1
|
Hillman NH, Kemp MW, Royse E, Grzych H, Usada H, Ikeda H, Takahashi Y, Takahashi T, Jobe AH, Fee E. Postnatal budesonide improved lung function in preterm lambs exposed to antenatal steroids and chorioamnionitis. Pediatr Res 2024:10.1038/s41390-024-03092-9. [PMID: 38368498 DOI: 10.1038/s41390-024-03092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/29/2023] [Accepted: 01/17/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND A combination of budesonide and surfactant decreases the rates of BPD in infants and lung injury in preterm sheep. Whether this combination will show benefit in the setting of chorioamnionitis and antenatal steroids is not known. METHODS Ewes at 123 ± 1 day gestational age received intra-amniotic (IA) injections of 10 mg LPS before being randomized to receive either 0.25 mg/kg maternal betamethasone phosphate and acetate or saline by intramuscular (IM) injection at 48 and 24 h prior to delivery at 125 ± 1 day. Lambs (N = 6-9/group) underwent intentionally injurious ventilation for 15 min, then lambs received surfactant mixed with either: (1) saline; or (2) Budesonide 0.25 mg/kg and were ventilated for 4 h. RESULTS Compared with LPS-exposed animals that received no IM steroid treatment, betamethasone exposed fetuses had improved hemodynamic stability, lung compliance, and ventilation efficiency. The addition of budesonide to surfactant further improved markers of injury and pro-inflammatory cytokine mRNA in both betamethasone IM or no IM lambs exposed to LPS IA. Antenatal betamethasone and IA LPS exposures decreased budesonide levels in the fetal lung and plasma. CONCLUSION Antenatal betamethasone stabilizes physiologic parameters in LPS treated lambs. Budesonide mixed with surfactant further decreases injury and improves respiratory physiology in betamethasone treated animals. IMPACT Antenatal betamethasone improved lung and systemic physiology in the setting of intra-amniotic LPS. The addition of budesonide to the surfactant further improved lung function. Budesonide levels in the plasma and lung were lower in lambs exposed to either LPS or LPS and Betamethasone animals, and these findings were not explained by increased esterification in the lungs. The combination of antenatal steroids and budesonide with surfactant had the lowest markers of pro-inflammatory cytokines in the lung of LPS exposed animals.
Collapse
Affiliation(s)
- Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA.
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hayley Grzych
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Haruo Usada
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Hideyuki Ikeda
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Yuki Takahashi
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Tsukasa Takahashi
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Alan H Jobe
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Erin Fee
- School of Women's and Infants' Health, University of Western Australia, Perth, WA, 6009, Australia
| |
Collapse
|
2
|
Animal Models of Chorioamnionitis: Considerations for Translational Medicine. Biomedicines 2022; 10:biomedicines10040811. [PMID: 35453561 PMCID: PMC9032938 DOI: 10.3390/biomedicines10040811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Preterm birth is defined as any birth occurring before 37 completed weeks of gestation by the World Health Organization. Preterm birth is responsible for perinatal mortality and long-term neurological morbidity. Acute chorioamnionitis is observed in 70% of premature labor and is associated with a heavy burden of multiorgan morbidities in the offspring. Unfortunately, chorioamnionitis is still missing effective biomarkers and early placento- as well as feto-protective and curative treatments. This review summarizes recent advances in the understanding of the underlying mechanisms of chorioamnionitis and subsequent impacts on the pregnancy outcome, both during and beyond gestation. This review also describes relevant and current animal models of chorioamnionitis used to decipher associated mechanisms and develop much needed therapies. Improved knowledge of the pathophysiological mechanisms underpinning chorioamnionitis based on preclinical models is a mandatory step to identify early in utero diagnostic biomarkers and design novel anti-inflammatory interventions to improve both maternal and fetal outcomes.
Collapse
|
3
|
A20 Is Increased in Fetal Lung in a Sheep LPS Model of Chorioamnionitis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6421419. [PMID: 35096271 PMCID: PMC8794675 DOI: 10.1155/2022/6421419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/21/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
Chorioamnionitis is associated with an increased risk of preterm birth and aggravates adverse outcomes such as BPD. Development of BPD is associated with chronic inflammatory reactions and oxidative stress in the airways which may be antenatally initiated by chorioamnionitis. A20 is an immunomodulatory protein involved in the negative feedback regulation of inflammatory reactions and is a possible regulator protein in oxidative stress reactions. The influence of chorioamnionitis on A20 gene regulation in the fetal lung is unknown. We characterized the influence of LPS and proinflammatory cytokines on A20 expression in human lung endothelial (HPMEC-ST1.6R) and epithelial (A549) cells in vitro by real-time PCR and/or western blotting and used a sheep model of LPS-induced chorioamnionitis for in vivo studies. To study the functional role of A20, endogenous A20 was overexpressed in HPMEC-ST1.6R and A549 cells. LPS induced proinflammatory cytokines in HPMEC-ST1.6R and A549 cells. Both LPS and/or proinflammatory cytokines elevated A20 at transcriptional and translational levels. Intra-amniotic LPS transiently increased IL-1β, IL-6, IL-8, and TNF-α mRNA levels in fetal lamb lungs, associated with an increase in A20 mRNA and protein levels. Overexpression of A20 reduced proinflammatory cytokines in vitro. Repeated LPS exposure induced LPS tolerance for proinflammatory cytokines and A20 in vitro and in vivo. Antenatal inflammation induced a transient increase in proinflammatory cytokines in the preterm fetal lung. The expression of proinflammatory cytokines increased expression of A20. Elevated A20 may have a protective role by downregulating chorioamnionitis-triggered fetal lung inflammation. A20 may be a novel target for pharmacological interventions to prevent chorioamnionitis-induced airway inflammation and lung damage, which can result in BPD later in life.
