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Barlow SM, Liao C, Lee J, Kim S, Maron JL, Song D, Jegatheesan P, Govindaswami B, Wilson BJ, Bhakta K, Cleary JP. Spectral features of non-nutritive suck dynamics in extremely preterm infants. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2023; 6:23. [PMID: 37900782 PMCID: PMC10611428 DOI: 10.21037/pm-21-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background Non-nutritive suck (NNS) is used to promote ororhythmic patterning and assess oral feeding readiness in preterm infants in the neonatal intensive care unit (NICU). While time domain measures of NNS are available in real time at cribside, our understanding of suck pattern generation in the frequency domain is limited. The aim of this study is to model the development of NNS in the frequency domain using Fourier and machine learning (ML) techniques in extremely preterm infants (EPIs). Methods A total of 117 EPIs were randomized to a pulsed or sham orocutaneous intervention during tube feedings 3 times/day for 4 weeks, beginning at 30 weeks post-menstrual age (PMA). Infants were assessed 3 times/week for NNS dynamics until they attained 100% oral feeding or NICU discharge. Digitized NNS signals were processed in the frequency domain using two transforms, including the Welch power spectral density (PSD) method, and the Yule-Walker PSD method. Data analysis proceeded in two stages. Stage 1: ML longitudinal cluster analysis was conducted to identify groups (classes) of infants, each showing a unique pattern of change in Welch and Yule-Walker calculations during the interventions. Stage 2: linear mixed modeling (LMM) was performed for the Welch and Yule-Walker dependent variables to examine the effects of gestationally-aged (GA), PMA, sex (male, female), patient type [respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD)], treatment (NTrainer, Sham), intervention phase [1, 2, 3], cluster class, and phase-by-class interaction. Results ML of Welch PSD method and Yule-Walker PSD method measures revealed three membership classes of NNS growth patterns. The dependent measures peak_Hz, PSD amplitude, and area under the curve (AUC) are highly dependent on PMA, but show little relation to respiratory status (RDS, BPD) or somatosensory intervention. Thus, neural regulation of NNS in the frequency domain is significantly different for each identified cluster (classes A, B, C) during this developmental period. Conclusions Efforts to increase our knowledge of the evolution of the suck central pattern generator (sCPG) in preterm infants, including NNS rhythmogenesis will help us better understand the observed phenotypes of NNS production in both the frequency and time domains. Knowledge of those features of the NNS which are relatively invariant vs. other features which are modifiable by experience will likewise inform more effective treatment strategies in this fragile population.
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Affiliation(s)
- Steven M. Barlow
- Department of Communication Disorders and Department of Biological Systems Engineering, Center for Brain, Biology & Behavior, University of Nebraska, Lincoln, NE, USA
| | - Chunxiao Liao
- Department of Biochemistry, Baylor College of Medicine, Houston, TX, USA
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Seungman Kim
- Department of Educational Psychology, Leadership & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Jill L. Maron
- Division of Newborn Medicine, Tufts Medical Center, Boston, MA, USA
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
- Division of Newborn Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Jegatheesan
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Balaji Govindaswami
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard J. Wilson
- Division of Neonatal-Perinatal Medicine, CHI Health St. Elizabeth, Lincoln, NE, USA
| | - Kushal Bhakta
- Neonatology, Children’s Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California-Irvine, Irvine, CA, USA
| | - John P. Cleary
- Neonatology, Children’s Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California-Irvine, Irvine, CA, USA
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2
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Cheng TY, Zimmerman JJ, Giménez-Lirola LG. Internal reference genes with the potential for normalizing quantitative PCR results for oral fluid specimens. Anim Health Res Rev 2022; 23:147-156. [PMID: 36330795 DOI: 10.1017/s1466252322000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In basic research, testing of oral fluid specimens by real-time quantitative polymerase chain reaction (qPCR) has been used to evaluate changes in gene expression levels following experimental treatments. In diagnostic medicine, qPCR has been used to detect DNA/RNA transcripts indicative of bacterial or viral infections. Normalization of qPCR using endogenous and exogenous reference genes is a well-established strategy for ensuring result comparability by controlling sample-to-sample variation introduced during sampling, storage, and qPCR testing. In this review, the majority of recent publications in human (n = 136) and veterinary (n = 179) medicine did not describe the use of internal reference genes in qPCRs for oral fluid specimens (52.9% animal studies; 57.0% human studies). However, the use of endogenous reference genes has not been fully explored or validated for oral fluid specimens. The lack of valid internal reference genes inherent to the oral fluid matrix will continue to hamper the reliability, reproducibility, and generalizability of oral fluid qPCR assays until this issue is addressed.
