Outside-in? Acute fetal systemic inflammation in very preterm chronically catheterized sheep fetuses is not driven by cells in the fetal blood

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• 作者：Matthew W. Kemp ; PhD^a ; ^{matthew.kemp@uwa.edu.au" class="auth_mail" title="E-mail the corresponding author} ; Timothy J. Molloy ; PhD^b ; Haruo Usuda ; MD^c ; Eleanor Woodward ; PhD^a ; Yuichiro Miura ; PhD^a ; Matthew S. Payne ; PhD^a ; Demelza J. Ireland ; PhD^a ; Alan H. Jobe ; PhD^a ; ^d ; Suhas G. Kallapur ; PhD^a ; ^d ; Sarah J. Stock ; PhD^e ; Owen B. Spiller ; PhD^f ; John P. Newnham ; MD^a ; Masatoshi Saito ; PhD^a ; ^c
• 关键词：fetus ; infection ; inflammation ; preterm birth ; sheep
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：214
• 期：2
• 页码：281.e1-281.e10
• 全文大小：1005 K

文摘

The preterm birth syndrome (delivery before 37 weeks gestation) is a major contributor to the global burden of perinatal morbidity and death. The cause of preterm birth is complex, multifactorial, and likely dependent, at least in part, on the gestational age of the fetus. Intrauterine infection is frequent in preterm deliveries that occur at <32 weeks gestation; understanding how the fetus responds to proinflammatory insult will be an important step towards early preterm birth prevention. However, animal studies of infection and inflammation in prematurity commonly use older fetuses that possess comparatively mature immune systems.

Objective

Aiming to characterize acute fetal responses to microbial agonist at a clinically relevant gestation, we used 92-day-old fetuses (62% of term) to develop a chronically catheterized sheep model of very preterm pregnancy. We hypothesized that any acute fetal systemic inflammatory responses would be driven by signaling from the tissues exposed to Escherichia coli lipopolysaccharide that is introduced into the amniotic fluid.

Study Design

Eighteen ewes that were carrying a single fetus at 92 days of gestation had recovery surgery to place fetal tracheal, jugular, and intraamniotic catheters. Animals were recovered for 24 hours before being administered either intraamniotic E coli lipopolysaccharide (n = 9) or sterile saline solution (n = 9). Samples were collected for 48 hours before euthanasia and necroscopy. Fetal inflammatory responses were characterized by microarray analysis, quantitative polymerase chain reaction, and enzyme-linked immunosorbent assay.

Results

Intraamniotic lipopolysaccharide reached the distal trachea within 2 hours. Lipopolysaccharide increased tracheal fluid interleukin-8 within 2 hours and generated a robust inflammatory response that was characterized by interleukin-6 signaling pathway activation and up-regulation of cell proliferation but no increases in inflammatory mediator expression in cord blood RNA.

Conclusions

In very preterm sheep fetuses, lipopolysaccharide stimulates inflammation in the fetal lung and fetal skin and stimulates a systemic inflammatory response that is not generated by fetal blood cells. These data argue for amniotic fluid-exposed tissues that play a key role in driving acute fetal and intrauterine inflammatory responses.