Collapse
|
4
|
Tiozzo C, Bustoros M, Lin X, Manzano De Mejia C, Gurzenda E, Chavez M, Hanna I, Aguiari P, Perin L, Hanna N. Placental extracellular vesicles-associated microRNA-519c mediates endotoxin adaptation in pregnancy. Am J Obstet Gynecol 2021; 225:681.e1-681.e20. [PMID: 34181894 PMCID: PMC8633060 DOI: 10.1016/j.ajog.2021.06.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pregnancy represents a unique challenge for the maternal-fetal immune interface, requiring a balance between immunosuppression, which is essential for the maintenance of a semiallogeneic fetus, and proinflammatory host defense to protect the maternal-fetal interface from invading organisms. Adaptation to repeated inflammatory stimuli (endotoxin tolerance) may be critical in preventing inflammation-induced preterm birth caused by exaggerated maternal inflammatory responses to mild or moderate infections that are common during pregnancy. However, the exact mechanisms contributing to the maintenance of tolerance to repeated infections are not completely understood. MicroRNAs play important roles in pregnancy with several microRNAs implicated in gestational tissue function and in pathologic pregnancy conditions. MicroRNA-519c, a member of the chromosome 19 microRNA cluster, is a human-specific microRNA mainly expressed in the placenta. However, its role in pregnancy is largely unknown. OBJECTIVE This study aimed to explore the role of "endotoxin tolerance" failure in the pathogenesis of an exaggerated inflammatory response often seen in inflammation-mediated preterm birth. In this study, we investigated the role of microRNA-519c, a placenta-specific microRNA, as a key regulator of endotoxin tolerance at the maternal-fetal interface. STUDY DESIGN Using a placental explant culture system, samples from term and second-trimester placentas were treated with lipopolysaccharide. After 24 hours, the conditioned media were collected for analysis, and the placental explants were re-exposed to repeated doses of lipopolysaccharide for 3 days. The supernatant was analyzed for inflammatory markers, the presence of extracellular vesicles, and microRNAs. To study the possible mechanism of action of the microRNAs, we evaluated the phosphodiesterase 3B pathway involved in tumor necrosis factor alpha production using a microRNA mimic and phosphodiesterase 3B small interfering RNA transfection. Finally, we analyzed human placental samples from different gestational ages and from women affected by inflammation-associated pregnancies. RESULTS Our data showed that repeated exposure of the human placenta to endotoxin challenges induced a tolerant phenotype characterized by decreased tumor necrosis factor alpha and up-regulated interleukin-10 levels. This reaction was mediated by the placenta-specific microRNA-519c packaged within placental extracellular vesicles. Lipopolysaccharide treatment increased the extracellular vesicles that were positive for the exosome tetraspanin markers, namely CD9, CD63, and CD81, and secreted primarily by trophoblasts. Primary human trophoblast cells transfected with a microRNA-519c mimic decreased phosphodiesterase 3B, whereas a lack of phosphodiesterase 3B, achieved by small interfering RNA transfection, led to decreased tumor necrosis factor alpha production. These data support the hypothesis that the anti-inflammatory action of microRNA-519c was mediated by a down-regulation of the phosphodiesterase 3B pathway, leading to inhibition of tumor necrosis factor alpha production. Furthermore, human placentas from normal and inflammation-associated pregnancies demonstrated that a decreased placental microRNA-519c level was linked to infection-induced inflammatory pathologies during pregnancy. CONCLUSION We identified microRNA-519c, a human placenta-specific microRNA, as a novel regulator of immune adaptation associated with infection-induced preterm birth at the maternal-fetal interface. Our study serves as a basis for future experiments to explore the potential use of microRNA-519c as a biomarker for infection-induced preterm birth.
Collapse
Affiliation(s)
- Caterina Tiozzo
- Division of Neonatology, Department of Pediatrics, NYU Langone Hospital-Long Island, New York University Long Island School of Medicine, Mineola, NY
| | - Mark Bustoros
- Women and Children's Research Laboratory, New York University Long Island School of Medicine, Mineola, NY; Division of Hematologic Neoplasia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Xinhua Lin
- Women and Children's Research Laboratory, New York University Long Island School of Medicine, Mineola, NY
| | - Claudia Manzano De Mejia
- Women and Children's Research Laboratory, New York University Long Island School of Medicine, Mineola, NY
| | - Ellen Gurzenda
- Research and Academic Center, New York University Long Island School of Medicine, Mineola, NY
| | - Martin Chavez
- Department of Obstetrics-Gynecology, NYU Langone Hospital-Long Island, New York University Long Island School of Medicine, Mineola, NY
| | - Iman Hanna
- Department of Pathology, NYU Langone Hospital-Long Island, New York University Long Island School of Medicine, Mineola, NY
| | - Paola Aguiari
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Division of Urology, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Laura Perin
- GOFARR Laboratory for Organ Regenerative Research and Cell Therapeutics, Division of Urology, Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Nazeeh Hanna
- Division of Neonatology, Department of Pediatrics, NYU Langone Hospital-Long Island, New York University Long Island School of Medicine, Mineola, NY.
| |
Collapse
|
5
|
Lung development and immune status under chronic LPS exposure in rat pups with and without CD26/DPP4 deficiency. Cell Tissue Res 2021; 386:617-636. [PMID: 34606000 PMCID: PMC8595150 DOI: 10.1007/s00441-021-03522-8] [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: 10/05/2020] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
Dipeptidyl-peptidase IV (CD26), a multifactorial integral type II protein, is expressed in the lungs during development and is involved in inflammation processes. We tested whether daily LPS administration influences the CD26-dependent retardation in morphological lung development and induces alterations in the immune status. Newborn Fischer rats with and without CD26 deficiency were nebulized with 1 µg LPS/2 ml NaCl for 10 min from days postpartum (dpp) 3 to 9. We used stereological methods and fluorescence activated cell sorting (FACS) to determine morphological lung maturation and alterations in the pulmonary leukocyte content on dpp 7, 10, and 14. Daily LPS application did not change the lung volume but resulted in a significant retardation of alveolarization in both substrains proved by significantly lower values of septal surface and volume as well as higher mean free distances in airspaces. Looking at the immune status after LPS exposure compared to controls, a significantly higher percentage of B lymphocytes and decrease of CD4+CD25+ T cells were found in both subtypes, on dpp7 a significantly higher percentage of CD4 T+ cells in CD26+ pups, and a significantly higher percentage of monocytes in CD26− pups. The percentage of T cells was significantly higher in the CD26-deficient group on each dpp. Thus, daily postnatal exposition to low doses of LPS for 1 week resulted in a delay in formation of secondary septa, which remained up to dpp 14 in CD26− pups. The retardation was accompanied by moderate parenchymal inflammation and CD26-dependent changes in the pulmonary immune cell composition.
