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Lavezzi AM, Mehboob R, Piscioli F, Pusiol T. New Step in Understanding the Pathogenetic Mechanism of Sudden Infant Death Syndrome: Involvement of the Pontine Reticular Gigantocellular Nucleus. Int J Mol Sci 2024; 25:6920. [PMID: 39000030 PMCID: PMC11241803 DOI: 10.3390/ijms25136920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
This study aimed to investigate, for the first time, the potential role of the gigantocellular nucleus, a component of the reticular formation, in the pathogenetic mechanism of Sudden Infant Death Syndrome (SIDS), an event frequently ascribed to failure to arouse from sleep. This research was motivated by previous experimental studies demonstrating the gigantocellular nucleus involvement in regulating the sleep-wake cycle. We analyzed the brains of 48 infants who died suddenly within the first 7 months of life, including 28 SIDS cases and 20 controls. All brains underwent a thorough histological and immunohistochemical examination, focusing specifically on the gigantocellular nucleus. This examination aimed to characterize its developmental cytoarchitecture and tyrosine hydroxylase expression, with particular attention to potential associations with SIDS risk factors. In 68% of SIDS cases, but never in controls, we observed hypoplasia of the pontine portion of the gigantocellular nucleus. Alterations in the catecholaminergic system were present in 61% of SIDS cases but only in 10% of controls. A strong correlation was observed between these findings and maternal smoking in SIDS cases when compared with controls. In conclusion we believe that this study sheds new light on the pathogenetic processes underlying SIDS, particularly in cases associated with maternal smoking during pregnancy.
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Affiliation(s)
- Anna Maria Lavezzi
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milano, Italy
| | - Riffat Mehboob
- Lahore Medical Research Center, Lahore 54000, Pakistan
- National Heart Lung and Blood Institute, National Institute of Health, Bethesda, MD 20892, USA
| | - Francesco Piscioli
- Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, 38068 Rovereto, Italy
| | - Teresa Pusiol
- Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, 38068 Rovereto, Italy
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2
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Beltrán-Castillo S, Bravo K, Eugenín J. Impact of Prenatal Nicotine Exposure on Placental Function and Respiratory Neural Network Development. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1428:233-244. [PMID: 37466776 DOI: 10.1007/978-3-031-32554-0_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Smoking during pregnancy is associated with multiple undesirable outcomes in infants, such as low birth weight, increased neonatal morbidity and mortality, and catastrophic conditions like sudden infant death syndrome (SIDS). Nicotine, the most addictive and teratogenic substance in tobacco smoke, reaches and crosses the placenta and can be accumulated in the amniotic fluid and distributed by fetal circulation, altering the cholinergic transmission by acting on the nicotinic acetylcholine receptors (nAChRs) expressed from very early gestational stages in the placenta and fetal tissue. Because nAChRs influence the establishment of feto-maternal circulation and the emergence of neuronal networks, prenatal nicotine exposure can lead to multiple alterations in newborns. In this mini-review, we discuss the undeniable effects of nicotine in the placenta and the respiratory neural network as examples of how prenatal nicotine and smoking exposition can affect brain development because dysfunction in this network is involved in SIDS etiology.
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Affiliation(s)
- Sebastián Beltrán-Castillo
- Centro integrativo de Biología y Química Aplicada (CIBQA), Universidad Bernardo O'Higgins, Santiago, Chile.
| | - Karina Bravo
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile
- Facultad de Ingeniería, Universidad Autónoma de Chile, Santiago, Chile
| | - Jaime Eugenín
- Laboratorio de Sistemas Neurales, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile USACH, Santiago, Chile.
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3
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Bednarczuk N, Milner A, Greenough A. The Role of Maternal Smoking in Sudden Fetal and Infant Death Pathogenesis. Front Neurol 2020; 11:586068. [PMID: 33193050 PMCID: PMC7644853 DOI: 10.3389/fneur.2020.586068] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022] Open
Abstract
Maternal smoking is a risk factor for both sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death syndrome (SIUDS). Both SIDS and SIUDS are more frequently observed in infants of smoking mothers. The global prevalence of smoking during pregnancy is 1.7% and up to 8.1% of women in Europe smoke during pregnancy and worldwide 250 million women smoke during pregnancy. Infants born to mothers who smoke have an abnormal response to hypoxia and hypercarbia and they also have reduced arousal responses. The harmful effects of tobacco smoke are mainly mediated by release of carbon monoxide and nicotine. Nicotine can enter the fetal circulation and affect multiple developing organs including the lungs, adrenal glands and the brain. Abnormalities in brainstem nuclei crucial to respiratory control, the cerebral cortex and the autonomic nervous system have been demonstrated. In addition, hypodevelopment of the intermediolateral nucleus in the spinal cord has been reported. It initiates episodic respiratory movements that facilitate lung development. Furthermore, abnormal maturation and transmitter levels in the carotid bodies have been described which would make infants more vulnerable to hypoxic challenges. Unfortunately, smoking cessation programs do not appear to have significantly reduced the number of pregnant women who smoke.
