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Beurel E, Nemeroff CB. Early Life Adversity, Microbiome, and Inflammatory Responses. Biomolecules 2024; 14:802. [PMID: 39062516 PMCID: PMC11275239 DOI: 10.3390/biom14070802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Early life adversity has a profound impact on physical and mental health. Because the central nervous and immune systems are not fully mature at birth and continue to mature during the postnatal period, a bidirectional interaction between the central nervous system and the immune system has been hypothesized, with traumatic stressors during childhood being pivotal in priming individuals for later adult psychopathology. Similarly, the microbiome, which regulates both neurodevelopment and immune function, also matures during childhood, rendering this interaction between the brain and the immune system even more complex. In this review, we provide evidence for the role of the immune response and the microbiome in the deleterious effects of early life adversity, both in humans and rodent models.
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Affiliation(s)
- Eléonore Beurel
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, Mulva Clinic for Neurosciences, University of Texas (UT) Dell Medical School, Austin, TX 78712, USA
- Mulva Clinic for Neurosciences, UT Austin Dell Medical School, Austin, TX 78712, USA
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Chatziparasidis G, Chatziparasidi MR, Kantar A, Bush A. Time-dependent gene-environment interactions are essential drivers of asthma initiation and persistence. Pediatr Pulmonol 2024; 59:1143-1152. [PMID: 38380964 DOI: 10.1002/ppul.26935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
Asthma is a clinical syndrome caused by heterogeneous underlying mechanisms with some of them having a strong genetic component. It is known that up to 82% of atopic asthma has a genetic background with the rest being influenced by environmental factors that cause epigenetic modification(s) of gene expression. The interaction between the gene(s) and the environment has long been regarded as the most likely explanation of asthma initiation and persistence. Lately, much attention has been given to the time frame the interaction occurs since the host response (immune or biological) to environmental triggers, differs at different developmental ages. The integration of the time variant into asthma pathogenesis is appearing to be equally important as the gene(s)-environment interaction. It seems that, all three factors should be present to trigger the asthma initiation and persistence cascade. Herein, we introduce the importance of the time variant in asthma pathogenesis and emphasize the long-term clinical significance of the time-dependent gene-environment interactions in childhood.
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Affiliation(s)
- Grigorios Chatziparasidis
- Faculty of Nursing, University of Thessaly, Volos, Greece
- School of Physical Education, Sport Science & Dietetics, University of Thessaly, Volos, Greece
| | | | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Instituti Ospedalieri Bergamashi, Bergamo, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrew Bush
- Departments of Paediatrics and Paediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, UK
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Adgent MA, Buth E, Noroña-Zhou A, Szpiro AA, Loftus CT, Moore PE, Wright RJ, Barrett ES, LeWinn KZ, Zhao Q, Nguyen R, Karr CJ, Bush NR, Carroll KN. Maternal stressful life events during pregnancy and childhood asthma and wheeze. Ann Allergy Asthma Immunol 2024; 132:594-601.e3. [PMID: 38122928 PMCID: PMC11069451 DOI: 10.1016/j.anai.2023.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Studies have linked prenatal maternal psychosocial stress to childhood wheeze/asthma but have rarely investigated factors that may mitigate risks. OBJECTIVE To investigate associations between prenatal stress and childhood wheeze/asthma, evaluating factors that may modify stress effects. METHODS Participants included 2056 mother-child dyads from Environmental influences on Child Health Outcomes (ECHO)-PATHWAYS, a consortium of 3 prospective pregnancy cohorts (the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study, The Infant Development and Environment Study, and a subset of the Global Alliance to Prevent Prematurity and Stillbirth study) from 6 cities. Maternal stressful life events experienced during pregnancy (PSLEs) were reported using the Pregnancy Risk Assessment Monitoring System Stressful Life Events questionnaire. Parents reported child wheeze/asthma outcomes at age 4 to 6 years using standardized questionnaires. We defined outcomes as ever asthma, current wheeze, current asthma, and strict asthma. We used modified Poisson regression with robust standard errors (SEs) to estimate risk ratios (RRs) and 95% CI per 1-unit increase in PSLE, adjusting for confounders. We evaluated effect modification by child sex, maternal history of asthma, maternal childhood traumatic life events, neighborhood-level resources, and breastfeeding. RESULTS Overall, we observed significantly elevated risk for current wheeze with increasing PSLE (RR, 1.09 [95% CI, 1.03-1.14]), but not for other outcomes. We observed significant effect modification by child sex for strict asthma (P interaction = .03), in which risks were elevated in boys (RR, 1.10 [95% CI, 1.02-1.19]) but not in girls. For all other outcomes, risks were significantly elevated in boys and not in girls, although there was no statistically significant evidence of effect modification. We observed no evidence of effect modification by other factors (P interactions > .05). CONCLUSION Risk of adverse childhood respiratory outcomes is higher with increasing maternal PSLEs, particularly in boys.
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Affiliation(s)
| | - Erin Buth
- University of Washington, Seattle WA
| | | | | | | | | | | | - Emily S. Barrett
- Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute; Piscataway NJ
| | - Kaja Z. LeWinn
- University of California San Francisco, San Francisco CA
| | - Qi Zhao
- University of Tennessee Health Sciences Center, Memphis TN
| | | | | | - Nicole R. Bush
- University of California San Francisco, San Francisco CA
| | - Kecia N. Carroll
- Vanderbilt University Medical Center, Nashville TN
- Icahn School of Medicine at Mount Sinai, New York NY
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Nusslock R, Alloy LB, Brody GH, Miller GE. Annual Research Review: Neuroimmune network model of depression: a developmental perspective. J Child Psychol Psychiatry 2024; 65:538-567. [PMID: 38426610 PMCID: PMC11090270 DOI: 10.1111/jcpp.13961] [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] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Depression is a serious public health problem, and adolescence is an 'age of risk' for the onset of Major Depressive Disorder. Recently, we and others have proposed neuroimmune network models that highlight bidirectional communication between the brain and the immune system in both mental and physical health, including depression. These models draw on research indicating that the cellular actors (particularly monocytes) and signaling molecules (particularly cytokines) that orchestrate inflammation in the periphery can directly modulate the structure and function of the brain. In the brain, inflammatory activity heightens sensitivity to threats in the cortico-amygdala circuit, lowers sensitivity to rewards in the cortico-striatal circuit, and alters executive control and emotion regulation in the prefrontal cortex. When dysregulated, and particularly under conditions of chronic stress, inflammation can generate feelings of dysphoria, distress, and anhedonia. This is proposed to initiate unhealthy, self-medicating behaviors (e.g. substance use, poor diet) to manage the dysphoria, which further heighten inflammation. Over time, dysregulation in these brain circuits and the inflammatory response may compound each other to form a positive feedback loop, whereby dysregulation in one organ system exacerbates the other. We and others suggest that this neuroimmune dysregulation is a dynamic joint vulnerability for depression, particularly during adolescence. We have three goals for the present paper. First, we extend neuroimmune network models of mental and physical health to generate a developmental framework of risk for the onset of depression during adolescence. Second, we examine how a neuroimmune network perspective can help explain the high rates of comorbidity between depression and other psychiatric disorders across development, and multimorbidity between depression and stress-related medical illnesses. Finally, we consider how identifying neuroimmune pathways to depression can facilitate a 'next generation' of behavioral and biological interventions that target neuroimmune signaling to treat, and ideally prevent, depression in youth and adolescents.
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Affiliation(s)
- Robin Nusslock
- Department of Psychology, Northwestern University, Evanston IL, USA
- Institute for Policy Research, Northwestern University, Evanston IL, USA
| | - Lauren B. Alloy
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA. USA
| | - Gene H. Brody
- Center for Family Research, University of Georgia, Athens GA, USA
| | - Gregory E. Miller
- Department of Psychology, Northwestern University, Evanston IL, USA
- Institute for Policy Research, Northwestern University, Evanston IL, USA
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Chen HJ, Galley JD, Verosky BG, Yang FT, Rajasekera TA, Bailey MT, Gur TL. Fetal CCL2 signaling mediates offspring social behavior and recapitulates effects of prenatal stress. Brain Behav Immun 2024; 115:308-318. [PMID: 37914098 PMCID: PMC10872760 DOI: 10.1016/j.bbi.2023.10.032] [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: 04/09/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023] Open
Abstract
Maternal stress during pregnancy is prevalent and associated with increased risk of neurodevelopmental disorders in the offspring. Maternal and offspring immune dysfunction has been implicated as a potential mechanism by which prenatal stress shapes offspring neurodevelopment; however, the impact of prenatal stress on the developing immune system has yet to be elucidated. Furthermore, there is evidence that the chemokine C-C motif chemokine ligand 2 (CCL2) plays a key role in mediating the behavioral sequelae of prenatal stress. Here, we use an established model of prenatal restraint stress in mice to investigate alterations in the fetal immune system, with a focus on CCL2. In the placenta, stress led to a reduction in CCL2 and Ccr2 expression with a concomitant decrease in leukocyte number. However, the fetal liver exhibited an inflammatory phenotype, with upregulation of Ccl2, Il6, and Lbp expression, along with an increase in pro-inflammatory Ly6CHi monocytes. Prenatal stress also disrupted chemokine signaling and increased the number of monocytes and microglia in the fetal brain. Furthermore, stress increased Il1b expression by fetal brain CD11b+ microglia and monocytes. Finally, intra-amniotic injections of recombinant mouse CCL2 partially recapitulated the social behavioral deficits in the adult offspring previously observed in the prenatal restraint stress model. Altogether, these data suggest that prenatal stress led to fetal inflammation, and that fetal CCL2 plays a role in shaping offspring social behavior.
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Affiliation(s)
- Helen J Chen
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States
| | - Jeffrey D Galley
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Branden G Verosky
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States
| | - Felix T Yang
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States
| | - Therese A Rajasekera
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael T Bailey
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Center for Microbial Pathogenesis, The Research Institute, Nationwide Children's Hospital, Columbus, OH, United States; Biosciences Division, College of Dentistry, The Ohio State University, Columbus, OH, United States; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tamar L Gur
- Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Medical Scientist Training Program, The Ohio State University, Columbus, OH, United States; Department of Obstetrics & Gynecology, The Ohio State University Wexner Medical Center, Columbus OH, United States.
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Falkenstein DK, Jarvis JN. Systemic lupus erythematosus in American Indian/Alaska natives: Incorporating our new understanding of the biology of trauma. Semin Arthritis Rheum 2023; 63:152245. [PMID: 37595507 DOI: 10.1016/j.semarthrit.2023.152245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE To review the literature regarding systemic lupus erythematosus (SLE) in American Indian/Alaska Native (AI/AN) people and relate prevalence and/or disease severity to our emerging understanding of the biology of trauma and toxic stress. METHODS We conducted a search and review of the literature using search terms "lupus and American Indians" "ACEs and disease outcome" "Biology of Adversity" "lupus and ACE scores," " lupus and childhood abuse." These search criteria were entered into Google Scholar and articles retrieved from PubMed, NBCI. This approach yielded a small numbers of papers used throughout this review. We excluded articles that were not published in a peer reviewed journals, as well as editorial commentaries. RESULTS In the AI/AN population, SLE shows high prevalence rates and severe disease manifestations, comparable to the African American population. AI/AN populations also have high rates of childhood trauma. Toxic stress and trauma such as those catalogued in the Adverse Childhood Experiences (ACE) study have broad-reaching immunologic and epigenetic effects that are likely to be relevant to our understanding of SLE in AI/AN people. CONCLUSIONS AI/AN people have high rates of SLE. These high rates are likely to be driven by many complex factors, not all of which are genetic. Future research is needed to establish (or refute) a causal connection between the biology of adversity and SLE in socially marginalized and historically traumatized populations.