Collapse
|
6
|
Budesonide with surfactant decreases systemic responses in mechanically ventilated preterm lambs exposed to fetal intra-amniotic lipopolysaccharide. Pediatr Res 2021; 90:328-334. [PMID: 33177678 PMCID: PMC7657068 DOI: 10.1038/s41390-020-01267-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chorioamnionitis is associated with increased rates of bronchopulmonary dysplasia (BPD) in ventilated preterm infants. Budesonide when added to surfactant decreased lung and systemic inflammation from mechanical ventilation in preterm lambs and decreased the rates and severity of BPD in preterm infants. We hypothesized that the addition of budesonide to surfactant will decrease the injury from mechanical ventilation in preterm lambs exposed to intra-amniotic (IA) lipopolysaccharide (LPS). METHODS Lambs at 126 ± 1 day GA received LPS 10 mg IA 48 h prior to injurious mechanical ventilation. After 15 min, lambs received either surfactant mixed with: (1) saline or (2) Budesonide 0.25 mg/kg, then ventilated with normal tidal volumes for 4 h. Injury markers in the lung, liver, and brain were compared. RESULTS Compared with surfactant alone, the addition of budesonide improved blood pressures, dynamic compliance, and ventilation, while decreasing mRNA for pro-inflammatory cytokines in the lung, liver, and multiple areas of the brain. LPS caused neuronal activation and structural changes in the brain that were not altered by budesonide. Budesonide was not retained within the lung beyond 4 h. CONCLUSIONS In preterm lambs exposed to IA LPS, the addition of budesonide to surfactant improved physiology and markers of lung and systemic inflammation. IMPACT The addition of budesonide to surfactant decreases the lung and systemic responses to injurious mechanical ventilation preterm lambs exposed to fetal LPS. Budesonide was present in the plasma by 15 min and the majority of the budesonide is no longer in the lung at 4 h of ventilation. IA LPS and mechanical ventilation caused structural changes in the brain that were not altered by short-term exposure to budesonide. The budesonide dose of 0.25 mg/kg being used clinically seems likely to decrease lung inflammation in preterm infants with chorioamnionitis.
Collapse
|
7
|
Cappelletti M, Presicce P, Kallapur SG. Immunobiology of Acute Chorioamnionitis. Front Immunol 2020; 11:649. [PMID: 32373122 PMCID: PMC7177011 DOI: 10.3389/fimmu.2020.00649] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/23/2020] [Indexed: 12/19/2022] Open
Abstract
Acute chorioamnionitis is characterized by neutrophilic infiltration and inflammation at the maternal fetal interface. It is a relatively common complication of pregnancy and can have devastating consequences including preterm labor, maternal infections, fetal infection/inflammation, fetal lung, brain, and gastrointestinal tract injury. In this review, we will discuss current understanding of the pathogenesis, immunobiology, and mechanisms of this condition. Most commonly, acute chorioamnionitis is a result of ascending infection with relatively low-virulence organisms such as the Ureaplasma species. Furthermore, recent vaginal microbiome studies suggest that there is a link between vaginal dysbiosis, vaginal inflammation, and ascending infection. Although less common, microorganisms invading the maternal-fetal interface via hematogenous route (e.g., Zika virus, Cytomegalovirus, and Listeria) can cause placental villitis and severe fetal inflammation and injury. We will provide an overview of the knowledge gleaned from different animal models of acute chorioamnionitis and the role of different immune cells in different maternal-fetal compartments. Lastly, we will discuss how infectious agents can break the maternal tolerance of fetal allograft during pregnancy and highlight the novel future therapeutic approaches.
Collapse
Affiliation(s)
- Monica Cappelletti
- Divisions of Neonatology and Developmental Biology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| | - Pietro Presicce
- Divisions of Neonatology and Developmental Biology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| | - Suhas G Kallapur
- Divisions of Neonatology and Developmental Biology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
8
|
Abstract
In the absence of effective interventions to prevent preterm births, improved survival of infants who are born at the biological limits of viability has relied on advances in perinatal care over the past 50 years. Except for extremely preterm infants with suboptimal perinatal care or major antenatal events that cause severe respiratory failure at birth, most extremely preterm infants now survive, but they often develop chronic lung dysfunction termed bronchopulmonary dysplasia (BPD; also known as chronic lung disease). Despite major efforts to minimize injurious but often life-saving postnatal interventions (such as oxygen, mechanical ventilation and corticosteroids), BPD remains the most frequent complication of extreme preterm birth. BPD is now recognized as the result of an aberrant reparative response to both antenatal injury and repetitive postnatal injury to the developing lungs. Consequently, lung development is markedly impaired, which leads to persistent airway and pulmonary vascular disease that can affect adult lung function. Greater insights into the pathobiology of BPD will provide a better understanding of disease mechanisms and lung repair and regeneration, which will enable the discovery of novel therapeutic targets. In parallel, clinical and translational studies that improve the classification of disease phenotypes and enable early identification of at-risk preterm infants should improve trial design and individualized care to enhance outcomes in preterm infants.
