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Lavezzi AM, Mehboob R, Piscioli F, Pusiol T. New Step in Understanding the Pathogenetic Mechanism of Sudden Infant Death Syndrome: Involvement of the Pontine Reticular Gigantocellular Nucleus. Int J Mol Sci 2024; 25:6920. [PMID: 39000030 PMCID: PMC11241803 DOI: 10.3390/ijms25136920] [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: 05/19/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
This study aimed to investigate, for the first time, the potential role of the gigantocellular nucleus, a component of the reticular formation, in the pathogenetic mechanism of Sudden Infant Death Syndrome (SIDS), an event frequently ascribed to failure to arouse from sleep. This research was motivated by previous experimental studies demonstrating the gigantocellular nucleus involvement in regulating the sleep-wake cycle. We analyzed the brains of 48 infants who died suddenly within the first 7 months of life, including 28 SIDS cases and 20 controls. All brains underwent a thorough histological and immunohistochemical examination, focusing specifically on the gigantocellular nucleus. This examination aimed to characterize its developmental cytoarchitecture and tyrosine hydroxylase expression, with particular attention to potential associations with SIDS risk factors. In 68% of SIDS cases, but never in controls, we observed hypoplasia of the pontine portion of the gigantocellular nucleus. Alterations in the catecholaminergic system were present in 61% of SIDS cases but only in 10% of controls. A strong correlation was observed between these findings and maternal smoking in SIDS cases when compared with controls. In conclusion we believe that this study sheds new light on the pathogenetic processes underlying SIDS, particularly in cases associated with maternal smoking during pregnancy.
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Affiliation(s)
- Anna Maria Lavezzi
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milano, Italy
| | - Riffat Mehboob
- Lahore Medical Research Center, Lahore 54000, Pakistan
- National Heart Lung and Blood Institute, National Institute of Health, Bethesda, MD 20892, USA
| | - Francesco Piscioli
- Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, 38068 Rovereto, Italy
| | - Teresa Pusiol
- Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, 38068 Rovereto, Italy
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Michelson AD, Frelinger Iii AL, Haynes RL, Kinney HC, Gremmel T. Platelet Pathophysiology: Unexpected New Research Directions. Semin Thromb Hemost 2024. [PMID: 38889800 DOI: 10.1055/s-0044-1787663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Alan D Michelson
- Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Andrew L Frelinger Iii
- Division of Hematology/Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Robin L Haynes
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hannah C Kinney
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas Gremmel
- Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
- Institute of Cardiovascular Pharmacotherapy and Interventional Cardiology, Karl Landsteiner Society, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
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Frelinger AL, Haynes RL, Goldstein RD, Berny-Lang MA, Gerrits AJ, Riehs M, Haas EA, Paunovic B, Mena OJ, Campman SC, Milne GL, Sleeper LA, Kinney HC, Michelson AD. Dysregulation of platelet serotonin, 14-3-3, and GPIX in sudden infant death syndrome. Sci Rep 2024; 14:11092. [PMID: 38750089 PMCID: PMC11096399 DOI: 10.1038/s41598-024-61949-9] [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: 02/12/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024] Open
Abstract
Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal infant mortality, but the underlying cause(s) are unclear. A subset of SIDS infants has abnormalities in the neurotransmitter, serotonin (5-hydroxytryptamine [5-HT]) and the adaptor molecule, 14-3-3 pathways in regions of the brain involved in gasping, response to hypoxia, and arousal. To evaluate our hypothesis that SIDS is, at least in part, a multi-organ dysregulation of 5-HT, we examined whether blood platelets, which have 5-HT and 14-3-3 signaling pathways similar to brain neurons, are abnormal in SIDS. We also studied platelet surface glycoprotein IX (GPIX), a cell adhesion receptor which is physically linked to 14-3-3. In infants dying of SIDS compared to infants dying of known causes, we found significantly higher intra-platelet 5-HT and 14-3-3 and lower platelet surface GPIX. Serum and plasma 5-HT were also elevated in SIDS compared to controls. The presence in SIDS of both platelet and brainstem 5-HT and 14-3-3 abnormalities suggests a global dysregulation of these pathways and the potential for platelets to be used as a model system to study 5-HT and 14-3-3 interactions in SIDS. Platelet and serum biomarkers may aid in the forensic determination of SIDS and have the potential to be predictive of SIDS risk in living infants.
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Affiliation(s)
- Andrew L Frelinger
- Center for Platelet Research Studies, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA.
- Center for Platelet Research Studies, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston Children's Hospital, Karp 08212, 300 Longwood Avenue, Boston, MA, 02115-5737, USA.
| | - Robin L Haynes
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard D Goldstein
- Robert's Program on Sudden Unexpected Death in Pediatrics, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Michelle A Berny-Lang
- Center for Platelet Research Studies, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anja J Gerrits
- Center for Platelet Research Studies, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Molly Riehs
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Othon J Mena
- County of Ventura Medical Examiner's Office, Ventura, CA, USA
| | - Steven C Campman
- County of San Diego Medical Examiner's Office, San Diego, CA, USA
| | - Ginger L Milne
- Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Hannah C Kinney
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alan D Michelson
- Center for Platelet Research Studies, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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Habich M, Zielenkiewicz P, Paczek L, Szczesny P. Correlation of gestational age and age at death in sudden infant death syndrome: another pointer to the role of critical developmental period? BMC Pediatr 2024; 24:259. [PMID: 38641787 PMCID: PMC11027530 DOI: 10.1186/s12887-024-04712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/18/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Filiano and Kinney proposed a triple-risk model for the sudden infant death syndrome (SIDS) that involves the intersection of three risks: (1) a vulnerable infant, (2) a critical developmental period in homeostatic control, and (3) an exogenous stressor(s). The primary evidence for the role of a critical developmental period in SIDS etiology is the peak of cases around the third month of life. Independently, several studies pointed to correlation between gestational age and age at death in SIDS, but used that to assess the SIDS risk for preterm infants, ignoring further ramifications. METHODS We did a detailed analysis of CDC data spanning over two decades (1983-2011). We focused not only on the correlation between two age variables (gestational and age at death), but also on the possibility of misdiagnosis. Also, we attempted to account for potential biases in the data induced by the ICD-9/ICD-190 transition or the "Back to Sleep" campaign. RESULTS The peak of deaths in the third month of life, that was the main argument for the role of the critical development period, wasn't unique to SIDS. However, we confirmed an almost linear and negative correlation between gestational age and the week of death due to SIDS. This pattern (slope of correlation < 0 and significance of correlation p < 0.05) is characteristic of SIDS among all diseases analyzed in the study. CONCLUSIONS We interpret the results as the evidence of the role of the critical development period in SIDS etiology. Possibly more attention in the future research should be put to theories that are based on homeostatic control.
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Affiliation(s)
- Malgorzata Habich
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland
| | - Piotr Zielenkiewicz
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland
| | - Leszek Paczek
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Pawel Szczesny
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, ul. Pawinskiego 5A, Warsaw, 02-106, Poland.
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Eugenín J, Richerson GB. Editorial: Alternative and expanding views on central respiratory chemoreception in health and disease. Front Physiol 2024; 15:1403768. [PMID: 38645691 PMCID: PMC11026679 DOI: 10.3389/fphys.2024.1403768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Jaime Eugenín
- Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - George B. Richerson
- Departments of Neurology and Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
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Fraile-Martinez O, García-Montero C, Díez SC, Bravo C, Quintana-Coronado MDG, Lopez-Gonzalez L, Barrena-Blázquez S, García-Honduvilla N, De León-Luis JA, Rodriguez-Martín S, Saez MA, Alvarez-Mon M, Diaz-Pedrero R, Ortega MA. Sudden Infant Death Syndrome (SIDS): State of the Art and Future Directions. Int J Med Sci 2024; 21:848-861. [PMID: 38617004 PMCID: PMC11008475 DOI: 10.7150/ijms.89490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/10/2024] [Indexed: 04/16/2024] Open
Abstract
Sudden infant death syndrome (SIDS) is a type of death that occurs suddenly and without any apparent explanation, affecting infants between 28 days of life and up to a year. Recognition of this entity includes performing an autopsy to determine if there is another explanation for the event and performing both an external and internal examination of the different tissues to search for possible histopathological findings. Despite the relative success of awareness campaigns and the implementation of prevention measures, SIDS still represents one of the leading causes of death among infants worldwide. In addition, although the development of different techniques has made it possible to make significant progress in the characterization of the etiopathogenic mechanisms underlying SIDS, there are still many unknowns to be resolved in this regard and the integrative consideration of this syndrome represents an enormous challenge to face both from a point of view scientific and medical view as humanitarian. For all these reasons, this paper aims to summarize the most relevant current knowledge of SIDS, exploring from the base the characterization and recognition of this condition, its forensic findings, its risk factors, and the main prevention measures to be implemented. Likewise, an attempt will be made to analyze the causes and pathological mechanisms associated with SIDS, as well as potential approaches and future paths that must be followed to reduce the impact of this condition.
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Affiliation(s)
- Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Sofía Castellanos Díez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - María de Guadalupe Quintana-Coronado
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Laura Lopez-Gonzalez
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
| | - Silvestra Barrena-Blázquez
- Department of General and Digestive Surgery, University Hospital Príncipe de Asturias, 28805 Madrid, Spain
- Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, 28009 Madrid, Spain
- Health Research Institute Gregorio Marañón, 28009 Madrid, Spain
| | - Sonia Rodriguez-Martín
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Service of Pediatric, Hospital Universitario Principe de Asturias, 28801 Alcalá de Henares, Spain
| | - Miguel A Saez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Pathological Anatomy Service, Central University Hospital of Defence-UAH Madrid, 28801 Alcala de Henares, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, CIBEREHD, 28806 Alcalá de Henares, Spain
| | - Raul Diaz-Pedrero
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcala de Henares, Spain
- Department of General and Digestive Surgery, University Hospital Príncipe de Asturias, 28805 Madrid, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
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Ahmadzadeh E, Dudink I, Walker DW, Sutherland AE, Pham Y, Stojanovska V, Polglase GR, Miller SL, Allison BJ. The medullary serotonergic centres involved in cardiorespiratory control are disrupted by fetal growth restriction. J Physiol 2023. [PMID: 37641535 DOI: 10.1113/jp284971] [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: 05/08/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
Fetal growth restriction (FGR) is associated with cardiovascular and respiratory complications after birth and beyond. Despite research showing a range of neurological changes following FGR, little is known about how FGR affects the brainstem cardiorespiratory control centres. The primary neurons that release serotonin reside in the brainstem cardiorespiratory control centres and may be affected by FGR. At two time points in the last trimester of sheep brain development, 110 and 127 days of gestation (0.74 and 0.86 of gestation), we assessed histopathological alterations in the brainstem cardiorespiratory control centres of the pons and medulla in early-onset FGR versus control fetal sheep. The FGR cohort were hypoxaemic and asymmetrically growth restricted. Compared to the controls, the brainstem of FGR fetuses exhibited signs of neuropathology, including elevated cell death and reduced cell proliferation, grey and white matter deficits, and evidence of oxidative stress and neuroinflammation. FGR brainstem pathology was predominantly observed in the medullary raphé nuclei, hypoglossal nucleus, nucleus ambiguous, solitary tract and nucleus of the solitary tract. The FGR groups showed imbalanced brainstem serotonin and serotonin 1A receptor abundance in the medullary raphé nuclei, despite evidence of increased serotonin staining within vascular regions of placentomes collected from FGR fetuses. Our findings demonstrate both early and adaptive brainstem neuropathology in response to placental insufficiency. KEY POINTS: Early-onset fetal growth restriction (FGR) was induced in fetal sheep, resulting in chronic fetal hypoxaemia. Growth-restricted fetuses exhibit persistent neuropathology in brainstem nuclei, characterised by disrupted cell proliferation and reduced neuronal cell number within critical centres responsible for the regulation of cardiovascular and respiratory functions. Elevated brainstem inflammation and oxidative stress suggest potential mechanisms contributing to the observed neuropathological changes. Both placental and brainstem levels of 5-HT were found to be impaired following FGR.
