression coefficients greater than R2 = 0.945. P-BMI was the most significant variable for estimating adiponectin and carbonylated proteins concentrations (37%), while gestational age was the most relevant variable to predict resistin and malondialdehyde (34%). Age, gestational age and p-BMI had the same significance for leptin values. Finally, for 8-oxo-2′-deoxyguanosine prediction, the most significant variable was age (37%). These models become relevant to improve clinical and nutrition interventions in prenatal care.
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Affiliation(s)
- Mario Solis-Paredes
- Department of Human Genetics and Genomics, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico;
- Posgrado en Ciencias Químico-Biológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico;
| | - Guadalupe Estrada-Gutierrez
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (G.E.-G.); (M.G.-H.); (A.C.-P.)
| | - Otilia Perichart-Perera
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (O.P.-P.); (H.B.-O.)
| | - Araceli Montoya-Estrada
- Department of Inmunobiochemistry, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (A.M.-E.); (E.B.-F.); (V.Z.-C.)
| | - Mario Guzmán-Huerta
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (G.E.-G.); (M.G.-H.); (A.C.-P.)
| | - Héctor Borboa-Olivares
- Department of Nutrition and Bioprogramming, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (O.P.-P.); (H.B.-O.)
| | - Eyerahi Bravo-Flores
- Department of Inmunobiochemistry, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (A.M.-E.); (E.B.-F.); (V.Z.-C.)
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
| | - Arturo Cardona-Pérez
- Research Division, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (G.E.-G.); (M.G.-H.); (A.C.-P.)
| | - Veronica Zaga-Clavellina
- Department of Inmunobiochemistry, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico; (A.M.-E.); (E.B.-F.); (V.Z.-C.)
| | - Ethel Garcia-Latorre
- Posgrado en Ciencias Químico-Biológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico;
| | - Gabriela Gonzalez-Perez
- Department of Physiology and Cellular Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico;
| | - José Alfredo Hernández-Pérez
- Centro de Investigación en Ingeniería y Ciencias Aplicadas-Instituto de Investigación en Ciencias Básicas y Aplicadas (CIICAp-IICBA), Universidad Autónoma de Morelos, Cuernavaca 62209, Mexico;
| | - Claudine Irles
- Department of Physiology and Cellular Development, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City 11000, Mexico;
- Correspondence: or ; Tel.: +52-55-5520-9900
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Vistnes M, Tapia G, Mårild K, Midttun Ø, Ueland PM, Viken MK, Magnus P, Berg JP, Gillespie KM, Skrivarhaug T, Njølstad PR, Joner G, Størdal K, Stene LC. Plasma immunological markers in pregnancy and cord blood: A possible link between macrophage chemo-attractants and risk of childhood type 1 diabetes. Am J Reprod Immunol 2017; 79. [PMID: 29266506 DOI: 10.1111/aji.12802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/24/2017] [Indexed: 12/18/2022] Open
Abstract
PROBLEM Previous studies have suggested that immune perturbations during pregnancy can affect offspring type 1 diabetes (T1D) risk. We aimed to identify immunological markers that could predict offspring T1D or that were linked to T1D risk factors. METHOD OF STUDY We quantified selected circulating immunological markers in mid-pregnancy (interleukin [IL]-1β, IL-1ra, IL-2Rα, IL-2, -4, -5, -6, -10, -12p70, 13, -17A, GM-CSF, IFN-γ, CXCL10, CCL 2, CCL3, CCL4, TNF) and cord blood plasma (neopterin and kynurenine/tryptophan ratio) in a case-control study with 175 mother/child T1D cases (median age 5.8, range 0.7-13.0 years) and 552 controls. RESULTS Pre-pregnancy obesity was positively associated with CCL4, CXCL10, kynurenine/tryptophan ratio and neopterin (P < .01). The established T1D SNPs rs1159465 (near IL2RA) and rs75352297 (near CCR2 and CCR3) were positively associated with IL-2Rα and CCL4, respectively (P < .01). There was a borderline association of CCL4 and offspring T1D risk, independent of maternal obesity and genotype. When grouping the immunological markers, there was a borderline association (P = .05) with M1 phenotype and no association between M2-, Th1-, Th2- or Th17 phenotypes and offspring T1D risk. CONCLUSION Increased mid-pregnancy CCL4 levels showed borderline associations with increased offspring T1D risk, which may indicate a link between environmental factors in pregnancy and offspring T1D risk.
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Affiliation(s)
- Maria Vistnes
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - German Tapia
- Norwegian Institute of Public Health, Oslo, Norway
| | - Karl Mårild
- Norwegian Institute of Public Health, Oslo, Norway.,Barbara Davis Center, University of Colorado, Aurora, CO, USA
| | | | - Per M Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Marte K Viken
- Department of Immunology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jens P Berg
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kathleen M Gillespie
- Diabetes and Metabolism, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Torild Skrivarhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål R Njølstad
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Geir Joner
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Ketil Størdal
- Norwegian Institute of Public Health, Oslo, Norway.,Pediatric Department, Østfold Hospital Trust, Grålum, Norway
| | - Lars C Stene
- Norwegian Institute of Public Health, Oslo, Norway
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39
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Graham C, Chooniedass R, Stefura WP, Becker AB, Sears MR, Turvey SE, Mandhane PJ, Subbarao P, HayGlass KT. In vivo immune signatures of healthy human pregnancy: Inherently inflammatory or anti-inflammatory? PLoS One 2017; 12:e0177813. [PMID: 28636613 PMCID: PMC5479559 DOI: 10.1371/journal.pone.0177813] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 05/03/2017] [Indexed: 12/20/2022] Open
Abstract
Changes in maternal innate immunity during healthy human pregnancy are not well understood. Whether basal immune status in vivo is largely unaffected by pregnancy, is constitutively biased towards an inflammatory phenotype (transiently enhancing host defense) or exhibits anti-inflammatory bias (reducing potential responsiveness to the fetus) is unclear. Here, in a longitudinal study of healthy women who gave birth to healthy infants following uncomplicated pregnancies within the Canadian Healthy Infant Longitudinal Development (CHILD) cohort, we test the hypothesis that a progressively altered bias in resting innate immune status develops. Women were examined during pregnancy and again, one and/or three years postpartum. Most pro-inflammatory cytokine expression, including CCL2, CXCL10, IL-18 and TNFα, was reduced in vivo during pregnancy (20-57%, p<0.0001). Anti-inflammatory biomarkers (sTNF-RI, sTNF-RII, and IL-1Ra) were elevated by ~50-100% (p<0.0001). Systemic IL-10 levels were unaltered during vs. post-pregnancy. Kinetic studies demonstrate that while decreased pro-inflammatory biomarker expression (CCL2, CXCL10, IL-18, and TNFα) was constant, anti-inflammatory expression increased progressively with increasing gestational age (p<0.0001). We conclude that healthy resting maternal immune status is characterized by an increasingly pronounced bias towards a systemic anti-inflammatory innate phenotype during the last two trimesters of pregnancy. This is resolved by one year postpartum in the absence of repeat pregnancy. The findings provide enhanced understanding of immunological changes that occur in vivo during healthy human pregnancy.
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Affiliation(s)
- Caroline Graham
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rishma Chooniedass
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William P. Stefura
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan B. Becker
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Malcolm R. Sears
- Department of Medicine, de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, Child & Family Research Institute and BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - CHILD Study Investigators
- CHILD (Canadian Healthy Infant Longitudinal Development Study) Investigators, McMaster University, Hamilton, Canada
| | - Kent T. HayGlass
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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