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Green AL, Cowell EC, Carr LM, Hemsley K, Sherratt E, Collins-Praino LE, Carr JM. Application of diceCT to Study the Development of the Zika Virus-Infected Mouse Brain. Viruses 2024; 16:1330. [PMID: 39205304 PMCID: PMC11358961 DOI: 10.3390/v16081330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/14/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Zika virus (ZIKV) impacts the developing brain. Here, a technique was applied to define, in 3D, developmental changes in the brains of ZIKV-infected mice. Postnatal day 1 mice were uninfected or ZIKV-infected, then analysed by iodine staining and micro-CT scanning (diffusible iodine contrast-enhanced micro-CT; diceCT) at 3-, 6-, and 10-days post-infection (dpi). Multiple brain regions were visualised using diceCT: the olfactory bulb, cerebrum, hippocampus, midbrain, interbrain, and cerebellum, along with the lens and retina of the eye. Brain regions were computationally segmented and quantitated, with increased brain volumes and developmental time in uninfected mice. Conversely, in ZIKV-infected mice, no quantitative differences were seen at 3 or 6 dpi when there were no clinical signs, but qualitatively, diverse visual defects were identified at 6-10 dpi. By 10 dpi, ZIKV-infected mice had significantly lower body weight and reduced volume of brain regions compared to 10 dpi-uninfected or 6 dpi ZIKV-infected mice. Nissl and immunofluorescent Iba1 staining on post-diceCT tissue were successful, but RNA extraction was not. Thus, diceCT shows utility for detecting both 3D qualitative and quantitative changes in the developing brain of ZIKV-infected mice, with the benefit, post-diceCT, of retaining the ability to apply traditional histology and immunofluorescent analysis to tissue.
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Affiliation(s)
- Amy L. Green
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide, SA 5001, Australia; (A.L.G.); (E.C.C.); (K.H.)
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5001, Australia
| | - Evangeline C. Cowell
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide, SA 5001, Australia; (A.L.G.); (E.C.C.); (K.H.)
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5001, Australia
| | - Laura M. Carr
- School of Biomedicine, The University of Adelaide, Adelaide, SA 5005, Australia; (L.M.C.); (L.E.C.-P.)
| | - Kim Hemsley
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide, SA 5001, Australia; (A.L.G.); (E.C.C.); (K.H.)
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5001, Australia
| | - Emma Sherratt
- School of Biological Sciences, The University of Adelaide, Adelaide, SA 5005, Australia;
| | - Lyndsey E. Collins-Praino
- School of Biomedicine, The University of Adelaide, Adelaide, SA 5005, Australia; (L.M.C.); (L.E.C.-P.)
| | - Jillian M. Carr
- College of Medicine and Public Health, Flinders University, P.O. Box 2100, Adelaide, SA 5001, Australia; (A.L.G.); (E.C.C.); (K.H.)
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA 5001, Australia
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Nogueira CDO, Lopes da Silva MO, de Lima EV, Christoff RR, Gavino-Leopoldino D, Lemos FS, da Silva NE, Da Poian AT, Assunção-Miranda I, Figueiredo CP, Clarke JR. Immunosuppression-induced Zika virus reactivation causes brain inflammation and behavioral deficits in mice. iScience 2024; 27:110178. [PMID: 38993676 PMCID: PMC11237861 DOI: 10.1016/j.isci.2024.110178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/27/2024] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
Zika virus (ZIKV) is a neurotropic flavivirus that can persist in several tissues. The late consequences of ZIKV persistence and whether new rounds of active replication can occur, remain unaddressed. Here, we investigated whether neonatally ZIKV-infected mice are susceptible to viral reactivation in adulthood. We found that when ZIKV-infected mice are treated with immunosuppressant drugs, they present increased susceptibility to chemically induced seizures. Levels of subgenomic flavivirus RNAs (sfRNAs) were increased, relative to the amounts of genomic RNAs, in the brains of mice following immunosuppression and were associated with changes in cytokine expression. We investigated the impact of immunosuppression on the testicles and found that ZIKV genomic RNA levels are increased in mice following immunosuppression, which also caused significant testicular damage. These findings suggest that ZIKV can establish new rounds of active replication long after acute stages of disease, so exposed patients should be monitored to ensure complete viral eradication.
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Affiliation(s)
- Clara de O Nogueira
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | | | - Emanuelle V de Lima
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Raíssa Rilo Christoff
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Daniel Gavino-Leopoldino
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Felipe S Lemos
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Nicolas E da Silva
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Andrea T Da Poian
- Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Iranaia Assunção-Miranda
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Claudia P Figueiredo
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
| | - Julia R Clarke
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941902, RJ, Brazil
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Pereira-Carvalho D, Chagas Valim AC, Borba Vieira Andrade C, Bloise E, Fontes Dias A, Muller Oliveira Nascimento V, Silva Alves RK, Dos Santos RC, Lopes Brum F, Gomes Medeiros I, Antunes Coelho SV, Barros Arruda L, Regina Todeschini A, Barbosa Dias W, Ortiga-Carvalho TM. Sex-specific effect of antenatal Zika virus infection on murine fetal growth, placental nutrient transporters, and nutrient sensor signaling pathways. FASEB J 2024; 38:e23799. [PMID: 38979938 DOI: 10.1096/fj.202301951rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 06/03/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
Maternal Zika virus (ZIKV) infection during pregnancy has been associated with severe intrauterine growth restriction (IUGR), placental damage, metabolism disturbances, and newborn neurological abnormalities. Here, we investigated the impact of maternal ZIKV infection on placental nutrient transporters and nutrient-sensitive pathways. Immunocompetent (C57BL/6) mice were injected with Low (103 PFU-ZIKVPE243) or High (5 × 107 PFU-ZIKVPE243) ZIKV titers at gestational day (GD) 12.5, and tissue was collected at GD18.5 (term). Fetal-placental growth was impaired in male fetuses, which exhibited higher placental expression of the ZIKV infective marker, eukaryotic translation initiation factor 2 (eIF2α), but lower levels of phospho-eIF2α. There were no differences in fetal-placental growth in female fetuses, which exhibited no significant alterations in placental ZIKV infective markers. Furthermore, ZIKV promoted increased expression of glucose transporter type 1 (Slc2a1/Glut1) and decreased levels of glucose-6-phosphate in female placentae, with no differences in amino acid transport potential. In contrast, ZIKV did not impact glucose transporters in male placentae but downregulated sodium-coupled neutral amino acid 2 (Snat2) transporter expression. We also observed sex-dependent differences in the hexosamine biosynthesis pathway (HBP) and O-GlcNAcylation in ZIKV-infected pregnancies, showing that ZIKV can disturb placental nutrient sensing. Our findings highlight molecular alterations in the placenta caused by maternal ZIKV infection, shedding light on nutrient transport, sensing, and availability. Our results also suggest that female and male placentae employ distinct coping mechanisms in response to ZIKV-induced metabolic changes, providing insights into therapeutic approaches for congenital Zika syndrome.