Collapse
|
9
|
Martinello KA, Meehan C, Avdic-Belltheus A, Lingam I, Ragab S, Hristova M, Tann CJ, Peebles D, Hagberg H, Wolfs TGAM, Klein N, Tachtsidis I, Golay X, Kramer BW, Fleiss B, Gressens P, Robertson NJ. Acute LPS sensitization and continuous infusion exacerbates hypoxic brain injury in a piglet model of neonatal encephalopathy. Sci Rep 2019; 9:10184. [PMID: 31308390 PMCID: PMC6629658 DOI: 10.1038/s41598-019-46488-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Co-existing infection/inflammation and birth asphyxia potentiate the risk of developing neonatal encephalopathy (NE) and adverse outcome. In a newborn piglet model we assessed the effect of E. coli lipopolysaccharide (LPS) infusion started 4 h prior to and continued for 48 h after hypoxia on brain cell death and systemic haematological changes compared to LPS and hypoxia alone. LPS sensitized hypoxia resulted in an increase in mortality and in brain cell death (TUNEL positive cells) throughout the whole brain, and in the internal capsule, periventricular white matter and sensorimotor cortex. LPS alone did not increase brain cell death at 48 h, despite evidence of neuroinflammation, including the greatest increases in microglial proliferation, reactive astrocytosis and cleavage of caspase-3. LPS exposure caused splenic hypertrophy and platelet count suppression. The combination of LPS and hypoxia resulted in the highest and most sustained systemic white cell count increase. These findings highlight the significant contribution of acute inflammation sensitization prior to an asphyxial insult on NE illness severity.
Collapse
Affiliation(s)
- Kathryn A Martinello
- Institute for Women's Health, University College London, London, United Kingdom
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Christopher Meehan
- Institute for Women's Health, University College London, London, United Kingdom
| | | | - Ingran Lingam
- Institute for Women's Health, University College London, London, United Kingdom
| | - Sara Ragab
- Institute for Women's Health, University College London, London, United Kingdom
| | - Mariya Hristova
- Institute for Women's Health, University College London, London, United Kingdom
| | - Cally J Tann
- Institute for Women's Health, University College London, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Donald Peebles
- Institute for Women's Health, University College London, London, United Kingdom
| | - Henrik Hagberg
- Centre of Perinatal Medicine & Health, Department of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre for the Developing Brain, Department of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Tim G A M Wolfs
- Department of Paediatrics, University of Maastricht, Maastricht, Netherlands
| | - Nigel Klein
- Infection, Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Xavier Golay
- Institute of Neurology, University College London, London, United Kingdom
| | - Boris W Kramer
- Department of Paediatrics, University of Maastricht, Maastricht, Netherlands
| | - Bobbi Fleiss
- Centre for the Developing Brain, Department of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
- PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Pierre Gressens
- Centre for the Developing Brain, Department of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
- PROTECT, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, United Kingdom.
- Division of Neonatology, Sidra Medicine, Doha, Qatar.
| |
Collapse
|
10
|
Gisslen T, Singh G, Georgieff MK. Fetal inflammation is associated with persistent systemic and hippocampal inflammation and dysregulation of hippocampal glutamatergic homeostasis. Pediatr Res 2019; 85:703-710. [PMID: 30745569 PMCID: PMC6435426 DOI: 10.1038/s41390-019-0330-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/29/2018] [Accepted: 02/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammation is a major cause of preterm birth and often results in a fetal inflammatory response syndrome (FIRS). Preterm infants with FIRS have a higher childhood incidence of neurodevelopmental disability than preterm infants without FIRS. The mechanisms connecting FIRS to neurodevelopmental disability in formerly preterm infants are not fully understood, but the effect on premature gray matter may have an important role. METHODS Fetal rats were exposed to intra-amniotic (i.a.) LPS 2 days prior to birth to model FIRS. On postnatal day 7, expression of inflammatory mediators was measured in the liver, lung, and brain. Activation of microglia and expression of glutamatergic receptor subunits and transporters were measured in the hippocampus and cortex. RESULTS LPS caused persistent systemic inflammatory mediators gene expression. In the brain, there was corresponding activation of microglia in the hippocampus and cortex. Expression of inflammatory mediators persisted in the hippocampus, but not the cortex, and was associated with altered glutamatergic receptor subunits and transporters. CONCLUSION Hippocampal inflammation and dysregulation of glutamate metabolism persisted well into the postnatal period following i.a. LPS. Poor neurodevelopmental outcomes after FIRS in preterm infants may result in part through glutamatergically driven gray matter injury to the neonatal hippocampus.
Collapse
Affiliation(s)
- Tate Gisslen
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Garima Singh
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Michael K Georgieff
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
11
|
Gisslen T, Alvarez M, Wells C, Soo MT, Lambers DS, Knox CL, Meinzen-Derr JK, Chougnet CA, Jobe AH, Kallapur SG. Fetal inflammation associated with minimal acute morbidity in moderate/late preterm infants. Arch Dis Child Fetal Neonatal Ed 2016; 101:F513-F519. [PMID: 27010018 DOI: 10.1136/archdischild-2015-308518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/30/2015] [Accepted: 02/24/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether exposure to acute chorioamnionitis and fetal inflammation caused short-term adverse outcomes. DESIGN This is a prospective observational study: subjects were mothers delivering at 32-36 weeks gestation and their preterm infants at a large urban tertiary level III perinatal unit (N=477 infants). Placentae and fetal membranes were scored for acute histological chorioamnionitis based on the Redline criteria. Fetal inflammation was characterised by histological diagnosis of funisitis (umbilical cord inflammation), increased cord blood cytokines measured by ELISA, and activation of the inflammatory cells infiltrating the placenta and fetal membranes measured by immunohistology. Maternal and infant data were collected. RESULTS Twenty-four per cent of 32-36-week infants were exposed to histological chorioamnionitis and 6.9% had funisitis. Immunostaining for leucocyte subsets showed selective infiltration of the placenta and fetal membranes with activated neutrophils and macrophages with chorioamnionitis. Interleukin (IL) 6, IL-8 and granulocyte colony-stimulating factor were selectively increased in the cord blood of preterm infants with funisitis. Compared with infants without chorioamnionitis, funisitis was associated with increased ventilation support during resuscitation (43.8% vs 15.4%) and more respiratory distress syndrome postnatally (27.3% vs 10.2%) in univariate analysis. However, these associations disappeared after adjusting for prematurity. CONCLUSIONS Despite fetal exposure to funisitis, increased cord blood cytokines and activated placental inflammatory cells, we could not demonstrate neonatal morbidity specifically attributable to fetal inflammation after adjusting for gestational age in moderate and late preterm infants.