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Affiliation(s)
- Ting-Yu Cheng
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Jeffrey J Zimmerman
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - Luis G Giménez-Lirola
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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3
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Azuma D, Maron JL. Individualizing Oral Feeding Assessment and Therapies in the Newborn . RESEARCH AND REPORTS IN NEONATOLOGY 2020. [DOI: 10.2147/rrn.s223472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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4
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Yen E, Kaneko-Tarui T, Maron JL. Technical Considerations and Protocol Optimization for Neonatal Salivary Biomarker Discovery and Analysis. Front Pediatr 2020; 8:618553. [PMID: 33575231 PMCID: PMC7870796 DOI: 10.3389/fped.2020.618553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/31/2020] [Indexed: 12/04/2022] Open
Abstract
Non-invasive techniques to monitor and diagnose neonates, particularly those born prematurely, are a long-sought out goal of Newborn Medicine. In recent years, technical advances, combined with increased assay sensitivity, have permitted the high-throughput analysis of multiple biomarkers simultaneously from a single sample source. Multiplexed transcriptomic and proteomic platforms, along with more comprehensive assays such as RNASeq, allow for interrogation of ongoing physiology and pathology in unprecedented ways. In the fragile neonatal population, saliva is an ideal biofluid to assess clinical status serially and offers many advantages over more invasively obtained blood samples. Importantly, saliva samples are amenable to analysis on emerging proteomic and transcriptomic platforms, even at quantitatively limited volumes. However, biomarker targets are often degraded in human saliva, and as a mixed source biofluid containing both human and microbial targets, saliva presents unique challenges for the investigator. Here, we provide insight into technical considerations and protocol optimizations developed in our laboratory to quantify and discover neonatal salivary biomarkers with improved reproducibility and reliability. We will detail insights learned from years of experimentation on neonatal saliva within our laboratory ranging from salivary collection techniques to processing to downstream analyses, highlighting the need for consistency in approach and a global understanding of both the potential benefits and limitations of neonatal salivary biomarker analyses. Importantly, we will highlight the need for robust and stringent research in this population to provide the field with standardized approaches and workflows to impact neonatal care successfully.
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Affiliation(s)
- Elizabeth Yen
- Mother Infant Research Institute at Tufts Medical Center, Boston, MA, United States.,Division of Newborn Medicine, Tufts Children's Hospital, Boston, MA, United States
| | - Tomoko Kaneko-Tarui
- Mother Infant Research Institute at Tufts Medical Center, Boston, MA, United States
| | - Jill L Maron
- Mother Infant Research Institute at Tufts Medical Center, Boston, MA, United States.,Division of Newborn Medicine, Tufts Children's Hospital, Boston, MA, United States
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5
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Yen E, Kaneko-Tarui T, Ruthazer R, Harvey-Wilkes K, Hassaneen M, Maron JL. Sex-Dependent Gene Expression in Infants with Neonatal Opioid Withdrawal Syndrome. J Pediatr 2019; 214:60-65.e2. [PMID: 31474426 PMCID: PMC10564583 DOI: 10.1016/j.jpeds.2019.07.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/14/2019] [Accepted: 07/11/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate salivary biomarkers that elucidate the molecular mechanisms by which in utero opioid exposure exerts sex-specific effects on select hypothalamic and reward genes driving hyperphagia, a hallmark symptom of infants suffering from neonatal opioid withdrawal syndrome (NOWS). STUDY DESIGN We prospectively collected saliva from 50 newborns born at ≥34 weeks of gestational age with prenatal opioid exposure and 50 sex- and gestational age-matched infants without exposure. Saliva underwent transcriptomic analysis for 4 select genes involved in homeostatic and hedonic feeding regulation (neuropeptide Y2 receptor [NPY2R], proopiomelanocortin [POMC], leptin receptor [LEPR], dopamine type 2 receptor [DRD2]). Normalized gene expression data were stratified based on sex and correlated with feeding volume on day of life 7 and length of stay in infants with NOWS requiring pharmacotherapy. RESULTS Expression of DRD2, a hedonistic/reward regulator, was significantly higher in male newborns compared with female newborns with NOWS (Δ threshold cycle 10.8 ± 3.8 vs 13.9 ± 3.7, P = .01). In NOWS requiring pharmacotherapy expression of leptin receptor, an appetite suppressor, was higher in male subjects than female subjects (Δ threshold cycle 8.4 ± 2.5 vs 12.4 ± 5.1, P = .05), DRD2 expression significantly correlated with intake volume on day of life 7 (r = 0.58, P = .02), and expression of NPY2R, an appetite regulator, negatively correlated with length of stay (r = -0.24, P = .05). CONCLUSIONS Prenatal opioid exposure exerts sex-dependent effects on hypothalamic feeding regulatory genes with clinical correlations. Neonatal salivary gene expression analyses may predict hyperphagia, severity of withdrawal state, and length of stay in infants with NOWS.