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Affiliation(s)
- Daniela Pereira-Carvalho
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Enrrico Bloise
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ariane Fontes Dias
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rakel Kelly Silva Alves
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronan Christian Dos Santos
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Lopes Brum
- Instituto do Cérebro, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | | | - Luciana Barros Arruda
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriane Regina Todeschini
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wagner Barbosa Dias
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Yates EF, Mulkey SB. Viral infections in pregnancy and impact on offspring neurodevelopment: mechanisms and lessons learned. Pediatr Res 2024; 96:64-72. [PMID: 38509227 PMCID: PMC11257821 DOI: 10.1038/s41390-024-03145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
Pregnant individuals with viral illness may experience significant morbidity and have higher rates of pregnancy and neonatal complications. With the growing number of viral infections and new viral pandemics, it is important to examine the effects of infection during pregnancy on both the gestational parent and the offspring. Febrile illness and inflammation during pregnancy are correlated with risk for autism, attention deficit/hyperactivity disorder, and developmental delay in the offspring in human and animal models. Historical viral epidemics had limited follow-up of the offspring of affected pregnancies. Infants exposed to seasonal influenza and the 2009 H1N1 influenza virus experienced increased risks of congenital malformations and neuropsychiatric conditions. Zika virus exposure in utero can lead to a spectrum of abnormalities, ranging from severe microcephaly to neurodevelopmental delays which may appear later in childhood and in the absence of Zika-related birth defects. Vertical infection with severe acute respiratory syndrome coronavirus-2 has occurred rarely, but there appears to be a risk for developmental delays in the infants with antenatal exposure. Determining how illness from infection during pregnancy and specific viral pathogens can affect pregnancy and neurodevelopmental outcomes of offspring can better prepare the community to care for these children as they grow. IMPACT: Viral infections have impacted pregnant people and their offspring throughout history. Antenatal exposure to maternal fever and inflammation may increase risk of developmental and neurobehavioral disorders in infants and children. The recent SARS-CoV-2 pandemic stresses the importance of longitudinal studies to follow pregnancies and offspring neurodevelopment.
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Affiliation(s)
- Emma F Yates
- Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Sarah B Mulkey
- Children's National Hospital, Washington, DC, USA.
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Max R, Toval-Ruiz C, Becker-Dreps S, Gajewski AM, Martinez E, Cross K, Blette B, Ortega O, Collado D, Zepeda O, Familiar I, Boivin MJ, Chavarria M, Meléndez MJ, Mercado JC, de Silva A, Collins MH, Westreich D, Bos S, Harris E, Balmaseda A, Gower EW, Bowman NM, Stringer E, Bucardo F. Neurodevelopment in preschool children exposed and unexposed to Zika virus in utero in Nicaragua: a prospective cohort study. Lancet Glob Health 2024; 12:e1129-e1138. [PMID: 38876760 PMCID: PMC11289744 DOI: 10.1016/s2214-109x(24)00176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2024] [Accepted: 04/11/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Data on long-term neurodevelopmental outcomes of normocephalic children (born with normal head circumference) exposed to Zika virus in utero are scarce. We aimed to compare neurodevelopmental outcomes in normocephalic children up to age 48 months with and without Zika virus exposure in utero. METHODS In this prospective cohort study, we included infants from two cohorts of normocephalic children born in León and Managua, Nicaragua during the 2016 Zika epidemic. In León, all women pregnant during the two enrolment periods were eligible. In Managua, mother-child pairs were included from three districts in the municipality of Managua: all women who became pregnant before June 15, 2016, and had a due date of Sept 15, 2016 or later were eligible. Infants were serologically classified as Zika virus-exposed or Zika virus-unexposed in utero and were followed up prospectively until age 48 months. At 36 months and 48 months of age, the Mullen Scales of Early Learning (MSEL) assessment was administered. Primary outcomes were MSEL early learning composite (ELC) scores at 30-48 months in León and 36-48 months in Managua. We used an inverse probability weighting generalised estimating equations model to assess the effect of Zika virus exposure on individual MSEL cognitive domain scores and ELC scores, adjusted for maternal education and age, poverty status, and infant sex. FINDINGS The initial enrolment period for the León cohort was between Jan 31 and April 5, 2017 and the second was between Aug 30, 2017, and Feb 22, 2018. The enrolment period for the Managua cohort was between Oct 24, 2019, and May 5, 2020. 478 mothers (482 infants) from the León cohort and 615 mothers (609 infants) from the Managua cohort were enrolled, of whom 622 children (303 from the León cohort; 319 from the Managua cohort) were included in the final analysis; four children had microcephaly at birth and thus were excluded from analyses, two from each cohort. 33 (11%) of 303 children enrolled in León and 219 (69%) of 319 children enrolled in Managua were exposed to Zika virus in utero. In both cohorts, no significant differences were identified in adjusted mean ELC scores between Zika virus-exposed and unexposed infants at 36 months (between-group difference 1·2 points [95% CI -4·2 to 6·5] in the León cohort; 2·8 [-2·4 to 8·1] in the Managua cohort) or at 48 months (-0·9 [-10·8 to 8·8] in the León cohort; 0·1 [-5·1 to 5·2] in the Managua cohort). No differences in ELC scores between Zika virus-exposed and unexposed infants exceeded 6 points at any time between 30 months and 48 months in León or between 36 months and 48 months in Managua, which was considered clinically significant in other settings. INTERPRETATION We found no significant differences in neurodevelopmental scores between normocephalic children with in-utero Zika virus exposure and Zika virus-unexposed children at age 36 months or 48 months. These findings are promising, supporting typical neurodevelopment in Zika virus-exposed normocephalic children, although additional follow-up and research is warranted. FUNDING National Institute of Child Health and Development, National Institute of Allergy and Infectious Diseases, and Fogarty International Center. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ryan Max