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Affiliation(s)
- Nadja Bednarczuk
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Anthony Milner
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.,The Asthma UK Centre for Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' National Health Service (NHS) Foundation Trust and King's College London, London, United Kingdom
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Baxter A, Wood EK, Barr CS, Kay DB, Suomi SJ, Higley JD. Maternal neglect and the serotonin system are associated with daytime sleep in infant rhesus monkeys. Dev Psychopathol 2020; 32:1-10. [PMID: 30712526 PMCID: PMC6679820 DOI: 10.1017/s0954579418001359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Environmental and biological factors contribute to sleep development during infancy. Parenting plays a particularly important role in modulating infant sleep, potentially via the serotonin system, which is itself involved in regulating infant sleep. We hypothesized that maternal neglect and serotonin system dysregulation would be associated with daytime sleep in infant rhesus monkeys. Subjects were nursery-reared infant rhesus macaques (n = 287). During the first month of life, daytime sleep-wake states were rated bihourly (0800-2100). Infants were considered neglected (n = 16) if before nursery-rearing, their mother repeatedly failed to retrieve them. Serotonin transporter genotype and concentrations of cerebrospinal fluid 5-hydroxyindoleacetic acid (5-HIAA) were used as markers of central serotonin system functioning. t tests showed that neglected infants were observed sleeping less frequently, weighed less, and had higher 5-HIAA than non-neglected nursery-reared infants. Regression revealed that serotonin transporter genotype moderated the relationship between 5-HIAA and daytime sleep: in subjects possessing the Ls genotype, there was a positive correlation between 5-HIAA and daytime sleep, whereas in subjects possessing the LL genotype there was no association. These results highlight the pivotal roles that parents and the serotonin system play in sleep development. Daytime sleep alterations observed in neglected infants may partially derive from serotonin system dysregulation.
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Affiliation(s)
- Alexander Baxter
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Elizabeth K Wood
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Christina S Barr
- Section of Comparative Behavioral Genomics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health Rockville, MD, USA
| | - Daniel B Kay
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Stephen J Suomi
- Laboratory of Comparative Ethology, National Institute of Child Health and Human Development, National Institutes of Health, Poolesville, MD, USA
| | - J Dee Higley
- Department of Psychology, Brigham Young University, Provo, UT, USA
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Lavezzi AM, Piscioli F, Pusiol T, Jorizzo G, Ferrero S. Sudden intrauterine unexplained death: time to adopt uniform postmortem investigative guidelines? BMC Pregnancy Childbirth 2019; 19:526. [PMID: 31888538 PMCID: PMC6936151 DOI: 10.1186/s12884-019-2603-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/14/2019] [Indexed: 01/30/2023] Open
Abstract
Background Worldwide approximately 2.6 million are stillborn, mostly occurring in developing countries. In the great part these deaths are inexplicable. The evenness and standardisation of the diagnostic criteria are prerequisites to understand their pathogenesis. The core goal of this article is to propose new evidence based investigative post-mortem guidelines that should be adopted in all the Institutions especially when a fetal death, after a routine autopsy procedure, is diagnosed as “unexplained”. The proposed protocol is mainly focused on the anatomopathological examination of the autonomic nervous system and in particular of the brainstem where the main centers that control vital functions are located. Methods Updated investigative guidelines for the examination of unexplained stillbirths, prevalently focused on the histological examination of the brainstem, where the main centers that are involved in monitoring the vital functions are located, are here presented. A section of this protocol concerns the Immunohistochemical evaluation of specific functional markers such as the neuronal nuclear antigen, nicotinic acetylcholine receptors, serotonin, orexin, apoptosis and gliosis. The important role of risk factors, having regard in particular to maternal smoking and air pollution is also contemplated in these guidelines. Results Specific morphological and/or functional alterations of vital brainstem structures have been found with high incidence in over 100 cases of unexplained fetal death sent to the “Lino Rossi Research Center” of the Milan University according to the Italian law. These alterations were rarely detected in a group of control cases. Conclusions We hope this protocol can be adopted in all the Institutions notably for the examination of unexplained fetal deaths, in order to make uniform investigations. This will lead to identify a plausible explanation of the pathogenetic mechanism behind the unexplained fetal deaths and to design preventive strategies to decrease the incidence of these very distressing events for both parents and clinicians. Trial registration not applicable for this study.
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Affiliation(s)
- Anna M Lavezzi
- "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 19, 20122, Milan, Italy.
| | | | - Teresa Pusiol
- Institute of Pathology, Hospital of Rovereto (Trento), Rovereto, Italy
| | | | - Stefano Ferrero
- "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 19, 20122, Milan, Italy.,Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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6
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Mehboob R, Kabir M, Ahmed N, Ahmad FJ. Towards Better Understanding of the Pathogenesis of Neuronal Respiratory Network in Sudden Perinatal Death. Front Neurol 2017; 8:320. [PMID: 28729852 PMCID: PMC5498558 DOI: 10.3389/fneur.2017.00320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/19/2017] [Indexed: 01/16/2023] Open
Abstract
Sudden perinatal death that includes the victims of sudden infant death syndrome, sudden intrauterine death syndrome, and stillbirth are heartbreaking events in the life of parents. Most of the studies about sudden perinatal death were reported from Italy, highlighting two main etiological factors: prone sleeping position and smoking. Other probable contributory factors are prematurity, male gender, lack of breastfeeding, respiratory tract infections, use of pacifiers, infant botulism, extensive use of pesticides and insecticides, etc. However, extensive studies across the world are required to establish the role of these factors in a different subset of populations. Previous studies confirmed the widely accepted hypothesis that neuropathology of the brainstem is one of the main cause of sudden perinatal death. This study is an effort to summarize the neuropathological evaluation of the brainstems and their association to sudden perinatal death. Brainstem nuclei in vulnerable infants undergo certain changes that may alter the sleep arousal cycle, cardiorespiratory control, and ultimately culminate in death. This review focuses on the roles of different brainstem nuclei, their pathologies, and the established facts in this regard in terms of it's link to such deaths. This study will also help to understand the role of brainstem nuclei in controlling the cardiorespiratory cycles in sudden perinatal death and may provide a better understanding to resolve the mystery of these deaths in future. It is also found that a global initiative to deal with perinatal death is required to facilitate the diagnosis and prevention in developed and as well as developing countries.