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Affiliation(s)
- Elizabeth Yen
- Department of Pediatrics, Floating Hospital for Children/Tufts University School of Medicine, Boston, MA.
| | | | - Robin Ruthazer
- Biostatistics, Epidemiology, and Research Design, Tufts Medical Center, Boston, MA
| | - Karen Harvey-Wilkes
- Department of Pediatrics, Floating Hospital for Children/Tufts University School of Medicine, Boston, MA
| | | | - Jill L Maron
- Department of Pediatrics, Floating Hospital for Children/Tufts University School of Medicine, Boston, MA; Mother Infant Research Institute, Tufts Medical Center, Boston, MA
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Abstract
BACKGROUND The term "oral feeding success" (OFS) is frequently used in clinical practice and research. However, OFS is inconsistently defined, which impacts the ability to adequately evaluate OFS, identify risk factors, and implement interventions in clinical practice and research. PURPOSE To develop the defining attributes, antecedents, and consequences for the concept of OFS in preterm infants during their initial hospitalization. METHODS PubMed, CINAHL, and PsycINFO databases were searched for English articles containing the key words "oral feeding success" and "preterm infants." The Walker and Avant method for concept analysis was employed. RESULTS Sixteen articles revealed the defining attributes, antecedents, and consequences. Defining attributes included (1) physiologic stability; (2) full oral feeding; and (3) combined criteria of feeding proficiency (≥30% of the prescribed volume during the first 5 minutes), feeding efficiency (≥1.5 mL/min over the entire feeding), and intake quantity (≥80% of the prescribed volume). IMPLICATIONS FOR PRACTICE The 3 defining attributes may be used in clinical practice to consistently evaluate OFS. The antecedents of OFS provide clinicians with a frame of reference to assess oral feeding readiness, identify risk factors, and implement effective interventions. The consequences of OFS allow clinicians to anticipate challenges when OFS is not achieved and create a care plan to support the infants. IMPLICATIONS FOR RESEARCH The empirical referents of OFS provide consistent and clear operational definitions of OFS for use in research. The antecedents and consequences may guide researchers to select specific measures or covariates to evaluate valid measures of OFS.
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7
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Griffith TT, Bell AF, White-Traut R, Medoff-Cooper B, Rankin K. Relationship Between Duration of Tube Feeding and Success of Oral Feeding in Preterm Infants. J Obstet Gynecol Neonatal Nurs 2018; 47:620-631. [DOI: 10.1016/j.jogn.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 02/01/2023] Open
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Abstract
Olfaction and gustation are critical for the enjoyment of food but also have important metabolic roles, initiating the cephalic phase response that sets in train secretion of hormones important for metabolism and digestion before any food is actually ingested. Smell and taste receptors are functional in the fetus and there is evidence for antenatal learning of odours. Despite enteral nutrition and metabolism being major issues in the care of very preterm infants, often little consideration is given to the potential role of smell and taste in supporting these processes, or in the role they may have in encoding hypothalamic circuitry in a way that promotes healthy metabolism in the post‑neonatal period. This review will discuss the evidence for the role of smell and taste in the newborn infant.
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Affiliation(s)
- Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand; Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand.
| | - Tanith Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand; Neonatal Unit, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
| | - Mariana Muelbert
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Friederike Beker
- Department of Newborn Services, Mater Mothers' Hospital, Brisbane, QLD, Australia; Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.
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9
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Khanna P, Johnson KL, Maron JL. Optimal reference genes for RT-qPCR normalization in the newborn. Biotech Histochem 2017; 92:459-466. [PMID: 28910197 DOI: 10.1080/10520295.2017.1362474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
It is difficult to identify reliable reference genes for transcriptomic analyses in biofluids such as saliva. This situation is particularly relevant for the newborn population, where rapid development is associated with dynamic changes in gene expression. Real-time gene expression monitoring holds great promise for elucidating disrupted pathways that result in morbidities unique to this population, such as retinopathy of prematurity, but its impact depends on identifying stable and consistently expressed genes across a wide range of gestational ages. We extracted total RNA from 400 neonatal saliva samples (postconceptional ages: 32 5/7 to 48 2/7 weeks), converted it to cDNA, and pre-amplified and analyzed it by qPCR for three commonly used reference genes, ACTB, GAPDH, and YWHAZ. Relative quantification was determined using the Δ Ct method. Data were analyzed as a whole and also stratified by age and sex. Descriptive statistics and homogeneity of variance were performed to identify optimal reference genes. Data analyzed from all ages and both sexes showed significant expression variation for ACTB, while GAPDH and YWHAZ showed greater stability. Male infants exhibited increased expression variation compared to females for ACTB, but neither GAPDH nor YWHAZ showed significant variance for either sex. We suggest that ACTB is an unreliable reference gene for the newborn population. Males showed significantly more variation in ACTB expression compared to females, which suggests a sex-specific developmental role for this biomarker. By contrast, GAPDH and YWHAZ were less variable and therefore preferable for use in neonates. Our findings may improve the use of reference genes for the RT-qPCR platform in the newborn over a wide range of gestational ages, thereby minimizing the likelihood of erroneous interpretation of gene expression during rapid growth, development, and differentiation.