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Christian Toval-Ruiz
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Facultad de Ingeniería, Universidad Tecnológica La Salle, León, Nicaragua
| | - Sylvia Becker-Dreps
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Evelin Martinez
- División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Ciudad de México, México
| | - Kaitlyn Cross
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bryan Blette
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oscar Ortega
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Omar Zepeda
- Centro de Investigación en Enfermedades Tropicales, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Meylin Chavarria
- Department of Microbiology, National Autonomous University of Nicaragua at León, León, Nicaragua
| | - María José Meléndez
- Department of Microbiology, National Autonomous University of Nicaragua at León, León, Nicaragua
| | - Juan Carlos Mercado
- Sustainable Sciences Institute, Managua, Nicaragua; National Virology Laboratory at the Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Aravinda de Silva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew H Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra Bos
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley, Berkeley, CA, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley, Berkeley, CA, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua; National Virology Laboratory at the Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalie M Bowman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Filemón Bucardo
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Tisoncik-Go J, Stokes C, Whitmore LS, Newhouse DJ, Voss K, Gustin A, Sung CJ, Smith E, Stencel-Baerenwald J, Parker E, Snyder JM, Shaw DW, Rajagopal L, Kapur RP, Adams Waldorf KM, Gale M. Disruption of myelin structure and oligodendrocyte maturation in a macaque model of congenital Zika infection. Nat Commun 2024; 15:5173. [PMID: 38890352 PMCID: PMC11189406 DOI: 10.1038/s41467-024-49524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
Zika virus (ZikV) infection during pregnancy can cause congenital Zika syndrome (CZS) and neurodevelopmental delay in infants, of which the pathogenesis remains poorly understood. We utilize an established female pigtail macaque maternal-to-fetal ZikV infection/exposure model to study fetal brain pathophysiology of CZS manifesting from ZikV exposure in utero. We find prenatal ZikV exposure leads to profound disruption of fetal myelin, with extensive downregulation in gene expression for key components of oligodendrocyte maturation and myelin production. Immunohistochemical analyses reveal marked decreases in myelin basic protein intensity and myelinated fiber density in ZikV-exposed animals. At the ultrastructural level, the myelin sheath in ZikV-exposed animals shows multi-focal decompaction, occurring concomitant with dysregulation of oligodendrocyte gene expression and maturation. These findings define fetal neuropathological profiles of ZikV-linked brain injury underlying CZS resulting from ZikV exposure in utero. Because myelin is critical for cortical development, ZikV-related perturbations in oligodendrocyte function may have long-term consequences on childhood neurodevelopment, even in the absence of overt microcephaly.
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Affiliation(s)
- Jennifer Tisoncik-Go
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA.
- Washington National Primate Research Center, University of Washington, Seattle, WA, USA.
| | - Caleb Stokes
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA.
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Leanne S Whitmore
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA
| | - Daniel J Newhouse
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA
| | - Kathleen Voss
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA
| | - Andrew Gustin
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA
| | - Cheng-Jung Sung
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA
| | - Elise Smith
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA
| | - Jennifer Stencel-Baerenwald
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA
| | - Edward Parker
- Department of Ophthalmology, NEI Core for Vision Research, University of Washington, Seattle, WA, USA
| | - Jessica M Snyder
- Department of Comparative Medicine, University of Washington, Seattle, WA, USA
| | - Dennis W Shaw
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Lakshmi Rajagopal
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Raj P Kapur
- Department of Pathology, University of Washington, Seattle, WA, USA
- Department of Pathology, Seattle Children's Hospital, Seattle, WA, USA
| | - Kristina M Adams Waldorf
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Michael Gale
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA, USA.
- Washington National Primate Research Center, University of Washington, Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
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7
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Creisher PS, Klein SL. Pathogenesis of viral infections during pregnancy. Clin Microbiol Rev 2024; 37:e0007323. [PMID: 38421182 PMCID: PMC11237665 DOI: 10.1128/cmr.00073-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
SUMMARYViral infections during pregnancy are associated with significant adverse perinatal and fetal outcomes. Pregnancy is a unique immunologic and physiologic state, which can influence control of virus replication, severity of disease, and vertical transmission. The placenta is the organ of the maternal-fetal interface and provides defense against microbial infection while supporting the semi-allogeneic fetus via tolerogenic immune responses. Some viruses, such as cytomegalovirus, Zika virus, and rubella virus, can breach these defenses, directly infecting the fetus and having long-lasting consequences. Even without direct placental infection, other viruses, including respiratory viruses like influenza viruses and severe acute respiratory syndrome coronavirus 2, still cause placental damage and inflammation. Concentrations of progesterone and estrogens rise during pregnancy and contribute to immunological adaptations, placentation, and placental development and play a pivotal role in creating a tolerogenic environment at the maternal-fetal interface. Animal models, including mice, nonhuman primates, rabbits, and guinea pigs, are instrumental for mechanistic insights into the pathogenesis of viral infections during pregnancy and identification of targetable treatments to improve health outcomes of pregnant individuals and offspring.