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Affiliation(s)
- Riffat Mehboob
- Biomedical Sciences, King Edward Medical University, Lahore, Pakistan.,Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Mahvish Kabir
- Department of Chemistry, School of Science, University of Management and Technology (UMT), Lahore, Pakistan
| | - Naseer Ahmed
- Department of Cardiac Surgery, University of Verona Medical School, Verona, Italy.,Section of Pharmacology, University of Verona Medical School, Verona, Italy
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Khanzada NS, Butler MG, Manzardo AM. GeneAnalytics Pathway Analysis and Genetic Overlap among Autism Spectrum Disorder, Bipolar Disorder and Schizophrenia. Int J Mol Sci 2017; 18:ijms18030527. [PMID: 28264500 PMCID: PMC5372543 DOI: 10.3390/ijms18030527] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 12/18/2022] Open
Abstract
Bipolar disorder (BPD) and schizophrenia (SCH) show similar neuropsychiatric behavioral disturbances, including impaired social interaction and communication, seen in autism spectrum disorder (ASD) with multiple overlapping genetic and environmental influences implicated in risk and course of illness. GeneAnalytics software was used for pathway analysis and genetic profiling to characterize common susceptibility genes obtained from published lists for ASD (792 genes), BPD (290 genes) and SCH (560 genes). Rank scores were derived from the number and nature of overlapping genes, gene-disease association, tissue specificity and gene functions subdivided into categories (e.g., diseases, tissues or functional pathways). Twenty-three genes were common to all three disorders and mapped to nine biological Superpathways including Circadian entrainment (10 genes, score = 37.0), Amphetamine addiction (five genes, score = 24.2), and Sudden infant death syndrome (six genes, score = 24.1). Brain tissues included the medulla oblongata (11 genes, score = 2.1), thalamus (10 genes, score = 2.0) and hypothalamus (nine genes, score = 2.0) with six common genes (BDNF, DRD2, CHRNA7, HTR2A, SLC6A3, and TPH2). Overlapping genes impacted dopamine and serotonin homeostasis and signal transduction pathways, impacting mood, behavior and physical activity level. Converging effects on pathways governing circadian rhythms support a core etiological relationship between neuropsychiatric illnesses and sleep disruption with hypoxia and central brain stem dysfunction.
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Affiliation(s)
- Naveen S Khanzada
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Merlin G Butler
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Ann M Manzardo
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Roncati L, Pusiol T, Piscioli F, Barbolini G, Maiorana A, Lavezzi A. The First 5-Year-Long Survey on Intrauterine Unexplained Sudden Deaths from the Northeast Italy. Fetal Pediatr Pathol 2016; 35:315-326. [PMID: 27308949 DOI: 10.1080/15513815.2016.1185751] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Sudden intrauterine unexplained death syndrome (SIUDS) represents one of the main open issues in the scientific and social setting of the modern medicine, and our efforts have aimed to understand its possible causes and risk factors. METHODS A 43-case series of consecutive unexplained fetal deaths coming from Northeast Italy, collected in a 5-year period (2011-2015), has been submitted to an in-depth investigation, based on neuropathological and cardiopathological examinations, immunohistochemistry for neuronal nuclear antigen (NeuN), genetic characterization for the serotonin transporter (5-HTT) gene polymorphisms, and toxicological environmental analyses. RESULTS The overall survey from the neuropathological findings highlights one or more congenital morphological abnormalities of the autonomic nervous system in 77% of cases of sudden fetal deaths. CONCLUSIONS From our results emerges the need to perform a complete autopsy of all SIUDS victims with an in-depth examination of the neuronal centers of the brainstem, which modulate the vital functions.