Collapse
Affiliation(s)
- Tate Gisslen
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Neonatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Manuel Alvarez
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Casey Wells
- Department of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Man-Ting Soo
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Donna S Lambers
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, Ohio, USA
| | - Christine L Knox
- Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jareen K Meinzen-Derr
- Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Claire A Chougnet
- Department of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alan H Jobe
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Suhas G Kallapur
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
12
|
Pagel J, Hartz A, Figge J, Gille C, Eschweiler S, Petersen K, Schreiter L, Hammer J, Karsten CM, Friedrich D, Herting E, Göpel W, Rupp J, Härtel C. Regulatory T cell frequencies are increased in preterm infants with clinical early-onset sepsis. Clin Exp Immunol 2016; 185:219-27. [PMID: 27163159 DOI: 10.1111/cei.12810] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/14/2016] [Accepted: 05/01/2016] [Indexed: 12/16/2022] Open
Abstract
The predisposition of preterm neonates to invasive infection is, as yet, incompletely understood. Regulatory T cells (Tregs ) are potential candidates for the ontogenetic control of immune activation and tissue damage in preterm infants. It was the aim of our study to characterize lymphocyte subsets and in particular CD4(+) CD25(+) forkhead box protein 3 (FoxP3)(+) Tregs in peripheral blood of well-phenotyped preterm infants (n = 117; 23 + 0 - 36 + 6 weeks of gestational age) in the first 3 days of life in comparison to term infants and adults. We demonstrated a negative correlation of Treg frequencies and gestational age. Tregs were increased in blood samples of preterm infants compared to term infants and adults. Notably, we found an increased Treg frequency in preterm infants with clinical early-onset sepsis while cause of preterm delivery, e.g. chorioamnionitis, did not affect Treg frequencies. Our data suggest that Tregs apparently play an important role in maintaining maternal-fetal tolerance, which turns into an increased sepsis risk after preterm delivery. Functional analyses are needed in order to elucidate whether Tregs have potential as future target for diagnostics and therapeutics.
Collapse
Affiliation(s)
- J Pagel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck.,Department of Infectious Diseases and Microbiology, University of Lübeck
| | - A Hartz
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck.,Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - J Figge
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - C Gille
- Department of Neonatology, University of Tübingen, Tübingen, Germany
| | - S Eschweiler
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - K Petersen
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - L Schreiter
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck.,Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - J Hammer
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - C M Karsten
- Institute for Systemic Inflammation Research, University of Lübeck, Lübeck
| | - D Friedrich
- Department of Infectious Diseases and Microbiology, University of Lübeck
| | - E Herting
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - W Göpel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| | - J Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck
| | - C Härtel
- Department of Pediatrics, University Clinic Schleswig Holstein, Campus Lübeck
| |
Collapse
|
13
|
Choi CW, Lee J, Oh JY, Lee SH, Lee HJ, Kim BI. Protective effect of chorioamnionitis on the development of bronchopulmonary dysplasia triggered by postnatal systemic inflammation in neonatal rats. Pediatr Res 2016; 79:287-94. [PMID: 26551413 PMCID: PMC4829878 DOI: 10.1038/pr.2015.224] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/08/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prenatal or postnatal systemic inflammation can contribute to the development of bronchopulmonary dysplasia (BPD). We investigated whether prenatal intra-amniotic (i.a.) inflammation or early postnatal systemic inflammation can induce BPD in a rat model. METHODS One microgram of lipopolysaccharide (LPS) or vehicle was injected into the amniotic sacs 2 d before delivery (E20). After birth, 0.25 mg/kg of LPS or vehicle was injected into the peritoneum of pups on postnatal day (P)1, P3, and P5. On P7 and P14, peripheral blood (PB), bronchoalveolar lavage fluid (BALF), and lung tissue were obtained and analyzed. RESULTS Postnatal i.p. injections of LPS significantly increased neutrophil counts in PB and BALF on P7 and P14. Similarly, proinflammatory cytokine and angiogenic factor transcript levels were increased in the lung by i.p. LPS on P7. Alveolar and pulmonary vascular development was markedly disrupted by i.p. LPS on P14. However, pretreatment with i.a. LPS significantly negated the detrimental effects of postnatal i.p. LPS on PB and BALF neutrophil counts and on lung proinflammatory cytokine expression and histopathological changes. CONCLUSION Exposure to early postnatal systemic LPS induces BPD, an arrest in alveolarization, in neonatal rats. Preceding exposure to i.a. LPS protects the lungs against BPD triggered by postnatal systemic inflammation.
Collapse
Affiliation(s)
- Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Juyoung Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea,()
| |
Collapse
|
14
|
Musk GC, Kemp MW. Maternal and fetal arterial blood gas data during general anaesthesia for caesarean delivery of preterm twin lambs. Lab Anim 2015. [PMID: 26219550 DOI: 10.1177/0023677215598449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Much remains to be understood with regards the effects of prolonged anaesthesia on maternal and fetal haemodynamics and oxygenation. With the aim of improving anaesthetic management of pregnant sheep undergoing recovery surgery under anaesthesia, paired maternal and fetal arterial blood samples were collected during caesarean delivery of twin preterm lambs to document the blood gas status of the ewe and fetus. Twenty-one Merino twin pregnant ewes at 126 (±1) days of gestation were anaesthetized for caesarean delivery of their fetuses. Arterial blood samples were collected from the radial artery of the ewe and umbilical artery of the fetus at the point of delivery. There was a significant difference between maternal PaCO2 and end-tidal CO2 and alveolar and arterial PaO2, indicating ventilation perfusion mismatch. Interestingly, the ewes were anaemic but the fetuses were not. These data underscore the need to undertake further work to determine the optimal anaesthetic regimen for twin pregnant ewes at different gestational ages in a biomedical research setting.