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Affiliation(s)
- Elham Ahmadzadeh
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Ingrid Dudink
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - David W Walker
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Amy E Sutherland
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Yen Pham
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Vanesa Stojanovska
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Beth J Allison
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Bosco F, Guarnieri L, Leo A, Tallarico M, Gallelli L, Rania V, Citraro R, De Sarro G. Audiogenic epileptic DBA/2 mice strain as a model of genetic reflex seizures and SUDEP. Front Neurol 2023; 14:1223074. [PMID: 37681009 PMCID: PMC10481168 DOI: 10.3389/fneur.2023.1223074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/14/2023] [Indexed: 09/09/2023] Open
Abstract
Epilepsy is a chronic neurological disease characterized by abnormal brain activity, which results in repeated spontaneous seizures. Sudden unexpected death in epilepsy (SUDEP) is the leading cause of seizure-related premature death, particularly in drug-resistant epilepsy patients. The etiology of SUDEP is a structural injury to the brain that is not fully understood, but it is frequently associated with poorly controlled and repeated generalized tonic-clonic seizures (GTCSs) that cause cardiorespiratory and autonomic dysfunctions, indicating the involvement of the brainstem. Both respiratory and cardiac abnormalities have been observed in SUDEP, but not much progress has been made in their prevention. Owing to the complexity of SUDEP, experimental animal models have been used to investigate cardiac and/or respiratory dysregulation due to or associated with epileptic seizures that may contribute to death in humans. Numerous rodent models, especially mouse models, have been developed to better understand epilepsy and SUDEP physiopathology. This review synthesizes the current knowledge about dilute brown agouti coat color (DBA/2) mice as a possible SUDEP model because respiratory arrest (RA) and sudden death induced by audiogenic generalized seizures (AGSs) have been observed in these animals. Respiratory/cardiac dysfunction, brainstem arousal system dysfunction, and alteration of the neurotransmitter systems, which are observed in human SUDEP, have also been observed in these mice. In particular, serotonin (5-HT) alteration and adenosine neurotransmission appear to contribute to not only the pathophysiological mechanisms of medication but also seizure-related respiratory dysfunctions in this animal model. These neurotransmitter systems could be the relevant targets for medication development for chronic epilepsy and SUDEP prevention. We reviewed data on AGSs in DBA/2 mice and the relevance of this model of generalized tonic-clonic epilepsy to human SUDEP. Furthermore, the advantages of using this strain prone to AGSs for the identification of possible new therapeutic targets and treatment options have also been assessed.
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Affiliation(s)
- Francesca Bosco
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Lorenza Guarnieri
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Martina Tallarico
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Luca Gallelli
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Vincenzo Rania
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
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9
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Bauer MB, Currie KPM. Serotonin and the serotonin transporter in the adrenal gland. VITAMINS AND HORMONES 2023; 124:39-78. [PMID: 38408804 PMCID: PMC11217909 DOI: 10.1016/bs.vh.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The adrenal glands are key components of the mammalian endocrine system, helping maintain physiological homeostasis and the coordinated response to stress. Each adrenal gland has two morphologically and functionally distinct regions, the outer cortex and inner medulla. The cortex is organized into three concentric zones which secrete steroid hormones, including aldosterone and cortisol. Neural crest-derived chromaffin cells in the medulla are innervated by preganglionic sympathetic neurons and secrete catecholamines (epinephrine, norepinephrine) and neuropeptides into the bloodstream, thereby functioning as the neuroendocrine arm of the sympathetic nervous system. In this article we review serotonin (5-HT) and the serotonin transporter (SERT; SLC6A4) in the adrenal gland. In the adrenal cortex, 5-HT, primarily sourced from resident mast cells, acts as a paracrine signal to stimulate aldosterone and cortisol secretion through 5-HT4/5-HT7 receptors. Medullary chromaffin cells contain a small amount of 5-HT due to SERT-mediated uptake and express 5-HT1A receptors which inhibit secretion. The atypical mechanism of the 5-HT1A receptors and interaction with SERT fine tune this autocrine pathway to control stress-evoked catecholamine secretion. Receptor-independent signaling by SERT/intracellular 5-HT modulates the amount and kinetics of transmitter release from single vesicle fusion events. SERT might also influence stress-evoked upregulation of tyrosine hydroxylase transcription. Transient signaling via 5-HT3 receptors during embryonic development can limit the number of chromaffin cells found in the mature adrenal gland. Together, this emerging evidence suggests that the adrenal medulla is a peripheral hub for serotonergic control of the sympathoadrenal stress response.
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Affiliation(s)
- Mary Beth Bauer
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, South Broadway, Camden, NJ, United States
| | - Kevin P M Currie
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, South Broadway, Camden, NJ, United States.
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10
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Vincent A, Chu NT, Shah A, Avanthika C, Jhaveri S, Singh K, Limaye OM, Boddu H. Sudden Infant Death Syndrome: Risk Factors and Newer Risk Reduction Strategies. Cureus 2023; 15:e40572. [PMID: 37465778 PMCID: PMC10351748 DOI: 10.7759/cureus.40572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/20/2023] Open
Abstract
Sudden infant death syndrome (SIDS) continues to be one of the top causes of infant death in the U.S. Despite significant public health initiatives focused on high-risk populations to enhance sleep environments and techniques. The SIDS rate has remained stable in recent years. Risk factors and newer risk reduction strategies for SIDS are the focus of this review article. We conducted a comprehensive literature search on Medline, Cochrane, Embase, and Google Scholar until July 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "SIDS," "Sudden Infant Death" and "SUID". We explored the literature on SIDS for its epidemiology, pathophysiology, the role of various etiologies and their influence, associated complications leading to SIDS, and preventive and treatment modalities. Despite a more than 50% drop-in rates since the start of the "Back to Sleep" campaign in 1994, sudden infant death syndrome (SIDS) continues to be the top cause of post-neonatal mortality in the United States, despite continued educational initiatives that support safe sleep and other risk reduction strategies. The new American Academy of Pediatrics guidelines for lowering the risk of SIDS include a lot of emphasis on sleeping habits, bedding, and environment but also include elements that are frequently ignored (i.e., prenatal care, smoking, alcohol and drug use, and childhood vaccinations). This study highlights these less-frequently discussed aspects and identifies treatments that have produced beneficial behavioral shifts that benefit newborns as well as their mothers' health and wellbeing.
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Affiliation(s)
- Anita Vincent
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Ngan Thy Chu
- Paediatrics, City Children's Hospital, Ho Chi Minh city, VNM
| | - Aashka Shah
- Paediatrics and Child Health, Pramukhswami Medical College, Karamsad, Anand, IND
| | - Chaithanya Avanthika
- Pediatrics, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York City, USA
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Sharan Jhaveri
- Medicine and Surgery, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College (NHLMMC), Ahmedabad, IND
| | - Kunika Singh
- Paediatrics, Xinjiang Medical University, Xinjiang, CHN
| | - Om M Limaye
- Paediatrics, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, IND
| | - Himasaila Boddu
- Paediatrics, Dr. Pinnamaneni Siddartha Institute of Medical Sciences and Research Foundation, Krishna, IND
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11
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Sania A, Myers MM, Pini N, Lucchini M, Nugent JD, Shuffrey LC, Rao S, Barbosa J, Angal J, Elliott AJ, Odendaal HJ, Fifer WP. Prenatal smoking and drinking are associated with altered newborn autonomic functions. Pediatr Res 2023; 93:242-252. [PMID: 35440768 PMCID: PMC9579213 DOI: 10.1038/s41390-022-02060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prenatal smoking and drinking are associated with sudden infant death syndrome and neurodevelopmental disorders. Infants with these outcomes also have altered autonomic nervous system (ANS) regulation. We examined the effects of prenatal smoking and drinking on newborn ANS function. METHODS Pregnant women were enrolled in Northern Plains, USA (NP) and Cape Town (CT), South Africa. Daily drinking and weekly smoking data were collected prenatally. Physiological measures were obtained during sleep 12-96 h post-delivery. RESULTS In all, 2913 infants from NP and 4072 from CT were included. In active sleep, newborns of mothers who smoked throughout pregnancy, compared to non-smokers, had higher breathing rates (2.2 breaths/min; 95% CI: 0.95, 3.49). Quit-early smoking was associated with reductions in beat-to-beat heart rate variability (HRV) in active (-0.08 s) and quiet sleep (-0.11 s) in CT. In girls, moderate-high continuous smoking was associated with increased systolic (3.0 mmHg, CI: 0.70, 5.24) and diastolic blood pressure (2.9 mmHg, CI: 0.72, 5.02). In quiet sleep, low-continuous drinking was associated with slower heart rate (-4.5 beat/min). In boys, low-continuous drinking was associated with a reduced ratio of low-to-high frequency HRV (-0.11, CI: -0.21, -0.02). CONCLUSIONS These findings highlight potential ANS pathways through which prenatal drinking and smoking may contribute to neurodevelopment outcomes. IMPACT In this prospective cohort study of 6985 mother-infant dyads prenatal drinking and smoking were associated with multiple ANS parameters. Smoking was associated with increased neonatal breathing rates among all infants, and heart rate variability (HRV) and blood pressure (BP) among girls. Drinking was associated with reductions in HR and BP among all newborns, and reductions in the ratio of low to-high frequency HRV among boys. These findings suggest that prenatal smoking and drinking alter newborn ANS which may presage future neurodevelopmental disorders.
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Affiliation(s)
- Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, 10032, USA. .,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - J David Nugent
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Lauren C. Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032
| | - Shreya Rao
- Department of Statistics, Columbia University, New York, NY 10032
| | - Jennifer Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032
| | - Jyoti Angal
- Avera Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57105
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, SD 57108,Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57105
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa 7530
| | - William P. Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032,Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032,Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032
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12
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Beltrán-Castillo S, Bravo K, Eugenín J. Impact of Prenatal Nicotine Exposure on Placental Function and Respiratory Neural Network Development. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:233-244. [PMID: 37466776 DOI: 10.1007/978-3-031-32554-0_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Smoking during pregnancy is associated with multiple undesirable outcomes in infants, such as low birth weight, increased neonatal morbidity and mortality, and catastrophic conditions like sudden infant death syndrome (SIDS). Nicotine, the most addictive and teratogenic substance in tobacco smoke, reaches and crosses the placenta and can be accumulated in the amniotic fluid and distributed by fetal circulation, altering the cholinergic transmission by acting on the nicotinic acetylcholine receptors (nAChRs) expressed from very early gestational stages in the placenta and fetal tissue. Because nAChRs influence the establishment of feto-maternal circulation and the emergence of neuronal networks, prenatal nicotine exposure can lead to multiple alterations in newborns. In this mini-review, we discuss the undeniable effects of nicotine in the placenta and the respiratory neural network as examples of how prenatal nicotine and smoking exposition can affect brain development because dysfunction in this network is involved in SIDS etiology.
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Affiliation(s)
- Sebastián Beltrán-Castillo
- Centro integrativo de Biología y Química Aplicada (CIBQA), Universidad Bernardo O'Higgins, Santiago, Chile.
| | - Karina Bravo
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile
- Facultad de Ingeniería, Universidad Autónoma de Chile, Santiago, Chile
| | - Jaime Eugenín
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile.
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13
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Genes involved in paediatric apnoea and death based on knockout animal models: Implications for sudden infant death syndrome (SIDS). Paediatr Respir Rev 2022; 44:53-60. [PMID: 34750067 DOI: 10.1016/j.prrv.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022]
Abstract
The mechanism of death in Sudden infant death syndrome (SIDS) remains unknown but it is hypothesised that cardiorespiratory failure of brainstem origin results in early post-natal death. For a subset of SIDS infants, an underlying genetic cause may be present, and genetic abnormalities affecting brainstem respiratory control may result in abnormalities that are detectable before death. Genetic knockout mice models were developed in the 1990s and have since helped to elucidate the physiological roles of a number of genes. This systematic review aimed to identify which genes, when knocked out, result in the phenotypes of abnormal cardiorespiratory control and/or early post-natal death. Three major genes were identified: Pet1- a serotonin transcription factor, the neurotrophin pituitary adenylate cyclase activating polypeptide (PACAP) and its receptor (PAC1). Knockouts targeting these genes had blunted hypercapnic and/or hypoxic responses and early post-natal death. The hypothesis that these genes have a role in SIDS is supported by their being identified as abnormal in SIDS cohorts. Future research in SIDS cohorts will be important to determine whether these genetic abnormalities coexist and their potential applicability as biomarkers.
