Late Preterm Birth, Ureaplasma Species and Childhood Lung Disease

晚期早产、解脲支原体和儿童肺病

• 批准号: 7938669
• 负责人: ALAN H JOBE
• 金额: $ 48.92万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-24 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938669
• 关键词: Affect; Age; Age-Months; Alveolar Macrophages; Amniocentesis; Amniotic Fluid; Animal Model; Animals; Anti-Inflammatory Agents; Anti-inflammatory; Antigens; Asthma; Bacteria; Biology; Birth; Bronchoalveolar Lavage; Bronchopulmonary Dysplasia; CD80 gene; Caring; Cells; Child; Childhood; Chronic; Clinical; Clinical Research; Dendritic Cells; Disease; Drug usage; Elderly; Exposure to; Fetal Membranes; Fetus; Freezing; Gestational Age; Grant; Growth; HLA-DR Antigens; Health; Health Surveys; Histologic; Histopathology; Human; Human Pathology; Hydrogen Peroxide; Hygiene; IL8 gene; Immune; Immune response; Immune system; Immunologics; In Vitro; Infant; Infection; Infection of amniotic sac and membranes; Inflammation; Inflammatory; Inflammatory Response; Injection of therapeutic agent; Interleukin-6; Length; Link; Lung; Lung Inflammation; Lung diseases; Measurement; Measures; Mediastinal lymph node group; Modeling; Mononuclear; Mothers; Mycoplasma; Neonatal; Newborn Infant; Organism; Outcome; Outcome Assessment; Perinatal Exposure; Plasma; Population; Population Study; Pregnancy; Premature Birth; Premature Infant; Production; Pulmonary function tests; Questionnaires; Reporting; Research; Research Personnel; Respiratory physiology; Risk; Risk Factors; Role; Severities; Sheep; Signaling Molecule; Structure; TLR2 gene; TLR3 gene; TLR4 gene; Testing; Time; Umbilical Cord Blood; Umbilical cord structure; Ureaplasma; Variant; Virulence; Virulence Factors; Virulent; abstracting; base; chemokine; cigarette smoking; clinically relevant; cohort; comparison group; cytokine; early childhood; experience; fetal; human disease; immune function; immunoregulation; in vivo; innovation; insight; lung development; mRNA Expression; macrophage; maternal diabetes; methacholine; molecular phenotype; monocyte; postnatal; prenatal; public health relevance; research study; response; surfactant; treatment strategy

DESCRIPTION (provided by applicant): Fetal exposures are known to influence lung function in childhood and later life. Although about 7% of all births are categorized as late-preterm (births at 32o-366 wks gestation) and these infants are at increased risk for lung related problems in childhood, this population has been minimally studied for lung outcomes. Fetal exposure to chorioamnionitis (inflammation/infection) can adversely affect lung development and modulate fetal immune function. The most frequent organism associated with fetal inflammation/chronic chorioamnionitis in the human is Ureaplasma spp. We hypothesize that fetal exposure to Ureaplasma spp modulates immune responses and increases the risk of lung disease in early childhood in late-preterm infants. We will test this hypothesis with a clinical study and a parallel experimental study with U. parvum chorioamnionitis in fetal sheep. The clinical study will select cohorts of late preterm infants based on cultures for Ureaplasma spp, and histopathology for chorioamnionitis. Fetal inflammatory responses will be evaluated by cytokine/chemokine profiles in cord blood, molecular phenotypes and immune modulation by cord blood monocytes, and dendritic cells will characterize fetal immune status. The ureaplasma exposed and unexposed late-preterm infants will have lung health assessments at 9 mos and 2 yrs, and pulmonary function tests at 9 mos to evaluate lung outcomes. In parallel experiments we will characterize the inflammatory and immune modulatory responses of fetal sheep to the chorioamnionitis caused by intra-amniotic injection of U. parvum. We will explore the in vivo inflammatory/immune responses to multi-banded antigen (MBA) variability because MBA has been identified in vitro as the virulence factor for U. parvum. We will characterize how gestational age and interval from exposure to delivery modulate the fetal immune and inflammatory responses to U. parvum. We will allow U. parvum exposed fetuses to deliver and measure immune status lung function and structure at 2 wks and 2 mos of age. The experiments are innovative be cause we will focus on late-preterm infants, a large understudied population, to define immune status at birth. We will correlate of fetal ureaplasma exposure and chorioamnionitis with pulmonary outcomes and with immunologic measurements. We will use a clinically relevant model of chorioamnionitis in sheep to evaluate aspects of immune modulation that are not possible in humans. The results will link for the first time a specific and common fetal inflammatory exposure with lung outcomes. The research will be performed by a team of experienced investigators with expertise for each component of the project: the biology of Ureaplasma spp, immune and inflammatory responses in the newborn human and fetal sheep, animal models of chorioamnionitis, and pulmonary assessments of children. PUBLIC HEALTH RELEVANCE: Fetal exposures to chorioamnionitis increase the risks for bronchopulmonary dysplasia and lung abnormalities in childhood in very preterm infants. Late-preterm infants have increased lung disease in childhood, but are a large and minimally studied population. We will evaluate the most common fetal inflammatory exposure - Ureaplasma spp associated chorioamnionitis - in the human and in a relevant sheep model by inflammatory, immune, and lung outcome assessments. The results will provide the information to identify infants at risk and to develop preventative and treatment strategies. (End of Abstract)