Collapse
Affiliation(s)
- G C Musk
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Western Australia Animal Care Services, University of Western Australia, Perth, Western Australia
| | - M W Kemp
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia
| |
Collapse
|
15
|
Empie K, Rangarajan V, Juul SE. Is the ferret a suitable species for studying perinatal brain injury? Int J Dev Neurosci 2015; 45:2-10. [PMID: 26102988 PMCID: PMC4793918 DOI: 10.1016/j.ijdevneu.2015.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/09/2015] [Accepted: 06/01/2015] [Indexed: 11/26/2022] Open
Abstract
Ferret brain architecture, composition, and development are similar to humans. Postnatal ferret brain development is comparable to that of premature infants. Ferrets have potential to model preterm and term neonatal brain injury. Ferrets may fulfill the need for an intermediate model species of neurodevelopment. Many opportunities exist to expand the use of ferrets as research subjects.
Complications of prematurity often disrupt normal brain development and/or cause direct damage to the developing brain, resulting in poor neurodevelopmental outcomes. Physiologically relevant animal models of perinatal brain injury can advance our understanding of these influences and thereby provide opportunities to develop therapies and improve long-term outcomes. While there are advantages to currently available small animal models, there are also significant drawbacks that have limited translation of research findings to humans. Large animal models such as newborn pig, sheep and nonhuman primates have complex brain development more similar to humans, but these animals are expensive, and developmental testing of sheep and piglets is limited. Ferrets (Mustela putorius furo) are born lissencephalic and undergo postnatal cortical folding to form complex gyrencephalic brains. This review examines whether ferrets might provide a novel intermediate animal model of neonatal brain disease that has the benefit of a gyrified, altricial brain in a small animal. It summarizes attributes of ferret brain growth and development that make it an appealing animal in which to model perinatal brain injury. We postulate that because of their innate characteristics, ferrets have great potential in neonatal neurodevelopmental studies.
Collapse
Affiliation(s)
- Kristen Empie
- Department of Neonatology, University of Washington, Seattle, USA
| | | | - Sandra E Juul
- Department of Neonatology, University of Washington, Seattle, USA.
| |
Collapse
|
16
|
Maneenil G, Kemp MW, Kannan PS, Kramer BW, Saito M, Newnham JP, Jobe AH, Kallapur SG. Oral, nasal and pharyngeal exposure to lipopolysaccharide causes a fetal inflammatory response in sheep. PLoS One 2015; 10:e0119281. [PMID: 25793992 PMCID: PMC4368156 DOI: 10.1371/journal.pone.0119281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/15/2015] [Indexed: 11/22/2022] Open
Abstract
Background A fetal inflammatory response (FIR) in sheep can be induced by intraamniotic or selective exposure of the fetal lung or gut to lipopolysaccharide (LPS). The oral, nasal, and pharyngeal cavities (ONP) contain lymphoid tissue and epithelium that are in contact with the amniotic fluid. The ability of the ONP epithelium and lymphoid tissue to initiate a FIR is unknown. Objective To determine if FIR occurs after selective ONP exposure to LPS in fetal sheep. Methods Using fetal recovery surgery, we isolated ONP from the fetal lung, GI tract, and amniotic fluid by tracheal and esophageal ligation and with an occlusive glove fitted over the snout. LPS (5 mg) or saline was infused with 24 h Alzet pumps secured in the oral cavity (n = 7–8/group). Animals were delivered 1 or 6 days after initiation of the LPS or saline infusions. Results The ONP exposure to LPS had time-dependent systemic inflammatory effects with changes in WBC in cord blood, an increase in posterior mediastinal lymph node weight at 6 days, and pro-inflammatory mRNA responses in the fetal plasma, lung, and liver. Compared to controls, the expression of surfactant protein A mRNA increased 1 and 6 days after ONP exposure to LPS. Conclusion ONP exposure to LPS alone can induce a mild FIR with time-dependent inflammatory responses in remote fetal tissues not directly exposed to LPS.
Collapse
Affiliation(s)
- Gunlawadee Maneenil
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Matthew W. Kemp
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
| | - Paranthaman Senthamarai Kannan
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
| | - Boris W. Kramer
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
- Department of Pediatrics, School of Oncology and Development Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Masatoshi Saito
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
- Department of Perinatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - John P. Newnham
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
| | - Alan H. Jobe
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
| | - Suhas G. Kallapur
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
- School of Women’s and Infants’ Health, The University of Western Australia, Perth, Australia
- * E-mail:
| |
Collapse
|
17
|
Rueda CM, Wells CB, Gisslen T, Jobe AH, Kallapur SG, Chougnet CA. Effect of chorioamnionitis on regulatory T cells in moderate/late preterm neonates. Hum Immunol 2015; 76:65-73. [PMID: 25451985 PMCID: PMC4282957 DOI: 10.1016/j.humimm.2014.10.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Abstract
Regulatory T-cells (Treg) have a protective role for the control of immune activation and tissue damage. The effects of chorioamnionitis (chorio) on Treg in moderate/late preterm newborns are not known. We hypothesized that infants exposed to chorio would have decreased Treg frequency and/or function. We isolated mononuclear cells from adult peripheral blood and cord blood from term and moderate/late preterm infants who were classified for severity of chorio exposure. Mononuclear cells were analyzed by flow cytometry for Treg frequency and phenotype. Treg suppression of activation of conventional T-cells (Tcon) was also quantified. Treg frequencies were similar in all groups of neonates, but lower than that found in adults. Newborn Treg had a naïve phenotype, with decreased levels of CD45RO, HLA-DR, CD39 and TIGIT compared to adult Treg and chorio did not affect the phenotype. Treg from preterm newborns exposed to severe chorio had higher expression of Ki67 compared to the other groups. Treg from preterm newborns were less suppressive than Treg from adults or term, and the level of suppression was reduced with severe chorio. Relative to term, Treg frequency and phenotype were not affected by prematurity and chorio but their functionality was decreased. Lower Treg activity may contribute to inflammation in newborns that is often associated with chorioamnionitis.