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14
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Falsaperla R, Consentino MC, Vitaliti G, Marino S, Ruggieri M. Isolated ictal apnea in neonatal age: Clinical features and treatment options. A systematic review. Auton Neurosci 2022; 243:103034. [PMID: 36174277 DOI: 10.1016/j.autneu.2022.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/27/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Among autonomic seizures apnea still represent a challenge for physicians, and it might constitute the only isolated sign of neurological disorder. The aim of this review is to describe ictal apnea (IA) and its treatment options. METHODS MeSH and keywords were combined: "neonatal seizures", "ictal neonatal apnea", "apneic seizures". All identified papers were screened for neonatal seizures titles and abstracts; case reports describing patients with IA as an isolated manifestation of neonatal seizures were included. RESULTS Eight studies including a total of 13 patients were identified. Among 13 patients, 9 were full-term and 4 were preterm neonates. All patients developed IA within twenty-one days from birth. Etiologies of seizures included: temporal lobe hemorrhage (3 pt), occipital stroke (1 pt), hypoxic-ischemic encephalopathy (HIE) (1 pt), parasagittal injury (1 pt), 18 trisomy (2 pt). Five patients showed no structural CNS alterations. Ten patients had the ictal focus localized in the temporal lobe; the occipital lobe was the second most involved site. Phenobarbital was administered in 76 % of cases with IA (10 pt), and showed efficacy in 74 % of them; 2 required a second anti-epileptic drug (AED) to reach seizure control. Levetiracetam was given to 11 % (2 pt) successfully. Only one was treated with midazolam and one did not require any anticonvulsant. CONCLUSIONS Not homogeneous data and paucity of isolated IA currently reported in literature limits agreement about definition, management and treatment of entity, however an ever-growing attention is needed, and EEG/aEEG, despite their possible controversies in the diagnosis, should be performed to investigate unexplained forms of apnea.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit [NICU], AOU "Rodolico - San Marco", PO "San Marco", University of Catania, Catania, Italy; Unit of Pediatrics and Pediatric Emergency, AOU "Rodolico - San Marco", PO "San Marco", University of Catania, Catania, Italy
| | - Maria Chiara Consentino
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, Catania, Italy
| | - Giovanna Vitaliti
- Unit of Pediatrics, Department of Medical Sciences, Section of Pediatrics, University Hospital Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, AOU "Rodolico - San Marco", PO "San Marco", University of Catania, Catania, Italy.
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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15
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Polavarapu M, Klonoff-Cohen H, Joshi D, Kumar P, An R, Rosenblatt K. Development of a Risk Score to Predict Sudden Infant Death Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610270. [PMID: 36011906 PMCID: PMC9407916 DOI: 10.3390/ijerph191610270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 06/12/2023]
Abstract
Sudden Infant Death Syndrome (SIDS) is the third leading cause of death among infants younger than one year of age. Effective SIDS prediction models have yet to be developed. Hence, we developed a risk score for SIDS, testing contemporary factors including infant exposure to passive smoke, circumcision, and sleep position along with known risk factors based on 291 SIDS and 242 healthy control infants. The data were retrieved from death certificates, parent interviews, and medical records collected between 1989−1992, prior to the Back to Sleep Campaign. Multivariable logistic regression models were performed to develop a risk score model. Our finalized risk score model included: (i) breastfeeding duration (OR = 13.85, p < 0.001); (ii) family history of SIDS (OR = 4.31, p < 0.001); (iii) low birth weight (OR = 2.74, p = 0.003); (iv) exposure to passive smoking (OR = 2.64, p < 0.001); (v) maternal anemia during pregnancy (OR = 2.07, p = 0.03); and (vi) maternal age <25 years (OR = 1.77, p = 0.01). The area under the curve for the overall model was 0.79, and the sensitivity and specificity were 79% and 63%, respectively. Once this risk score is further validated it could ultimately help physicians identify the high risk infants and counsel parents about modifiable risk factors that are most predictive of SIDS.
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Affiliation(s)
- Mounika Polavarapu
- School of Population Health, The University of Toledo, HH 1010, Mail Stop 119, 2801 W. Bancroft St., Toledo, OH 43606, USA
| | - Hillary Klonoff-Cohen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Divya Joshi
- Department of Pediatrics, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA
| | - Praveen Kumar
- Department of Pediatrics, Children’s Hospital of Illinois, Peoria, IL 61603, USA
| | - Ruopeng An
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Karin Rosenblatt
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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16
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Leitner DF, Kanshin E, Askenazi M, Faustin A, Friedman D, Devore S, Ueberheide B, Wisniewski T, Devinsky O. Raphe and ventrolateral medulla proteomics in epilepsy and sudden unexpected death in epilepsy. Brain Commun 2022; 4:fcac186. [PMID: 35928051 PMCID: PMC9344977 DOI: 10.1093/braincomms/fcac186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/29/2022] [Accepted: 07/11/2022] [Indexed: 12/26/2022] Open
Abstract
Brainstem nuclei dysfunction is implicated in sudden unexpected death in epilepsy. In animal models, deficient serotonergic activity is associated with seizure-induced respiratory arrest. In humans, glia are decreased in the ventrolateral medullary pre-Botzinger complex that modulate respiratory rhythm, as well as in the medial medullary raphe that modulate respiration and arousal. Finally, sudden unexpected death in epilepsy cases have decreased midbrain volume. To understand the potential role of brainstem nuclei in sudden unexpected death in epilepsy, we evaluated molecular signalling pathways using localized proteomics in microdissected midbrain dorsal raphe and medial medullary raphe serotonergic nuclei, as well as the ventrolateral medulla in brain tissue from epilepsy patients who died of sudden unexpected death in epilepsy and other causes in diverse epilepsy syndromes and non-epilepsy control cases (n = 15-16 cases per group/region). Compared with the dorsal raphe of non-epilepsy controls, we identified 89 proteins in non-sudden unexpected death in epilepsy and 219 proteins in sudden unexpected death in epilepsy that were differentially expressed. These proteins were associated with inhibition of EIF2 signalling (P-value of overlap = 1.29 × 10-8, z = -2.00) in non-sudden unexpected death in epilepsy. In sudden unexpected death in epilepsy, there were 10 activated pathways (top pathway: gluconeogenesis I, P-value of overlap = 3.02 × 10-6, z = 2.24) and 1 inhibited pathway (fatty acid beta-oxidation, P-value of overlap = 2.69 × 10-4, z = -2.00). Comparing sudden unexpected death in epilepsy and non-sudden unexpected death in epilepsy, 10 proteins were differentially expressed, but there were no associated signalling pathways. In both medullary regions, few proteins showed significant differences in pairwise comparisons. We identified altered proteins in the raphe and ventrolateral medulla of epilepsy patients, including some differentially expressed in sudden unexpected death in epilepsy cases. Altered signalling pathways in the dorsal raphe of sudden unexpected death in epilepsy indicate a shift in cellular energy production and activation of G-protein signalling, inflammatory response, stress response and neuronal migration/outgrowth. Future studies should assess the brain proteome in relation to additional clinical variables (e.g. recent tonic-clonic seizures) and in more of the reciprocally connected cortical and subcortical regions to better understand the pathophysiology of epilepsy and sudden unexpected death in epilepsy.
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Affiliation(s)
- Dominique F Leitner
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Evgeny Kanshin
- Proteomics Laboratory, Division of Advanced Research Technologies, Grossman
School of Medicine, New York University, 223 East 34th
Street, New York, NY 10016, USA
| | - Manor Askenazi
- Biomedical Hosting LLC, Arlington, MA
02140, USA
- Department of Biochemistry and Molecular Pharmacology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
| | - Arline Faustin
- Center for Cognitive Neurology, Department of Neurology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
- Department of Pathology, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Daniel Friedman
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Sasha Devore
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Beatrix Ueberheide
- Proteomics Laboratory, Division of Advanced Research Technologies, Grossman
School of Medicine, New York University, 223 East 34th
Street, New York, NY 10016, USA
- Department of Biochemistry and Molecular Pharmacology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
- Center for Cognitive Neurology, Department of Neurology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
| | - Thomas Wisniewski
- Center for Cognitive Neurology, Department of Neurology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
- Department of Pathology, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
- Department of Psychiatry, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
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17
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Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics 2022; 150:188305. [PMID: 35921639 DOI: 10.1542/peds.2022-057991] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Every year in the United States, approximately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca F Carlin
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York City, New York
| | - Ivan Hand
- Department of Pediatrics, SUNY-Downstate College of Medicine, NYC Health + Hospitals, Kings County, Brooklyn, New York
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18
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Biancardi V, Patrone LGA, Vicente MC, Marques DA, Bicego KC, Funk GD, Gargaglioni LH. Prenatal fluoxetine has long lasting, differential effects on respiratory control in male and female rats. J Appl Physiol (1985) 2022; 133:371-389. [PMID: 35708704 DOI: 10.1152/japplphysiol.00020.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Serotonin (5-HT) is an important modulator of brain networks that control breathing. The selective serotonin reuptake inhibitor fluoxetine (FLX) is the first-line antidepressant drug prescribed during pregnancy. We investigated the effects of prenatal FLX on baseline breathing, ventilatory and metabolic responses to hypercapnia and hypoxia as well as number of brainstem 5-HT and tyrosine hydroxylase (TH) neurons of rats during postnatal development (P0-82). Prenatal FLX exposure of males showed a lower baseline that appeared in juveniles and remained in adulthood, with no sleep-wake state dependency. Prenatal FLX exposure of females did not affect baseline breathing. Juvenile male FLX rats showed increased CO2 and hypoxic ventilatory responses, normalizing by adulthood. Alterations in juvenile-FLX treated males were associated with greater number of 5-HT neurons in the ROB and RMAG. Adult FLX-exposed males showed greater number of 5-HT neurons in the RPA and TH neurons in the A5, while reduced number of TH neurons in A7. Prenatal FLX exposure of female rats was associated with greater hyperventilation induced by hypercapnia at P0-2 and juveniles whereas P12-14 and adult FLX (NREM sleep) rats showed an attenuation of the hypercapnic hyperventilation.FLX-exposed females had fewer 5-HT neurons in the RPA and reduced TH A6 density at P0-2; and greater number of TH neurons in the A7 at P12-14. These data indicate that prenatal FLX exposure affects the number of neurons of some monoaminergic regions in the brain and results in long lasting, sex specific changes in baseline breathing pattern and ventilatory responses to respiratory challenges.
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Affiliation(s)
- Vivian Biancardi
- Department of Animal Morphology and Physiology, Sao Paulo State University, Jaboticabal, Sao Paulo, Brazil.,Department of Physiology, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Luis Gustavo A Patrone
- Department of Animal Morphology and Physiology, Sao Paulo State University, Jaboticabal, Sao Paulo, Brazil
| | - Mariane C Vicente
- Department of Animal Morphology and Physiology, Sao Paulo State University, Jaboticabal, Sao Paulo, Brazil
| | - Danuzia A Marques
- Department of Animal Morphology and Physiology, Sao Paulo State University, Jaboticabal, Sao Paulo, Brazil.,Department of Pediatrics, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
| | - Kênia C Bicego
- Department of Animal Morphology and Physiology, Sao Paulo State University, Jaboticabal, Sao Paulo, Brazil
| | - Gregory D Funk
- Department of Physiology, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Luciane H Gargaglioni
- Department of Animal Morphology and Physiology, Sao Paulo State University, Jaboticabal, Sao Paulo, Brazil
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19
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Domingues RR, Wiltbank MC, Hernandez LL. Pregnancy Complications and Neonatal Mortality in a Serotonin Transporter Null Mouse Model: Insight Into the Use of Selective Serotonin Reuptake Inhibitor During Pregnancy. Front Med (Lausanne) 2022; 9:848581. [PMID: 35360732 PMCID: PMC8960382 DOI: 10.3389/fmed.2022.848581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRI) are widely prescribed to pregnant woman. Although some SSRI compounds are known to cause pregnancy loss and fetal malformations, other SSRI continue to be used by pregnant women. However, several studies have associated the use of SSRI with adverse pregnancy outcomes: intrauterine growth restriction, preterm birth, and neonatal morbidity. Nonetheless, interpretation of studies in humans are typically complicated by the adverse pregnancy outcomes caused by depression itself. Therefore, we used a mutant mouse model with genetic ablation of the serotonin transporter, the target site for SSRI, to unravel the role of the serotonin transporter on pregnancy outcomes. The serotonin transporter null mice had increased pregnancy loss (17.5 vs. 0%), decreased number of pups born (6.6 ± 0.2 vs. 7.5 ± 0.2), and increased neonatal mortality (2.3-fold). Furthermore, preterm birth, dystocia, and fetal malformations were only observed in serotonin transporter null mice. This genetically ablated serotonin transporter mouse recapitulates several adverse pregnancy outcomes similar to those in women undergoing SSRI treatment during gestation. Additionally, neonatal loss in the present study reproduced a sudden infant death phenotype as in humans and mice with altered serotonergic signaling. In conclusion, findings from this study demonstrate a role for serotonin transporter in pregnancy maintenance and neonatal health. Additionally, it suggests that the adverse pregnancy outcomes in women taking SSRI during gestation might be due to altered serotonin transporter function caused by SSRI independent of underlying depression. This is a critical finding, given the number of women prescribed SSRI during pregnancy, and provides the framework for critical research in this area.