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Affiliation(s)
- P Khanna
- a Sackler School of Graduate Biomedical Sciences
| | | | - J L Maron
- c Mother Infant Research Institute, Floating Hospital for Children, Tufts Medical Center , Boston , Massachusetts
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10
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Barlow SM, Maron JL, Alterovitz G, Song D, Wilson BJ, Jegatheesan P, Govindaswami B, Lee J, Rosner AO. Somatosensory Modulation of Salivary Gene Expression and Oral Feeding in Preterm Infants: Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e113. [PMID: 28615158 PMCID: PMC5489710 DOI: 10.2196/resprot.7712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite numerous medical advances in the care of at-risk preterm neonates, oral feeding still represents one of the first and most advanced neurological challenges facing this delicate population. Objective, quantitative, and noninvasive assessment tools, as well as neurotherapeutic strategies, are greatly needed in order to improve feeding and developmental outcomes. Pulsed pneumatic orocutaneous stimulation has been shown to improve nonnutritive sucking (NNS) skills in preterm infants who exhibit delayed or disordered nipple feeding behaviors. Separately, the study of the salivary transcriptome in neonates has helped identify biomarkers directly linked to successful neonatal oral feeding behavior. The combination of noninvasive treatment strategies and transcriptomic analysis represents an integrative approach to oral feeding in which rapid technological advances and personalized transcriptomics can safely and noninvasively be brought to the bedside to inform medical care decisions and improve care and outcomes. OBJECTIVE The study aimed to conduct a multicenter randomized control trial (RCT) to combine molecular and behavioral methods in an experimental conceptualization approach to map the effects of PULSED somatosensory stimulation on salivary gene expression in the context of the acquisition of oral feeding habits in high-risk human neonates. The aims of this study represent the first attempt to combine noninvasive treatment strategies and transcriptomic assessments of high-risk extremely preterm infants (EPI) to (1) improve oral feeding behavior and skills, (2) further our understanding of the gene ontology of biologically diverse pathways related to oral feeding, (3) use gene expression data to personalize neonatal care and individualize treatment strategies and timing interventions, and (4) improve long-term developmental outcomes. METHODS A total of 180 extremely preterm infants from three neonatal intensive care units (NICUs) will be randomized to receive either PULSED or SHAM (non-pulsing) orocutaneous intervention simultaneous with tube feedings 3 times per day for 4 weeks, beginning at 30 weeks postconceptional age. Infants will also be assessed 3 times per week for NNS performance, and multiple saliva samples will be obtained each week for transcriptomic analysis, until infants have achieved full oral feeding status. At 18 months corrected age (CA), infants will undergo neurodevelopmental follow-up testing, the results of which will be correlated with feeding outcomes in the neo-and post-natal period and with gene expression data and intervention status. RESULTS The ongoing National Institutes of Health funded randomized controlled trial R01HD086088 is actively recruiting participants. The expected completion date of the study is 2021. CONCLUSIONS Differential salivary gene expression profiles in response to orosensory entrainment intervention are expected to lead to the development of individualized interventions for the diagnosis and management of oral feeding in preterm infants. TRIAL REGISTRATION ClinicalTrials.gov NCT02696343; https://clinicaltrials.gov/ct2/show/NCT02696343 (Archived by WebCite at http://www.webcitation.org/6r5NbJ9Ym).