Collapse
Affiliation(s)
- Cesar M Rueda
- Division of Immunobiology, Cincinnati Children's Hospital Research Foundation, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Casey B Wells
- Division of Immunobiology, Cincinnati Children's Hospital Research Foundation, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tate Gisslen
- Division of Neonatology/Pulmonary Biology, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA
| | - Alan H Jobe
- Division of Neonatology/Pulmonary Biology, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA
| | - Suhas G Kallapur
- Division of Neonatology/Pulmonary Biology, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH, USA
| | - Claire A Chougnet
- Division of Immunobiology, Cincinnati Children's Hospital Research Foundation, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| |
Collapse
|
18
|
Kemp MW. Preterm birth, intrauterine infection, and fetal inflammation. Front Immunol 2014; 5:574. [PMID: 25520716 PMCID: PMC4249583 DOI: 10.3389/fimmu.2014.00574] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/27/2014] [Indexed: 01/07/2023] Open
Abstract
Preterm birth (PTB) (delivery before 37 weeks’ gestation) is a leading cause of neonatal death and disease in industrialized and developing countries alike. Infection (most notably in high-risk deliveries occurring before 28 weeks’ gestation) is hypothesized to initiate an intrauterine inflammatory response that plays a key role in the premature initiation of labor as well as a host of the pathologies associated with prematurity. As such, a better understanding of intrauterine inflammation in pregnancy is critical to our understanding of preterm labor and fetal injury, as well as on-going efforts to prevent PTB. Focusing on the fetal innate immune system responses to intrauterine infection, the present paper will review clinical and experimental studies to discuss the capacity for a fetal contribution to the intrauterine inflammation associated with PTB. Evidence from experimental studies to suggest that the fetus has the capacity to elicit a pro-inflammatory response to intrauterine infection is highlighted, with reference to the contribution of the lung, skin, and gastrointestinal tract. The paper will conclude that pathological intrauterine inflammation is a complex process that is modified by multiple factors including time, type of agonist, host genetics, and tissue.
Collapse
Affiliation(s)
- Matthew W Kemp
- School of Women's and Infants' Health, The University of Western Australia , Perth, WA , Australia
| |
Collapse
|
19
|
Davis J, Musk GC. Pressure and volume controlled mechanical ventilation in anaesthetized pregnant sheep. Lab Anim 2014; 48:321-7. [DOI: 10.1177/0023677214543842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Optimal mechanical ventilation of the pregnant ewe during anaesthesia is of vital importance for maintaining fetal viability. This study aimed to compare peak inspiratory pressure (PIP), oxygenation and cardiovascular parameters with pressure-control (PCV) or volume-control (VCV) mechanical ventilation of anaesthetized pregnant sheep. Twenty ewes at 110 days gestation underwent general anaesthesia in dorsal recumbency for fetal surgery in a research setting. All the sheep were mechanically ventilated; one group with PCV ( n = 10) and another with VCV ( n = 10) to maintain normocapnia. PIP, direct arterial blood pressure, heart rate, arterial pH and arterial oxygen tension were recorded. PIP was lower in the PCV group ( P < 0.001). Arterial oxygen tension was higher in the PCV group ( P = 0.013). Mean and diastolic pressures were lower in the PCV group ( P = 0.029 and P = 0.047, respectively). Both VCV and PCV provide adequate oxygenation of pregnant sheep anaesthetized in dorsal recumbency, though PCV may provide superior oxygenation at a lower PIP.
Collapse
Affiliation(s)
- J Davis
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
| | - GC Musk
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
- Animal Care Services, Faculty of Medicine, Dentistry & Health Sciences, University of Western Australia, Australia
| |
Collapse
|
20
|
Hillman NH, Gisslen T, Polglase GR, Kallapur SG, Jobe AH. Ventilation-induced increases in EGFR ligand mRNA are not altered by intra-amniotic LPS or ureaplasma in preterm lambs. PLoS One 2014; 9:e96087. [PMID: 24788984 PMCID: PMC4005755 DOI: 10.1371/journal.pone.0096087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/02/2014] [Indexed: 11/18/2022] Open
Abstract
Chorioamnionitis and mechanical ventilation are associated with bronchopulmonary dysplasia (BPD) in preterm infants. Mechanical ventilation at birth activates both inflammatory and acute phase responses. These responses can be partially modulated by previous exposure to intra-amniotic (IA) LPS or Ureaplasma parvum (UP). Epidermal growth factor receptor (EGFR) ligands participate in lung development, and angiotensin converting enzyme (ACE) 1 and ACE2 contribute to lung inflammation. We asked whether brief mechanical ventilation at birth altered EGFR and ACE pathways and if antenatal exposure to IA LPS or UP could modulate these effects. Ewes were exposed to IA injections of UP, LPS or saline multiple days prior to preterm delivery at 85% gestation. Lambs were either immediately euthanized or mechanically ventilated for 2 to 3 hr. IA UP and LPS cause modest changes in the EGFR ligands amphiregulin (AREG), epiregulin (EREG), heparin binding epidermal growth factor (HB-EGF), and betacellulin (BTC) mRNA expression. Mechanical ventilation greatly increased mRNA expression of AREG, EREG, and HB-EGF, with no additional increases resulting from IA LPS or UP. With ventilation AREG and EREG mRNA localized to cells in terminal airspace. EGFR mRNA also increased with mechanical ventilation. IA UP and LPS decreased ACE1 mRNA and increased ACE2 mRNA, resulting in a 4 fold change in the ACE1/ACE2 ratio. Mechanical ventilation with large tidal volumes increased both ACE1 and ACE2 expression. The alterations seen in ACE with IA exposures and EGFR pathways with mechanical ventilation may contribute to the development of BPD in preterm infants.
