VDAART FLORA ANCILLARY STUDY

VDAART 植物群辅助研究

• 批准号: 8152908
• 负责人: DIANE R GOLD
• 金额: $ 45.9万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8152908
• 关键词: 1 year old; 3 year old; Adult; Age; Age-Months; Allergens; Allergic; Allergic Disease; Allergic rhinitis; Anaerobic Bacteria; Ancillary Study; Anti-Inflammatory Agents; Anti-inflammatory; Asthma; Atopic Dermatitis; Bacteroides fragilis; Biology; Birth; CD4 Positive T Lymphocytes; Cells; Characteristics; Child; Childhood; Chronic; Clinical Trials; Development; Diagnosis; Diet; Dietary Intervention; Disease; Eczema; Enrollment; Exposure to; Extrinsic asthma; Frequencies; Funding; Gastrointestinal tract structure; Generations; Grant; Hay fever; Health; Helper-Inducer T-Lymphocyte; High Prevalence; Homing; Human; Hypersensitivity; Immune; Immune response; Immunology; Infant; Inflammatory; Interleukin-10; Intervention Trial; Intestines; Lactobacillus; Life; Link; Lymphoid Tissue; Microbiology; Mothers; Parents; Pathway interactions; Pilot Projects; Play; Population; Pregnancy; Prevalence; Public Health; Recurrence; Regulation; Regulatory T-Lymphocyte; Reporting; Research Design; Risk; Rodent; Role; Skin; Source; Sterility; Subgroup; Supplementation; T-Lymphocyte; Testing; Time; Translating; Umbilical Cord Blood; United States; United States National Institutes of Health; Urbanization; Vitamin D; Vitamin D Deficiency; Wheezing; abstracting; cytokine; disorder risk; follow-up; immune function; microbial; microorganism antigen; oral tolerance; postnatal; public health relevance; research study; response

DESCRIPTION (provided by applicant): Asthma is the most common cause of chronic childhood disease in the United States, and is a major health problem, particularly in urban pediatric populations. Most asthma is diagnosed before the age of six, and most children with asthma are atopic with sensitization to at least one allergen. Bacterial gut colonization and Vitamin D exposure are two factors that vary in children with urbanization, may influence immune function at the intestinal and systemic levels, and may increase the risk of allergy and asthma. In a small pilot study we found that the anti-inflammatory immunomodulatory cytokine IL-10 was increased in the cord blood of children whose mothers had a higher proportion of anaerobes in the gut. Infant gut diversity was protective against atopic dermatitis in the first 6 months of life. However, there has been no adequate long-term follow-up study of the gut flora in human early life and the development of atopic diseases. In the only U.S. pre-birth Vitamin D asthma intervention trial (NIH Grant number: U01 HL091528, co-PIs: Litonjua & Weiss), we have a unique opportunity to evaluate the influences of gut colonization (maternal and child) on the risk of early life wheeze, atopic dermatitis, and allergic sensitization. Moreover, this proposed ancillary study will optimize the chance to evaluate whether gut colonization and vitamin D influences on allergy and asthma development are independent or linked. We propose to test the following primary hypotheses in a subset of 200 mother:child pairs: (1) Higher levels of maternal vitamin D during pregnancy will increase numbers of total and specific anaerobes (B fragilis, and Lactobacillus) in the maternal and child intestinal flora; (2) Increased numbers of anaerobes in the maternal intestinal flora, and in the child intestinal flora at 4 months of age will reduce the risk of wheeze, recurrent wheeze (>2 reports of wheeze in the previous year), atopic dermatitis (eczema), and sensitization to >1 allergen at 1 year of age. We will consider exposures to total anaerobes, as well as the specific anaerobes B fragilis, and Lactobacillus; To further explore whether there are common pathways through which intestinal flora and vitamin D influence allergy and wheeze, we will test the following three secondary hypotheses: 3) Higher levels of maternal vitamin D during pregnancy will reduce the risk of recurrent wheeze, atopic dermatitis and sensitization in part through increasing numbers of anaerobes in the maternal intestinal flora, and in the child intestinal flora at 4 months of age. (4) Increased numbers of total and specific anaerobes in maternal and child intestinal flora will increase the frequency and anti-inflammatory function of Foxp3+ and IL-10+ Treg cells in cord blood.(5) Maternal supplementation with vitamin D during pregnancy will increase the diversity/complexity of maternal and child fecal flora. This proposal is time-sensitive. As ascertainment of the composition of maternal intestinal flora is central to our hypotheses, it is critically important that this ancillary study be initiated early in the final year (2011) of the enrollment and delivery period of the parent clinical trial VDAART. PUBLIC HEALTH RELVEANCE: Asthma is a major public health problem and the most common cause of chronic childhood disease in the United States. Over a 40 year period, allergic asthma, allergic rhinitis (hay fever) and atopic dermatitis (atopic eczema) prevalence increased, and the high prevalence of asthma persists, particularly in urban pediatric populations in the United States. If we identify components of maternal or childhood intestinal microbial flora that are protective against allergy, wheeze or asthma, and that vary with vitamin D levels or diet, this could be translated into pharmacologic or dietary interventions that would be of great benefit to public health. (End of Abstract)