描述（由申请人提供）： 众所周知，胎儿接触该物质会影响儿童期和以后生活中的肺功能。尽管约 7% 的新生儿被归类为晚期早产儿（妊娠 32-366 周的新生儿），并且这些婴儿在儿童时期出现肺部相关问题的风险较高，但对这一人群的肺部结局研究却很少。胎儿接触绒毛膜羊膜炎（炎症/感染）会对肺部发育产生不利影响并调节胎儿的免疫功能。与人类胎儿炎症/慢性绒毛膜羊膜炎相关的最常见微生物是解脲支原体。我们假设胎儿​​接触解脲支原体会调节免疫反应并增加晚期早产儿患肺部疾病的风险。我们将通过临床研究和胎羊绒毛膜羊膜炎的平行实验研究来检验这一假设。该临床研究将根据解脲支原体培养和绒毛膜羊膜炎的组织病理学选择晚期早产儿队列。胎儿炎症反应将通过脐带血中的细胞因子/趋化因子谱、分子表型和脐带血单核细胞的免疫调节来评估，树突状细胞将表征胎儿的免疫状态。暴露于解脲支原体和未暴露于解脲支原体的晚期早产儿将在 9 个月和 2 岁时进行肺部健康评估，并在 9 个月时进行肺功能测试，以评估肺部结果。在平行实验中，我们将表征胎羊对羊膜内注射小 U. parvum 引起的绒毛膜羊膜炎的炎症和免疫调节反应。我们将探讨多带抗原 (MBA) 变异性的体内炎症/免疫反应，因为 MBA 已在体外被鉴定为小 U. parvum 的毒力因子。我们将描述胎龄和从暴露到分娩的间隔如何调节胎儿对微小 U. 菌的免疫和炎症反应。我们将允许暴露于小 U. parvum 的胎儿在 2 周和 2 个月大时交付并测量免疫状态、肺功能和结构。这些实验具有创新性，因为我们将重点关注晚期早产儿（大量未被研究的人群），以确定出生时的免疫状态。我们将胎儿解脲支原体暴露和绒毛膜羊膜炎与肺部结局和免疫学测量相关联。我们将使用绵羊绒毛膜羊膜炎的临床相关模型来评估人类不可能实现的免疫调节方面。研究结果将首次将特定且常见的胎儿炎症暴露与肺部结果联系起来。该研究将由经验丰富的研究人员团队进行，他们对项目的每个组成部分都有专业知识：脲原体属的生物学、新生儿和胎羊的免疫和炎症反应、绒毛膜羊膜炎的动物模型以及儿童的肺部评估。公共卫生相关性：胎儿暴露于绒毛膜羊膜炎会增加极早产儿儿童期支气管肺发育不良和肺部异常的风险。晚期早产儿在童年时期肺部疾病的发病率较高，但这一群体数量庞大且研究很少。我们将通过炎症、免疫和肺部结果评估，在人类和相关绵羊模型中评估最常见的胎儿炎症暴露——解脲支原体相关的绒毛膜羊膜炎。结果将提供信息来识别处于危险中的婴儿并制定预防和治疗策略。 （摘要完）