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Affiliation(s)
- Steven Michael Barlow
- Center for Brain, Biology, and Behavior, Department of Special Education and Communication Disorders, Biological Systems Engineering, University of Nebraska, Lincoln, NE, United States
| | - Jill Lamanna Maron
- Tufts Medical Center, Division of Neonatology, Department of Pediatrics, Boston, MA, United States
| | - Gil Alterovitz
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Bernard Joseph Wilson
- CHI Health St. Elizabeth, Division of Neonatal-Perinatal Medicine, Lincoln, NE, United States
| | - Priya Jegatheesan
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Balaji Govindaswami
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Jaehoon Lee
- IMMAP, Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, TX, United States
| | - Austin Oder Rosner
- Tufts Medical Center, Division of Neonatology, Department of Pediatrics, Boston, MA, United States
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Hassaneen M, Maron JL. Salivary Diagnostics in Pediatrics: Applicability, Translatability, and Limitations. Front Public Health 2017; 5:83. [PMID: 28473973 PMCID: PMC5397421 DOI: 10.3389/fpubh.2017.00083] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 04/03/2017] [Indexed: 12/21/2022] Open
Abstract
In the last decade, technological advances, combined with an improved appreciation of the ability of saliva to inform caregivers about both oral health and systemic disease, have led to the emergence of salivary diagnostic platforms. However, the majority of these assays have targeted diseases that more commonly affect the adult population, largely neglecting infants and children who arguably could benefit the most from non-invasive assessment tools for health monitoring. Gaining access into development, infection, and disease through comprehensive "omic" analyses of saliva could significantly improve care and enhance health access. In this review, we will highlight novel applications of salivary diagnostics in pediatrics across the "omic" spectrum, including at the genomic, transcriptomic, proteomic, microbiomic, and metabolomic level. The challenges to implementing salivary platforms into care, including the effects of age, diet, and developmental stage on salivary components, will be reviewed. Ultimately, large-scale, multicenter trials must be performed to establish normative biomarker values across the age spectrum to accurately discriminate between health and disease. Only then can salivary diagnostics truly translate into pediatric care.
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Affiliation(s)
- Mona Hassaneen
- Mother Infant Research Institute at Tufts Medical Center, Boston, MA, USA
| | - Jill L. Maron
- Mother Infant Research Institute at Tufts Medical Center, Boston, MA, USA
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
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12
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Khanna P, Maron JL, Walt DR. Development of a Rapid Salivary Proteomic Platform for Oral Feeding Readiness in the Preterm Newborn. Front Pediatr 2017; 5:268. [PMID: 29312906 PMCID: PMC5733069 DOI: 10.3389/fped.2017.00268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/30/2017] [Indexed: 12/20/2022] Open
Abstract
Oral feeding competency is a major determinant of length of stay in the neonatal intensive care unit. An infant must be able to consistently demonstrate the ability to take all required enteral nutrition by mouth before discharge home. Most infants born prematurely (<37 weeks) will require days, if not weeks, to master this oral feeding competency skill. Inappropriately timed feeding attempts can lead to acute and long-term morbidities, prolonged hospitalizations, and increased health-care costs. Previously, a panel of five genes involved in essential developmental pathways including sensory integration (nephronophthisis 4, Plexin A1), hunger signaling [neuropeptide Y2 receptor (NPY2R), adenosine-monophosphate-activated protein kinase (AMPK)], and facial development (wingless-type MMTV integration site family, member 3) required for oral feeding success were identified in neonatal saliva. This study aimed to translate these five transcriptomic biomarkers into a rapid proteomic platform to provide objective, real-time assessment of oral feeding skills, to better inform care, and to improve neonatal outcomes. Total protein was extracted from saliva of 10 feeding-successful and 10 feeding-unsuccessful infants matched for age, sex, and post-conceptional age. Development of immunoassays was attempted for five oral feeding biomarkers and two reference biomarkers (GAPDH and YWHAZ) to normalize for starting protein concentrations. Normalized protein concentrations were correlated to both feeding status at time of sample collection and previously described gene expression profiles. Only the reference proteins and those involved in hunger signaling were detected in neonatal saliva at measurable levels. Expression patterns for NPY2R and AMPK correlated with the gene expression patterns previously seen between successful and unsuccessful feeders and predicted feeding outcome. Salivary proteins associated with hunger signaling are readily quantifiable in neonatal saliva and may be utilized to assess oral feeding readiness in the newborn. This study lays the foundation for the development of an informative, rapid, proteomic platform to assess neonatal oral feeding maturation.
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Affiliation(s)
- Prarthana Khanna
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, United States
| | - Jill L Maron
- Mother Infant Research Institute, Floating Hospital for Children at Tufts Medical Center, Boston, MA, United States
| | - David R Walt
- Department of Pathology, Brigham and Women's Hospital, Wyss Institute for Biologically Inspired Engineering, Harvard Medical School, Boston, MA, United States
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13
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Zimmerman E, Maron JL. FOXP2 gene deletion and infant feeding difficulties: a case report. Cold Spring Harb Mol Case Stud 2016; 2:a000547. [PMID: 27148578 PMCID: PMC4849845 DOI: 10.1101/mcs.a000547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Forkhead box protein P2 (FOXP2) is a well-studied gene known to play an essential role in normal speech development. Deletions in the gene have been shown to result in developmental speech disorders and regulatory disruption of downstream gene targets associated with common forms of language impairments. Despite similarities in motor planning and execution between speech development and oral feeding competence, there have been no reports to date linking deletions within the FOXP2 gene to oral feeding impairments in the newborn. The patient was a nondysmorphic, appropriately and symmetrically grown male infant born at 35-wk gestational age. He had a prolonged neonatal intensive care unit stay because of persistent oral feeding incoordination requiring gastrostomy tube placement. Cardiac and neurological imagings were within normal limits. A microarray analysis found an ∼9-kb loss within chromosome band 7q3.1 that contains exon 2 of FOXP2, demonstrating a single copy of this region instead of the normal two copies per diploid gene. This case study expands our current understanding of the role FOXP2 exerts on motor planning and coordination necessary for both oral feeding success and speech–language development. This case report has important consequences for future diagnosis and treatment for infants with FOXP2 deletions, mutations, and varying levels of gene expression.