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Affiliation(s)
- Danielle K Falkenstein
- Medical Student, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA
| | - James N Jarvis
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA; Genetics, Genomics, & Bioinformatics Program, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA.
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Chen E, Jiang T, Chen MA, Chiu RY, Miller GE. Resilience in children with chronic illness: Tests of the shift-and-persist and skin-deep resilience theories. Dev Psychopathol 2023; 35:2264-2274. [PMID: 37340834 DOI: 10.1017/s0954579423000603] [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] [Indexed: 06/22/2023]
Abstract
This study investigated, and discusses the integration of, the shift-and-persist (SAP) and skin-deep resilience (SDR) theories. The SAP theory states that the combination of shifting (adjusting oneself to stressful situations through strategies like emotion regulation) and persisting (enduring adversity with strength by finding meaning and maintaining optimism) will be beneficial to physical health in children experiencing adversity. The SDR theory states that high striving/self-control will be beneficial to mental health but detrimental to physical health among those confronting adversity. This study investigated 308 children ages 8-17 experiencing the adversity of a chronic illness (asthma). SAP and SDR (striving/self-control) were assessed via questionnaires, and physical health (asthma symptoms, inflammatory profiles), mental health (anxiety/depression, emotional functioning), and behavioral (medication adherence, activity limitations, collaborative relationships with providers) outcomes were measured cross-sectionally. SAP was associated with better physical health, whereas SDR was associated with worse physical health. Both were associated with better mental health. Only SDR was associated with better behavioral outcomes. Implications of findings and discussion of how to integrate these theories are provided. We suggest that future interventions might seek to cultivate both SAP and SDR to promote overall better health and well-being across multiple domains in children experiencing adversity.
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Affiliation(s)
- Edith Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Tao Jiang
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Michelle A Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Rachel Y Chiu
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - Gregory E Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
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Zhou J, Tong J, Ru X, Teng Y, Geng M, Yan S, Tao F, Huang K. Placental inflammatory cytokines mRNA expression and preschool children's cognitive performance: a birth cohort study in China. BMC Med 2023; 21:449. [PMID: 37981714 PMCID: PMC10658981 DOI: 10.1186/s12916-023-03173-2] [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: 01/31/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND The immunologic milieu at the maternal-fetal interface has profound effects on propelling the development of the fetal brain. However, accessible epidemiological studies concerning the association between placental inflammatory cytokines and the intellectual development of offspring in humans are limited. Therefore, we explored the possible link between mRNA expression of inflammatory cytokines in placenta and preschoolers' cognitive performance. METHODS Study subjects were obtained from the Ma'anshan birth cohort (MABC). Placental samples were collected after delivery, and real-time quantitative polymerase chain reaction (RT-qPCR) was utilized to measure the mRNA expression levels of IL-8, IL-1β, IL-6, TNF-α, CRP, IFN-γ, IL-10, and IL-4. Children's intellectual development was assessed at preschool age by using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Multiple linear regression and restricted cubic spline models were used for statistical analysis. RESULTS A total of 1665 pairs of mother and child were included in the analysis. After adjusting for confounders and after correction for multiple comparisons, we observed that mRNA expression of IL-8 (β = - 0.53; 95% CI, - 0.92 to - 0.15), IL-6 (β = - 0.58; 95% CI, - 0.97 to - 0.19), TNF-α (β = - 0.37; 95% CI, - 0.71 to - 0.02), and IFN-γ (β = - 0.31; 95% CI, - 0.61 to - 0.03) in the placenta was negatively associated with preschoolers' full scale intelligence quotient (FSIQ). Both higher IL-8 and IL-6 were associated with lower children's low fluid reasoning index (FRI), and higher IFN-γ was associated with lower children's working memory index (WMI). After further adjusting for confounders and children's age at cognitive testing, the integrated index of six pro-inflammatory cytokines (index 2) was found to be significantly and negatively correlated with both the FSIQ and each sub-dimension (verbal comprehension index (VCI), visual spatial index (VSI), FRI, WMI, processing speed index (PSI)). Sex-stratified analyses showed that the association of IL-8, IFN-γ, and index 2 with children's cognitive development was mainly concentrated in boys. CONCLUSIONS Evidence of an association between low cognitive performance and high expression of placental inflammatory cytokines (IL-8, IL-6, TNF-α, and IFN-γ) was found, highlighting the potential importance of intrauterine placental immune status in dissecting offspring cognitive development.
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Affiliation(s)
- Jixing Zhou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Juan Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Xue Ru
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Yuzhu Teng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Menglong Geng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Shuangqin Yan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Maternal and Child Health Care Center of Ma'anshan, No 24 Jiashan Road, Ma'anshan 243011, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, 230032, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.
- Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, Hefei, 230032, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, 230032, China.
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Anhui Province, China.
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Han YY, Chen W, Forno E, Celedón JC. Adverse Events during Adulthood, Child Maltreatment, and Asthma among British Adults in the UK Biobank. Ann Am Thorac Soc 2023; 20:1614-1623. [PMID: 37668472 PMCID: PMC10632932 DOI: 10.1513/annalsats.202305-481oc] [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: 05/28/2023] [Accepted: 09/05/2023] [Indexed: 09/06/2023] Open
Abstract
Rationale: Intimate partner violence and child maltreatment have been separately associated with asthma in adults. No study has concurrently examined of adulthood adverse events (including, but not limited to, intimate partner violence) and child maltreatment on asthma in adults. Objectives: To concurrently examine of adulthood adverse events and child maltreatment on asthma in adults. Methods: This was a cross-sectional study of adulthood adverse events and child maltreatment on current asthma in 87,891 adults 40-69 years old who participated in the UK Biobank. Adulthood adverse events were assessed using questions adapted from a national crime survey. Child maltreatment was ascertained using the Childhood Trauma Screener questionnaire. Current asthma was defined as physician-diagnosed asthma and current wheeze and was further classified as noneosinophilic or eosinophilic according to eosinophil count (<300 vs. ⩾300 cells per microliter). Results: In a multivariable analysis, participants who reported two or more types of adulthood adverse events had 1.19-1.45 times significantly higher odds of asthma than those who did not, whereas participants who reported two or more types of child maltreatment had 1.25-1.59 significantly higher odds of asthma than those who reported no child maltreatment. After stratification by sex, similar results were obtained for child maltreatment in women and men, whereas adulthood adverse events were only significantly associated with asthma in women. Similar findings were observed in analyses that were restricted to never-smokers and former smokers with <10 pack-years of smoking and in analyses of noneosinophilic and eosinophilic asthma. Conclusions: In a cohort of British adults, child maltreatment was associated with current asthma in men and women, whereas adulthood adverse events were associated with current asthma in women only. This was independent of cigarette smoking or eosinophil count.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Clayborne ZM, Zou R, Gilman SE, Khandaker GM, Fell DB, Colman I, El Marroun H. Associations between prenatal maternal stress, maternal inflammation during pregnancy, and children's internalizing and externalizing symptoms throughout childhood. Brain Behav Immun 2023; 114:165-172. [PMID: 37607663 DOI: 10.1016/j.bbi.2023.08.017] [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: 02/02/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Maternal immune activation is a potential mechanism underlying associations between maternal stress during pregnancy and offspring mental health problems. This study examined associations between prenatal maternal stress, maternal inflammation during pregnancy, and children's internalizing and externalizing symptoms from 3 to 10 years of age, and whether maternal inflammation mediated the associations between prenatal maternal stress and children's internalizing and externalizing symptoms. METHODS This study comprised 4,902 mother-child dyads in the Generation R study. Prenatal maternal stress was assessed using self-reported data collected during pregnancy and analyzed as a latent variable consisting of four stress domains. Maternal inflammation during pregnancy was assessed using serum concentrations of C-reactive protein (CRP) measured at a median of 13.5 weeks' gestation. Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist (CBCL) by maternal report at ages 3 years, 5 years, and 10 years; paternal-reported CBCL data were also available at 3 years and 10 years. RESULTS Prenatal maternal stress was associated with maternal-reported internalizing and externalizing symptoms of the child at 3, 5, and 10 years of age, and with paternal-reported internalizing and externalizing symptoms at 3 and 10 years. Prenatal maternal stress was associated with maternal CRP concentrations prior to, but not after, covariate adjustment. Maternal CRP concentrations during pregnancy were associated with paternal-reported internalizing symptoms of offspring at 10 years of age prior to, but not after, covariate adjustment. There was no evidence that CRP concentrations mediated the associations between prenatal maternal stress and children's internalizing or externalizing symptoms. CONCLUSIONS Maternal stress during pregnancy is associated with higher levels of internalizing and externalizing symptoms in children, but this association is not because of differences in maternal immune activation linked to maternal stress. Replication of these findings in other cohorts is required; examination of other biomarkers or variation in immune activity during pregnancy would also benefit from further exploration.
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Affiliation(s)
- Zahra M Clayborne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Runyu Zou
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Golam M Khandaker
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Deshayne B Fell
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
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11
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Bermejo-Haro MY, Camacho-Pacheco RT, Brito-Pérez Y, Mancilla-Herrera I. The hormonal physiology of immune components in breast milk and their impact on the infant immune response. Mol Cell Endocrinol 2023:111956. [PMID: 37236499 DOI: 10.1016/j.mce.2023.111956] [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: 03/07/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
During pregnancy, the maternal body undergoes a considerable transformation regarding the anatomy, metabolism, and immune profile that, after delivery, allows for protection and nourishment of the offspring via lactation. Pregnancy hormones are responsible for the development and functionality of the mammary gland for breast milk production, but little is known about how hormones control its immune properties. Breast milk composition is highly dynamic, adapting to the nutritional and immunological needs that the infant requires in the first months of life and is responsible for the main immune modeling of breastfed newborns. Therefore, alterations in the mechanisms that control the endocrinology of mammary gland adaptation for lactation could disturb the properties of breast milk that prepare the neonatal immune system to respond to the first immunologic challenges. In modern life, humans are chronically exposed to endocrine disruptors (EDs), which alter the endocrine physiology of mammals, affecting the composition of breast milk and hence the neonatal immune response. In this review, we provide a landscape of the possible role of hormones in the control of passive immunity transferred by breast milk and the possible effect of maternal exposure to EDs on lactation, as well as their impacts on the development of neonatal immunity.
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Affiliation(s)
- Mextli Y Bermejo-Haro
- Infectology and Immunology Department, National Institute of Perinatology (INPer), Mexico City, Mexico; Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico; Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, 11340, Mexico
| | - Rodrigo T Camacho-Pacheco
- Infectology and Immunology Department, National Institute of Perinatology (INPer), Mexico City, Mexico; Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico; Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, 11340, Mexico
| | - Yesenia Brito-Pérez
- Infectology and Immunology Department, National Institute of Perinatology (INPer), Mexico City, Mexico; Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico; Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, 11340, Mexico
| | - Ismael Mancilla-Herrera
- Infectology and Immunology Department, National Institute of Perinatology (INPer), Mexico City, Mexico.