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Affiliation(s)
- Luca Roncati
- a Provincial Health Care Services , Institute of Pathology, Santa Maria del Carmine Hospital , Rovereto ( TN ), Italy.,b Department of Diagnostic and Clinical Medicine and of Public Health , Section of Pathology, University of Modena and Reggio Emilia , Modena ( MO ), Italy
| | - Teresa Pusiol
- a Provincial Health Care Services , Institute of Pathology, Santa Maria del Carmine Hospital , Rovereto ( TN ), Italy
| | - Francesco Piscioli
- a Provincial Health Care Services , Institute of Pathology, Santa Maria del Carmine Hospital , Rovereto ( TN ), Italy
| | - Giuseppe Barbolini
- b Department of Diagnostic and Clinical Medicine and of Public Health , Section of Pathology, University of Modena and Reggio Emilia , Modena ( MO ), Italy
| | - Antonio Maiorana
- b Department of Diagnostic and Clinical Medicine and of Public Health , Section of Pathology, University of Modena and Reggio Emilia , Modena ( MO ), Italy
| | - Anna Lavezzi
- c Department of Biomedical , Surgical and Dental Sciences, Lino Rossi Research Center, University of Milan , Milan ( MI ), Italy
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9
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Lavezzi AM. A New Theory to Explain the Underlying Pathogenetic Mechanism of Sudden Infant Death Syndrome. Front Neurol 2015; 6:220. [PMID: 26539157 PMCID: PMC4610199 DOI: 10.3389/fneur.2015.00220] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/05/2015] [Indexed: 12/14/2022] Open
Abstract
The author, on the basis of numerous studies on the neuropathology of SIDS, performed on a very wide set of cases, first highlights the neuronal centers of the human brainstem involved in breathing control in perinatal life, with the pontine Kölliker-Fuse nucleus (KFN) as main coordinator. What emerges from this analysis is that the prenatal respiratory movements differ from those post-natally in two respects: (1) they are episodic, only aimed at the lung development and (2) they are abolished by hypoxia, not being of vital importance in utero, mainly to limit the consumption of oxygen. Then, as this fetal inhibitory reflex represents an important defense expedient, the author proposes a new original interpretation of the pathogenetic mechanism leading to SIDS. Infants, in a critical moment of the autonomic control development, in hypoxic conditions could awaken the reflex left over from fetal life and arrest breathing, as he did in similar situations in prenatal life, rather than promote the hyperventilation usually occurring to restore the normal concentration of oxygen. This behaviour obviously leads to a fatal outcome. This hypothesis is supported by immunohistochemical results showing in high percentage of SIDS victims, and not in age-matched infant controls, neurochemical alterations of the Kölliker-Fuse neurons, potentially indicative of their inactivation. The new explanation of SIDS blames a sort of auto-inhibition of the KFN functionality, wrongly arisen with the same protective purpose to preserve the life in utero, as trigger of the sudden infant death.
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Affiliation(s)
- Anna Maria Lavezzi
- “Lino Rossi” Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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10
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Lavezzi AM, Pusiol T, Matturri L. Cytoarchitectural and functional abnormalities of the inferior colliculus in sudden unexplained perinatal death. Medicine (Baltimore) 2015; 94:e487. [PMID: 25674737 PMCID: PMC4602737 DOI: 10.1097/md.0000000000000487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The inferior colliculus is a mesencephalic structure endowed with serotonergic fibers that plays an important role in the processing of acoustic information. The implication of the neuromodulator serotonin also in the aetiology of sudden unexplained fetal and infant death syndromes and the demonstration in these pathologies of developmental alterations of the superior olivary complex (SOC), a group of pontine nuclei likewise involved in hearing, prompted us to investigate whether the inferior colliculus may somehow contribute to the pathogenetic mechanism of unexplained perinatal death. Therefore, we performed in a wide set of fetuses and infants, aged from 33 gestational weeks to 7 postnatal months and died of both known and unknown cause, an in-depth anatomopathological analysis of the brainstem, particularly of the midbrain. Peculiar neuroanatomical and functional abnormalities of the inferior colliculus, such as hypoplasia/structural disarrangement and immunonegativity or poor positivity of serotonin, were exclusively found in sudden death victims, and not in controls. In addition, these alterations were frequently related to dysgenesis of connected structures, precisely the raphé nuclei and the superior olivary complex, and to nicotine absorption in pregnancy. We propose, on the basis of these results, the involvement of the inferior colliculus in more important functions than those related to hearing, as breathing and, more extensively, all the vital activities, and then in pathological conditions underlying a sudden death in vulnerable periods of the autonomic nervous system development, particularly associated to harmful risk factors as cigarette smoking.
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Affiliation(s)
- Anna M Lavezzi
- From the "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy (AML, LM) and Institute of Anatomic Pathology, Hospital of Rovereto (Trento), Italy (TP)
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Lavezzi AM, Cappiello A, Pusiol T, Corna MF, Termopoli V, Matturri L. Pesticide exposure during pregnancy, like nicotine, affects the brainstem α7 nicotinic acetylcholine receptor expression, increasing the risk of sudden unexplained perinatal death. J Neurol Sci 2014; 348:94-100. [PMID: 25433450 DOI: 10.1016/j.jns.2014.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/24/2014] [Accepted: 11/10/2014] [Indexed: 12/16/2022]
Abstract
This study indicates the impact of nicotine and pesticides (organochlorine and organophosphate insecticides used in agriculture) on neuronal α7-nicotinic acetylcholine receptor expression in brainstem regions receiving cholinergic projections in human perinatal life. An in-depth anatomopathological examination of the autonomic nervous system and immunohistochemistry to analyze the α7-nicotinic acetylcholine receptor expression in the brainstem from 44 fetuses and newborns were performed. In addition, the presence of selected agricultural pesticides in cerebral cortex samples of the victims was determined by specific analytical procedures. Hypodevelopment of brainstem structures checking the vital functions, frequently associated with α7-nicotinic acetylcholine receptor immunopositivity and smoke absorption in pregnancy, was observed in high percentages of victims of sudden unexpected perinatal death. In nearly 30% of cases however the mothers never smoked, but lived in rural areas. The search for pesticides highlighted in many of these cases traces of both organochlorine and organophosphate pesticides. We detain that exposition to pesticides in pregnancy produces homologous actions to those of nicotine on neuronal α7-nicotinic acetylcholine receptor, allowing to developmental alterations of brainstem vital centers in victims of sudden unexplained death.