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Affiliation(s)
- Rafael R. Domingues
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Milo C. Wiltbank
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Laura L. Hernandez
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Laura L. Hernandez,
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20
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Smith JC. Respiratory rhythm and pattern generation: Brainstem cellular and circuit mechanisms. HANDBOOK OF CLINICAL NEUROLOGY 2022; 188:1-35. [PMID: 35965022 DOI: 10.1016/b978-0-323-91534-2.00004-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Breathing movements in mammals are driven by rhythmic neural activity automatically generated within spatially and functionally organized brainstem neural circuits comprising the respiratory central pattern generator (CPG). This chapter reviews up-to-date experimental information and theoretical studies of the cellular and circuit mechanisms of respiratory rhythm and pattern generation operating within critical components of this CPG in the lower brainstem. Over the past several decades, there have been substantial advances in delineating the spatial architecture of essential medullary regions and their regional cellular and circuit properties required to understand rhythm and pattern generation mechanisms. A fundamental concept is that the circuits in these regions have rhythm-generating capabilities at multiple cellular and circuit organization levels. The regional cellular properties, circuit organization, and control mechanisms allow flexible expression of neural activity patterns for a repertoire of respiratory behaviors under various physiologic conditions that are dictated by requirements for homeostatic regulation and behavioral integration. Many mechanistic insights have been provided by computational modeling studies driven by experimental results and have advanced understanding in the field. These conceptual and theoretical developments are discussed.
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Affiliation(s)
- Jeffrey C Smith
- Cellular and Systems Neurobiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
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21
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Teran FA, Bravo E, Richerson GB. Sudden unexpected death in epilepsy: Respiratory mechanisms. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:153-176. [PMID: 36031303 PMCID: PMC10191258 DOI: 10.1016/b978-0-323-91532-8.00012-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Epilepsy is one of the most common chronic neurologic diseases, with a prevalence of 1% in the US population. Many people with epilepsy live normal lives, but are at risk of sudden unexpected death in epilepsy (SUDEP). This mysterious comorbidity of epilepsy causes premature death in 17%-50% of those with epilepsy. Most SUDEP occurs after a generalized seizure, and patients are typically found in bed in the prone position. Until recently, it was thought that SUDEP was due to cardiovascular failure, but patients who died while being monitored in hospital epilepsy units revealed that most SUDEP is due to postictal central apnea. Some cases may occur when seizures invade the amygdala and activate projections to the brainstem. Evidence suggests that the pathophysiology is linked to defects in the serotonin system and central CO2 chemoreception, and that there is considerable overlap with mechanisms thought to be involved in sudden infant death syndrome (SIDS). Future work is needed to identify biomarkers for patients at highest risk, improve ascertainment, develop methods to alert caregivers when SUDEP is imminent, and find effective approaches to prevent these fatal events.
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Affiliation(s)
- Frida A Teran
- Department of Neurology, University of Iowa, Iowa City, IA, United States; Medical Scientist Training Program, University of Iowa, Iowa City, IA, United States.
| | - Eduardo Bravo
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - George B Richerson
- Department of Neurology, University of Iowa, Iowa City, IA, United States; Department of Molecular Physiology & Biophysics, University of Iowa, Iowa City, IA, United States
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22
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Goldwater PN. The Science (or Nonscience) of Research Into Sudden Infant Death Syndrome (SIDS). Front Pediatr 2022; 10:865051. [PMID: 35498810 PMCID: PMC9051368 DOI: 10.3389/fped.2022.865051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This Viewpoint paper presents a timely and constructive critique of mainstream SIDS research. It is concerning that twenty-first century medical science has not provided an answer to the tragic enigma of SIDS. The paper helps explain why this is so and illustrates possible shortcomings in the investigation of Sudden Infant Death Syndrome/Sudden Unexplained Infant Death (SIDS/SUID) by mainstream researchers. Mainstream findings are often based on questionable and dogmatic assumptions that return to founding notions such as the Triple Risk Hypothesis and the contention that the mechanisms underlying SIDS/SUID are heterogeneous in nature. The paper illustrates how the pathological findings in SIDS have been under-investigated (or ignored) and that key epidemiological risk factors have slipped from memory. This apparent amnesia has resulted in failure to use these established SIDS facts to substantiate the significance of various neuropathological, neurochemical, or other research findings. These unsupported findings and their derivative hypotheses are therefore ill-founded and lack scientific rigor. CONCLUSION The deficits of SIDS "science" revealed in this paper explain why the SIDS enigma has not yet been solved. To make progress in understanding SIDS, it is important that researchers, as scientists, uphold standards of research. Encouragement for new directions of research is offered.
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Affiliation(s)
- Paul Nathan Goldwater
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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23
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Sudden infant death syndrome revisited: serotonin transporter gene, polymorphisms and promoter methylation. Pediatr Res 2022; 92:694-699. [PMID: 34764460 PMCID: PMC9556327 DOI: 10.1038/s41390-021-01773-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Based on findings in the brain stems of SIDS victims, the serotonin transporter (5-HTT) gene has been discussed to be associated with SIDS. METHODS In the largest study to date, we investigated the promoter length (5-HTTLPR) and intron 2 VNTR polymorphisms in 274 cases and 264 controls and the Ile425Val polymorphism in 65 cases and 64 controls. Moreover, the methylation of the internal promoter region was investigated in 35 cases and 14 controls. RESULTS For 5-HTTLPR, we observed a trend towards an association of allele L (58.8% vs. 53.4%) with SIDS and significant results were observed after stratifying for age, season at death, and prone position. Nevertheless, when pooling all published data, a significant association of allele L with SIDS is confirmed (p: 0.001). For the intron 2 VNTR polymorphism, no significant differences were observed. After pooling, a significant accumulation of the rare allele 9 was observed in SIDS (2.1% vs. 0.6%; p: 0.018). For the Ile425Val polymorphism, no differences were observed. CONCLUSION We conclude that genetic variation at this gene might be of some importance in SIDS. Epigenetic analysis of the internal promoter, however, revealed no influence on the relative risk to succumb to SIDS. IMPACT This is the largest study published up to now on 5-HTT gene polymorphisms and SIDS. Polymorphisms in the 5-HTT gene appear to contribute (although to a small degree) to the risk to die from SIDS. There is no evidence that a methylation of the promoter region is of impact for the etiology of SIDS.
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24
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Morris A, Elliott E, Jeffery H. Paediatrician experience of management of Sudden Unexpected Death in Infancy. J Forensic Leg Med 2021; 84:102268. [PMID: 34768190 DOI: 10.1016/j.jflm.2021.102268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/20/2021] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
Sudden unexpected death in infancy (SUDI) requires a thorough process of inquiry including a detailed history, death scene investigation and autopsy by appropriate and informed health professionals to identify aetiology. Paediatricians are required to conduct the medical, social and family history as well as provide support to the family for the approximately 45 deaths each year in New South Wales (NSW). The aim of this study is describe paediatricians' experience in conducting SUDI assessments with reference to current NSW Health policy and identify barriers to its implementation. METHODS Paediatricians in NSW who participate in the Australian Paediatric Surveillance Unit (APSU) were invited to complete a questionnaire requesting information about their knowledge and confidence in managing an infant presenting with SUDI, awareness and use of the NSW Health Policy Directive, and their own recommendations for management. A second questionnaire was completed by paediatricians who had attended a SUDI in the previous five years. RESULTS The first survey was completed by 234/524 (44%) NSW paediatricians. Half the respondents (118/234) were aware of the SUDI Policy Directive and of those 72/118 (61%) had read it. Few paediatricians (63/234) 27% had received education on the Policy Directive or about SUDI management 55/234 (24%). The second survey was completed by 33/36 (92%) who had attended a SUDI, of whom 29% had not used the history protocol within the Policy Directive. CONCLUSION Lack of awareness, perceived problems with the current Policy, and limited confidence suggests the model in NSW needs revision to meet international recommendations for best management and diagnosis and also supportive and preventive practices for parents.
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Affiliation(s)
- Anne Morris
- The University of Sydney, Faculty of Medicine and Health, The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia.
| | - Elizabeth Elliott
- The University of Sydney, Faculty of Medicine and Health, The Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Heather Jeffery
- Sydney School Public Health & Previously Clinical Academic Neonatologist, Royal Prince Alfred Hospital, Sydney, Australia
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25
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Miller NZ. Vaccines and sudden infant death: An analysis of the VAERS database 1990-2019 and review of the medical literature. Toxicol Rep 2021; 8:1324-1335. [PMID: 34258234 PMCID: PMC8255173 DOI: 10.1016/j.toxrep.2021.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/31/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022] Open
Abstract
Although there is considerable evidence that a subset of infants has an increased risk of sudden death after receiving vaccines, health authorities eliminated "prophylactic vaccination" as an official cause of death, so medical examiners are compelled to misclassify and conceal vaccine-related fatalities under alternate cause-of-death classifications. In this paper, the Vaccine Adverse Event Reporting System (VAERS) database was analyzed to ascertain the onset interval of infant deaths post-vaccination. Of 2605 infant deaths reported to VAERS from 1990 through 2019, 58 % clustered within 3 days post-vaccination and 78.3 % occurred within 7 days post-vaccination, confirming that infant deaths tend to occur in temporal proximity to vaccine administration. The excess of deaths during these early post-vaccination periods was statistically significant (p < 0.00001). A review of the medical literature substantiates a link between vaccines and sudden unexplained infant deaths. Several theories regarding the pathogenic mechanism behind these fatal events have been proposed, including the role of inflammatory cytokines as neuromodulators in the infant medulla preceding an abnormal response to the accumulation of carbon dioxide; fatal disorganization of respiratory control induced by adjuvants that cross the blood-brain barrier; and biochemical or synergistic toxicity due to multiple vaccines administered concurrently. While the findings in this paper are not proof of an association between infant vaccines and infant deaths, they are highly suggestive of a causal relationship.
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Affiliation(s)
- Neil Z. Miller
- Institute of Medical and Scientific Inquiry, Santa Fe, New Mexico, 87506, USA
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26
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Castanza AS, Ramirez S, Tripathi PP, Daza RAM, Kalume FK, Ramirez JM, Hevner RF. AUTS2 Regulates RNA Metabolism and Dentate Gyrus Development in Mice. Cereb Cortex 2021; 31:4808-4824. [PMID: 34013328 DOI: 10.1093/cercor/bhab124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/23/2022] Open
Abstract
Human AUTS2 mutations are linked to a syndrome of intellectual disability, autistic features, epilepsy, and other neurological and somatic disorders. Although it is known that this unique gene is highly expressed in developing cerebral cortex, the molecular and developmental functions of AUTS2 protein remain unclear. Using proteomics methods to identify AUTS2 binding partners in neonatal mouse cerebral cortex, we found that AUTS2 associates with multiple proteins that regulate RNA transcription, splicing, localization, and stability. Furthermore, AUTS2-containing protein complexes isolated from cortical tissue bound specific RNA transcripts in RNA immunoprecipitation and sequencing assays. Deletion of all major functional isoforms of AUTS2 (full-length and C-terminal) by conditional excision of exon 15 caused breathing abnormalities and neonatal lethality when Auts2 was inactivated throughout the developing brain. Mice with limited inactivation of Auts2 in cerebral cortex survived but displayed abnormalities of cerebral cortex structure and function, including dentate gyrus hypoplasia with agenesis of hilar mossy neurons, and abnormal spiking activity on EEG. Also, RNA transcripts that normally associate with AUTS2 were dysregulated in mutant mice. Together, these findings indicate that AUTS2 regulates RNA metabolism and is essential for development of cerebral cortex, as well as subcortical breathing centers.