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12
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Busse W, Bartels C, Rosenkranz M. Brain-Airway Interactions in Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:185-214. [PMID: 37464122 DOI: 10.1007/978-3-031-32259-4_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma and brain interactions have long been appreciated and initially centered on increased anxiety and depression. Epidemiology studies have shown that early life stressors and situational disadvantages are risk factors for asthma. Conversely, the presence of asthma is a risk for mood and anxiety disorders, thus indicating a bidirectional effect between asthma and brain-related health. To substantiate asthma-brain interactions, validated instruments indicate and elucidate that communication likely exists between asthma and the brain. For example, provocation of an asthmatic response with an allergen challenge modulates how the brain responds to emotion-laden information. As detected by imaging studies, emotion-related brain activation is associated with generating airway inflammation. However, the specific mediators and processes mediating airway communication with the brain have yet to be established.Systemic inflammation is also associated with asthma and can affect other organ systems such as the cardiovascular system and the brain. Epidemiology studies have shown that asthma is a risk factor for dementia and Alzheimer's disease. In support of the importance of asthma as a risk factor for impaired cognitive function, imaging studies have shown changes to the white matter of the brain in asthma patients that resemble neuroinflammation changes seen in Alzheimer's disease and other neurodegenerative diseases. Therefore, bidirectional links between asthma and the brain exist with an important next research step to define asthma-brain interactions linked to neurodegeneration and dementia and explore whether treatments directed toward asthma-related inflammation can prevent the deleterious effects of asthma on brain health.
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Affiliation(s)
- William Busse
- Department of Medicine, Division of Allergy Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Christie Bartels
- Department of Medicine, Division of Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Melissa Rosenkranz
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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13
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Wang Y, Tzeng JY, Huang Y, Maguire R, Hoyo C, Allen TK. Duration of exposure to epidural anesthesia at delivery, DNA methylation in umbilical cord blood and their association with offspring asthma in Non-Hispanic Black women. ENVIRONMENTAL EPIGENETICS 2022; 9:dvac026. [PMID: 36694712 PMCID: PMC9854336 DOI: 10.1093/eep/dvac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/16/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Epidural anesthesia is an effective pain relief modality, widely used for labor analgesia. Childhood asthma is one of the commonest chronic medical illnesses in the USA which places a significant burden on the health-care system. We recently demonstrated a negative association between the duration of epidural anesthesia and the development of childhood asthma; however, the underlying molecular mechanisms still remain unclear. In this study of 127 mother-child pairs comprised of 75 Non-Hispanic Black (NHB) and 52 Non-Hispanic White (NHW) from the Newborn Epigenetic Study, we tested the hypothesis that umbilical cord blood DNA methylation mediates the association between the duration of exposure to epidural anesthesia at delivery and the development of childhood asthma and whether this differed by race/ethnicity. In the mother-child pairs of NHB ancestry, the duration of exposure to epidural anesthesia was associated with a marginally lower risk of asthma (odds ratio = 0.88, 95% confidence interval = 0.76-1.01) for each 1-h increase in exposure to epidural anesthesia. Of the 20 CpGs in the NHB population showing the strongest mediation effect, 50% demonstrated an average mediation proportion of 52%, with directional consistency of direct and indirect effects. These top 20 CpGs mapped to 21 genes enriched for pathways engaged in antigen processing, antigen presentation, protein ubiquitination and regulatory networks related to the Major Histocompatibility Complex (MHC) class I complex and Nuclear Factor Kappa-B (NFkB) complex. Our findings suggest that DNA methylation in immune-related pathways contributes to the effects of the duration of exposure to epidural anesthesia on childhood asthma risk in NHB offspring.
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Affiliation(s)
- Yaxu Wang
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27607, USA
| | - Jung-Ying Tzeng
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27607, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695-7633, USA
- Department of Statistics, North Carolina State University, Raleigh, NC 27607, USA
| | - Yueyang Huang
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27607, USA
| | - Rachel Maguire
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695-7633, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Terrence K Allen
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27710, USA
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14
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Kwok J, Hall HA, Murray AL, Lombardo MV, Auyeung B. Maternal infections during pregnancy and child cognitive outcomes. BMC Pregnancy Childbirth 2022; 22:848. [PMCID: PMC9670450 DOI: 10.1186/s12884-022-05188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Maternal prenatal infections have been linked to children’s neurodevelopment and cognitive outcomes. It remains unclear, however, whether infections occurring during specific vulnerable gestational periods can affect children’s cognitive outcomes. The study aimed to examine maternal infections in each trimester of pregnancy and associations with children’s developmental and intelligence quotients. The ALSPAC birth cohort was used to investigate associations between maternal infections in pregnancy and child cognitive outcomes.
Methods
Infection data from mothers and cognition data from children were included with the final study sample size comprising 7,410 mother-child participants. Regression analysis was used to examine links between maternal infections occurring at each trimester of pregnancy and children’s cognition at 18 months, 4 years, and 8 years.
Results
Infections in the third trimester were significantly associated with decreased verbal IQ at age 4 (p < .05, adjusted R2 = 0.004); decreased verbal IQ (p < .01, adjusted R2 = 0.001), performance IQ (p < .01, adjusted R2 = 0.0008), and total IQ at age 8 (p < .01, adjusted R2 = 0.001).
Conclusion
Results suggest that maternal infections in the third trimester could have a latent effect on cognitive development, only emerging when cognitive load increases over time, though magnitude of effect appears to be small. Performance IQ may be more vulnerable to trimester-specific exposure to maternal infection as compared to verbal IQ. Future research could include examining potential mediating mechanisms on childhood cognition, such as possible moderating effects of early childhood environmental factors, and if effects persist in future cognitive outcomes.
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15
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Heydarian M, Schulz C, Stoeger T, Hilgendorff A. Association of immune cell recruitment and BPD development. Mol Cell Pediatr 2022; 9:16. [PMID: 35917002 PMCID: PMC9346035 DOI: 10.1186/s40348-022-00148-w] [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: 04/12/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
In the neonatal lung, exposure to both prenatal and early postnatal risk factors converge into the development of injury and ultimately chronic disease, also known as bronchopulmonary dysplasia (BPD). The focus of many studies has been the characteristic inflammatory responses provoked by these exposures. Here, we review the relationship between immaturity and prenatal conditions, as well as postnatal exposure to mechanical ventilation and oxygen toxicity, with the imbalance of pro- and anti-inflammatory regulatory networks. In these conditions, cytokine release, protease activity, and sustained presence of innate immune cells in the lung result in pathologic processes contributing to lung injury. We highlight the recruitment and function of myeloid innate immune cells, in particular, neutrophils and monocyte/macrophages in the BPD lung in human patients and animal models. We also discuss dissimilarities between the infant and adult immune system as a basis for the development of novel therapeutic strategies.
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Affiliation(s)
- Motaharehsadat Heydarian
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christian Schulz
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Department of Medicine I, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Tobias Stoeger
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Anne Hilgendorff
- Institute for Lung Health and Immunity and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany. .,Center for Comprehensive Developmental Care (CDeCLMU) at the interdisciplinary Social Pediatric Center, (iSPZ), University Hospital Ludwig-Maximilian University, Munich, Germany.
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16
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Mrug S, Barker-Kamps M, Orihuela CA, Patki A, Tiwari HK. Childhood Neighborhood Disadvantage, Parenting, and Adult Health. Am J Prev Med 2022; 63:S28-S36. [PMID: 35725138 PMCID: PMC9219037 DOI: 10.1016/j.amepre.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Growing up in disadvantaged neighborhoods is associated with poor adult health indicators. Consistent and supportive parenting plays a key role in life-long health, but it is not known whether positive parenting can mitigate the relationship between neighborhood adversity and poor health. This study examines parenting as a moderator of the links between childhood neighborhood characteristics and adult health indicators. METHODS A sample of 305 individuals (61% female; 82% African American, 18% Caucasian) were assessed in childhood (T1; age 11 years; 2003‒2004) and adulthood (T2; age 27 years; 2018‒2021). At T1, neighborhood poverty was derived from census data; neighborhood disorder was reported by parents. Children reported on parental harsh discipline, inconsistent discipline, and parental nurturance. At T2, health outcomes included BMI, serum cortisol and C-reactive protein (CRP), and salivary DNA methylation index related to CRP. Regression models predicted T2 health outcomes from T1 neighborhood and parenting variables and their interactions, adjusting for clustering and confounders. Data were analyzed in 2021. RESULTS Neighborhood poverty was associated with lower cortisol, whereas neighborhood disorder was linked with CRP‒related DNA methylation. Multiple interactions between neighborhood and parenting variables emerged, indicating that adverse neighborhood conditions were only related to poor adult health when combined with inconsistent discipline and low parental nurturance. By contrast, warm and supportive parenting, consistent discipline, and to a lesser extent harsh discipline buffered children from poor health outcomes associated with neighborhood disadvantage. CONCLUSIONS Interventions enhancing consistent and nurturing parenting may help to reduce the long-term associations of neighborhood disadvantage with poor health.
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Affiliation(s)
- Sylvie Mrug
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, Alabama.
| | - Malcolm Barker-Kamps
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Catheryn A Orihuela
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Amit Patki
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Hemant K Tiwari
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
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17
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Costa TJ, De Oliveira JC, Giachini FR, Lima VV, Tostes RC, Bomfim GF. Programming of Vascular Dysfunction by Maternal Stress: Immune System Implications. Front Physiol 2022; 13:787617. [PMID: 35360231 PMCID: PMC8961444 DOI: 10.3389/fphys.2022.787617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence highlights that several insults during pregnancy impact the vascular function and immune response of the male and female offspring. Overactivation of the immune system negatively influences cardiovascular function and contributes to cardiovascular disease. In this review, we propose that modulation of the immune system is a potential link between prenatal stress and offspring vascular dysfunction. Glucocorticoids are key mediators of stress and modulate the inflammatory response. The potential mechanisms whereby prenatal stress negatively impacts vascular function in the offspring, including poor hypothalamic–pituitary–adrenal axis regulation of inflammatory response, activation of Th17 cells, renin–angiotensin–aldosterone system hyperactivation, reactive oxygen species imbalance, generation of neoantigens and TLR4 activation, are discussed. Alterations in the immune system by maternal stress during pregnancy have broad relevance for vascular dysfunction and immune-mediated diseases, such as cardiovascular disease.
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Affiliation(s)
- Tiago J. Costa
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Júlio Cezar De Oliveira
- Health Education Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | - Fernanda Regina Giachini
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Victor Vitorino Lima
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Brazil
| | - Rita C. Tostes
- Health Education Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | - Gisele Facholi Bomfim
- Health Education Research Center (NUPADS), Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
- *Correspondence: Gisele Facholi Bomfim,
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18
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Morales E, Alcantara-Lopez MV, Cabezas-Herrera J, de Diego T, Hernandez-Caselles T, Jimenez-Guerrero P, Larque E, Lopez-Soler C, Martinez-Gracia C, Martinez-Torres A, Martin-Orozco E, Mendiola J, Nieto-Díaz A, Noguera JA, Perez-Fernandez V, Prieto-Sánchez MT, Salvador-Garcia C, Sanchez-Solis M, Santaella-Pascual M, Sola-Martinez RA, Torres-Cantero A, Yagüe-Guirao G, Zornoza-Moreno M, Garcia-Marcos L. The Nutrition in Early Life and Asthma (NELA) birth cohort study: Rationale, design, and methods. Paediatr Perinat Epidemiol 2022; 36:310-324. [PMID: 34841558 DOI: 10.1111/ppe.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary prevention strategies for asthma are lacking. Its inception probably starts in utero and/or during the early postnatal period as the developmental origins of health and disease (DOHaD) paradigm suggests. OBJECTIVES The main objective of Nutrition in Early Life and Asthma (NELA) cohort study is to unravel whether the following factors contribute causally to the developmental origins of asthma: (1) maternal obesity/adiposity and foetal growth; (2) maternal and child nutrition; (3) outdoor air pollution; (4) endocrine disruptors; and (5) maternal psychological stress. Maternal and offspring biological samples are used to assess changes in offspring microbiome, immune system, epigenome and volatilome as potential mechanisms influencing disease susceptibility. POPULATION Randomly selected pregnant women from three health areas of Murcia, a south-eastern Mediterranean region of Spain, who fulfilled the inclusion criteria were invited to participate at the time of the follow-up visit for routine foetal anatomy scan at 19-22 weeks of gestation, at the Maternal-Fetal Medicine Unit of the "Virgen de la Arrixaca" University Clinical Hospital over a 36-month period, from March 2015 to April 2018. DESIGN Prospective, population-based, maternal-child, birth cohort study. METHODS Questionnaires on exposures and outcome variables were administered to mothers at 20-24 gestation week; 32-36 gestation week; and delivery. Children were surveyed at birth, 3 and 18 months of age and currently at 5 years. Furthermore, physical examinations were performed; and different measurements and biological samples were obtained at these time points. PRELIMINARY RESULTS Among the 1350 women invited to participate, 738 (54%) were finally enrolled in the study and 720 of their children were eligible at birth. The adherence was high with 612 children (83%) attending the 3 months' visit and 532 children (72%) attending the 18 months' visit. CONCLUSION The NELA cohort will add original and unique knowledge to the developmental origins of asthma.