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Affiliation(s)
- Patrick S Creisher
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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8
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Abdelmalek CM, Singh S, Fasil B, Horvath AR, Mulkey SB, Curé C, Campos M, Cavalcanti DP, Tong VT, Mercado M, Daza M, Marcela Benavides M, Acosta J, Gilboa S, Valencia D, Sancken CL, Newton S, Scalabrin DMF, Mussi-Pinhata MM, Vasconcelos Z, Chakhtoura N, Moye J, Leslie EJ, Bulas D, Vezina G, Marques FJP, Leyser M, Del Campo M, Vilain E, DeBiasi RL, Wang T, Nath A, Haydar T, Muenke M, Mansour TA, du Plessis AJ, Murray JC, Cordero JF, Kousa YA. Building a growing genomic data repository for maternal and fetal health through the PING Consortium. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.24.24307899. [PMID: 38826415 PMCID: PMC11142296 DOI: 10.1101/2024.05.24.24307899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Prenatally transmitted viruses can cause severe damage to the developing brain. There is unexplained variability in prenatal brain injury and postnatal neurodevelopmental outcomes, suggesting disease modifiers. Discordant outcomes among dizygotic twins could be explained by genetic susceptibly or protection. Among several well-recognized threats to the developing brain, Zika is a mosquito-borne, positive-stranded RNA virus that was originally isolated in Uganda and spread to cause epidemics in Africa, Asia, and the Americas. In the Americas, the virus caused congenital Zika syndrome and a multitude of neurodevelopmental disorders. As of now, there is no preventative treatment or cure for the adverse outcomes caused by prenatal Zika infection. The Prenatal Infection and Neurodevelopmental Genetics (PING) Consortium was initiated in 2016 to identify factors modulating prenatal brain injury and postnatal neurodevelopmental outcomes for Zika and other prenatal viral infections. Methods The Consortium has pooled information from eight multi-site studies conducted at 23 research centers in six countries to build a growing clinical and genomic data repository. This repository is being mined to search for modifiers of virally induced brain injury and developmental outcomes. Multilateral partnerships include commitments with Children's National Hospital (USA), Instituto Nacional de Salud (Colombia), the Natural History of Zika Virus Infection in Gestation program (Brazil), and Zika Instituto Fernandes Figueira (Brazil), in addition to the Centers for Disease Control and Prevention and the National Institutes of Health. Discussion Our goal in bringing together these sets of patient data was to test the hypothesis that personal and populational genetic differences affect the severity of brain injury after a prenatal viral infection and modify neurodevelopmental outcomes. We have enrolled 4,102 mothers and 3,877 infants with 3,063 biological samples and clinical data covering over 80 phenotypic fields and 5,000 variables. There were several notable challenges in bringing together cohorts enrolled in different studies, including variability in the timepoints evaluated and the collected clinical data and biospecimens. Thus far, we have performed whole exome sequencing on 1,226 participants. Here, we present the Consortium's formation and the overarching study design. We began our investigation with prenatal Zika infection with the goal of applying this knowledge to other prenatal infections and exposures that can affect brain development.
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Rodríguez-Rabassa M, Appleton AA, Rosario-Villafañe V, Repollet-Carrer I, Borges-Rodríguez M, Dedós-Peña L, González M, Velázquez-González P, Muniz-Rodriguez K, Mántaras-Ortiz C, Rivera-Amill V, Olivieri-Ramos O, Alvarado-Domenech LI. Associations between the social environment and early childhood developmental outcomes of Puerto Rican children with prenatal Zika virus exposure: a cross-sectional study. BMC Pediatr 2024; 24:342. [PMID: 38755525 PMCID: PMC11100158 DOI: 10.1186/s12887-024-04806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally. STUDY DESIGN This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children's developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale. RESULTS Linear regression models, adjusting for a child's sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children. CONCLUSIONS Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.
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Affiliation(s)
- Mary Rodríguez-Rabassa
- Department of Pediatrics, Ponce Health Sciences University, Ponce, PR, Puerto Rico.
- RCMI Center for Research Resources, Ponce Health Sciences University, Ponce, PR, Puerto Rico.
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico.
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY, USA
| | | | | | | | - Lydiet Dedós-Peña
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, Puerto Rico
| | - Marielly González
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico
| | - Paola Velázquez-González
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico
| | | | - Claudia Mántaras-Ortiz
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico
| | - Vanessa Rivera-Amill
- RCMI Center for Research Resources, Ponce Health Sciences University, Ponce, PR, Puerto Rico
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Fortin O, DeBiasi RL, Mulkey SB. Congenital infectious encephalopathies from the intrapartum period to postnatal life. Semin Fetal Neonatal Med 2024:101526. [PMID: 38677956 DOI: 10.1016/j.siny.2024.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Congenital infections are a common but often underrecognized cause of fetal brain abnormalities, as well as fetal-neonatal morbidity and mortality, that should be considered by all healthcare professionals providing neurological care to fetuses and newborns. Maternal infection with various pathogens (cytomegalovirus, Toxoplasmosis, Rubella virus, Parvovirus B19, lymphocytic choriomeningitis virus, syphilis, Zika virus, varicella zoster virus) during pregnancy can be transmitted to the developing fetus, which can cause multisystem dysfunction and destructive or malformative central nervous system lesions. These can be recognized on fetal and neonatal imaging, including ultrasound and MRI. Imaging and clinical features often overlap, but some distinguishing features can help identify specific pathogens and guide subsequent testing strategies. Some pathogens can be specifically treated, and others can be managed with targeted interventions or symptomatic therapy based on expected complications. Neurological and neurodevelopmental complications related to congenital infections vary widely and are likely driven by a combination of pathophysiologic factors, alone or in combination. These include direct invasion of the fetal central nervous system by pathogens, inflammation of the maternal-placental-fetal triad in response to infection, and long-term effects of immunogenic and epigenetic changes in the fetus in response to maternal-fetal infection. Congenital infections and their neurodevelopmental impacts should be seen as an issue of public health policy, given that infection and the associated complications disproportionately affect woman and children from low- and middle-income countries and those with lower socio-economic status in high-income countries. Congenital infections may be preventable and treatable, which can improve long-term neurodevelopmental outcomes in children.