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Affiliation(s)
- Anthony S Castanza
- Department of Pathology, University of Washington, Seattle, WA 98195, USA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.,Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
| | - Sanja Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Prem P Tripathi
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Ray A M Daza
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.,Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
| | - Franck K Kalume
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.,Department of Neurological Surgery, University of Washington, Seattle, WA 98014, USA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.,Department of Neurological Surgery, University of Washington, Seattle, WA 98014, USA
| | - Robert F Hevner
- Department of Pathology, University of Washington, Seattle, WA 98195, USA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.,Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA.,Department of Neurological Surgery, University of Washington, Seattle, WA 98014, USA
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27
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Mouradian GC, Lakshminrusimha S, Konduri GG. Perinatal Hypoxemia and Oxygen Sensing. Compr Physiol 2021; 11:1653-1677. [PMID: 33792908 DOI: 10.1002/cphy.c190046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The development of the control of breathing begins in utero and continues postnatally. Fetal breathing movements are needed for establishing connectivity between the lungs and central mechanisms controlling breathing. Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. Though the fetus and neonate have different hypoxia sensing mechanisms and respond differently to acute hypoxia, both responses prevent deviations to respiratory and other developmental processes. Intermittent and chronic hypoxia pose much greater threats to the normal developmental respiratory processes. Gestational intermittent hypoxia, due to maternal sleep-disordered breathing and sleep apnea, increases eupneic breathing and decreases the hypoxic ventilatory response associated with impaired gasping and autoresuscitation postnatally. Chronic fetal hypoxia, due to biologic or environmental (i.e. high-altitude) factors, is implicated in fetal growth restriction and preterm birth causing a decrease in the postnatal hypoxic ventilatory responses with increases in irregular eupneic breathing. Mechanisms driving these changes include delayed chemoreceptor development, catecholaminergic activity, abnormal myelination, increased astrocyte proliferation in the dorsal respiratory group, among others. Long-term high-altitude residents demonstrate favorable adaptations to chronic hypoxia as do their offspring. Neonatal intermittent hypoxia is common among preterm infants due to immature respiratory systems and thus, display a reduced drive to breathe and apneas due to insufficient hypoxic sensitivity. However, ongoing intermittent hypoxia can enhance hypoxic sensitivity causing ventilatory overshoots followed by apnea; the number of apneas is positively correlated with degree of hypoxic sensitivity in preterm infants. Chronic neonatal hypoxia may arise from fetal complications like maternal smoking or from postnatal cardiovascular problems, causing blunting of the hypoxic ventilatory responses throughout at least adolescence due to attenuation of carotid body fibers responses to hypoxia with potential roles of brainstem serotonin, microglia, and inflammation, though these effects depend on the age in which chronic hypoxia initiates. Fetal and neonatal intermittent and chronic hypoxia are implicated in preterm birth and complicate the respiratory system through their direct effects on hypoxia sensing mechanisms and interruptions to the normal developmental processes. Thus, precise regulation of oxygen homeostasis is crucial for normal development of the respiratory control network. © 2021 American Physiological Society. Compr Physiol 11:1653-1677, 2021.
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Affiliation(s)
- Gary C Mouradian
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, UC Davis Children's Hospital, UC Davis Health, UC Davis, Davis, California, USA
| | - Girija G Konduri
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Children's Research Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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28
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Vivekanandarajah A, Nelson ME, Kinney HC, Elliott AJ, Folkerth RD, Tran H, Cotton J, Jacobs P, Minter M, McMillan K, Duncan JR, Broadbelt KG, Schissler K, Odendaal HJ, Angal J, Brink L, Burger EH, Coldrey JA, Dempers J, Boyd TK, Fifer WP, Geldenhuys E, Groenewald C, Holm IA, Myers MM, Randall B, Schubert P, Sens MA, Wright CA, Roberts DJ, Nelsen L, Wadee S, Zaharie D, Haynes RL. Nicotinic Receptors in the Brainstem Ascending Arousal System in SIDS With Analysis of Pre-natal Exposures to Maternal Smoking and Alcohol in High-Risk Populations of the Safe Passage Study. Front Neurol 2021; 12:636668. [PMID: 33776893 PMCID: PMC7988476 DOI: 10.3389/fneur.2021.636668] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
Pre-natal exposures to nicotine and alcohol are known risk factors for sudden infant death syndrome (SIDS), the leading cause of post-neonatal infant mortality. Here, we present data on nicotinic receptor binding, as determined by 125I-epibatidine receptor autoradiography, in the brainstems of infants dying of SIDS and of other known causes of death collected from the Safe Passage Study, a prospective, multicenter study with clinical sites in Cape Town, South Africa and 5 United States sites, including 2 American Indian Reservations. We examined 15 pons and medulla regions related to cardiovascular control and arousal in infants dying of SIDS (n = 12) and infants dying from known causes (n = 20, 10 pre-discharge from time of birth, 10 post-discharge). Overall, there was a developmental decrease in 125I-epibatidine binding with increasing postconceptional age in 5 medullary sites [raphe obscurus, gigantocellularis, paragigantocellularis, centralis, and dorsal accessory olive (p = 0.0002-0.03)], three of which are nuclei containing serotonin cells. Comparing SIDS with post-discharge known cause of death (post-KCOD) controls, we found significant decreased binding in SIDS in the nucleus pontis oralis (p = 0.02), a critical component of the cholinergic ascending arousal system of the rostral pons (post-KCOD, 12.1 ± 0.9 fmol/mg and SIDS, 9.1 ± 0.78 fmol/mg). In addition, we found an effect of maternal smoking in SIDS (n = 11) combined with post-KCOD controls (n = 8) on the raphe obscurus (p = 0.01), gigantocellularis (p = 0.02), and the paragigantocellularis (p = 0.002), three medullary sites found in this study to have decreased binding with age and found in previous studies to have abnormal indices of serotonin neurotransmission in SIDS infants. At these sites, 125I-epibatidine binding increased with increasing cigarettes per week. We found no effect of maternal drinking on 125I-epibatidine binding at any site measured. Taken together, these data support changes in nicotinic receptor binding related to development, cause of death, and exposure to maternal cigarette smoking. These data present new evidence in a prospective study supporting the roles of developmental factors, as well as adverse exposure on nicotinic receptors, in serotonergic nuclei of the rostral medulla-a finding that highlights the interwoven and complex relationship between acetylcholine (via nicotinic receptors) and serotonergic neurotransmission in the medulla.
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Affiliation(s)
- Arunnjah Vivekanandarajah
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Morgan E. Nelson
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Hannah C. Kinney
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Rebecca D. Folkerth
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Forensic Medicine, New York University School of Medicine, New York City, NY, United States
| | - Hoa Tran
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jacob Cotton
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Perri Jacobs
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Megan Minter
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kristin McMillan
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jhodie R. Duncan
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kevin G. Broadbelt
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kathryn Schissler
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Hein J. Odendaal
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Jyoti Angal
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Lucy Brink
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Elsie H. Burger
- Division of Forensic Pathology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University & Western Cape Forensic Pathology Service, Tygerberg, South Africa
| | - Jean A. Coldrey
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Johan Dempers
- Division of Forensic Pathology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University & Western Cape Forensic Pathology Service, Tygerberg, South Africa
| | - Theonia K. Boyd
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - William P. Fifer
- Department of Psychiatry and Pediatrics, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Elaine Geldenhuys
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Coen Groenewald
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Ingrid A. Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Michael M. Myers
- Department of Psychiatry and Pediatrics, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Bradley Randall
- Department of Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Pawel Schubert
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Mary Ann Sens
- Department of Pathology, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Colleen A. Wright
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
- Lancet Laboratories, Johannesburg, South Africa
| | - Drucilla J. Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Shabbir Wadee
- Division of Forensic Pathology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University & Western Cape Forensic Pathology Service, Tygerberg, South Africa
| | - Dan Zaharie
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Robin L. Haynes
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
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29
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Sudden Infant Death Syndrome: Beyond Risk Factors. Life (Basel) 2021; 11:life11030184. [PMID: 33652660 PMCID: PMC7996806 DOI: 10.3390/life11030184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Sudden infant death syndrome (SIDS) is defined as "the sudden death of an infant under 1 year of age which remains unexplained after thorough investigation including a complete autopsy, death scene investigation, and detailed clinical and pathological review". A significant decrease of SIDS deaths occurred in the last decades in most countries after the beginning of national campaigns, mainly as a consequence of the implementation of risk reduction action mostly concentrating on the improvement of sleep conditions. Nevertheless, infant mortality from SIDS still remains unacceptably high. There is an urgent need to get insight into previously unexplored aspects of the brain system with a special focus on high-risk groups. SIDS pathogenesis is associated with a multifactorial condition that comprehends genetic, environmental and sociocultural factors. Effective prevention of SIDS requires multiple interventions from different fields. Developing brain susceptibility, intrinsic vulnerability and early identification of infants with high risk of SIDS represents a challenge. Progress in SIDS research appears to be fundamental to the ultimate aim of eradicating SIDS deaths. A complex model that combines different risk factor data from biomarkers and omic analysis may represent a tool to identify a SIDS risk profile in newborn settings. If high risk is detected, the infant may be referred for further investigations and follow ups. This review aims to illustrate the most recent discoveries from different fields, analyzing the neuroanatomical, genetic, metabolic, proteomic, environmental and sociocultural aspects related to SIDS.
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30
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Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem Neurosci 2021; 12:573-580. [PMID: 33538586 PMCID: PMC7874499 DOI: 10.1021/acschemneuro.0c00793] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
Long-COVID is a postviral illness that can affect survivors of COVID-19, regardless of initial disease severity or age. Symptoms of long-COVID include fatigue, dyspnea, gastrointestinal and cardiac problems, cognitive impairments, myalgia, and others. While the possible causes of long-COVID include long-term tissue damage, viral persistence, and chronic inflammation, the review proposes, perhaps for the first time, that persistent brainstem dysfunction may also be involved. This hypothesis can be split into two parts. The first is the brainstem tropism and damage in COVID-19. As the brainstem has a relatively high expression of ACE2 receptor compared with other brain regions, SARS-CoV-2 may exhibit tropism therein. Evidence also exists that neuropilin-1, a co-receptor of SARS-CoV-2, may be expressed in the brainstem. Indeed, autopsy studies have found SARS-CoV-2 RNA and proteins in the brainstem. The brainstem is also highly prone to damage from pathological immune or vascular activation, which has also been observed in autopsy of COVID-19 cases. The second part concerns functions of the brainstem that overlap with symptoms of long-COVID. The brainstem contains numerous distinct nuclei and subparts that regulate the respiratory, cardiovascular, gastrointestinal, and neurological processes, which can be linked to long-COVID. As neurons do not readily regenerate, brainstem dysfunction may be long-lasting and, thus, is long-COVID. Indeed, brainstem dysfunction has been implicated in other similar disorders, such as chronic pain and migraine and myalgic encephalomyelitis or chronic fatigue syndrome.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological
Sciences, Sunway University, Petaling Jaya, Selangor 47500, Malaysia
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Association between monoamine oxidase A promoter polymorphism and the risk of sudden infant death syndrome: a meta-analysis. Int J Legal Med 2021; 135:1179-1190. [PMID: 33523250 PMCID: PMC8205865 DOI: 10.1007/s00414-020-02496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022]
Abstract
Introduction The etiology of sudden infant death syndrome (SIDS) remains an unsolved problem. The aim of this meta-analysis is to investigate the potential association between monoamine oxidase A (MAOA) promoter variable number tandem repeat (VNTR) polymorphism and SIDS risk. Methods A systematic review and meta-analysis were conducted on studies from accessible electronic databases. Each VNTR variant was examined in each gender independently by comparing with the pooled results of other alleles. Results A total of six independent case–control studies including 1022 SIDS cases and 1839 controls were enrolled in this meta-analysis. In both of the whole populations and Caucasian populations, male infants with the low-MAOA-expression alleles (2R+3R) were found to exhibit a statistically significant increased risk of SIDS, whereas those with a 4R allele exhibited a reduced risk of SIDS. Besides, an increased risk of SIDS was detected in male Caucasian infants with 2R or 3R alleles. However, none of the allele or genotype variants was associated with SIDS in female victims. Conclusion In male Caucasian infants, the low expression of MAOA promoter VNTR alleles (2R and 3R) is associated with an increased risk of SIDS, and the existence of the 4R allele could be regarded as a protective factor.