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Affiliation(s)
- Emily Zimmerman
- Northeastern University, Department of Communication Sciences & Disorders, Boston, Massachusetts 02115, USA
| | - Jill L Maron
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts 02111, USA
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14
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Zimmerman E, Maki M, Maron J. Salivary FOXP2 expression and oral feeding success in premature infants. Cold Spring Harb Mol Case Stud 2016; 2:a000554. [PMID: 27148579 PMCID: PMC4849846 DOI: 10.1101/mcs.a000554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The objective of the study is to determine whether salivary FOXP2 gene expression levels at the initiation of oral feeding attempts are predictive of oral feeding success in the premature newborn. In this prospective study, saliva samples from 21 premature infants (13 males; birth gestational age [GA]: 30–34 wk) were collected around the initiation of oral feeding trials. Total RNA was extracted and underwent reverse transcription-quantitative polymerase chain reaction amplification for FOXP2. Oral feeding success was denoted by the days required to attain full oral feeds. A linear regression model, controlling for sex, birth GA, and weight at salivary collection, revealed that FOXP2 expression was significantly associated with oral feeding success (P = 0.002). The higher the expression level of FOXP2, the shorter the duration to feed. Salivary FOXP2 expression levels are significantly associated with oral feeding success in the preterm infant. FOXP2 may serve as a novel and informative biomarker to noninvasively assess infant feeding skills to reduce morbidities and length of stay.
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts 02115, USA
| | - Monika Maki
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts 02115, USA
| | - Jill Maron
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts 02111, USA
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Abstract
The ability to noninvasively assess the physical and developmental status of a neonate is a goal of modern medicine. In recent years, technological advances have permitted the high-throughput analysis of saliva for thousands of genes, proteins, and metabolites from a single sample source. Saliva is an ideal biofluid to assess health, disease, and development in the newborn. It may be harnessed repeatedly, even in the most vulnerable patients, without risk of harm. Translating novel information about an infant's global development and risk of disease to the neonatal bedside through the salivary transcriptome has the potential to significantly improve clinical care and outcomes in this at-risk population.
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Affiliation(s)
- Jill L Maron
- Department of Pediatrics, Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts 02111
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Maron JL, Johnson KL. Comparative performance analyses of commercially available products for salivary collection and nucleic acid processing in the newborn. Biotech Histochem 2015; 90:581-6. [PMID: 26052888 DOI: 10.3109/10520295.2015.1048289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Analysis of saliva for clinical monitoring and biomarker detection holds great promise for improving health care. Commercially available assays are not intended for use with neonates, however, and collection and processing of saliva for subsequent transcriptomic analysis presents unique challenges in this population. We compared RNA yield, quality, stability and RT-qPCR performance for two commonly used commercial systems: the Qiagen RNeasy Protect Saliva Mini Kit(®) and the DNA Genotek Oragene•RNA(®) assay. Two 10 μl saliva samples were collected from ten newborns and stabilized for each assay. Total RNA was extracted following incubation for 3, 10, 15 or 20 days. Total RNA extracted from each assay was analyzed for integrity, quality and quantity using the Agilent BioAnalyzer 2100. RT-qPCR was performed for the reference gene, GAPDH, to assess subsequent performance of the extracted RNA. Although the DNA Genotek extraction protocol required nearly twice the time of the Qiagen protocol, RNA integrity did not differ between the kits. RNA concentration using the DNA Genotek assay, however, was 3,264 pg/μl (range: 262 - 10,336 pg/μl) compared to 822.4 pg/μl (range: 0 - 1,856 pg/μl) for the Qiagen protocol. Linear regression analysis showed a stronger correlation between the threshold cycle and RNA concentration using DNA Genotek (r(2) = 0.356) compared to Qiagen (r(2) = 0.0331). Our results suggest that although the Qiagen assay may reduce overall extraction time, RNA yield and performance in subsequent transcriptomic analysis is more robust using the DNA Genotek assay.