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Affiliation(s)
- Eva Morales
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain
| | - Maria V Alcantara-Lopez
- Paediatric Psychology Unit, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Juan Cabezas-Herrera
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Molecular Therapy and Biomarkers Research Group, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Teresa de Diego
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Trinidad Hernandez-Caselles
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Pedro Jimenez-Guerrero
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Regional Atmospheric Modelling Group, Department of Physics, University of Murcia, Murcia, Spain
| | - Elvira Larque
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Physiology, University of Murcia, Murcia, Spain.,Maternal and Children Health Network (SAMID III), Murcia, Spain
| | - Concepción Lopez-Soler
- Paediatric Psychology Unit, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain.,Paediatric and Adolescent Clinical Psychology University Research Group (GUIIA-PC), University of Murcia, Murcia, Spain
| | - Carmen Martinez-Gracia
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Food Science and Technology, University of Murcia, Murcia, Spain
| | - Antonela Martinez-Torres
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Paediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Elena Martin-Orozco
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Jaime Mendiola
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain
| | - Anibal Nieto-Díaz
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Materno-Fetal Medicine Unit, Obstetrics and Gynaecology Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Jose A Noguera
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Molecular Therapy and Biomarkers Research Group, Clinical Analysis Service, University Clinical Hospital, Murcia, Spain
| | - Virginia Perez-Fernandez
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain
| | - M Teresa Prieto-Sánchez
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Materno-Fetal Medicine Unit, Obstetrics and Gynaecology Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Carme Salvador-Garcia
- Microbiology Service, General University Hospital Consortium, University of Valencia, Valencia, Spain
| | - Manuel Sanchez-Solis
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Paediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Marina Santaella-Pascual
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Food Science and Technology, University of Murcia, Murcia, Spain
| | - Rosa A Sola-Martinez
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Alberto Torres-Cantero
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain.,Preventive Medicine Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Genoveva Yagüe-Guirao
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Microbiology Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain.,Department of Genetics and Microbiology, University of Murcia, Murcia, Spain
| | - Matilde Zornoza-Moreno
- Department of Physiology, University of Murcia, Murcia, Spain.,"Vistalegre-La Flota" Health Center, Health System of Murcia (SMS), Murcia, Spain
| | - Luis Garcia-Marcos
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Paediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain.,Network of Asthma and Adverse and Allergic Reactions (ARADyAL), Murcia, Spain
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Surakul P, Chutabhakdikul N, Vanichviriyakit R, Promthep K, Thangnipon W. Maternal Stress Induced Autophagy Dysfunction and Immune Activation in the Hippocampus of Adolescence Rat Pups. J Chem Neuroanat 2022; 121:102085. [DOI: 10.1016/j.jchemneu.2022.102085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 11/24/2022]
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20
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Singh G, Tucker EW, Rohlwink UK. Infection in the Developing Brain: The Role of Unique Systemic Immune Vulnerabilities. Front Neurol 2022; 12:805643. [PMID: 35140675 PMCID: PMC8818751 DOI: 10.3389/fneur.2021.805643] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Central nervous system (CNS) infections remain a major burden of pediatric disease associated with significant long-term morbidity due to injury to the developing brain. Children are susceptible to various etiologies of CNS infection partly because of vulnerabilities in their peripheral immune system. Young children are known to have reduced numbers and functionality of innate and adaptive immune cells, poorer production of immune mediators, impaired responses to inflammatory stimuli and depressed antibody activity in comparison to adults. This has implications not only for their response to pathogen invasion, but also for the development of appropriate vaccines and vaccination strategies. Further, pediatric immune characteristics evolve across the span of childhood into adolescence as their broader physiological and hormonal landscape develop. In addition to intrinsic vulnerabilities, children are subject to external factors that impact their susceptibility to infections, including maternal immunity and exposure, and nutrition. In this review we summarize the current evidence for immune characteristics across childhood that render children at risk for CNS infection and introduce the link with the CNS through the modulatory role that the brain has on the immune response. This manuscript lays the foundation from which we explore the specifics of infection and inflammation within the CNS and the consequences to the maturing brain in part two of this review series.
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Affiliation(s)
- Gabriela Singh
- Division of Neurosurgery, Department of Surgery, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Elizabeth W. Tucker
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ursula K. Rohlwink
- Division of Neurosurgery, Department of Surgery, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Francis Crick Institute, London, United Kingdom
- *Correspondence: Ursula K. Rohlwink
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Grant T, Croce E, Matsui EC. Asthma and the social determinants of health. Ann Allergy Asthma Immunol 2022; 128:5-11. [PMID: 34673220 PMCID: PMC8671352 DOI: 10.1016/j.anai.2021.10.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To synthesize the growing body of literature on the role of social determinants of health (SDoH) in asthma and asthma disparities. DATA SOURCES A pubmed.gov search was performed to identify published literature on SDoH, asthma, asthma disparities, and race and ethnicity. Current asthma statistics of the Centers for Disease Control and Prevention were reviewed. STUDY SELECTIONS Relevant articles on SDoH, asthma, asthma disparities, and race and ethnicity were reviewed in detail. RESULTS Black and Latinx Americans have a higher asthma prevalence and greater asthma morbidity than White Americans and also bear a disproportionate burden of SDoH. Inequities in SDoH are rooted in structural racism and population-level injustices that affect the socioeconomic status, physical environment, and health care access/quality of Black and Latinx Americans. There is evidence that racial/ethnic inequities in SDoH, such as socioeconomic status, neighborhood environment, housing, environmental exposures, and health care access/quality, contribute to excess burden of asthma prevalence/incidence, morbidity, exacerbations, and abnormal lung function among certain racial/ethnic populations. In addition, Black and Latinx communities experience high levels of long-term stress, which may increase asthma risk through direct effects on the immune system and hypothalamic-pituitary-adrenocortical activation. Long-term stress may also mediate the effects of SDoH on asthma. CONCLUSION Although there is clear evidence linking SDoH to excess asthma risk and implicating SDoH in asthma disparities, the extent to which asthma disparities are explained by inequities in SDoH and the relative contributions of each of these SDoH to asthma disparities remain unclear. This knowledge is needed to effectively develop and test systems-level interventions targeting SDoH, with the ultimate goal of meaningfully reducing racial/ethnic asthma disparities.
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Affiliation(s)
- Torie Grant
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily Croce
- The University of Texas at Austin Dell Medical School, Austin, Texas
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22
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Bush A. Impact of early life exposures on respiratory disease. Paediatr Respir Rev 2021; 40:24-32. [PMID: 34144911 DOI: 10.1016/j.prrv.2021.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/20/2021] [Indexed: 12/21/2022]
Abstract
The antecedents of asthma and chronic obstructive pulmonary disease (COPD) lie before school age. Adverse effects are transgenerational, antenatal and in the preschool years. Antenatal adverse effects impair spirometry by causing low birth weight, altered lung structure and immune function, and sensitizing the foetus to later insults. The key stages of normal lung health are lung function at birth, lung growth to a plateau age 20-25 years, and the phase of decline thereafter; contrary to perceived wisdom, accelerated decline is not related to smoking. There are different trajectories of lung function. Lung function usually tracks from preschool to late middle age. Asthma is driven by antenatal and early life influences. The airflow obstruction, emphysema and multi-morbidity of COPD all start early. Failure to reach a normal plateau and accelerated decline in lung function are risk factors for COPD. Airway disease cannot be prevented in adult life; prevention must start early.
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Affiliation(s)
- Andrew Bush
- Paediatrics and Paediatric Respirology, Imperial College, UK; Imperial Centre for Paediatrics and Child Health, UK; Consultant Paediatric Chest Physician, Royal Brompton Harefield NHS Foundation Trust, UK.
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Ostlund BD, Olavson K, Brown MA, Shakiba N, Saenz C, Crowell SE, Conradt E. Maternal mindfulness during pregnancy predicts newborn neurobehavior. Dev Psychobiol 2021; 63:e22131. [PMID: 34053072 PMCID: PMC8933861 DOI: 10.1002/dev.22131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 02/23/2021] [Accepted: 04/30/2021] [Indexed: 11/06/2022]
Abstract
Newborn neurobehavioral competencies portend a young child's abilities to modulate their arousal and attention in response to dynamic environmental cues. Although evidence suggests prenatal contributions to newborn neurobehavioral differences, no study to date has examined wellness-promoting traits, such as a pregnant woman's mindfulness, in this association. We examined whether a mother's mindfulness while pregnant related to neurobehavioral outcomes in her neonate, as well as whether maternal mindfulness moderated the link between prenatal maternal emotion dysregulation and newborn neurobehavior. Mothers (N = 162) reported on their mindfulness and emotion dysregulation while pregnant. Newborn arousal and attention were assessed at least 24 h after birth (M = 3.8 days, SD = 8.3) using the NICU Network Neurobehavioral Scale (NNNS). Highly mindful pregnant women reported lower levels of emotion dysregulation. Newborns of highly mindful mothers exhibited higher levels of arousal (e.g., excitability, motor activity) but did not differ in regards to attention at birth. Maternal emotion dysregulation while pregnant was associated with blunted newborn attention, but only among mothers who were less mindful. Our findings suggest that a mother's mindfulness while pregnant may influence her fetus' neurobehavioral development in ways that are evident at birth.