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Altamirano AE, Wilson CG. An overview of developmental dysregulation of autonomic control in infants. Birth Defects Res 2021; 113:864-871. [PMID: 33421331 DOI: 10.1002/bdr2.1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022]
Abstract
In this short review, we provide an overview of developmental disorders causing autonomic nervous system dysregulation. We briefly discuss perinatal conditions that adversely impact developmental outcomes including apnea of prematurity, sudden infant death syndrome, and Rett syndrome. We provide a brief clinical description, an overview of known or hypothesized mechanisms for the disorder, and current standard of practice for treatment of each condition. Additionally, we consider preventative measures and complications of these disorders to provide further insight into the pathogenesis of specific autonomic dysregulation in neonates. The goal of this short review is to provide an updated understanding of the impact of autonomic dysregulation on development of brainstem circuits and to briefly highlight promising future treatment options and controversies.
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Affiliation(s)
- Adulzir E Altamirano
- Center for Health Disparities, Loma Linda University, Loma Linda, California, USA.,Lawrence D. Longo, M.D. Center for Perinatal Biology, Loma Linda, California, USA
| | - Christopher G Wilson
- Lawrence D. Longo, M.D. Center for Perinatal Biology, Loma Linda, California, USA
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Zuzarte I, Gee AH, Sternad D, Paydarfar D. Automated movement detection reveals features of maturation in preterm infants. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:600-603. [PMID: 33018060 DOI: 10.1109/embc44109.2020.9176091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Nearly 10% of all births in the United States are preterm. Preterm birth is a major risk for developmental neuromotor disorders. Early characterization of a future developmental outcome is necessary to design early interventions. However, such evaluations are currently subjective and typically happen only several months after birth. The aim of this study was to quantify movement bouts after birth and to determine if features of maturation might be characterized. Four preterm infants were continuously monitored for several months, from a few days after birth until discharge, in the Neonatal Intensive Care Unit. Movement was quantified from the photoplethysmogram using a wavelet-based algorithm. In all 4 infants, maturation was associated with a decrease (p < 0.001) in the occurrence of movement bouts ≤ 30s and an increase (p < 0.001) in longer movement bouts (> 30s). The distribution of movement durations followed a power law function with its exponent defining the characteristic of the distribution. The exponent significantly increased with post-menstrual age. Future research will test whether these maturational changes can predict developmental outcomes.Clinical Relevance- Early identification of changes in features of preterm infant movement may be useful in predicting neuromotor development and potential disorders.
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Macchione AF, Trujillo V, Anunziata F, Sahonero M, Anastasia A, Abate P, Molina JC. Early ethanol pre-exposure alters breathing patterns by disruptions in the central respiratory network and serotonergic balance in neonate rats. Behav Brain Res 2020; 396:112908. [PMID: 32961215 DOI: 10.1016/j.bbr.2020.112908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/04/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
Early ethanol exposure alters neonatal breathing plasticity. Respiratory EtOH's effects are attributed to central respiratory network disruptions, particularly in the medullary serotonin (5HT) system. In this study we evaluated the effects of neonatal pre-exposure to low/moderate doses upon breathing rates, activation patterns of brainstem's nuclei and expression of 5HT 2A and 2C receptors. At PD9, breathing frequencies, tidal volumes and apneas were examined in pups pre-exposed to vehicle or ethanol (2.0 g/kg) at PDs 3, 5 and 7. This developmental stage is equivalent to the 3rd human gestational trimester, characterized by increased levels of synaptogenesis. Pups were tested under sobriety or under the state of ethanol intoxication and when subjected to normoxia or hypoxia. Number of c-Fos and 5HT immunolabelled cells and relative mRNA expression of 5HT 2A and 2C receptors were quantified in the brainstem. Under normoxia, ethanol pre-exposed pups exhibited breathing depressions and a high number of apneas. An opposite phenomenon was found in ethanol pre-treated pups tested under hypoxia where an exacerbated hypoxic ventilatory response (HVR) was observed. The breathing depression was associated with an increase in the neural activation levels of the raphe obscurus (ROb) and a high mRNA expression of the 5HT 2A receptor in the brainstem while desactivation of the ROb and high activation levels in the solitary tract nucleus and area postrema were associated to the exacerbated HVR. In summary, early ethanol experience induces respiratory disruptions indicative of sensitization processes. Neuroadaptive changes in central respiratory areas under consideration appear to be strongly associated with changes in their respiratory plasticity.
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Affiliation(s)
- A F Macchione
- Instituto De Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional De Córdoba, Córdoba, Argentina; Facultad De Psicología, Universidad Nacional De Córdoba, Córdoba, Argentina; Instituto De Investigaciones Psicológicas, IIPsi-CONICET-Universidad Nacional De Córdoba, Córdoba, Argentina.
| | - V Trujillo
- Instituto De Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional De Córdoba, Córdoba, Argentina
| | - F Anunziata
- Instituto De Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional De Córdoba, Córdoba, Argentina
| | - M Sahonero
- Facultad De Psicología, Universidad Nacional De Córdoba, Córdoba, Argentina
| | - A Anastasia
- Instituto De Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional De Córdoba, Córdoba, Argentina; Facultad De Psicología, Universidad Nacional De Córdoba, Córdoba, Argentina
| | - P Abate
- Facultad De Psicología, Universidad Nacional De Córdoba, Córdoba, Argentina; Instituto De Investigaciones Psicológicas, IIPsi-CONICET-Universidad Nacional De Córdoba, Córdoba, Argentina
| | - J C Molina
- Instituto De Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET- Universidad Nacional De Córdoba, Córdoba, Argentina; Facultad De Psicología, Universidad Nacional De Córdoba, Córdoba, Argentina.
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Avraam J, Wu Y, Richerson GB. Perinatal Nicotine Reduces Chemosensitivity of Medullary 5-HT Neurons after Maturation in Culture. Neuroscience 2020; 446:80-93. [PMID: 32818601 DOI: 10.1016/j.neuroscience.2020.08.012] [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] [Received: 03/14/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023]
Abstract
Perinatal exposure to nicotine produces ventilatory and chemoreflex deficits in neonatal mammals. Medullary 5-HT neurons are putative central chemoreceptors that innervate respiratory nuclei and promote ventilation, receive cholinergic input and express nicotinic acetylcholine receptors (nAChRs). Perforated patch clamp recordings were made from cultured 5-HT neurons dissociated from the medullary raphé of 0-3 day old mice expressing enhanced yellow fluorescent protein driven by the enhancer region for PET1 (ePet-EYFP). The effect of exposure to low (6 mg kg-1day-1) or high (60 mg kg-1day-1) doses of nicotine in utero (prenatal), in culture (postnatal), or both and the effect of acute nicotine exposure (10 μM), were examined on baseline firing rate (FR at 5% CO2, pH = 7.4) and the change in FR with acidosis (9% CO2, pH 7.2) in young (12-21 days in vitro, DIV) and older (≥22 DIV) acidosis stimulated 5-HT neurons. Nicotine exposed neurons exhibited ∼67% of the response to acidosis recorded in neurons given vehicle (p = 0.005), with older neurons exposed to high dose prenatal and postnatal nicotine, exhibiting only 28% of that recorded in the vehicle neurons (p < 0.01). In neurons exposed to low or high dose prenatal and postnatal nicotine, acute nicotine exposure led to a smaller increase in FR (∼+51% vs +168%, p = 0.026) and response to acidosis (+6% vs +67%, p = 0.014) compared to vehicle. These data show that exposure to nicotine during development reduces chemosensitivity of 5-HT neurons as they mature, an effect that may be related to the abnormal chemoreflexes reported in rodents exposed to nicotine in utero, and may cause a greater risk for sudden infant death syndrome (SIDS).
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Affiliation(s)
- Joanne Avraam
- Department of Neurology, University of Iowa, Iowa City, IA 52242, United States; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Yuanming Wu
- Department of Neurology, University of Iowa, Iowa City, IA 52242, United States
| | - George Bradley Richerson
- Department of Neurology, University of Iowa, Iowa City, IA 52242, United States; Veteran's Affairs Medical Center, Iowa City, IA 52242, United States; Department of Molecular Physiology & Biophysics, University of Iowa, Iowa City, IA 52242, United States; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, United States.
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Post-mortem genetic investigation of cardiac disease-associated genes in sudden infant death syndrome (SIDS) cases. Int J Legal Med 2020; 135:207-212. [PMID: 32789579 PMCID: PMC7782403 DOI: 10.1007/s00414-020-02394-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
The sudden infant death syndrome (SIDS) is one of the leading causes of postneonatal infant death. It has been shown that there exists a complex relationship between SIDS and inherited cardiac disease. Next-generation sequencing and surveillance of cardiac channelopathy and cardiomyopathy genes represent an important tool for investigating the cause of death in SIDS cases. In the present study, targeted sequencing of 80 genes associated with genetic heart diseases in a cohort of 31 SIDS cases was performed. To determine the spectrum and prevalence of genetic heart disease associated mutations as a potential monogenic basis for SIDS, a stringent variant classification was applied and the percentage of rare (minor allele frequency ≤ 0.2%) and ultra-rare variants (minor allele frequency ≤ 0.005%) in these genes was assessed. With a minor allele frequency of ≤ 0.005%, about 20% of the SIDS cases exhibited a variant of uncertain significance (VUS), but in only 6% of these cases, gene variants proved to be “potentially informative.” The present study shows the importance of careful variant interpretation. Applying stringent criteria misinterpretations are avoided, as the results of genetic analyses may have an important impact of the family members involved.
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Kinney HC, Haynes RL. The Serotonin Brainstem Hypothesis for the Sudden Infant Death Syndrome. J Neuropathol Exp Neurol 2020; 78:765-779. [PMID: 31397480 DOI: 10.1093/jnen/nlz062] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/28/2019] [Accepted: 06/25/2019] [Indexed: 01/04/2023] Open
Abstract
The sudden infant death syndrome (SIDS) is the leading cause of postneonatal infant mortality in the United States today, with an overall rate of 0.39/1000 live births. It is defined as the sudden and unexpected death of an infant <12 months of age that remains unexplained after a complete autopsy, death scene investigation, and review of the clinical history. The serotonin brainstem hypothesis has been a leading hypothesis for SIDS over the last 2 decades. Our laboratory has studied this hypothesis over time with a variety of tissue techniques, including tissue receptor autoradiography, high performance liquid chromatography, Western blot analysis, immunocytochemistry, and proteomics. The purpose of this article is to review the progress in our laboratory toward supporting this hypothesis. We conclude that an important subset of SIDS infants has serotonergic abnormalities resulting from a "core lesion" in the medullary reticular formation comprised of nuclei that contain serotonin neurons. This lesion could lead to a failure of protective brainstem responses to homeostatic challenges during sleep in a critical developmental period which cause sleep-related sudden death.