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Affiliation(s)
- Olivier Fortin
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA
| | - Roberta L DeBiasi
- Division of Pediatric Infectious Disease, Children's National Hospital, Washington DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA; Department of Tropical Medicine, Microbiology and Infectious Diseases, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA; Department of Neurology and Rehabilitation Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
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11
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Mulkey SB, Williams ME, Peyton C, Arroyave-Wessel M, Berl MM, Cure C, Msall ME. Understanding the multidimensional neurodevelopmental outcomes in children after congenital Zika virus exposure. Pediatr Res 2024:10.1038/s41390-024-03056-z. [PMID: 38438554 PMCID: PMC11371942 DOI: 10.1038/s41390-024-03056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024]
Abstract
Since 2016, international research groups have focused on assessing outcomes of children with in utero Zika virus (ZIKV) exposure. While the more severe outcomes of congenital Zika syndrome (CZS) occur in up to 10% of children with antenatal exposure, early findings among ZIKV-exposed children without CZS ages 0-5 years suggest that they may also have differences in multiple domains of neurodevelopment. Thus, longitudinal follow-up of all children with antenatal ZIKV exposure has been recommended. This review presents a summary of neurodevelopmental phenotypes of infants and children following antenatal ZIKV exposure. We present a multidimensional framework to understand child neurodevelopment from an interdisciplinary and whole-child perspective (International Classification of Functioning, Disability and Health model) and multi-domain ZIKV Outcome Toolboxes. The toolboxes are for clinicians, researchers, child educators, and others to implement longitudinal multi-domain neurodevelopmental assessments between ages 0-12 years. Recent innovations in telehealth and neuroimaging can help evaluate outcomes in ZIKV exposed children. The objective is to describe the multiple facets of neurodevelopmental focused care that can support the health, function, and well-being of children with antenatal ZIKV exposure. The research and clinical follow-up strategies are applicable to ZIKV and other congenital infectious or environmental exposures that can impact child neurodevelopment. IMPACT: International longitudinal cohort studies have revealed a range of differences in neurodevelopment among children with antenatal Zika virus (ZIKV) exposure. A multidimensional and whole-child framework is necessary to understand the neurodevelopment of children with antenatal ZIKV exposure in relation to family life, community participation, and environment. Multi-domain toolboxes that utilize parent questionnaires and child evaluations are presented. These toolboxes can be used internationally alongside telehealth, brain imaging, and other innovations to improve understanding of child outcomes.
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Affiliation(s)
- Sarah B Mulkey
- Children's National Hospital, Washington, DC, USA.
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | | | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | | | - Madison M Berl
- Children's National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Michael E Msall
- University of Chicago Medicine Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, IL, USA
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12
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Mulkey SB, Corn E, Williams ME, Peyton C, Andringa-Seed R, Arroyave-Wessel M, Vezina G, Bulas DI, Podolsky RH, Msall ME, Cure C. Neurodevelopmental Outcomes of Normocephalic Colombian Children with Antenatal Zika Virus Exposure at School Entry. Pathogens 2024; 13:170. [PMID: 38392908 PMCID: PMC10892822 DOI: 10.3390/pathogens13020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
The long-term neurodevelopmental effects of antenatal Zika virus (ZIKV) exposure in children without congenital Zika syndrome (CZS) remain unclear, as few children have been examined to the age of school entry level. A total of 51 Colombian children with antenatal ZIKV exposure without CZS and 70 unexposed controls were evaluated at 4-5 years of age using the Behavior Rating Inventory of Executive Function (BRIEF), the Pediatric Evaluation of Disability Inventory (PEDI-CAT), the Bracken School Readiness Assessment (BSRA), and the Movement Assessment Battery for Children (MABC). The mean ages at evaluation were 5.3 and 5.2 years for cases and controls, respectively. Elevated BRIEF scores in Shift and Emotional Control may suggest lower emotional regulation in cases. A greater number of cases were reported by parents to have behavior and mood problems. BSRA and PEDI-CAT activity scores were unexpectedly higher in cases, most likely related to the COVID-19 pandemic and a delayed school entry among the controls. Although PEDI-CAT mobility scores were lower in cases, there were no differences in motor scores on the MABC. Of 40 cases with neonatal neuroimaging, neurodevelopment in 17 with mild non-specific findings was no different from 23 cases with normal neuroimaging. Normocephalic children with ZIKV exposure have positive developmental trajectories at 4-5 years of age but differ from controls in measures of emotional regulation and adaptive mobility, necessitating continued follow-up.
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Affiliation(s)
- Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
- Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC 20037, USA
| | - Elizabeth Corn
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Meagan E. Williams
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Regan Andringa-Seed
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Margarita Arroyave-Wessel
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA; (E.C.); (M.E.W.); (R.A.-S.); (M.A.-W.)
| | - Gilbert Vezina
- Division of Radiology, Children’s National Hospital, Washington, DC 20010, USA; (G.V.); (D.I.B.)
| | - Dorothy I. Bulas
- Division of Radiology, Children’s National Hospital, Washington, DC 20010, USA; (G.V.); (D.I.B.)