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Affiliation(s)
| | | | | | | | | | - Sheila E. Crowell
- Department of Psychology, University of Utah
- Department of Pediatrics, University of Utah
- Department of Psychiatry, University of Utah
| | - Elisabeth Conradt
- Department of Psychology, University of Utah
- Department of Pediatrics, University of Utah
- Department of Obstetrics and Gynecology, University of Utah
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Engel ML, Pike MR, Cohen MF, Dunlop AL, Corwin EJ, Pearce BD, Brennan PA. Intergenerational Impacts of Maternal Stress on Early Childhood Atopy in Black Americans. J Pediatr Psychol 2021; 46:891-901. [PMID: 34100948 PMCID: PMC8357225 DOI: 10.1093/jpepsy/jsab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Black children are disproportionately affected by atopic diseases (i.e., atopic dermatitis, allergic rhinitis, asthma, and food allergies), with health disparities present in early life. Studies in White samples suggest that maternal stress confers risk for offspring atopy, yet little is known about these relationships in Black populations. This study seeks to (a) examine the relationship between self-reported and physiological indicators of maternal stress and offspring atopy and (b) explore warm and responsive caregiving as a potential protective factor in Black Americans. METHODS A sample of 179 Black mother-child dyads of varying socioeconomic status participated in a prospective longitudinal study. Mothers completed self-reports of childhood trauma, prenatal stress, postnatal stress, and physician diagnosis of offspring atopy; provided blood samples to assess physiological responses to chronic stress exposure; and participated in a behavioral task with their infant. RESULTS Maternal self-reports of childhood trauma, prenatal stress, and postnatal stress were not associated with offspring diagnosis of atopy by 2-3 years of age. Mothers who produced a smaller inflammatory response during pregnancy were more likely to have an offspring with atopy by 2-3 years of age. Warm and responsive parenting demonstrated a protective effect; the positive association between maternal stress and offspring atopy was less apparent in cases of mother-child interactions characterized by high levels warm and responsive parenting. CONCLUSION Failure to replicate previous findings suggests that the maternal stress-offspring atopy relationship is complex. Future studies must examine the unique stressors in Black Americans, as well as caregiving as a potential protective factor.
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Affiliation(s)
| | - Madeline R Pike
- Department of Psychiatry and Behavioral Sciences, Emory University, USA
| | | | - Anne L Dunlop
- Nell Hodgson Woodruff School of Nursing, Emory University, USA
| | | | - Brad D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
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Bou Zerdan M, Moussa S, Atoui A, Assi HI. Mechanisms of Immunotoxicity: Stressors and Evaluators. Int J Mol Sci 2021; 22:8242. [PMID: 34361007 PMCID: PMC8348050 DOI: 10.3390/ijms22158242] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 12/12/2022] Open
Abstract
The immune system defends the body against certain tumor cells and against foreign agents such as fungi, parasites, bacteria, and viruses. One of its main roles is to distinguish endogenous components from non-self-components. An unproperly functioning immune system is prone to primary immune deficiencies caused by either primary immune deficiencies such as genetic defects or secondary immune deficiencies such as physical, chemical, and in some instances, psychological stressors. In the manuscript, we will provide a brief overview of the immune system and immunotoxicology. We will also describe the biochemical mechanisms of immunotoxicants and how to evaluate immunotoxicity.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, 1107 2020 Beirut, Lebanon; (M.B.Z.); (A.A.)
| | - Sara Moussa
- Faculty of Medicine, University of Balamand, 1100 Beirut, Lebanon;
| | - Ali Atoui
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, 1107 2020 Beirut, Lebanon; (M.B.Z.); (A.A.)
| | - Hazem I. Assi
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, 1107 2020 Beirut, Lebanon; (M.B.Z.); (A.A.)
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Chen S, Chen S. Are prenatal anxiety or depression symptoms associated with asthma or atopic diseases throughout the offspring's childhood? An updated systematic review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:435. [PMID: 34158009 PMCID: PMC8218439 DOI: 10.1186/s12884-021-03909-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Asthma is the most common respiratory disease among children, while atopic diseases such as atopic dermatitis affect about 20% of infants under 2 years of age. Studies suggested that these conditions might be related to prenatal depression or anxiety. This study aimed to explore the association between prenatal mental disorders and childhood asthma or atopic disease in a systematic review and meta-analysis. Methods PubMed, Embase, and the Cochrane Library were searched up to May 2020. The primary outcome was childhood asthma and childhood atopic dermatitis. Random-effects models were used because of high heterogeneity indicated by I2 > 50% and Q-test P < 0.10. Results A total of 598 studies were initially identified, but nine studies met the inclusion criteria. Prenatal mental disorder was associated with childhood asthma (n = 6 studies; ES = 1.146, 95%CI: 1.054–1.245, P = 0.001; I2 = 93.5%, Pheterogeneity < 0.001) whereas no significant association was found for childhood atopic dermatitis (n = 4 studies; ES = 1.211, 95%CI: 0.982–1.494, P = 0.073; I2 = 78.5%, Pheterogeneity < 0.001). Childhood asthma seems to be related more to depression (n = 1 study; ES = 1.170, 95%CI: 1.061–1.291, P = 0.002) and anxiety/depression (n = 4 studies; ES = 1.157, 95%CI: 1.050–1.275, P = 0.073; I2 = 95.3%, Pheterogeneity < 0.001). Conclusion This meta-analysis demonstrated that prenatal mental disorders increase the risk of childhood asthma. We limited the included samples to pregnant women to investigate the association between prenatal psychological factors and offspring’s physical health. Future studies should include large high-quality cohort studies to investigate the behavioral, environmental, and genetic causes for this association. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03909-z.
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Affiliation(s)
- Shuguang Chen
- Department of Dermatology, Southwest Hospital, Third Military M, edical University, Chongqing, China
| | - Sheng Chen
- Department of Pediatrics, Southwest Hospital, Third Military Medical University, Chongqing, 400030, China.
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Letourneau N, Ntanda H, Jong VL, Mahinpey N, Giesbrecht G, Ross KM. Prenatal maternal distress and immune cell epigenetic profiles at 3-months of age. Dev Psychobiol 2021; 63:973-984. [PMID: 33569773 DOI: 10.1002/dev.22103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prenatal maternal distress predicts altered offspring immune outcomes, potentially via altered epigenetics. The role of different kinds of prenatal maternal distress on DNA methylation profiles is not understood. METHODS A sample of 117 women (APrON cohort) were followed from pregnancy to the postpartum period. Maternal distress (depressive symptoms, pregnancy-specific anxiety, stressful life events) were assessed mid-pregnancy, late-pregnancy, and 3-months postpartum. DNA methylation profiles were obtained from 3-month-old blood samples. Principal component analysis identified two epigenetic components, characterized as Immune Signaling and DNA Transcription through gene network analysis. Covariates were maternal demographics, pre-pregnancy body mass index, child sex, birth gestational age, and postpartum maternal distress. Penalized regression (LASSO) models were used. RESULTS Late-pregnancy stressful life events, b = 0.006, early-pregnancy depressive symptoms, b = 0.027, late-pregnancy depressive symptoms, b = 0.014, and pregnancy-specific anxiety during late pregnancy, b = -0.631, were predictive of the Immune Signaling component, suggesting that these aspects of maternal distress could affect methylation in offspring immune signaling pathways. Only early-pregnancy depressive symptoms was predictive of the DNA Transcription component, b = -0.0004, suggesting that this aspect of maternal distress is implicated in methylation of offspring DNA transcription pathways. CONCLUSIONS Exposure timing and kind of prenatal maternal distress could matter in the prediction of infant immune epigenetic profiles.
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Affiliation(s)
| | | | - Victor L Jong
- University Medical Center Utrecht, Utrecht, The Netherlands
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28
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Maternal prenatal stress exposure and sex-specific risk of severe infection in offspring. PLoS One 2021; 16:e0245747. [PMID: 33513152 PMCID: PMC7845992 DOI: 10.1371/journal.pone.0245747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
Background Maternal stressful life events during pregnancy have been associated with immune dysregulation and increased risk for asthma and atopy in offspring. Few studies have investigated whether prenatal stress is associated with increased overall or specific infectious diseases in childhood, nor explored sex differences. We sought to examine the relationship between the nature and timing of maternal stress in pregnancy and hospitalisation with infection in offspring. Methods Between 1989 and 1992, exposure data on stressful life events were collected from pregnant women (Gen1) in the Raine Study at 18 and 34 weeks’ gestation and linked to statutory state-wide hospital morbidity data. We examined associations between the number, category and timing of maternal prenatal stress events and overall and clinical groups of offspring (Gen2) infection-related hospitalisation until age 16 years, adjusting for maternal age, education, and smoking in pregnancy in addition to the presence of siblings at birth. Results Of 2,141 offspring with complete stress in pregnancy data available, 1,089 had at least one infection-related hospitalisation, with upper respiratory tract infections the most common (n = 556). Each additional stressful life event during pregnancy was associated with increased risk in male offspring for hospitalisation with all infection types. There was little evidence of these associations in girls. Conclusions Increased exposure to stressful life events in utero is associated with sex-specific infection-related hospitalisations in childhood. Prenatal stress may adversely affect early immune development for boys and increase the risk of more severe infections. Mechanistic understanding would inform preventative interventions.
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Bush NR, Savitz J, Coccia M, Jones-Mason K, Adler N, Boyce WT, Laraia B, Epel E. Maternal Stress During Pregnancy Predicts Infant Infectious and Noninfectious Illness. J Pediatr 2021; 228:117-125.e2. [PMID: 32827529 PMCID: PMC7752845 DOI: 10.1016/j.jpeds.2020.08.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the association between prenatal stress and infant physical health in the first year of life within an understudied, racially and ethnically diverse, highly stressed community sample. We expected that greater stress exposure would predict higher rates of infant illness. STUDY DESIGN Low-income, racially/ethnically diverse, overweight women with low medical risk pregnancies were recruited (2011-2014) during pregnancy. Pregnancy Stressful Life Events were assessed retrospectively (mean, 11.88 months postpartum). Perceived stress was assessed twice during pregnancy (at a mean of 17.4 weeks and again at a mean of 25.6 weeks) and at 6 months postpartum. Women with live births (n = 202) were invited; 162 consented to the offspring study. Medical records from pediatric clinics and emergency departments for 148 infants were abstracted for counts of total infectious illnesses, total noninfectious illness, and diversity of illnesses over the first year of life. RESULTS The final analytic sample included 109 women (mean age, 28.08 years) and their infants. In covariate-adjusted negative binomial models, maternal perceptions of stress across pregnancy were positively associated with infant illness. Each 1-point increase in average stress was associated with a 38% increase in incidence of infant infections (Incidence rate ratio, 1.38; 95% CI, 1.01-1.88; P < .05), a 73% increase in noninfectious illness (IRR, 1.73; 95% CI, 1.34-2.23; P < .05), and a 53% increase in illness diversity (IRR, 1.53; 95% CI, 1.25, 1.88; P < .01); effect sizes were larger for perceived stress later in pregnancy. Stressful life events count and postnatal stress were not uniquely associated with illness. CONCLUSIONS In line with recommendations from the American Academy of Pediatrics to screen for maternal perinatal depression, screening and support for stress reduction during pregnancy may benefit both maternal and child health.