描述（由申请人提供）：哮喘是美国慢性儿童疾病的最常见原因，也是一个主要的健康问题，特别是对于城市儿童群体。大多数哮喘在六岁之前被诊断出来，并且大多数哮喘儿童都患有特应性，对至少一种过敏原过敏。细菌肠道定植和维生素 D 暴露是城市化儿童中不同的两个因素，可能会影响肠道和全身水平的免疫功能，并可能增加过敏和哮喘的风险。在一项小型试点研究中，我们发现，如果母亲肠道中厌氧菌比例较高，则孩子的脐带血中抗炎免疫调节细胞因子 IL-10 会增加。婴儿肠道多样性可以在生命的前 6 个月内预防特应性皮炎。然而，目前还没有对人类早期生命中的肠道菌群和特应性疾病的发展进行充分的长期随访研究。在美国唯一的出生前维生素 D 哮喘干预试验（NIH 授权号：U01 HL091528，共同负责人：Litonjua & Weiss）中，我们有一个独特的机会来评估肠道定植（母亲和儿童）对早年喘息、特应性皮炎和过敏性过敏风险的影响。此外，这项拟议的辅助研究将优化评估肠道定植和维生素 D 对过敏和哮喘发展的影响是否独立或相关的机会。我们建议在 200 对母子对中测试以下主要假设：(1) 怀孕期间母体维生素 D 水平较高会增加总数量和特定数量 母婴肠道菌群中的厌氧菌（脆弱芽孢杆菌和乳酸杆菌）； (2) 母体肠道菌群和 4 个月大的儿童肠道菌群中厌氧菌数量的增加将降低喘息、反复喘息（前一年报告有 2 次以上喘息）、特应性皮炎（湿疹）和 1 岁时对 1 种以上过敏原过敏的风险。我们将考虑总厌氧菌以及特定厌氧菌脆弱芽孢杆菌和乳酸菌的暴露；为了进一步探讨肠道菌群和维生素 D 影响过敏和喘息是否存在共同途径，我们将检验以下三个次要假设：3) 怀孕期间母体维生素 D 水平较高将降低复发性喘息、特应性皮炎和过敏的风险，部分原因是母体肠道菌群和 4 个月大的儿童肠道菌群中厌氧菌数量增加。 (4)母婴肠道菌群中总厌氧菌和特异性厌氧菌数量的增加，会增加脐带血中Foxp3+和IL-10+ Treg细胞的频率和抗炎功能。(5)母亲在怀孕期间补充维生素D会增加母婴粪便菌群的多样性/复杂性。该提议具有时效性。由于确定母体肠道菌群的组成是我们假设的核心，因此在母体临床试验 VDAART 的入组和交付期的最后一年（2011 年）尽早启动这项辅助研究至关重要。公共卫生相关性：哮喘是一个主要的公共卫生问题，也是美国慢性儿童疾病的最常见原因。 40多年来，过敏性哮喘、过敏性鼻炎（花粉热）和特应性皮炎（特应性湿疹）的患病率有所增加，并且哮喘的高患病率持续存在，特别是在美国的城市儿童群体中。如果我们确定孕产妇或儿童肠道微生物菌群的成分能够预防过敏、喘息或哮喘，并且随维生素 D 水平或饮食的不同而变化，那么这可以转化为药理或饮食干预措施，对公众健康大有裨益。 （摘要完）