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Affiliation(s)
- Anna Maria Lavezzi
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy.
| | | | - Teresa Pusiol
- Institute of Anatomic Pathology, Hospital of Rovereto (Trento), Italy
| | - Melissa Felicita Corna
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy
| | | | - Luigi Matturri
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy
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12
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Forensische Molekularpathologie. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Salomonis N. Systems-level perspective of sudden infant death syndrome. Pediatr Res 2014; 76:220-9. [PMID: 24964230 PMCID: PMC4193964 DOI: 10.1038/pr.2014.90] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/21/2014] [Indexed: 02/01/2023]
Abstract
Sudden infant death syndrome (SIDS) remains one of the primary causes of infant mortality in developed countries. Although the causes of SIDS remain largely inconclusive, some of the most informative associations implicate molecular, genetic, anatomical, physiological, and environmental (i.e., infant sleep) factors. Thus, a comprehensive and evolving systems-level model is required to understand SIDS susceptibility. Such models, by being powerful enough to uncover indirect associations, could be used to expand our list of candidate targets for in-depth analysis. We present an integrated WikiPathways model for SIDS susceptibility that includes associated cell systems, signaling pathways, genetics, and animal phenotypes. Experimental and literature-based gene-regulatory data have been integrated into this model to identify intersecting upstream control elements and associated interactions. To expand this pathway model, we performed a comprehensive analysis of existing proteomics data from brainstem samples of infants with SIDS. From this analysis, we discovered changes in the expression of several proteins linked to known SIDS pathologies, including factors involved in glial cell production, hypoxia regulation, and synaptic vesicle release, in addition to interactions with annotated SIDS markers. Our results highlight new targets for further consideration that further enrich this pathway model, which, over time, can improve as a wiki-based, community curation project.
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Affiliation(s)
- Nathan Salomonis
- Department of Pediatrics, Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center Research Foundation, Cincinnati, Oh 45229, USA
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14
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Mecchia D, Casale V, Oneda R, Matturri L, Lavezzi AM. Sudden death of an infant with cardiac, nervous system and genetic involvement--a case report. Diagn Pathol 2013; 8:159. [PMID: 24053176 PMCID: PMC3852348 DOI: 10.1186/1746-1596-8-159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/13/2013] [Indexed: 11/29/2022] Open
Abstract
Abstract We present a case of sudden death of a 1-month-old male infant with heart, brainstem and genetic polymorphism involvement. Previously considered quite healthy, the child died suddenly and unexpectedly during sleep. The autopsy protocol included an in-depth anatomopathological examination of both the autonomic nervous system and the cardiac conduction system, and molecular analysis of the serotonin transporter gene promoter region, in which a specific genetic condition seems to be associated with sudden infant death. Histological examination revealed the presence of congenital cardiac alterations (hypertrophic cardiomyopathy and an accessory Mahaim fiber in the cardiac conduction system), severe hypodevelopment of all the raphe nuclei and a heterozygous genotype L/S related to the serotonin transporter gene. The sudden death of this infant was the unavoidable outcome of a complex series of congenital anomalies, each predisposing to SIDS. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3480540091031788
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Affiliation(s)
- Donatella Mecchia
- "Lino Rossi" Research Center for the study and prevention of unexpected perinatal death and SIDS - Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 19, Milan 20122, Italy.
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Rand CM, Patwari PP, Carroll MS, Weese-Mayer DE. Congenital central hypoventilation syndrome and sudden infant death syndrome: disorders of autonomic regulation. Semin Pediatr Neurol 2013; 20:44-55. [PMID: 23465774 DOI: 10.1016/j.spen.2013.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Long considered a rare and unique disorder of respiratory control, congenital central hypoventilation syndrome has recently been further distinguished as a disorder of autonomic regulation. Similarly, more recent evidence suggests that sudden infant death syndrome is also a disorder of autonomic regulation. Congenital central hypoventilation syndrome typically presents in the newborn period with alveolar hypoventilation, symptoms of autonomic dysregulation and, in a subset of cases, Hirschsprung disease or tumors of neural crest origin or both. Genetic investigation identified PHOX2B, a crucial gene during early autonomic development, as disease defining for congenital central hypoventilation syndrome. Although sudden infant death syndrome is most likely defined by complex multifactorial genetic and environmental interactions, it is also thought to result from central deficits in the control of breathing and autonomic regulation. The purpose of this article is to review the current understanding of these autonomic disorders and discuss the influence of this information on clinical practice and future research directions.