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Affiliation(s)
- Nicole R. Bush
- Weill Institute for Neurosciences, Center for Health and Community, Department of Psychiatry,Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco
| | - Jennifer Savitz
- Departments of Medicine and Clinical Pharmacy, University of California, San Francisco, CA,University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Michael Coccia
- Weill Institute for Neurosciences, Center for Health and Community, Department of Psychiatry
| | - Karen Jones-Mason
- Weill Institute for Neurosciences, Center for Health and Community, Department of Psychiatry
| | - Nancy Adler
- Weill Institute for Neurosciences, Center for Health and Community, Department of Psychiatry
| | - W. Thomas Boyce
- Weill Institute for Neurosciences, Center for Health and Community, Department of Psychiatry,Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco
| | - Barbara Laraia
- School of Public Health, University of California, Berkeley, CA
| | - Elissa Epel
- Weill Institute for Neurosciences, Center for Health and Community, Department of Psychiatry
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30
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Prenatal stress and epigenetics. Neurosci Biobehav Rev 2020; 117:198-210. [DOI: 10.1016/j.neubiorev.2017.05.016] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/22/2022]
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Racial Differences in the Biochemical Effects of Stress in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196941. [PMID: 32977397 PMCID: PMC7579659 DOI: 10.3390/ijerph17196941] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women’s Hospital. Participants (n = 200) were stratified by cumulative risk scores using a combination of individual factors (maternal education, diabetes, hypertension, smoking, relationship status, obesity, depression) and neighborhood deprivation scores. We hypothesized that inflammatory cytokines levels differ by risk group and race. Multiplex analyses of IL-6, IL-8, IL-10, IL-13 and TNF-alpha were run. We found that Black birthing people had more risk factors for chronic stress and had lower levels of IL-6 compared to White birthing people. When stratified by risk group and race, low-risk Black birthing people had lower levels of IL-6 compared to low-risk White birthing people, and high-risk Black birthing people had lower levels of IL-8 compared to high-risk White birthing people. Higher area deprivation scores were associated with lower IL-6 levels. Our results suggest that the relationship between chronic stress and inflammatory cytokines is modified by race. We theorize that Black birthing people encounter repetitive stress due to racism and social disadvantage which may result in stress pathway desensitization and a blunted cytokine response to future stressors.
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Kim P, Tribble R, Olsavsky AK, Dufford AJ, Erhart A, Hansen M, Grande L, Gonzalez DM. Associations between stress exposure and new mothers' brain responses to infant cry sounds. Neuroimage 2020; 223:117360. [PMID: 32927083 PMCID: PMC8291268 DOI: 10.1016/j.neuroimage.2020.117360] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023] Open
Abstract
Exposure to severe stress has been linked to negative postpartum outcomes among new mothers including mood disorders and harsh parenting. Non-human animal studies show that stress exposure disrupts the normative adaptation of the maternal brain, thus identifying a neurobiological mechanism by which stress can lead to negative maternal outcomes. However, little is known about the impact of stress exposure on the maternal brain response to infant cues in human mothers. We examined the association of stress exposure with brain response to infant cries and maternal behaviors, in a socioeconomically diverse (low- and middle-income) sample of first-time mothers (N=53). Exposure to stress across socioeconomic, environmental, and psychosocial domains was associated with reduced brain response to infant cry sounds in several regions, including the right insula/inferior frontal gyrus and superior temporal gyrus. Reduced activation in these regions was further associated with lower maternal sensitivity observed during a mother-infant interaction. The findings demonstrate that higher levels of stress exposure may be associated with reduced brain response to an infant’s cry in regions that are important for emotional and social information processing, and that reduced brain responses may further be associated with increased difficulties in developing positive mother-infant relationships.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States.
| | - Rebekah Tribble
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Aviva K Olsavsky
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; University of Colorado Anschutz School of Medicine/Children's Hospital Colorado, 13123 E. 16th Avenue, CO 80045, United States
| | - Alexander J Dufford
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Andrew Erhart
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Melissa Hansen
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Leah Grande
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Daniel M Gonzalez
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; Harvard Medical School, Boston, 25 Shattuck St, Boston, MA 02115, United States
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Kawamoto T, Miyake Y, Tanaka K, Nagano J, Sasaki S, Hirota Y. Maternal prenatal stress and infantile wheeze and asthma: The Osaka Maternal and Child Health Study. J Psychosom Res 2020; 135:110143. [PMID: 32470843 DOI: 10.1016/j.jpsychores.2020.110143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Some recent studies suggest that maternal prenatal stress (MPS) increases allergic diseases in the children. However, knowledge on this issue in Asian children are lacking. We investigated the association between MPS and the risks of wheeze and asthma in Japanese infants aged 16-24 months. METHODS The present subjects were 763 Japanese mother-child pairs. The first, second, and third surveys based on self-administered questionnaires were performed during pregnancy, between 2 and 9 months postpartum, and from 16 to 24 months postpartum, respectively. Data on MPS was obtained in the first survey, using the Stress Inventory (SI), which constructs 12 specific behavioral patterns as response styles to stressors. Data on wheeze and asthma was obtained in the third survey, where wheeze was based on the International Study of Asthma and Allergies in Childhood criteria and asthma was based on doctors' diagnosis. RESULTS There were 169 infants with wheeze (22.1%) and 33 infants with asthma (4.3%), at the time of the third survey. Multiple logistic regression analyses found that a maternal behavioral pattern characterized by chronic irritation and anger was associated with the risk of childhood asthma (adjusted odds ratio [OR] = 1.56, 95% confidence interval [CI]: 1.11 to 2.22), but not wheeze (adjusted OR = 1.02, 95%CI: 0.88 to 1.19), while there was no appreciable association between the other SI scales and the risk of childhood wheeze or asthma. CONCLUSIONS The results partly supported the hypothesis that MPS might increase the risk of asthma in their infants in Japanese.
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Affiliation(s)
- Tetsuya Kawamoto
- Center for Advanced School Education and Evidence-based Research (CASEER), The University of Tokyo, Tokyo, Japan; Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan; Research Promotion Unit, Translational Research Center, Ehime University Hospital, Ehime, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan; Research Promotion Unit, Translational Research Center, Ehime University Hospital, Ehime, Japan
| | - Jun Nagano
- Center for Health Sciences and Counseling, Kyushu University, Fukuoka, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yoshio Hirota
- Clinical Epidemiology Research Center, Medical Co. LTA (SOUSEIKAI), Fukuoka, Japan
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Carrilero N, Dalmau-Bueno A, García-Altés A. Comorbidity patterns and socioeconomic inequalities in children under 15 with medical complexity: a population-based study. BMC Pediatr 2020; 20:358. [PMID: 32731853 PMCID: PMC7391621 DOI: 10.1186/s12887-020-02253-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/21/2020] [Indexed: 11/11/2022] Open
Abstract
Background Children with medical complexity (CMC) denotes the profile of a child with diverse acute and chronic conditions, making intensive use of the healthcare services and with special health and social needs. Previous studies show that CMC are also affected by the socioeconomic position (SEP) of their family. The aim of this study is to describe the pathologic patterns of CMC and their socioeconomic inequalities in order to better manage their needs, plan healthcare services accordingly, and improve the care models in place. Methods Cross-sectional study with latent class analysis (LCA) of the CMC population under the age of 15 in Catalonia in 2016, using administrative data. LCA was used to define multimorbidity classes based on the presence/absence of 57 conditions. All individuals were assigned to a best-fit class. Each comorbidity class was described and its association with SEP tested. The Adjusted Morbidity Groups classification system (Catalan acronym GMA) was used to identify the CMC. The main outcome measures were SEP, GMA score, sex, and age distribution, in both populations (CMC and non-CMC) and in each of the classes identified. Results 71% of the CMC population had at least one parent with no employment or an annual income of less than €18,000. Four comorbidity classes were identified in the CMC: oncology (36.0%), neurodevelopment (13.7%), congenital and perinatal (19.8%), and respiratory (30.5%). SEP associations were: oncology OR 1.9 in boys and 2.0 in girls; neurodevelopment OR 2.3 in boys and 1.8 in girls; congenital and perinatal OR 1.7 in boys and 2.1 in girls; and respiratory OR 2.0 in boys and 2.0 in girls. Conclusions Our findings show the existence of four different patterns of comorbidities in CMC and a significantly high proportion of lower SEP children in all classes. These results could benefit CMC management by creating more efficient multidisciplinary medical teams according to each comorbidity class and a holistic perspective taking into account its socioeconomic vulnerability.
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Affiliation(s)
- Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,Department of Experimental and Health Sciences (DCEXS), Universitat Pompeu Fabra, Barcelona, Spain.,Institut de Recerda de l'Hospital de la Santa Creu i Sant Pau (IR Sant Pau), Barcelona, Spain
| | - Albert Dalmau-Bueno
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Carrer de Roc Boronat, 81-95, 08005, Barcelona, Spain.
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35
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Al-Hussainy A, Mohammed R. Consequences of maternal psychological stress during pregnancy for the risk of asthma in the offspring. Scand J Immunol 2020; 93:e12919. [PMID: 32542784 DOI: 10.1111/sji.12919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 02/01/2023]
Abstract
Asthma is a common lung condition that makes breathing difficult through the inflammation and constriction of the lung airways. Epidemiological evidence supports the presence of a positive association between prenatal maternal psychological stress (PMPS) and asthma in the offspring, suggesting the disease may have developmental origins. T-helper 2 (Th2) cells are a major subtype of T-helper cells, producing Th2 cytokines, which may be the main drivers of asthma symptoms. A Th2 dominant blood cytokine profile may therefore indicate an increased risk of asthma, as studies have shown a link between PMPS and a T-helper 2 (Th2) cytokine profile in offspring. The mechanism by which PMPS may cause Th2 cytokine dominance in the offspring is unclear. Epigenetic modifications in utero can lead to long-lasting effects that persist postnatally and have therefore been implicated in this relationship. Increased maternal blood cortisol levels due to PMPS may increase transfer of cortisol to the foetus, where the temporarily increased levels may induce changes in the epigenome. Evidence from animal studies suggests that genes controlling cytokine production in T cells can be epigenetically modified in a way that increases Th2 cytokine production. Other evidence suggests that methylation of the NR3C1 gene decreases hippocampal glucocorticoid receptor expression, leading to decreased negative regulation of the hypothalamus-pituitary-adrenal axis. This can increase cortisol production which has been shown to increase Th2 cytokine production. Therefore, the link between PMPS and a Th2 offspring cytokine profile, mediated through epigenetic changes, may explain the positive relationship between PMPS and asthma in the offspring.
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Affiliation(s)
| | - Raihan Mohammed
- Department of Medicine, University of Cambridge, Cambridge, UK
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Iannantuoni F, M. de Marañon A, Abad-Jiménez Z, Canet F, Díaz-Pozo P, López-Domènech S, Morillas C, Rocha M, Víctor VM. Mitochondrial Alterations and Enhanced Human Leukocyte/Endothelial Cell Interactions in Type 1 Diabetes. J Clin Med 2020; 9:jcm9072155. [PMID: 32650465 PMCID: PMC7408780 DOI: 10.3390/jcm9072155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
Type 1 diabetes has been associated with oxidative stress. This study evaluates the rates of oxidative stress, mitochondrial function, leukocyte–endothelium interactions and adhesion molecules in type 1 diabetic patients. The study population consisted of 52 diabetic patients and 46 body-composition and age-matched controls. We assessed anthropometric and metabolic parameters, oxidative stress and mitochondrial function by evaluating reactive oxygen species (ROS) production, mitochondrial ROS production, mitochondrial membrane potential and superoxide dismutase (SOD) and catalase (CAT) expression in polymorphonuclear leukocytes from type 1 diabetic patients. In addition, we evaluated interactions between leukocytes and human umbilical vein endothelial cells (HUVEC), and serum expression of adhesion molecules (P-selectin, VCAM-1 and ICAM-1), proinflammatory cytokines (IL-6 and TNFα) and myeloperoxidase (MPO). HbA1C and glucose levels were higher in diabetic patients than in control subjects, as expected. Mitochondrial function was altered and leukocyte–endothelium interactions were enhanced in diabetic patients, which was evident in the increase in total and mitochondrial ROS production, higher mitochondrial membrane potential, enhanced leukocyte rolling and adhesion, and decreased rolling velocity. Furthermore, we observed an increase in levels of adhesion molecules P-selectin, VCAM-1, and ICAM-1 in these subjects. In addition, type 1 diabetic patients exhibited an increase in proinflammatory mediators TNFα and MPO, and a decreased expression of SOD. The enhancement of leukocyte–endothelium interactions and proinflammatory markers correlated with glucose and HbA1Clevels. Mitochondrial alteration, oxidative stress, and enhanced leukocyte–endothelium interactions are features of type 1 diabetes and may be related to cardiovascular implications.