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Affiliation(s)
- J L Maron
- a Mother Infant Research Institute at Tufts Medical Center, Division of Newborn Medicine , Boston , Massachusetts
| | - K L Johnson
- b Tufts University School of Medicine , Boston , Massachusetts
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Khanna P, Walt DR. Salivary diagnostics using a portable point-of-service platform: a review. Clin Ther 2015; 37:498-504. [PMID: 25732629 DOI: 10.1016/j.clinthera.2015.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 11/19/2022]
Abstract
Clinical diagnostics can be improved by faster and more accessible disease detection. Our laboratory has developed a point-of-service (POS) device capable of rapid, sensitive, automated, and multiplexed biomarker detection that uses human saliva instead of other biofluids. Here, we review the technology that led to the development of this POS device. This POS technology can advance clinical diagnostics by saving time because of faster diagnosis, saving money because of a shorter hospital stay, and ultimately improving clinical care.
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Affiliation(s)
- Prarthana Khanna
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111
| | - David R Walt
- Department of Chemistry, Tufts University, Medford, Massachusetts.
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Maron JL, Hwang JS, Pathak S, Ruthazer R, Russell RL, Alterovitz G. Computational gene expression modeling identifies salivary biomarker analysis that predict oral feeding readiness in the newborn. J Pediatr 2015; 166:282-8.e5. [PMID: 25620512 PMCID: PMC4306816 DOI: 10.1016/j.jpeds.2014.10.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/05/2014] [Accepted: 10/24/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To combine mathematical modeling of salivary gene expression microarray data and systems biology annotation with reverse-transcription quantitative polymerase chain reaction amplification to identify (phase I) and validate (phase II) salivary biomarker analysis for the prediction of oral feeding readiness in preterm infants. STUDY DESIGN Comparative whole-transcriptome microarray analysis from 12 preterm newborns pre- and postoral feeding success was used for computational modeling and systems biology analysis to identify potential salivary transcripts associated with oral feeding success (phase I). Selected gene expression biomarkers (15 from computational modeling; 6 evidence-based; and 3 reference) were evaluated by reverse-transcription quantitative polymerase chain reaction amplification on 400 salivary samples from successful (n = 200) and unsuccessful (n = 200) oral feeders (phase II). Genes, alone and in combination, were evaluated by a multivariate analysis controlling for sex and postconceptional age (PCA) to determine the probability that newborns achieved successful oral feeding. RESULTS Advancing PCA (P < .001) and female sex (P = .05) positively predicted an infant's ability to feed orally. A combination of 5 genes, neuropeptide Y2 receptor (hunger signaling), adneosine-monophosphate-activated protein kinase (energy homeostasis), plexin A1 (olfactory neurogenesis), nephronophthisis 4 (visual behavior), and wingless-type MMTV integration site family, member 3 (facial development), in addition to PCA and sex, demonstrated good accuracy for determining feeding success (area under the receiver operator characteristic curve = 0.78). CONCLUSIONS We have identified objective and biologically relevant salivary biomarkers that noninvasively assess a newborn's developing brain, sensory, and facial development as they relate to oral feeding success. Understanding the mechanisms that underlie the development of oral feeding readiness through translational and computational methods may improve clinical decision making while decreasing morbidities and health care costs.
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Affiliation(s)
- Jill L Maron
- Division of Newborn Medicine, Mother Infant Research Institute at Tufts Medical Center, Floating Hospital for Children at Tufts Medical Center, Boston, MA.
| | - Jooyeon S Hwang
- Division of Newborn Medicine, Mother Infant Research Institute at Tufts Medical Center, Floating Hospital for Children at Tufts Medical Center, Boston, MA
| | - Subash Pathak
- Research Design Center/Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Robin Ruthazer
- Research Design Center/Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Ruby L Russell
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Gil Alterovitz
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA
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Great expectorations: the potential of salivary 'omic' approaches in neonatal intensive care. J Perinatol 2014; 34:169-73. [PMID: 24406743 PMCID: PMC3962691 DOI: 10.1038/jp.2013.170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/26/2013] [Accepted: 10/21/2013] [Indexed: 12/13/2022]
Abstract
Among those that require critical care, preterm neonates have the greatest limitations on available blood or body fluids for clinical or research-based assessments. Recent technological advancements have improved our ability to detect genetic, proteomic and microbial material at the nanoscale level, making analyte and biomarker assessment from even the smallest quantities possible. Saliva is a unique body fluid that not only may be noninvasively and repeatedly obtained, but also contains multiple serum components, making it promising for noninvasive assessment of the newborn. The integration of high-throughput or 'omic' approaches on neonatal saliva holds great potential to improve diagnostic and prognostic accuracy for a wide range of developmental and pathological conditions affecting the vulnerable preterm neonatal population. Herein, we review the clinical applications and technical considerations regarding the integration of salivary 'omic' technology into the neonatal intensive care unit.