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Affiliation(s)
- Hannah C Kinney
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robin L Haynes
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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38
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Matschke J, Sperhake JP, Wilke N, Püschel K, Glatzel M. Cerebellar heterotopia of infancy in sudden infant death syndrome: an observational neuropathological study of four cases. Int J Legal Med 2020; 134:2143-2147. [PMID: 32435901 PMCID: PMC7577907 DOI: 10.1007/s00414-020-02316-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/08/2020] [Indexed: 12/31/2022]
Abstract
Sudden infant death syndrome (SIDS) is the sudden unexpected death of an infant < 1 year of age that remains unexplained after comprehensive workup including complete autopsy and investigation of the circumstances of death. The triple risk hypothesis posits that SIDS results as a combination of both intrinsic and extrinsic factors on the background of a predisposing vulnerability. Neuropathological examination in the past has focussed mainly on the brainstem as the major player in respiratory control, where subtle findings have been linked to the chain of events leading to death in SIDS. The cerebellum has received less attention, probably due to an assumed negligible role in central cardiorespiratory control. We report four cases of SIDS in which neuropathological investigation revealed cerebellar heterotopia of infancy, a distinct malformation of the cerebellum, and discuss the potential impact of this condition on the aetiology and pathogenesis of SIDS.
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Affiliation(s)
- Jakob Matschke
- Forensic Neuropathology Unit, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Jan-Peter Sperhake
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nadine Wilke
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Institute of Legal Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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39
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Erickson JT. Central serotonin and autoresuscitation capability in mammalian neonates. Exp Neurol 2020; 326:113162. [DOI: 10.1016/j.expneurol.2019.113162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/04/2019] [Accepted: 12/23/2019] [Indexed: 01/08/2023]
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40
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Nasirova N, Quina LA, Agosto-Marlin IM, Ramirez JM, Lambe EK, Turner EE. Dual recombinase fate mapping reveals a transient cholinergic phenotype in multiple populations of developing glutamatergic neurons. J Comp Neurol 2020; 528:283-307. [PMID: 31396962 PMCID: PMC6889053 DOI: 10.1002/cne.24753] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/16/2019] [Accepted: 08/02/2019] [Indexed: 01/13/2023]
Abstract
Cholinergic transmission shapes the maturation of glutamatergic circuits, yet the developmental sources of acetylcholine have not been systematically explored. Here, we have used Cre-recombinase-mediated genetic labeling to identify and map both mature and developing CNS neurons that express choline acetyltransferase (ChAT). Correction of a significant problem with a widely used ChatCre transgenic line ensures that this map does not contain expression artifacts. ChatCre marks all known cholinergic systems in the adult brain, but also identifies several brain areas not usually regarded as cholinergic, including specific thalamic and hypothalamic neurons, the subiculum, the lateral parabrachial nucleus, the cuneate/gracilis nuclei, and the pontocerebellar system. This ChatCre fate map suggests transient developmental expression of a cholinergic phenotype in areas important for cognition, motor control, and respiration. We therefore examined expression of ChAT and the vesicular acetylcholine transporter in the embryonic and early postnatal brain to determine the developmental timing of this transient cholinergic phenotype, and found that it mirrored the establishment of relevant glutamatergic projection pathways. We then used an intersectional genetic strategy combining ChatCre with Vglut2Flp to show that these neurons adopt a glutamatergic fate in the adult brain. The transient cholinergic phenotype of these glutamatergic neurons suggests a homosynaptic source of acetylcholine for the maturation of developing glutamatergic synapses. These findings thus define critical windows during which specific glutamatergic circuits may be vulnerable to disruption by nicotine in utero, and suggest new mechanisms for pediatric disorders associated with maternal smoking, such as sudden infant death syndrome.
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Affiliation(s)
- Nailyam Nasirova
- Center for Integrative Brain Research, Seattle Children’s Research Institute
| | - Lely A. Quina
- Center for Integrative Brain Research, Seattle Children’s Research Institute
| | | | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research Institute
| | - Evelyn K. Lambe
- Departments of Physiology, Obstetrics and Gynecology, and Psychiatry, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Eric E. Turner
- Center for Integrative Brain Research, Seattle Children’s Research Institute
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle WA, 98101
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Effects of inflammation on the developing respiratory system: Focus on hypoglossal (XII) neuron morphology, brainstem neurochemistry, and control of breathing. Respir Physiol Neurobiol 2020; 275:103389. [PMID: 31958568 DOI: 10.1016/j.resp.2020.103389] [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] [Received: 06/03/2019] [Revised: 01/03/2020] [Accepted: 01/16/2020] [Indexed: 12/20/2022]
Abstract
Breathing is fundamental to life and any adverse change in respiratory function can endanger the health of an organism or even be fatal. Perinatal inflammation is known to adversely affect breathing in preterm babies, but lung infection/inflammation impacts all stages of life from birth to death. Little is known about the role of inflammation in respiratory control, neuronal morphology, or neural function during development. Animal models of inflammation can provide understanding and insight into respiratory development and how inflammatory processes alter developmental phenotype in addition to providing insight into new treatment modalities. In this review, we focus on recent work concerning the development of neurons, models of perinatal inflammation with an emphasis on two common LPS-based models, inflammation and its impact on development, and current and potential treatments for inflammation within the respiratory control circuitry of the mammalian brainstem. We have also discussed models of inflammation in adults and have specifically focused on hypoglossal motoneurons (XII) and neurons of the nucleus tractus solitarii (nTS) as these nuclei have been studied more extensively than other brainstem nuclei participating in breathing and airway control. Understanding the impact of inflammation on the developmental aspects of respiratory control and breathing pattern is critical to addressing problems of cardiorespiratory dysregulation in disease and this overview points out many gaps in our current knowledge.
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Vagnozzi AN, Garg K, Dewitz C, Moore MT, Cregg JM, Jeannotte L, Zampieri N, Landmesser LT, Philippidou P. Phrenic-specific transcriptional programs shape respiratory motor output. eLife 2020; 9:52859. [PMID: 31944180 PMCID: PMC7007220 DOI: 10.7554/elife.52859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/14/2020] [Indexed: 12/30/2022] Open
Abstract
The precise pattern of motor neuron (MN) activation is essential for the execution of motor actions; however, the molecular mechanisms that give rise to specific patterns of MN activity are largely unknown. Phrenic MNs integrate multiple inputs to mediate inspiratory activity during breathing and are constrained to fire in a pattern that drives efficient diaphragm contraction. We show that Hox5 transcription factors shape phrenic MN output by connecting phrenic MNs to inhibitory premotor neurons. Hox5 genes establish phrenic MN organization and dendritic topography through the regulation of phrenic-specific cell adhesion programs. In the absence of Hox5 genes, phrenic MN firing becomes asynchronous and erratic due to loss of phrenic MN inhibition. Strikingly, mice lacking Hox5 genes in MNs exhibit abnormal respiratory behavior throughout their lifetime. Our findings support a model where MN-intrinsic transcriptional programs shape the pattern of motor output by orchestrating distinct aspects of MN connectivity. In mammals, air is moved in and out of the lungs by a sheet of muscle called the diaphragm. When this muscle contracts air gets drawn into the lungs and as the muscle relaxes this pushes air back out. Movement of the diaphragm is controlled by a group of nerve cells called motor neurons which are part of the phrenic motor column (or PMC for short) that sits within the spinal cord. The neurons within this column work together with nerve cells in the brain to coordinate the speed and duration of each breath. For the lungs to develop normally, the neurons that control how the diaphragm contracts need to start working before birth. During development, motor neurons in the PMC cluster together and connect with other nerve cells involved in breathing. But, despite their essential role, it is not yet clear how neurons in the PMC develop and join up with other nerve cells. Now, Vagnozzi et al. show that a set of genes which make the transcription factor Hox5 control the position and organization of motor neurons in the PMC. Transcription factors work as genetic switches, turning sets of genes on and off. Vagnozzi et al. showed that removing the Hox5 transcription factors from motor neurons in the PMC changed their activity and disordered their connections with other breathing-related nerve cells. Hox5 transcription factors regulate the production of proteins called cadherins which join together neighboring cells. Therefore, motor neurons lacking Hox5 were unable to make enough cadherins to securely stick together and connect with other nerve cells. Further experiments showed that removing the genes that code for Hox5 caused mice to have breathing difficulties in the first two weeks after birth. Although half of these mutant mice were eventually able to breathe normally, the other half died within a week. These breathing defects are reminiscent of the symptoms observed in sudden infant death syndrome (also known as SIDS). Abnormalities in breathing occur in many other diseases, including sleep apnea, muscular dystrophy and amyotrophic lateral sclerosis (ALS). A better understanding of how the connections between nerve cells involved in breathing are formed, and the role of Hox5 and cadherins, could lead to improved treatment options for these diseases.
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Affiliation(s)
- Alicia N Vagnozzi
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Kiran Garg
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Carola Dewitz
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Matthew T Moore
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Jared M Cregg
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Lucie Jeannotte
- Centre de Recherche sur le Cancer de l'Université Laval, Centre de recherche du CHU de Québec-Université Laval (Oncology), Québec, Canada
| | - Niccolò Zampieri
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Lynn T Landmesser
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, United States
| | - Polyxeni Philippidou
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, United States
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Beyeler SA, Hodges MR, Huxtable AG. Impact of inflammation on developing respiratory control networks: rhythm generation, chemoreception and plasticity. Respir Physiol Neurobiol 2020; 274:103357. [PMID: 31899353 DOI: 10.1016/j.resp.2019.103357] [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: 07/31/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
The respiratory control network in the central nervous system undergoes critical developmental events early in life to ensure adequate breathing at birth. There are at least three "critical windows" in development of respiratory control networks: 1) in utero, 2) newborn (postnatal day 0-4 in rodents), and 3) neonatal (P10-13 in rodents, 2-4 months in humans). During these critical windows, developmental processes required for normal maturation of the respiratory control network occur, thereby increasing vulnerability of the network to insults, such as inflammation. Early life inflammation (induced by LPS, chronic intermittent hypoxia, sustained hypoxia, or neonatal maternal separation) acutely impairs respiratory rhythm generation, chemoreception and increases neonatal risk of mortality. These early life impairments are also greater in young males, suggesting sex-specific impairments in respiratory control. Further, neonatal inflammation has a lasting impact on respiratory control by impairing adult respiratory plasticity. This review focuses on how inflammation alters respiratory rhythm generation, chemoreception and plasticity during each of the three critical windows. We also highlight the need for additional mechanistic studies and increased investigation into how glia (such as microglia and astrocytes) play a role in impaired respiratory control after inflammation. Understanding how inflammation during critical windows of development disrupt respiratory control networks is essential for developing better treatments for vulnerable neonates and preventing adult ventilatory control disorders.
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Affiliation(s)
- Sarah A Beyeler
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, United States
| | - Matthew R Hodges
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Adrianne G Huxtable
- Department of Human Physiology, University of Oregon, Eugene, OR, 97403, United States.
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5-HT neurons and central CO2 chemoreception. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/b978-0-444-64125-0.00021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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45
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Petrucci AN, Joyal KG, Purnell BS, Buchanan GF. Serotonin and sudden unexpected death in epilepsy. Exp Neurol 2019; 325:113145. [PMID: 31866464 DOI: 10.1016/j.expneurol.2019.113145] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 12/20/2022]
Abstract
Epilepsy is a highly prevalent disease characterized by recurrent, spontaneous seizures. Approximately one-third of epilepsy patients will not achieve seizure freedom with medical management and become refractory to conventional treatments. These patients are at greatest risk for sudden unexpected death in epilepsy (SUDEP). The exact etiology of SUDEP is unknown, but a combination of respiratory, cardiac, neuronal electrographic dysfunction, and arousal impairment is thought to underlie SUDEP. Serotonin (5-HT) is involved in regulation of breathing, sleep/wake states, arousal, and seizure modulation and has been implicated in the pathophysiology of SUDEP. This review explores the current state of understanding of the relationship between 5-HT, epilepsy, and respiratory and autonomic control processes relevant to SUDEP in epilepsy patients and in animal models.
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Affiliation(s)
- Alexandra N Petrucci
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA 52242, United States of America; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States of America
| | - Katelyn G Joyal
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA 52242, United States of America; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States of America
| | - Benton S Purnell
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA 52242, United States of America; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States of America
| | - Gordon F Buchanan
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, IA 52242, United States of America; Department of Neurology, University of Iowa, Iowa City, IA 52242, United States of America; Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States of America.