Collapse
Affiliation(s)
- Noah H. Hillman
- Division of Neonatology, Saint Louis University, Saint Louis, Missouri, United States of America
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Tate Gisslen
- Division of Neonatology, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Graeme R. Polglase
- School of Women and Infants' Health, University of Western Australia Perth, WA, Australia
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Melbourne, VIC, Australia
| | - Suhas G. Kallapur
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
- School of Women and Infants' Health, University of Western Australia Perth, WA, Australia
| | - Alan H. Jobe
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
- School of Women and Infants' Health, University of Western Australia Perth, WA, Australia
| |
Collapse
|
21
|
Wolfs TGAM, Kramer BW, Thuijls G, Kemp MW, Saito M, Willems MGM, Senthamarai-Kannan P, Newnham JP, Jobe AH, Kallapur SG. Chorioamnionitis-induced fetal gut injury is mediated by direct gut exposure of inflammatory mediators or by lung inflammation. Am J Physiol Gastrointest Liver Physiol 2014; 306:G382-93. [PMID: 24458021 PMCID: PMC3949018 DOI: 10.1152/ajpgi.00260.2013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intra-amniotic exposure to proinflammatory agonists causes chorioamnionitis and fetal gut inflammation. Fetal gut inflammation is associated with mucosal injury and impaired gut development. We tested whether this detrimental inflammatory response of the fetal gut results from a direct local (gut derived) or an indirect inflammatory response mediated by the chorioamnion/skin or lung, since these organs are also in direct contact with the amniotic fluid. The gastrointestinal tract was isolated from the respiratory tract and the amnion/skin epithelia by fetal surgery in time-mated ewes. Lipopolysaccharide (LPS) or saline (controls) was selectively infused in the gastrointestinal tract, trachea, or amniotic compartment at 2 or 6 days before preterm delivery at 124 days gestation (term 150 days). Gastrointestinal and intratracheal LPS exposure caused distinct inflammatory responses in the fetal gut. Inflammatory responses could be distinguished by the influx of leukocytes (MPO(+), CD3(+), and FoxP3(+) cells), tumor necrosis factor-α, and interferon-γ expression and differential upregulation of mRNA levels for Toll-like receptor 1, 2, 4, and 6. Fetal gut inflammation after direct intestinal LPS exposure resulted in severe loss of the tight junctional protein zonula occludens protein 1 (ZO-1) and increased mitosis of intestinal epithelial cells. Inflammation of the fetal gut after selective LPS instillation in the lungs caused only mild disruption of ZO-1, loss in epithelial cell integrity, and impaired epithelial differentiation. LPS exposure of the amnion/skin epithelia did not result in gut inflammation or morphological, structural, and functional changes. Our results indicate that the detrimental consequences of chorioamnionitis on fetal gut development are the combined result of local gut and lung-mediated inflammatory responses.
Collapse
Affiliation(s)
- Tim G. A. M. Wolfs
- 1Division of Neonatology, the Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio; ,2Department of Pediatrics, Maastricht University Medical Center, School of Oncology and Developmental Biology, Maastricht, the Netherlands; and
| | - Boris W. Kramer
- 2Department of Pediatrics, Maastricht University Medical Center, School of Oncology and Developmental Biology, Maastricht, the Netherlands; and
| | - Geertje Thuijls
- 1Division of Neonatology, the Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio;
| | - Matthew W. Kemp
- 3School of Women's and Infants Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Masatoshi Saito
- 3School of Women's and Infants Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Monique G. M. Willems
- 2Department of Pediatrics, Maastricht University Medical Center, School of Oncology and Developmental Biology, Maastricht, the Netherlands; and
| | - Paranthaman Senthamarai-Kannan
- 1Division of Neonatology, the Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio;
| | - John P. Newnham
- 3School of Women's and Infants Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Alan H. Jobe
- 1Division of Neonatology, the Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio; ,3School of Women's and Infants Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Suhas G. Kallapur
- 1Division of Neonatology, the Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, Ohio; ,3School of Women's and Infants Health, The University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
22
|
Kallapur SG, Presicce P, Rueda CM, Jobe AH, Chougnet CA. Fetal immune response to chorioamnionitis. Semin Reprod Med 2014; 32:56-67. [PMID: 24390922 DOI: 10.1055/s-0033-1361823] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chorioamnionitis is a frequent cause of preterm birth and is associated with an increased risk for injury responses in the lung, gastrointestinal tract, brain, and other fetal organs. Chorioamnionitis is a polymicrobial nontraditional infectious disease because the organisms causing chorioamnionitis are generally of low virulence and colonize the amniotic fluid often for extended periods, and the host (mother and the fetus) does not have typical infection-related symptoms such as fever. In this review, we discuss the effects of chorioamnionitis in experimental animal models that mimic the human disease. Our focus is on the immune changes in multiple fetal organs and the pathogenesis of chorioamnionitis-induced injury in different fetal compartments. As chorioamnionitis disproportionately affects preterm infants, we discuss the relevant developmental context for the immune system. We also provide a clinical context for the fetal responses.
Collapse
Affiliation(s)
- Suhas G Kallapur
- Division of Neonatology/Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | - Pietro Presicce
- Division of Neonatology/Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | - Cesar M Rueda
- Division of Immunobiology, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Alan H Jobe
- Division of Neonatology/Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | - Claire A Chougnet
- Division of Immunobiology, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|