| | - Robert H. Podolsky
- Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC 20010, USA;
| | - Michael E. Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL 60637, USA;
| | - Carlos Cure
- BIOMELab, Atlántico, Barranquilla 080001, Colombia;
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Msall ME, Lagatta JM, Bora S. Optimizing trajectories of social adaptive competencies after extreme prematurity during the first 1000 days. Semin Fetal Neonatal Med 2024; 29:101531. [PMID: 38632009 PMCID: PMC11156543 DOI: 10.1016/j.siny.2024.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Over 75% of surviving extremely preterm infants do not have major neurodevelopmental disabilities; however, more than half face difficulties with communication, coordination, attention, learning, social, and executive function abilities. These "minor" challenges can have a negative impact on educational and social outcomes, resulting in physical, behavioral, and social health problems in adulthood. We will review assessment tools for social-emotional and adaptive functional skills in early childhood as these determine family and early childhood supports. We highlight bronchopulmonary dysplasia as an example of the critical intersections of parental wellbeing, medical and developmental adaptive trajectories in infancy and early childhood, and partnerships between child neurologists and community medical and developmental professionals. We examine studies of engaging parents to promote developmental trajectories, with a focus on supporting parent-child interactions that underlie communication, social-adaptive behaviors, and learning in the first 1000 days of life. Recommendations for neurodevelopmental surveillance and screening of extremely preterm infants can also be applied to infants with other risk factors for altered neurodevelopment.
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Affiliation(s)
- Michael E Msall
- Department of Pediatrics, Section of Developmental and Behavioral Pediatrics and Kennedy Research Center on Intellectual and Developmental Disabilities, University of Chicago Medicine, Chicago, IL, USA.
| | - Joanne M Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Samudragupta Bora
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Mulkey SB, Arroyave-Wessel M, Peyton C, Ansusinha E, Gutierrez C, Sorkar A, Cure A, Samper Y, Cure D, Msall ME, Cure C. Harnessing the power of telemedicine to accomplish international pediatric outcome research during the COVID-19 pandemic. J Telemed Telecare 2024; 30:388-392. [PMID: 34962177 PMCID: PMC9237184 DOI: 10.1177/1357633x211063166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic occurred during planned neurodevelopmental follow-up of Colombian children with antenatal Zika-virus exposure. The objective of the study was to leverage the institution's telemedicine infrastructure to support international clinical child outcome research. In a prospective cohort study of child neurodevelopment (NCT04398901), we used synchronous telemedicine to remotely train a research team and perform live observational assessments of children in Sabanalarga, Colombia. An observational motor and conceptional standardized tool kit was mailed to Colombia; other materials were translated and emailed; team training was done virtually. Children were recruited by team on the ground. Synchronous activities were video-recorded directly to two laptops, each with a telehealth Zoom link to allow simultaneous evaluation of "table" and "standing" activities, and backup recordings were captured directly on the device in Colombia. The U.S. team attended live over Zoom from four states and five distinct locations, made observational notes, and provided real-time feedback. Fifty-seven, 3-4-year-old children with Zika-virus exposure and 70 non-exposed controls were studied during 10 daytrips. Direct laptop recording ensured complete record of child activities due to internet outages. Telemedicine can be used to successfully perform international neurodevelopmental outcome research in children during the COVID-19 pandemic. Telemedicine can benefit global health studies.
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Affiliation(s)
- Sarah B Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology, The George Washington, University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Pediatrics, The George Washington, University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Emily Ansusinha
- Division of Pediatric Infectious Disease, Children's National Hospital, Washington, DC, USA
| | | | | | | | | | | | - Michael E Msall
- Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Medicine, Chicago, IL, USA
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15
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Calado AM, Seixas F, Dos Anjos Pires M. Virus as Teratogenic Agents. Methods Mol Biol 2024; 2753:105-142. [PMID: 38285335 DOI: 10.1007/978-1-0716-3625-1_4] [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: 01/30/2024]
Abstract
Viral infectious diseases are important causes of reproductive disorders, as abortion, fetal mummification, embryonic mortality, stillbirth, and congenital abnormalities in animals and in humans. In this chapter, we provide an overview of some virus, as important agents in teratology.We begin by describing the Zika virus, whose infection in humans had a very significant impact in recent years and has been associated with major health problems worldwide. This virus is a teratogenic agent in humans and has been classified as a public health emergency of international concern (PHEIC).Then, some viruses associated with reproductive abnormalities on animals, which have a significant economic impact on livestock, are described, as bovine herpesvirus, bovine viral diarrhea virus, Schmallenberg virus, Akabane virus, and Aino virus.For all viruses mentioned in this chapter, the teratogenic effects and the congenital malformations associated with fetus and newborn are described, according to the most recent scientific publications.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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16
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Neelam V, Woodworth KR, Chang DJ, Roth NM, Reynolds MR, Akosa A, Carr CP, Anderson KN, Mulkey SB, DeBiasi RL, Biddle C, Lee EH, Elmore AL, Scotland SJ, Sowunmi S, Longcore ND, Ahmed M, Langlois PH, Khuwaja S, Browne SE, Lind L, Shim K, Gosciminski M, Blumenfeld R, Khuntia S, Halai UA, Locklear A, Chan M, Willabus T, Tonzel J, Marzec NS, Barreto NA, Sanchez C, Fornoff J, Hale S, Nance A, Iguchi L, Adibhatla SN, Potts E, Schiffman E, Raman D, McDonald MF, Stricklin B, Ludwig E, Denson L, Contreras D, Romitti PA, Ferrell E, Marx M, Signs K, Cook A, Leedom VO, Beauregard S, Orantes LC, Cronquist L, Roush L, Godfred-Cato S, Gilboa SM, Meaney-Delman D, Honein MA, Moore CA, Tong VT. Outcomes up to age 36 months after congenital Zika virus infection-U.S. states. Pediatr Res 2024; 95:558-565. [PMID: 37658124 PMCID: PMC10913023 DOI: 10.1038/s41390-023-02787-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.