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van der Heijden ME, Zoghbi HY. Development of the brainstem respiratory circuit. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2019; 9:e366. [PMID: 31816185 DOI: 10.1002/wdev.366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 02/01/2023]
Abstract
The respiratory circuit is comprised of over a dozen functionally and anatomically segregated brainstem nuclei that work together to control respiratory rhythms. These respiratory rhythms emerge prenatally but only acquire vital importance at birth, which is the first time the respiratory circuit faces the sole responsibility for O2 /CO2 homeostasis. Hence, the respiratory circuit has little room for trial-and-error-dependent fine tuning and relies on a detailed genetic blueprint for development. This blueprint is provided by transcription factors that have specific spatiotemporal expression patterns along the rostral-caudal or dorsal-ventral axis of the developing brainstem, in proliferating precursor cells and postmitotic neurons. Studying these transcription factors in mice has provided key insights into the functional segregation of respiratory control and the vital importance of specific respiratory nuclei. Many studies converge on just two respiratory nuclei that each have rhythmogenic properties during the prenatal period: the preBötzinger complex (preBötC) and retrotrapezoid nucleus/parafacial nucleus (RTN/pF). Here, we discuss the transcriptional regulation that guides the development of these nuclei. We also summarize evidence showing that normal preBötC development is necessary for neonatal survival, and that neither the preBötC nor the RTN/pF alone is sufficient to sustain normal postnatal respiratory rhythms. Last, we highlight several studies that use intersectional genetics to assess the necessity of transcription factors only in subregions of their expression domain. These studies independently demonstrate that lack of RTN/pF neurons weakens the respiratory circuit, yet these neurons are not necessary for neonatal survival because developmentally related populations can compensate for abnormal RTN/pF function at birth. This article is categorized under: Nervous System Development > Vertebrates: Regional Development.
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Affiliation(s)
- Meike E van der Heijden
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas
| | - Huda Y Zoghbi
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Howard Hughes Medical Institute, Baylor College of Medicine, Houston, Texas
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Lertwittayanon W, Devinsky O, Carlen PL. Cardiorespiratory depression from brainstem seizure activity in freely moving rats. Neurobiol Dis 2019; 134:104628. [PMID: 31669732 DOI: 10.1016/j.nbd.2019.104628] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022] Open
Abstract
Cardiorespiratory dysfunction during or after seizures may contribute to sudden unexpected death in epilepsy. Disruption of lower brainstem cardiorespiratory systems by seizures is postulated to impair respiratory and cardiac function. Here, we explore the effects of brainstem seizures and stimulation on cardiorespiratory function using a rat model of intrahippocampal 4-aminopyridine (4-AP)-induced acute recurrent seizures. Cardiac and respiratory monitoring together with local field potential recordings from hippocampus, contralateral parietal cortex and caudal dorsomedial brainstem, were conducted in freely moving adult male Wistar rats. Seizures were induced by intrahippocampal injection of 4-AP. Increased respiratory rate but unchanged heart rate occurred during hippocampal and secondarily generalized cortical seizures. Status epilepticus without brainstem seizures increased respiratory and heart rates, whereas status epilepticus with intermittent brainstem seizures induced repeated episodes of cardiorespiratory depression leading to death. Respiratory arrest occurred prior to asystole which was the terminal event. Phenytoin (100 mg/kg, intraperitoneal injection), administered after 4-AP intrahippocampal injection, terminated brainstem seizures and the associated cardiorespiratory depression, preventing death in five of six rats. Focal electrical stimulation of the caudal dorsomedial brainstem also suppressed cardiorespiratory rates. We conclude that in our model, brainstem seizures were associated with respiratory depression followed by cardiac arrest, and then death. We hypothesize this model shares mechanisms in common with the classic sudden unexpected death in epilepsy (SUDEP) syndrome associated with spontaneous seizures.
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Affiliation(s)
- Wanida Lertwittayanon
- Krembil Research Institute, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Department of Physiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand; Research unit for EEG biomarkers of neuronal diseases, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Orrin Devinsky
- New York University Medical Center, Neurology, NY, New York, United States
| | - Peter L Carlen
- Krembil Research Institute, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Departments of Medicine (Neurology), Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada.
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Murugesan A, Rani MRS, Vilella L, Lacuey N, Hampson JP, Faingold CL, Friedman D, Devinsky O, Sainju RK, Schuele S, Diehl B, Nei M, Harper RM, Bateman LM, Richerson G, Lhatoo SD. Postictal serotonin levels are associated with peri-ictal apnea. Neurology 2019; 93:e1485-e1494. [PMID: 31484709 DOI: 10.1212/wnl.0000000000008244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine the relationship between serum serotonin (5-HT) levels, ictal central apnea (ICA), and postconvulsive central apnea (PCCA) in epileptic seizures. METHODS We prospectively evaluated video EEG, plethysmography, capillary oxygen saturation (SpO2), and ECG for 49 patients (49 seizures) enrolled in a multicenter study of sudden unexpected death in epilepsy (SUDEP). Postictal and interictal venous blood samples were collected after a clinical seizure for measurement of serum 5-HT levels. Seizures were classified according to the International League Against Epilepsy 2017 seizure classification. We analyzed seizures with and without ICA (n = 49) and generalized convulsive seizures (GCS) with and without PCCA (n = 27). RESULTS Postictal serum 5-HT levels were increased over interictal levels for seizures without ICA (p = 0.01), compared to seizures with ICA (p = 0.21). In patients with GCS without PCCA, serum 5-HT levels were increased postictally compared to interictal levels (p < 0.001), but not in patients with seizures with PCCA (p = 0.22). Postictal minus interictal 5-HT levels also differed between the 2 groups with and without PCCA (p = 0.03). Increased heart rate was accompanied by increased serum 5-HT levels (postictal minus interictal) after seizures without PCCA (p = 0.03) compared to those with PCCA (p = 0.42). CONCLUSIONS The data suggest that significant seizure-related increases in serum 5-HT levels are associated with a lower incidence of seizure-related breathing dysfunction, and may reflect physiologic changes that confer a protective effect against deleterious phenomena leading to SUDEP. These results need to be confirmed with a larger sample size study.
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Affiliation(s)
- Arun Murugesan
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - M R Sandhya Rani
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD.
| | - Laura Vilella
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Nuria Lacuey
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Johnson P Hampson
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Carl L Faingold
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Daniel Friedman
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Orrin Devinsky
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Rup K Sainju
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Stephan Schuele
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Beate Diehl
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Maromi Nei
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Ronald M Harper
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Lisa M Bateman
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - George Richerson
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
| | - Samden D Lhatoo
- From the Department of Neurology (A.M.), Case Western Reserve University; Department of Neurology (M.R.S.R., L.V., N.L., J.P.H., S.D.L.), McGovern Medical School, University of Texas Health Science Center at Houston; Department of Pharmacology and Neurology (C.L.F.), Southern Illinois University School of Medicine, Springfield; Department of Neurology (D.F., O.D.), New York University School of Medicine, New York; Department of Neurology (R.K.S., G.R.), University of Iowa Carver College of Medicine, Iowa City; Department of Neurology (S.S.), Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Neurology (B.D.), University College London, UK; Department of Neurology (M.N.), Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Department of Neurobiology (R.M.H.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Neurology (L.M.B.), Columbia University Medical Center, New York, NY; and Center for SUDEP Research (M.R.S.R., L.V., N.L., D.F., O.D., R.K.S., S.S., B.D., M.N., R.M.H., L.M.B., G.R., S.D.L.), National Institute for Neurological Disorders and Stroke, Bethesda, MD
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Lacuey N, Martins R, Vilella L, Hampson JP, Rani MRS, Strohl K, Zaremba A, Hampson JS, Sainju RK, Friedman D, Nei M, Scott C, Gehlbach BK, Hupp NJ, Schuele S, Ogren J, Harper RM, Allen L, Diehl B, Bateman LM, Devinsky O, Richerson GB, Lhatoo S. The association of serotonin reuptake inhibitors and benzodiazepines with ictal central apnea. Epilepsy Behav 2019; 98:73-79. [PMID: 31301453 PMCID: PMC8975169 DOI: 10.1016/j.yebeh.2019.06.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Ictal (ICA) and postconvulsive central apnea (PCCA) have been implicated in sudden unexpected death in epilepsy (SUDEP) pathomechanisms. Previous studies suggest that serotonin reuptake inhibitors (SRIs) and benzodiazepines (BZDs) may influence breathing. The aim of this study was to investigate if chronic use of these drugs alters central apnea occurrence in patients with epilepsy. METHODS Patients with epilepsy admitted to epilepsy monitoring units (EMUs) in nine centers participating in a SUDEP study were consented. Polygraphic physiological parameters were analyzed, including video-electroencephalography (VEEG), thoracoabdominal excursions, and pulse oximetry. Outpatient medication details were collected. Patients and seizures were divided into SRI, BZD, and control (no SRI or BZD) groups. Ictal central apnea and PCCA, hypoxemia, and electroclinical features were assessed for each group. RESULTS Four hundred and seventy-six seizures were analyzed (204 patients). The relative risk (RR) for ICA in the SRI group was half that of the control group (p = 0.02). In the BZD group, ICA duration was significantly shorter than in the control group (p = 0.02), as was postictal generalized EEG suppression (PGES) duration (p = 0.021). Both SRI and BZD groups were associated with smaller seizure-associated oxygen desaturation (p = 0.009; p ≪ 0.001). Neither presence nor duration of PCCA was significantly associated with SRI or BZD (p ≫ 0.05). CONCLUSIONS Seizures in patients taking SRIs have lower occurrence of ICA, and patients on chronic treatment with BZDs have shorter ICA and PGES durations. Preventing or shortening ICA duration by using SRIs and/or BZD in patients with epilepsy may play a possible role in SUDEP risk reduction.
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Affiliation(s)
- Nuria Lacuey
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Rita Martins
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Laura Vilella
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Johnson P. Hampson
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Kingman Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Medical Center, Cleveland, OH, USA
| | - Anita Zaremba
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | | | - Rup K. Sainju
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daniel Friedman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,NYU Langone School of Medicine, New York, NY, USA
| | - Maromi Nei
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Catherine Scott
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Brian K Gehlbach
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Norma J. Hupp
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
| | - Stephan Schuele
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Northwestern University, Feinberg School of Medicine, Chicago
| | - Jennifer Ogren
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ronald M. Harper
- Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal,Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Luke Allen
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Beate Diehl
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Institute of Neurology, University College London, London, UK
| | - Lisa M. Bateman
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,Department of Neurology, Columbia University, New York, NY, USA
| | - Orrin Devinsky
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,NYU Langone School of Medicine, New York, NY, USA
| | - George B. Richerson
- NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA,University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Samden Lhatoo
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,NINDS Center for SUDEP Research (CSR), Cleveland, OH, USA
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Sex differences in breathing. Comp Biochem Physiol A Mol Integr Physiol 2019; 238:110543. [PMID: 31445081 DOI: 10.1016/j.cbpa.2019.110543] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/15/2023]
Abstract
Breathing is a vital behavior that ensures both the adequate supply of oxygen and the elimination of CO2, and it is influenced by many factors. Despite that most of the studies in respiratory physiology rely heavily on male subjects, there is much evidence to suggest that sex is an important factor in the respiratory control system, including the susceptibility for some diseases. These different respiratory responses in males and females may be related to the actions of sex hormones, especially in adulthood. These hormones affect neuromodulatory systems that influence the central medullary rhythm/pontine pattern generator and integrator, sensory inputs to the integrator and motor output to the respiratory muscles. In this article, we will first review the sex dependence on the prevalence of some respiratory-related diseases. Then, we will discuss the role of sex and gonadal hormones in respiratory control under resting conditions and during respiratory challenges, such as hypoxia and hypercapnia, and whether hormonal fluctuations during the estrous/menstrual cycle affect breathing control. We will then discuss the role of the locus coeruleus, a sexually dimorphic CO2/pH-chemosensitive nucleus, on breathing regulation in males and females. Next, we will highlight the studies that exist regarding sex differences in respiratory control during development. Finally, the few existing studies regarding the influence of sex on breathing control in non-mammalian vertebrates will be discussed.
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