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Affiliation(s)
- Francesca Iannantuoni
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
| | - Aranzazu M. de Marañon
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
| | - Zaida Abad-Jiménez
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
| | - Francisco Canet
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
| | - Pedro Díaz-Pozo
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
| | - Sandra López-Domènech
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
| | - Carlos Morillas
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
| | - Milagros Rocha
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
- CIBERehd—Department of Pharmacology and Physiology, University of Valencia, 46010 Valencia, Spain
- Correspondence: (M.R.); (V.M.V.)
| | - Víctor M. Víctor
- Service of Endocrinology and Nutrition, University Hospital Doctor Peset, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain; (F.I.); (A.M.d.M.); (Z.A.-J.); (F.C.); (P.D.-P.); (S.L.-D.); (C.M.)
- CIBERehd—Department of Pharmacology and Physiology, University of Valencia, 46010 Valencia, Spain
- Department of Physiology, University of Valencia, 46010 Valencia, Spain
- Correspondence: (M.R.); (V.M.V.)
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Socolovsky C, Phipatanakul W. Maternal Distress and Allergic Disease: Early Childhood Stressors Shape Long-Term Health. Chest 2020; 158:5-6. [PMID: 32654728 DOI: 10.1016/j.chest.2020.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/21/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Carmela Socolovsky
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wanda Phipatanakul
- Asthma Clinical Research Center, Pediatric Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
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Szefler SJ, Fitzgerald DA, Adachi Y, Doull IJ, Fischer GB, Fletcher M, Hong J, García‐Marcos L, Pedersen S, Østrem A, Sly PD, Williams S, Winders T, Zar HJ, Bush A, Lenney W. A worldwide charter for all children with asthma. Pediatr Pulmonol 2020; 55:1282-1292. [PMID: 32142219 PMCID: PMC7187318 DOI: 10.1002/ppul.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022]
Abstract
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence-based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be community involvement together with the local and national development of asthma champions. We call on governments, institutions, and healthcare services to support its implementation.
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Affiliation(s)
- Stanley J. Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Pediatric Asthma Research Program, Anschutz Medical Campus, Breathing Institute, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColorado
| | - Dominic A. Fitzgerald
- Discipline of Child and Adolescent HealthSydney Medical School, University of SydneySydneyAustralia
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Yuichi Adachi
- Department of PediatricsUniversity of ToyamaToyamaJapan
| | - Iolo J. Doull
- Department of Paediatric Respiratory MedicineChildren's Hospital for WalesCardiffUK
| | - Gilberto B. Fischer
- Department of PaediatricsUniversidade Federal de Ciencias da Saúde de Porto AlegrePorto AlegreRio Grande do SulBrazil
| | - Monica Fletcher
- Asthma UK Centre for Applied ResearchUniversity of EdinburghEdinburghUK
| | - Jianguo Hong
- Department of Paediatrics, Shanghai General HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Luis García‐Marcos
- Department of Paediatrics, “Virgen de la Arrixaca” University Children's HospitalUniversity of MurciaMurciaSpain
| | - Søren Pedersen
- Paediatric Research Unit, Kolding HospitalUniversity of Southern DenmarkKoldingDenmark
| | | | - Peter D. Sly
- Children's Health and Environment Program and World Health Organisation Collaborating Centre for Children's Health and Environment, Child Health Research CentreUniversity of QueenslandBrisbaneAustralia
| | - Siân Williams
- International Primary Care Respiratory GroupLondonUK
| | - Tonya Winders
- Allergy & Asthma NetworkViennaVirginia
- Global Allergy & Asthma Patient PlatformViennaVirginia
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalMRC Unit on Child & Adolescent Health, University of Cape TownCape TownSouth Africa
| | - Andy Bush
- Department of Paediatrics, National Heart and Lung Institute and Royal Brompton & Harefield NHS Foundation TrustImperial CollegeLondonUK
| | - Warren Lenney
- Department of Child Health, Institute of Applied Clinical ScienceKeele UniversityKeeleUK
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Csaba G. Reprogramming of the Immune System by Stress and Faulty Hormonal Imprinting. Clin Ther 2020; 42:983-992. [PMID: 32307123 DOI: 10.1016/j.clinthera.2020.03.003] [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: 02/11/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Hormonal imprinting is taking place perinatally at the first encounter between the developing hormone receptors and their target hormones. However, in this crucial period when the developmental window for physiological imprinting is open, other molecules, such as synthetic hormones and endocrine disruptors can bind to the receptors, leading to faulty imprinting with life-long consequences, especially to the immune system. This review presents the factors of stress and faulty hormonal imprinting that lead to reprogramming of the immune system. METHODS Relevant publications from Pubmed since 1990 were reviewed and synthesized. FINDINGS The developing immune system is rather sensitive to hormonal effects. Faulty hormonal imprinting is able to reprogram the original developmental program present in a given cell, with lifelong consequences, manifested in alteration of hormone binding by receptors, susceptibility to certain (non-infectious) diseases, and triggering of other diseases. As stress mobilizes the hypothalamic-pituitary-adrenal axis if it occurred during gestation or perinatally, it could lead to faulty hormonal imprinting in the immune system, manifested later as allergic and autoimmune diseases or weakness of normal immune defenses. Hormonal imprinting is an epigenetic process and is carried to the offspring without alteration of DNA base sequences. This means that any form of early-life stress alone or in association with hormonal imprinting could be associated with the developmental origin of health and disease (DOHaD). As puberty is also a period of reprogramming, stress or faulty imprinting can change the original (developmental) program, also with life-long consequences. IMPLICATIONS Considering the continuous differentiation of immune cells (from blast-cells) during the whole life, there is a possibility of late-imprinting or stress-activated reprogramming in the immune system at any periods of life, with later pathogenetic consequences.
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Affiliation(s)
- György Csaba
- Department of Genetics, Cell, and Immunobiology, Semmelweis University, Budapest, Hungary.
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Landeo-Gutierrez J, Forno E, Miller GE, Celedón JC. Exposure to Violence, Psychosocial Stress, and Asthma. Am J Respir Crit Care Med 2020; 201:917-922. [PMID: 31801032 PMCID: PMC7159436 DOI: 10.1164/rccm.201905-1073pp] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jeremy Landeo-Gutierrez
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Gregory E. Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
| | - Juan C. Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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van der Leek AP, Bahreinian S, Chartier M, Dahl ME, Azad MB, Brownell MD, Kozyrskyj AL. Maternal Distress During Pregnancy and Recurrence in Early Childhood Predicts Atopic Dermatitis and Asthma in Childhood. Chest 2020; 158:57-67. [PMID: 32173490 DOI: 10.1016/j.chest.2020.01.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early-life stress is becoming an important determinant of immune system programming. Maternal prenatal distress is found to be associated with atopic disease in offspring but the separate effects of postnatal distress are not well-studied. RESEARCH QUESTION Does the likelihood of asthma and atopic dermatitis in children increase when they are exposed to maternal distress pre- and postnatally in a sex-specific manner? STUDY DESIGN AND METHODS Using data from a provincial newborn screen and health-care database for 12,587 children born in 2004, maternal distress (depression or anxiety) was defined as prenatal, self-limiting, recurrent, or late-onset postpartum. Atopic dermatitis (AD) and asthma at ages 5 years and 7 years of age were diagnosed by using hospitalization, physician visit, or prescription records. Associations between maternal distress and childhood asthma and AD were determined by using multiple logistic regression. RESULTS After adjusting for risk factors, a significant association between maternal prenatal (OR, 1.27; 95% CI, 1.11-1.46), recurrent postpartum (OR, 1.28; 95% CI, 1.11-1.48), and late-onset postpartum (OR, 1.19, 95% CI, 1.06-1.34) distress was found with AD at age 5 years. Asthma at age 7 years was also associated with maternal prenatal distress (OR, 1.57; 95% CI, 1.29-1.91) and late-onset postnatal distress (OR, 1.22; 95% CI, 1.01-1.46). Self-limiting postnatal distress was not found to be a risk factor for either atopic condition. Associations with AD or asthma were of a similar magnitude in boys and girls; the exception was recurrent postnatal distress, which increased risk for asthma in boys only. INTERPRETATION This population-based study provides evidence for sex-specific associations between maternal prenatal and postnatal distress, as well as the development of AD and asthma. The findings support recommendations for greater psychosocial support of mothers during pregnancy and early childhood to prevent childhood atopic disease.
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Affiliation(s)
| | - Salma Bahreinian
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew E Dahl
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Marni D Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Socolovsky C, Phipatanakul W. Nature and nurture: Lifelong consequences of environmental exposures. Ann Allergy Asthma Immunol 2020; 123:532-533. [PMID: 31761012 DOI: 10.1016/j.anai.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Carmela Socolovsky
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Garcia-Flores V, Romero R, Furcron AE, Levenson D, Galaz J, Zou C, Hassan SS, Hsu CD, Olson D, Metz GAS, Gomez-Lopez N. Prenatal Maternal Stress Causes Preterm Birth and Affects Neonatal Adaptive Immunity in Mice. Front Immunol 2020; 11:254. [PMID: 32174914 PMCID: PMC7054386 DOI: 10.3389/fimmu.2020.00254] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022] Open
Abstract
Maternal stress is a well-established risk factor for preterm birth and has been associated with adverse neonatal outcomes in the first and subsequent generations, including increased susceptibility to disease and lasting immunological changes. However, a causal link between prenatal maternal stress and preterm birth, as well as compromised neonatal immunity, has yet to be established. To fill this gap in knowledge, we used a murine model of prenatal maternal stress across three generations and high-dimensional flow cytometry to evaluate neonatal adaptive immunity. We report that recurrent prenatal maternal stress induced preterm birth in the first and second filial generations and negatively impacted early neonatal growth. Strikingly, prenatal maternal stress induced a systematic reduction in T cells and B cells, the former including regulatory CD4+ T cells as well as IL-4- and IL-17A-producing T cells, in the second generation. Yet, neonatal adaptive immunity gained resilience against prenatal maternal stress by the third generation. We also show that the rate of prenatal maternal stress-induced preterm birth can be reduced upon cessation of stress, though neonatal growth impairments persisted. These findings provide evidence that prenatal maternal stress causes preterm birth and affects neonatal immunity across generations, adverse effects that can be ameliorated upon cessation.
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Affiliation(s)
- Valeria Garcia-Flores
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, United States
- Detroit Medical Center, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Florida International University, Miami, FL, United States
| | - Amy-Eunice Furcron
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Dustyn Levenson
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Jose Galaz
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Chengrui Zou
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - David Olson
- Department of Obstetrics and Gynecology, Pediatrics, and Physiology, University of Alberta, Edmonton, AB, Canada
| | - Gerlinde A. S. Metz
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U. S. Department of Health and Human Services, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Immunology, Microbiology and Biochemistry, Wayne State University School of Medicine, Detroit, MI, United States
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Pereira Gray D, Dean D, Dean PM. Childcare outside the family for the under-threes: cause for concern? J R Soc Med 2020; 113:140-142. [PMID: 32053757 DOI: 10.1177/0141076820903494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Denis Pereira Gray
- St Leonard's Research Practice, Exeter EX1 1FB, UK.,What About the Children?, Newbold on Stour CV37 8TY, UK
| | - Diana Dean
- What About the Children?, Newbold on Stour CV37 8TY, UK
| | - Philip M Dean
- What About the Children?, Newbold on Stour CV37 8TY, UK
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45
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Stern J, Pier J, Litonjua AA. Asthma epidemiology and risk factors. Semin Immunopathol 2020; 42:5-15. [PMID: 32020334 DOI: 10.1007/s00281-020-00785-1] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/15/2020] [Indexed: 12/20/2022]
Abstract
Asthma is a clinical syndrome that affects all age groups. Asthma prevalence worldwide has seen a rapid increase in the latter part of the last century. Recent data has shown that asthma prevalence has plateaued and even decreased in some areas of the world, despite continuing to increase in other areas of the world. Many risk factors have been associated with asthma and the differences in distributions of these risk factors may explain the differences in prevalence. This article will review recent trends in the prevalence of asthma and recent studies that investigate risk factors of asthma.