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Affiliation(s)
- Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel J Chang
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Nicole M Roth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan R Reynolds
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Akosa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kayla N Anderson
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah B Mulkey
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Roberta L DeBiasi
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Cara Biddle
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Ellen H Lee
- New York City Department of Health & Mental Hygiene, New York City, NY, USA
| | | | | | | | | | | | | | | | | | - Leah Lind
- Pennsylvania Department of Health, Pittsburgh, PA, USA
| | - Kyoo Shim
- Dallas County Health and Human Services, Dallas, TX, USA
| | | | | | - Shreya Khuntia
- District of Columbia Department of Health, Washington, D. C, USA
| | - Umme-Aiman Halai
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Autumn Locklear
- North Carolina Department of Health and Human Services, Chapel Hill, NC, USA
| | - Mary Chan
- Washington State Department of Health, Seattle, WA, USA
| | | | - Julius Tonzel
- Louisiana Department of Health, New Orleans, LA, USA
| | - Natalie S Marzec
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | - Connie Sanchez
- Hidalgo County Health & Human Services Department, Hidalgo, TX, USA
| | - Jane Fornoff
- Illinois Department of Public Health, Springfield, IL, USA
| | - Shelby Hale
- Ohio Department of Health, Columbus, OH, USA
| | - Amy Nance
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | | | | | - Emily Potts
- Indiana Department of Health, Indianapolis, IN, USA
| | | | - Devin Raman
- Southern Nevada Health District, Las Vegas, NV, USA
| | | | | | - Elizabeth Ludwig
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Lindsay Denson
- Oklahoma State Department of Health, Oklahoma City, OK, USA
| | | | - Paul A Romitti
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Emily Ferrell
- Kentucky Department for Public Health, Georgetown, KY, USA
| | - Meghan Marx
- South Dakota Department of Health, Pierre, SD, USA
| | - Kimberly Signs
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Amie Cook
- Kansas Department of Health and Environment, Topeka, KS, USA
| | - Vinita Oberoi Leedom
- South Carolina Department of Health and Environmental Control, Florence, SC, USA
| | - Suzann Beauregard
- New Hampshire Department of Health and Human Services, Concord, NH, USA
| | | | | | - Lesley Roush
- West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shana Godfred-Cato
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Alger J, Cafferata ML, López R, Wiggins LD, Callejas A, Castillo M, Fúnes J, Rico F, Valencia D, Varela D, Alvarez Z, Berrueta M, Bock H, Bustillo C, Calderón A, Ciganda A, García-Aguilar J, García K, Gibbons L, Gilboa SM, Harville EW, Hernández G, López W, Lorenzana I, Luque MT, Maldonado C, Moore C, Ochoa C, Parham L, Pastrana K, Paternina-Caicedo A, Rodríguez H, Stella C, Tannis AF, Wesson DM, Zúniga C, Tong VT, Buekens P. Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people. Pediatr Res 2024; 95:566-572. [PMID: 38057577 PMCID: PMC11045253 DOI: 10.1038/s41390-023-02951-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.
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Affiliation(s)
- Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras.
| | | | - Raquel López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Callejas
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Mario Castillo
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Jenny Fúnes
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Fátima Rico
- Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas Varela
- Servicio de Neurología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Zulma Alvarez
- Unidad de Vigilancia de la Salud, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Harry Bock
- Dirección General, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Dra. Nerza Paz, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Carolina Bustillo
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Alejandra Calderón
- Centro de Salud Alonso Suazo, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Villanueva, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Alvaro Ciganda
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Jorge García-Aguilar
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Kimberly García
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gustavo Hernández
- Departamento de Pediatría, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Wendy López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Marco T Luque
- Servicio de Infectología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Carlos Maldonado
- Servicio de Oftalmología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Cynthia Moore
- Goldbelt Professional Services, LLC, Chesapeake, VA, USA
| | - Carlos Ochoa
- Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Leda Parham
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Karla Pastrana
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Angel Paternina-Caicedo
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Heriberto Rodríguez
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Candela Stella
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Dawn M Wesson
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Van T Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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18
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Udenze D, Trus I, Lipsit S, Napper S, Karniychuk U. Offspring affected with in utero Zika virus infection retain molecular footprints in the bone marrow and blood cells. Emerg Microbes Infect 2023; 12:2147021. [PMID: 36369716 PMCID: PMC9869997 DOI: 10.1080/22221751.2022.2147021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
Congenital virus infections, for example cytomegalovirus and rubella virus infections, commonly affect the central nervous and hematological systems in fetuses and offspring. However, interactions between emerging congenital Zika virus and hematological system-bone marrow and blood-in fetuses and offspring are mainly unknown. Our overall goal was to determine whether silent in utero Zika virus infection can cause functional and molecular footprints in the bone marrow and blood of fetuses and offspring. We specifically focused on silent fetal infection because delayed health complications in initially asymptomatic offspring were previously demonstrated in animal and human studies. Using a well-established porcine model for Zika virus infection and a set of cellular and molecular experimental tools, we showed that silent in utero infection causes multi-organ inflammation in fetuses and local inflammation in the fetal bone marrow. In utero infection also caused footprints in the offspring bone marrow and PBMCs. These findings should be considered in a broader clinical context because of growing concerns about health sequelae in cohorts of children affected with congenital Zika virus infection in the Americas. Understanding virus-induced molecular mechanisms of immune activation and inflammation in fetuses may provide targets for early in utero interventions. Also, identifying early biomarkers of in utero-acquired immunopathology in offspring may help to alleviate long-term sequelae.