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Affiliation(s)
- Casey M Rand
- Center for Autonomic Medicine in Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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16
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Gonda X, Fountoulakis KN, Csukly G, Dome P, Sarchiapone M, Laszik A, Bedi K, Juhasz G, Siamouli M, Rudisch T, Molnar E, Pap D, Bagdy G, Rihmer Z. Star-crossed? The association of the 5-HTTLPR s allele with season of birth in a healthy female population, and possible consequences for temperament, depression and suicide. J Affect Disord 2012; 143:75-83. [PMID: 22840619 DOI: 10.1016/j.jad.2012.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/29/2012] [Accepted: 05/29/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Birth season has well-known effects on neuropsychiatric disorders, and may also influence genotype distribution by possibly influencing chance of conception via parental idiosyncratic conception patterns or survival of foetuses or infants. The 5-HTTLPR is associated with phenomena including affective temperaments or suicide which are also associated with birth season. Our aim was to investigate the association of 5-HTTLPR genotype and birth season in a healthy female population. METHODS Birth date and 5-HTTLPR genotype was determined for 327 psychiatrically healthy women. The association between presence of s allele and time of birth was analysed using generalized linear models. RESULTS A significant association between s allele frequency and time of birth was detected. S allele carrier frequency was marginally significantly higher in July borns and significantly lower in autumn borns. LIMITATIONS We investigated an adult sample so genotype frequency data do not reflect birth frequencies. Our sample consisted exclusively of females. CONCLUSIONS There is no clear explanation for the observed association, although idiosyncratic parental conception patterns, the association of 5-HTTLPR with sudden infant/intrauterine death, or other s allele-mediated behaviours may play a role. Our results are strikingly parallel with earlier data reporting a higher risk of completed suicide in July borns, and higher scores of July borns and lower scores of autumn borns on certain affective temperament scales, both of which are also associated with the s allele of 5-HTTLPR. Thus our results may add to the growing body of evidence regarding the etiological background of affective disorders.
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Affiliation(s)
- Xenia Gonda
- Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, Semmelweis University, Budapest, Hungary.
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17
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Lavezzi AM, Weese-Mayer DE, Yu MY, Jennings LJ, Corna MF, Casale V, Oneda R, Matturri L. Developmental alterations of the respiratory human retrotrapezoid nucleus in sudden unexplained fetal and infant death. Auton Neurosci 2012; 170:12-9. [PMID: 22796552 DOI: 10.1016/j.autneu.2012.06.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 06/16/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022]
Abstract
The study aims were twofold: 1) identify the localization and the cytoarchitecture of the retrotrapezoid nucleus (RTN) in the human fetus and infant and 2) ascertain if the RTN, given its essential role in animal studies for the maintenance of breathing and chemoreception, showed abnormalities in victims of sudden perinatal and infant death (sudden intrauterine unexplained death/SIUD - and sudden infant death syndrome/SIDS). We examined SIDS and SIUD cases and Controls (n=58) from 34 gestational weeks to 8 months of postnatal age by complete autopsy, in-depth autonomic nervous system histological examination, and immunohistochemical analysis of the PHOX2B gene, a transcriptional factor involved in Congenital Central Hypoventilation Syndrome that has been defined as a marker of rat RTN neurons. We identified a group of PHOX2B-immunopositive neurons within the caudal pons, contiguous to the facial/parafacial complex, in 90% of Controls, likely the homologous human RTN (hRTN). We observed structural and/or PHOX2B-expression abnormalities of the hRTN in 71% of SIUD/SIDS cases vs 10% of Controls (p<0.05). In conclusion we suggest that developmental abnormalities of the hRTN may seriously compromise chemoreception control, playing a critical role in the pathogenesis of both SIUD and SIDS.
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Affiliation(s)
- Anna M Lavezzi
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy.
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18
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Casale V, Oneda R, Matturri L, Lavezzi AM. Investigation of 5-HTT expression using quantitative real-time PCR in the human brain in SIDS Italian cases. Exp Mol Pathol 2012; 94:239-42. [PMID: 22771822 DOI: 10.1016/j.yexmp.2012.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/11/2012] [Accepted: 06/25/2012] [Indexed: 12/01/2022]
Abstract
The sudden infant death syndrome (SIDS) is the main cause of postneonatal infant death, being defined as the sudden death of an infant under one year of age that remains unexplained after a complete clinical review, autopsy and death scene investigation. The neurotransmitter serotonin (5-HT) is involved in the regulation of a broad array of behavioral and biological functions. By controlling the reuptake of 5-HT from the extracellular space, the serotonin transporter (5-HTT) regulates the duration and strength of the interactions between 5-HT and its receptors. It has been shown that the activity of the human 5-HTT gene promoter is regulated by polymorphic repetitive elements, resulting in differences in the efficacy of 5-HTT reuptake among the allelic variants: the short (S) allele is associated with lower transcriptional efficiency of the promoter compared with the long (L) allele. Using qRT-PCR we studied the gene expression of 5-HTT in ten SIDS cases, previously analyzed at a molecular level and which showed the genetic S/S profile. In nine cases we observed 5-HTT expression levels comparable to those seen in the control case, while in one case there was a remarkable reduction in the expression of the gene. It is presumable that, despite the presence of the same S/S genotype, the different genetic background could influence the transcript stability and that the polimorphic variant of the 5-HTT gene could respond differently to the external environmental stimuli.
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Affiliation(s)
- Valentina Casale
- Lino Rossi Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy.
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Dergacheva O, Kamendi HW, Wang X, Mendelowitz D. 5HT1A receptors inhibit glutamate inputs to cardiac vagal neurons post-hypoxia/hypercapnia. Respir Physiol Neurobiol 2011; 179:254-8. [PMID: 21930251 DOI: 10.1016/j.resp.2011.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/12/2011] [Accepted: 09/06/2011] [Indexed: 12/21/2022]
Abstract
Synaptic inputs to cardiac vagal neurons (CVNs) regulate parasympathetic activity to the heart. Previous work has shown insults such as hypoxia and hypercapnia (H/H) alter CVN activity by activating post-synaptic serotonergic, purinergic, and glutamatergic receptors in CVNs. This study examines the role of serotonergic 5HT1A receptors in modulating these excitatory neurotransmissions to CVNs during control conditions, H/H and recovery from H/H. Excitatory post-synaptic currents (EPSCs) were recorded from identified CVNs in vitro before, during and post H/H. The 5HT1A receptor antagonist WAY 100635 had no effect on EPSCs in CVNs before, and during H/H. However, during recovery from H/H inspiratory-related excitatory serotonergic and purinergic pathways were recruited to excite CVNs. However, when these serotonergic and purinergic pathways are blocked, the 5HT1A receptor antagonist WAY 100635 restores an excitatory glutamatergic neurotransmission to CVNs. This study indicates endogenous activation of serotonergic 5HT1A receptors diminishes glutamatergic neurotransmission to CVNs following H/H, likely via a presynaptic site of action.