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Affiliation(s)
- Jessica Stern
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Division of Allergy and Immunology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer Pier
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Division of Allergy and Immunology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 667, Rochester, NY, 14642, USA. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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46
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Peden DB. The "envirome" and what the practitioner needs to know about it. Ann Allergy Asthma Immunol 2019; 123:542-549. [PMID: 31560947 DOI: 10.1016/j.anai.2019.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This review on the "envirome" focuses on pollution, microbial, and social stressor elements of the environment that may impact development or expression of allergic diseases. DATA SOURCES Peer-reviewed publications on the impact of environmental factors indexed in PubMed were the primary data source for this review. STUDY SELECTIONS The primary search strategy for this review employed cross-referencing asthma, atopic dermatitis, and immunoglobulin E (IgE) against pollution (ozone, particulate matter, nitrogen oxides, tobacco smoke), microbial exposures (farm exposure, microbiome, infection, antibiotic use) and psychosocial stressors, with emphasis on results in the past 5 years, with inclusion of key seminal articles or comprehensive reviews. RESULTS Air pollution is a clear cause of allergic disease exacerbation, with increasing recognition that pollutant exposure increases risk of allergic disease. Microbial exposures and maternal and child stress also modulate development and expression of allergic disease. Early life exposures are especially critical periods during which all of these factors have notable impacts on allergic disease. CONCLUSION Nonallergenic environmental factors are important modulators and adjuvants for development of allergic disease, with early life exposures being especially important. Development and validation of interventions directed toward these factors during early life is a significant opportunity for primary prevention of allergic disease.
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Affiliation(s)
- David B Peden
- The Center for Environmental Medicine, Asthma and Lung Biology and Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, the School of Medicine, The University of North Carolina at Chapel Hill.
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47
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Teach SJ, Shelef DQ, Fousheé N, Horn IB, Yadav K, Wang Y, Rand CS, Streisand R. Randomized clinical trial of parental psychosocial stress management to improve asthma outcomes. J Asthma 2019; 58:121-132. [PMID: 31545115 DOI: 10.1080/02770903.2019.1665063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Because higher parental psychosocial stress is associated with worsened asthma outcomes in children, we sought to determine if a parent-focused stress management intervention would improve outcomes among their at-risk African American children. METHODS We enrolled self-identified African American parent-child dyads (children aged 4-12 years old with persistent asthma, no co-morbidities, on Medicaid) in a prospective, single-blind, randomized clinical trial with follow-up at 3, 6, and 12 months. All children received care based on the guidelines of the National Institutes of Health. Developed with extensive local stakeholder engagement, the intervention consisted of four individual sessions with a community wellness coach (delivered over 3 months) supplemented with weekly text messaging and twice monthly group sessions (both delivered for 6 months). The main outcome was asthma symptom-free days in the prior 14 days by repeated measures at 3 and 6 months follow-up. RESULTS We randomized 217 parent-child dyads and followed 196 (90.3%) for 12 months. Coaches completed 338/428 (79%) of all individual sessions. Symptom-free days increased significantly from baseline in both groups at 3, 6, and 12 months, but there were no significant differences between groups over the first 6 months. At 12 months, the intervention group sustained a significantly greater increase in symptom-free days from baseline [adjusted difference = 0.92 days, 95% confidence interval (0.04, 1.8)]. CONCLUSION The intervention did not achieve its primary outcome. The efficacy of providing psychosocial stress management training to parents of at-risk African American children with persistent asthma in order to improve the children's outcomes may be limited. CLINICALTRIALS.GOV NCT02374138.
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Affiliation(s)
- Stephen J Teach
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Deborah Q Shelef
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA
| | - Naja Fousheé
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA
| | | | - Kabir Yadav
- Los Angeles Medical Center, Harbor-University of California, Torrance, CA, USA
| | - Yunfei Wang
- Duke Human Vaccine Institute, Duke University, Durham, NC, USA
| | - Cynthia S Rand
- Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA
| | - Randi Streisand
- Pediatrics, Children's National Medical Center, George Washington University, Washington, DC, USA.,School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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48
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Robijn AL, Jensen ME, McLaughlin K, Gibson PG, Murphy VE. Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta-analysis. Clin Exp Allergy 2019; 49:1403-1417. [PMID: 31357230 DOI: 10.1111/cea.13474] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/16/2019] [Accepted: 08/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies demonstrate the prescription rate for inhaled corticosteroids (ICS) decreases in early pregnancy, possibly increasing exacerbation risk. This could be related to non-adherence to prescribed asthma medication or medication cessation by the patient or doctor. ICS use during pregnancy has not previously been summarized in a systematic review. OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the use of ICS during pregnancy among asthmatic women, specifically: (1) the prevalence of use, (2) changes of use during pregnancy compared with pre-pregnancy and (3) medication adherence among ICS users. METHODS We systematically searched literature in Embase, MEDLINE, CINAL and Cochrane, using terms related to asthma, pregnancy and medication use. All English articles reporting ICS among pregnant women with asthma were included. Prevalence, changes in ICS use during pregnancy and ICS adherence were pooled using STATA (version 15.0, StataCorp USA). RESULTS A total of 4237 references were retrieved in the initial search. Screening and review led to the inclusion of 52 articles for one or more aims (Aim 1: N = 45; Aim 2, N = 13; and Aim 3, N = 5). The pooled prevalence of ICS use during pregnancy was 41% (95%CI 36%-45%); 49% (95%CI 44%-55%) in Europe, 39% (95%CI 32%-47%) in Australia and 34% (95%CI 27%-41%) in North America. In eight prescription databases, ICS prescription rates lowered in the first trimester of pregnancy, compared with pre-pregnancy, increased in the second trimester and decreased in the third trimester. Five studies reported ICS adherence among pregnant women, using four measures of self-reported non-adherence. In two comparable studies, pooled ICS non-adherence was 40% (95%CI 36%-44%). CONCLUSIONS The prevalence of ICS use among pregnant women with asthma is 41% and varies widely between countries and continents, and prescription rates for ICS change throughout pregnancy. More studies are needed to investigate ICS adherence during pregnancy in women with asthma.
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Affiliation(s)
- Annelies L Robijn
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Megan E Jensen
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Karen McLaughlin
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
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49
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Chen E, Hayen R, Le V, Austin MK, Shalowitz MU, Story RE, Miller GE. Neighborhood Social Conditions, Family Relationships, and Childhood Asthma. Pediatrics 2019; 144:peds.2018-3300. [PMID: 31320467 PMCID: PMC6856806 DOI: 10.1542/peds.2018-3300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Poor neighborhood conditions have established associations with poorer child health, but little is known about protective factors that mitigate the effects of difficult neighborhood conditions. In this study, we tested if positive family relationships can buffer youth who live in dangerous and/or disorderly neighborhoods from poor asthma outcomes. METHODS A total of 308 youths (aged 9-17) who were physician-diagnosed with asthma and referred from community pediatricians and/or family practitioners participated in this cross-sectional study. Neighborhood conditions around families' home addresses were coded by using Google Street View images. Family relationship quality was determined via youth interviews. Clinical asthma outcomes (asthma symptoms, activity limitations, and forced expiratory volume in 1 second percentile), asthma management behaviors (family response to asthma symptoms and integration of asthma into daily life), and asthma-relevant immunologic processes (lymphocyte T helper 1 and T helper 2 cytokine production and sensitivity to glucocorticoid inhibition) were assessed via questionnaires, interviews, spirometry, and blood draws. RESULTS Significant interactions were found between neighborhood conditions and family relationship quality (β = |.11-.15|; P < .05). When neighborhood danger and/or disorder was low, family relationships were not associated with asthma. When neighborhood danger and/or disorder was high, better family relationship quality was associated with fewer asthma symptoms, fewer activity limitations, and higher forced expiratory volume in 1 second percentile. Similar patterns emerged for asthma management behaviors. With immunologic measures, greater neighborhood danger and/or disorder was associated with greater T helper 1 and T helper 2 cytokine production and reduced glucocorticoid sensitivity. CONCLUSIONS When youth live in dangerous and/or disorderly neighborhoods, high family relationship quality can buffer youth from poor asthma outcomes. Although families may not be able to change their neighborhoods, they may nonetheless be able to facilitate better asthma outcomes in their children through strong family relationships.
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Affiliation(s)
- Edith Chen
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois; and
| | - Robin Hayen
- Department of Psychology and Institute for Policy
Research, Northwestern University, Evanston, Illinois; and
| | - Van Le
- Department of Psychology and Institute for Policy
Research, Northwestern University, Evanston, Illinois; and
| | - Makeda K. Austin
- Department of Psychology and Institute for Policy
Research, Northwestern University, Evanston, Illinois; and
| | - Madeleine U. Shalowitz
- Center for Clinical Research Informatics, NorthShore
University HealthSystem, Evanston, Illinois
| | | | - Gregory E. Miller
- Department of Psychology and Institute for Policy
Research, Northwestern University, Evanston, Illinois; and
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50
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The costs of high self-control in Black and Latino youth with asthma: Divergence of mental health and inflammatory profiles. Brain Behav Immun 2019; 80:120-128. [PMID: 30818034 PMCID: PMC6660352 DOI: 10.1016/j.bbi.2019.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/23/2019] [Accepted: 02/23/2019] [Indexed: 10/27/2022] Open
Abstract
Emerging evidence in psychology suggests a paradox whereby high levels of self-control when striving for academic success among minority youth can have physical health costs. This study tested the skin-deep resilience hypothesis in asthma- whether minority youth who are striving hard to succeed academically experience good psychological outcomes but poor asthma outcomes. Youth physician-diagnosed with asthma (N = 276, M age = 12.99; 155 = White, 121 = Black/Latino) completed interviews about school stress and a self-control questionnaire. Outcomes included mental health (anxiety/depression) and ex-vivo immunologic processes relevant to asthma (lymphocyte Th-1 and Th-2 cytokine production, and sensitivity to glucocorticoid inhibition). Physician contacts were tracked over a one-year follow-up. For minority youth experiencing high levels of school stress, greater self-control was associated with fewer mental health symptoms (beta = -0.20, p < .05), but worse asthma inflammatory profiles (larger Th-1 and Th-2 cytokine responses, lower sensitivity to glucocorticoid inhibition), and more frequent physician contacts during the one-year follow-up (beta's ranging from 0.22 to 0.43, p's < .05). These patterns were not evident in White youth. In minority youth struggling with school, high levels of self-control are detrimental to asthma inflammatory profiles and clinical outcomes. This suggests the need for health monitoring to be incorporated into academic programs to ensure that 'overcoming the odds' does not lead to heightened health risks in minority youth.
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