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State of the science: a contemporary review of feeding readiness in the preterm infant. J Perinat Neonatal Nurs 2014; 28:51-8; quiz E3-4. [PMID: 24476652 DOI: 10.1097/jpn.0000000000000011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Oral feeding readiness has been described by researchers in the neonatal intensive care unit, and research has continued on this topic for many years. The purpose of this narrative review is to identify research and practice guidelines related to oral feeding readiness in preterm infants that have occurred during the last decade. The introduction and mastery of oral feeding is a major developmental task for the preterm infant that is often a prerequisite for discharge from the neonatal intensive care unit. Having a better understanding of the evidence supporting the development of this skill will help the practicing nurse choose appropriate interventions and the researcher to develop trajectories of research that continue to increase our knowledge in this important practice area.
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A multi-platform draft de novo genome assembly and comparative analysis for the Scarlet Macaw (Ara macao). PLoS One 2013; 8:e62415. [PMID: 23667475 PMCID: PMC3648530 DOI: 10.1371/journal.pone.0062415] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/21/2013] [Indexed: 12/31/2022] Open
Abstract
Data deposition to NCBI Genomes: This Whole Genome Shotgun project has been deposited at DDBJ/EMBL/GenBank under the accession AMXX00000000 (SMACv1.0, unscaffolded genome assembly). The version described in this paper is the first version (AMXX01000000). The scaffolded assembly (SMACv1.1) has been deposited at DDBJ/EMBL/GenBank under the accession AOUJ00000000, and is also the first version (AOUJ01000000). Strong biological interest in traits such as the acquisition and utilization of speech, cognitive abilities, and longevity catalyzed the utilization of two next-generation sequencing platforms to provide the first-draft de novo genome assembly for the large, new world parrot Ara macao (Scarlet Macaw). Despite the challenges associated with genome assembly for an outbred avian species, including 951,507 high-quality putative single nucleotide polymorphisms, the final genome assembly (>1.035 Gb) includes more than 997 Mb of unambiguous sequence data (excluding N's). Cytogenetic analyses including ZooFISH revealed complex rearrangements associated with two scarlet macaw macrochromosomes (AMA6, AMA7), which supports the hypothesis that translocations, fusions, and intragenomic rearrangements are key factors associated with karyotype evolution among parrots. In silico annotation of the scarlet macaw genome provided robust evidence for 14,405 nuclear gene annotation models, their predicted transcripts and proteins, and a complete mitochondrial genome. Comparative analyses involving the scarlet macaw, chicken, and zebra finch genomes revealed high levels of nucleotide-based conservation as well as evidence for overall genome stability among the three highly divergent species. Application of a new whole-genome analysis of divergence involving all three species yielded prioritized candidate genes and noncoding regions for parrot traits of interest (i.e., speech, intelligence, longevity) which were independently supported by the results of previous human GWAS studies. We also observed evidence for genes and noncoding loci that displayed extreme conservation across the three avian lineages, thereby reflecting their likely biological and developmental importance among birds.
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Noteworthy Professional News. Adv Neonatal Care 2012. [DOI: 10.1097/anc.0b013e3182614baa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Insights into Neonatal Oral Feeding through the Salivary Transcriptome. Int J Pediatr 2012; 2012:195153. [PMID: 22844301 PMCID: PMC3400363 DOI: 10.1155/2012/195153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/21/2012] [Indexed: 11/17/2022] Open
Abstract
Background. The development of safe and effective oral feeding skills in the newborn is complex and may be associated with significant morbidities. Our understanding of neonatal oral feeding maturation at the molecular level is limited, providing an opportunity to utilize emerging molecular techniques to accurately assess neonatal oral feeding skills. Objective. To identify key regulatory genes in neonatal saliva involved in successful oral feeding. Methods. Previously, our laboratory identified 9,286 genes in saliva that statistically significantly altered their gene expression as premature newborns gained advanced oral feeding skills. In this report, genes previously identified underwent an updated and targeted pathway analysis with Ingenuity Pathway Analysis (IPA) to identify potential candidate genes involved in successful oral feeding. Genes were considered if they were in the five most significantly up- and down-regulated physiological pathways and were associated with the keywords “feeding”, “digestion” and “development”. Results. There were 2,186 genes that met criteria. Pathways associated with feeding behavior, cranial nerve development, and the development of the nervous, skeletal, and muscular systems were highlighted. Discussion. These data provide important insights into the biological processes involved in oral feeding in the newborn at a molecular level and identify novel pathways associated with successful oral feeding.
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