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Affiliation(s)
- Olga Dergacheva
- Department of Pharmacology and Physiology, The George Washington University, Washington, DC 20037, United States
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20
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Ottaviani G. Sudden infant and perinatal unexplained death: are we moving forward yet? Cardiovasc Pathol 2011; 20:302-6. [DOI: 10.1016/j.carpath.2010.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 01/23/2010] [Accepted: 08/09/2010] [Indexed: 11/26/2022] Open
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21
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Tang Y, Siegel D, Sampson B. Molecular Investigations of Sudden Unexplained Deaths. Acad Forensic Pathol 2011. [DOI: 10.23907/2011.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sudden unexplained deaths in apparently healthy individuals (newborn through adult) pose a vexing challenge to medical examiners, law enforcement and society as a whole. Recent advances in “molecular autopsies” have begun to uncover the mystery surrounding sudden unexplained deaths by identifying mutations that can result in or predispose an apparently healthy individual to sudden death. Genetic risks of sudden unexplained deaths have been studied from several different perspectives, and categorized generally by systems, including: cardiac, nervous, immune, and metabolic. This article reviews the genetic risks in sudden unexplained deaths, presents the current state and challenges of molecular investigations, and sheds light on future directions in sudden unexplained death investigations.
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Affiliation(s)
- Yingying Tang
- Molecular Genetics Laboratory in the New York City Office of Chief Medical Examiner and Forensic Medicine Department at New York University School of Medicine, New York, New York
| | - Donald Siegel
- New York City Office of Chief Medical Examiner, and Forensic Medicine Department at New York University School of Medicine, New York, New York (DS, BS)
| | - Barbara Sampson
- New York City Office of Chief Medical Examiner, and Forensic Medicine Department at New York University School of Medicine, New York, New York (DS, BS)
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22
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Matturri L, Lavezzi AM. Unexplained stillbirth versus SIDS: common congenital diseases of the autonomic nervous system--pathology and nosology. Early Hum Dev 2011; 87:209-15. [PMID: 21262556 DOI: 10.1016/j.earlhumdev.2010.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/10/2010] [Accepted: 12/20/2010] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To contribute to a more balanced assessment of the morphological substrates underlying unexplained perinatal death and SIDS. METHODS In-depth histological, immunohistochemical and genetic examinations were performed on the autonomic nervous and cardiac conduction systems in 95 unexpected perinatal deaths, 140 SIDS and 78 controls (44 infants and 34 perinatal death victims). RESULTS The study revealed the localization and the nature of a variety of specific congenital abnormalities of the autonomic nervous system, central and peripheral, and of the cardiac conduction system that represent the morphological substrates of the pathophysiological mechanism of sudden fetal death and SIDS. CONCLUSIONS The observation of similar anomalies of the autonomic nervous and the cardiac conduction systems in both unexplained perinatal deaths and SIDS indicates their common congenital nature. Therefore, the definitions of these deaths, currently nosographically distinct, should be unified.
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Affiliation(s)
- Luigi Matturri
- Lino Rossi Research Center for the Study and Prevention of Sudden Perinatal Death and SIDS, Department of Surgical, Reconstructive and Diagnostic Sciences, University of Milan, Milan 20122, Italy.
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23
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Lavezzi AM, Mehboob R, Matturri L. Developmental alterations of the spinal trigeminal nucleus disclosed by substance P immunohistochemistry in fetal and infant sudden unexplained deaths. Neuropathology 2011; 31:405-13. [PMID: 21276082 DOI: 10.1111/j.1440-1789.2010.01190.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We investigated the immunohistochemical expression of substance P (SP) in the brainstems of 56 subjects aged from 17 gestational weeks to 10 post natal months, who died of unknown (sudden unexplained fetal deaths and SIDS) and known causes (controls). The goals of this study were: (i) to obtain basic information about the expression of SP during the first phases of human nervous system development; (ii) to evaluate whether there are alterations of this neuromodulator in victims of sudden death; and (iii) to verify any correlation with maternal cigarette smoking. Immunohistochemistry demonstrated SP immunoreactivity in the caudal trigeminal nucleus area, with a progressive increase in the density of SP-positive fibers of the corresponding tract during normal development from fetal life to the first post natal months. Delineation of the structure of the human trigeminal nucleus, little investigated so far, provided essential data on its morphologic and functional development. Instead, a negative or low SP expression was detectable in the fibers of this tract in a wide subset of SIDS victims and, conversely, a high SP-expression in a wide subset of sudden fetal deaths. We postulate, on the basis of these results, that SP has a functional importance in the early phases of central nervous system development and in the regulation of autonomic functions. In addition, the observation of a significant correlation between sudden unexplained death, altered SP staining and maternal smoking leads us to suggest a close relation between the absorption of cigarette smoke in utero and a decreased functional activity of the trigeminal nucleus, that can trigger sudden death of the fetus during pregnancy or of the infant in the first months of life.
