Prenatal inflammation enhances antenatal corticosteroid-induced fetal lung maturation.

Prenatal inflammation enhances antenatal corticosteroid-induced fetal lung maturation.
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产前炎症促进产前皮质类固醇诱导的胎儿肺成熟。

DOI:
10.1172/jci.insight.139452
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发表时间:
2020
期刊:
影响因子:
8
通讯作者:
Jobe,AlanH
Jobe,AlanH
中科院分区:
医学1区
文献类型:
--
作者:
Schmidt,AugustoF;Kannan,ParanthamanS;Bridges,James;Presicce,Pietro;Jackson,CourtneyM;Miller,LisaA;Kallapur,SuhasG;Chougnet,ClaireA;Jobe,AlanH

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呼吸系统并发症是早产儿发病率和死亡率的主要原因,产前皮质类固醇(ACS)的管理可以部分预防。大多数极早产儿暴露于绒毛膜炎,但ACS治疗在这种情况下的短期和长期影响尚不明确。在低资源环境中,ACS可能通过增加感染而增加新生儿死亡率。我们报告说,在恒河猴羊膜内脂多糖(LPS)诱导的炎症背景下,低剂量ACS治疗可改善肺顺应性,并增加表面活性剂的产生,相对于单独暴露。RNA测序显示,这些变化是通过抑制增殖和诱导间充质细胞死亡介导的,通过TP53。联合暴露导致成熟样转录组学特征,通过抑制胶原基因COL1A1、COL1A2和COL3A1以及肺发育调节因子FGF9和FGF10抑制细胞外基质发育。ACS和炎症也抑制了与增殖性间充质祖细胞相关的特征基因,类似于妊娠期肺。在炎症背景下用ACS治疗可能导致早产儿的早期呼吸优势,但这种优势可能伴随着异常细胞外基质发育的风险,这可能与慢性肺部疾病的风险增加有关。
Respiratory complications are the major cause of morbidity and mortality among preterm infants, which is partially prevented by the administration of antenatal corticosteroids (ACS). Most very preterm infants are exposed to chorioamnionitis, but short- and long-term effects of ACS treatment in this setting are not well defined. In low-resource settings, ACS increased neonatal mortality by perhaps increasing infection. We report that treatment with low-dose ACS in the setting of inflammation induced by intraamniotic lipopolysaccharide (LPS) in rhesus macaques improves lung compliance and increases surfactant production relative to either exposure alone. RNA sequencing shows that these changes are mediated by suppression of proliferation and induction of mesenchymal cellular death via TP53. The combined exposure results in a mature-like transcriptomic profile with inhibition of extracellular matrix development by suppression of collagen genes COL1A1, COL1A2, and COL3A1 and regulators of lung development FGF9 and FGF10. ACS and inflammation also suppressed signature genes associated with proliferative mesenchymal progenitors similar to the term gestation lung. Treatment with ACS in the setting of inflammation may result in early respiratory advantage to preterm infants, but this advantage may come at a risk of abnormal extracellular matrix development, which may be associated with increased risk of chronic lung disease.
皮质类固醇和表面活性剂可增加早产兔肺的肺容量并降低破裂压力。
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