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Affiliation(s)
- Anna M Lavezzi
- Lino Rossi Research Center for the Study and Prevention of Unexpected Perinatal Death and SIDS, Department of Surgical, Reconstructive and Diagnostic Sciences, University of Milan, Milan, Italy.
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24
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Abstract
Sudden infant death syndrome (SIDS) is a major contributor to postneonatal infant death, and is the third leading cause of infant mortality in the USA. While public health efforts have reduced these deaths in recent years, the pathogenesis of SIDS remains unclear. Epidemiological data on SIDS-related deaths have suggested genetic factors, and many studies have attempted to identify SIDS-associated genes. This has resulted in a large body of literature implicating various genes and their encoded proteins and signaling pathways in numerous cohorts of various sizes and ethnicities. This review has undertaken a systematic evaluation of these studies, identifying the pathways that have been implicated in these studies, including central nervous system pathways, cardiac channelopathies, immune dysfunction, metabolism/energy pathways, and nicotine response. This review also explores how new genomic techniques will aid in advancing our knowledge of the genomic risk factors associated with SIDS, including SNPs and copy number variation. Last, this review explores how the current information can be applied to aid in our assessment of the at risk infant population.
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Affiliation(s)
- David W Van Norstrand
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA.
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25
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Opdal SH, Rognum TO. Gene variants predisposing to SIDS: current knowledge. Forensic Sci Med Pathol 2010; 7:26-36. [PMID: 20623341 DOI: 10.1007/s12024-010-9182-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2010] [Indexed: 01/04/2023]
Abstract
Genetic risk factors play a role in sudden unexpected infant death; either as a cause of death, such as in cases with medium-chain acyl-coenzyme A dehydrogenase deficiency and cardiac arrest due to long QT syndrome, or as predisposing factors for sudden infant death syndrome (SIDS). Most likely genetic predisposition to SIDS represent a polygenic inheritance pattern leading to sudden death when combined with other risk factors, such as a vulnerable developmental stage of the central nervous system and/or the immune system, in addition to environmental risk factors, such as a common cold or prone sleeping position. Genes involved in the regulation of the immune system, cardiac function, the serotonergic network and brain function and development have so far emerged as the most important with respect to SIDS. The purpose of the present paper is to survey current knowledge on SIDS and possible genetic contributions.
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Affiliation(s)
- Siri H Opdal
- Institute of Forensic Medicine, University of Oslo, Oslo, Norway.
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26
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Horne RSC, Witcombe NB, Yiallourou SR, Scaillet S, Thiriez G, Franco P. Cardiovascular control during sleep in infants: Implications for Sudden Infant Death Syndrome. Sleep Med 2010; 11:615-21. [PMID: 20609624 DOI: 10.1016/j.sleep.2009.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 10/22/2009] [Accepted: 10/22/2009] [Indexed: 10/19/2022]
Abstract
In infants the cardiorespiratory system undergoes significant functional maturation after birth and these changes are sleep-state dependent. Given the immaturity of these systems it is not surprising that infants are at risk of cardiorespiratory instability, especially during sleep. A failure of cardiovascular control mechanisms in particular is believed to play a role in the final event of Sudden Infant Death Syndrome (SIDS). The "triple risk model" describes SIDS as an event that results from the intersection of three overlapping factors: (1) a vulnerable infant, (2) a critical development period in homeostatic control, and (3) an exogenous stressor. This review summarises normal development of cardiovascular control during sleep in infants and describes the association of impaired cardiovascular control with the three overlapping factors proposed to be involved in SIDS pathogenesis.
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Affiliation(s)
- Rosemary S C Horne
- Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Australia.
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27
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Paterson DS, Hilaire G, Weese-Mayer DE. Medullary serotonin defects and respiratory dysfunction in sudden infant death syndrome. Respir Physiol Neurobiol 2009; 168:133-43. [PMID: 19481178 PMCID: PMC2737726 DOI: 10.1016/j.resp.2009.05.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 05/13/2009] [Accepted: 05/18/2009] [Indexed: 11/27/2022]
Abstract
Sudden infant death syndrome (SIDS) is defined as the sudden and unexpected death of an infant less than 12 months of age that occurs during sleep and remains unexplained after a complete autopsy, death scene investigation, and review of the clinical history. It is the leading cause of postneonatal mortality in the developed world. The cause of SIDS is unknown, but is postulated to involve impairment of brainstem-mediated homeostatic control. Extensive evidence from animal studies indicates that serotonin (5-HT) neurons in the medulla oblongata play a role in the regulation of multiple aspects of respiratory and autonomic function. A subset of SIDS infants have several abnormalities in medullary markers of 5-HT function and genetic polymorphisms impacting the 5-HT system, informing the hypothesis that SIDS results from a defect in 5-HT brainstem-mediated control of respiratory (and autonomic) regulation. Here we review the evidence from postmortem human studies and animal studies to support this hypothesis and discuss how the pathogenesis of SIDS is likely to originate in utero during fetal development.
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Affiliation(s)
- David S Paterson
- Department of Pathology, Enders Building Room 1109, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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