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Affiliation(s)
- Daniel Udenze
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Ivan Trus
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
- Dioscuri Centre for RNA-Protein Interactions in Human Health and Disease, International Institute of Molecular and Cell Biology, Warsaw, Poland
| | - Sean Lipsit
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
| | - Scott Napper
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Saskatchewan, Saskatoon, Canada
| | - Uladzimir Karniychuk
- Vaccine and Infectious Disease Organization (VIDO), University of Saskatchewan, Saskatoon, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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19
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Ma L, Wang F, Li Y, Wang J, Chang Q, Du Y, Sadan J, Zhao Z, Fan G, Yao B, Chen JF. Brain methylome remodeling selectively regulates neuronal activity genes linking to emotional behaviors in mice exposed to maternal immune activation. Nat Commun 2023; 14:7829. [PMID: 38030616 PMCID: PMC10687003 DOI: 10.1038/s41467-023-43497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
How early life experience is translated into storable epigenetic information leading to behavioral changes remains poorly understood. Here we found that Zika virus (ZIKV) induced-maternal immune activation (MIA) imparts offspring with anxiety- and depression-like behavior. By integrating bulk and single-nucleus RNA sequencing (snRNA-seq) with genome-wide 5hmC (5-hydroxymethylcytosine) profiling and 5mC (5-methylcytosine) profiling in prefrontal cortex (PFC) of ZIKV-affected male offspring mice, we revealed an overall loss of 5hmC and an increase of 5mC levels in intragenic regions, associated with transcriptional changes in neuropsychiatric disorder-related genes. In contrast to their rapid initiation and inactivation in normal conditions, immediate-early genes (IEGs) remain a sustained upregulation with enriched expression in excitatory neurons, which is coupled with increased 5hmC and decreased 5mC levels of IEGs in ZIKV-affected male offspring. Thus, MIA induces maladaptive methylome remodeling in brain and selectively regulates neuronal activity gene methylation linking to emotional behavioral abnormalities in offspring.
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Affiliation(s)
- Li Ma
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Feng Wang
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Yangping Li
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jing Wang
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Qing Chang
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Yuanning Du
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Jotham Sadan
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Zhen Zhao
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Guoping Fan
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Bing Yao
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
| | - Jian-Fu Chen
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA, 90033, USA.
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20
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Russ JB, Ostrem BEL. Acquired Brain Injuries Across the Perinatal Spectrum: Pathophysiology and Emerging Therapies. Pediatr Neurol 2023; 148:206-214. [PMID: 37625929 DOI: 10.1016/j.pediatrneurol.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/29/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
The development of the central nervous system can be directly disrupted by a variety of acquired factors, including infectious, inflammatory, hypoxic-ischemic, and toxic insults. Influences external to the fetus also impact neurodevelopment, including placental health, maternal comorbidities, adverse experiences, environmental exposures, and social determinants of health. Acquired perinatal brain insults tend to affect the developing brain in a stage-specific manner that reflects the susceptible cell types, developmental processes, and risk factors present at the time of the insult. In this review, we discuss the pathophysiology, neurodevelopmental outcomes, and management of common acquired perinatal brain conditions. In the fetal brain, we divide insults based on trimester, and in the postnatal brain, we focus on common pathologies that have a presentation dependent on gestational age at birth: white matter injury and germinal matrix hemorrhage/intraventricular hemorrhage in preterm infants and hypoxic-ischemic encephalopathy in term infants. Although specific treatments for fetal and newborn brain disorders are currently limited, we emphasize therapies in preclinical or early clinical phases of the development pipeline. The growing number of novel cell type- and stage-specific emerging therapies suggests that in the near future we may have a dramatically improved ability to treat acquired perinatal brain disorders and to mitigate the associated neurodevelopmental consequences.
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Affiliation(s)
- Jeffrey B Russ
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Bridget E L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, California.
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21
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Moadab G, Pittet F, Bennett JL, Taylor CL, Fiske O, Singapuri A, Coffey LL, Van Rompay KKA, Bliss-Moreau E. Prenatal Zika virus infection has sex-specific effects on infant physical development and mother-infant social interactions. Sci Transl Med 2023; 15:eadh0043. [PMID: 37878673 DOI: 10.1126/scitranslmed.adh0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
There is enormous variation in the extent to which fetal Zika virus (fZIKV) infection affects the developing brain. Despite the neural consequences of fZIKV infection observed in people and animal models, many open questions about the relationship between infection dynamics and fetal and infant development remain. To further understand how ZIKV affects the developing nervous system and the behavioral consequences of prenatal infection, we adopted a nonhuman primate model of fZIKV infection in which we inoculated pregnant rhesus macaques and their fetuses with ZIKV in the early second trimester of fetal development. We then tracked their health across gestation and characterized infant development across the first month of life. ZIKV-infected pregnant mothers had long periods of viremia and mild changes to their hematological profiles. ZIKV RNA concentrations, an indicator of infection magnitude, were higher in mothers whose fetuses were male, and the magnitude of ZIKV RNA in the mothers' plasma or amniotic fluid predicted infant outcomes. The magnitude of ZIKV RNA was negatively associated with infant growth across the first month of life, affecting males' growth more than females' growth, although for most metrics, both males and females evidenced slower growth rates as compared with control animals whose mothers were not ZIKV inoculated. Compared with control infants, fZIKV infants also spent more time with their mothers during the first month of life, a social behavior difference that may have long-lasting consequences on psychosocial development during childhood.
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Affiliation(s)
- Gilda Moadab
- Department of Psychology, University of California, Davis, Davis, CA 95616, USA
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Florent Pittet
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Jeffrey L Bennett
- Department of Psychology, University of California, Davis, Davis, CA 95616, USA
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Christopher L Taylor
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Olivia Fiske
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
| | - Anil Singapuri
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA 95616, USA
| | - Lark L Coffey
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA 95616, USA
| | - Koen K A Van Rompay
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA 95616, USA
| | - Eliza Bliss-Moreau
- Department of Psychology, University of California, Davis, Davis, CA 95616, USA
- California National Primate Research Center, University of California, Davis, Davis, CA 95616, USA
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22
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Tisoncik-Go J, Stokes C, Whitmore LS, Newhouse DJ, Voss K, Gustin A, Sung CJ, Smith E, Stencel-Baerenwald J, Parker E, Snyder JM, Shaw DW, Rajagopal L, Kapur RP, Waldorf KA, Gale M. Disruption of myelin structure and oligodendrocyte maturation in a pigtail macaque model of congenital Zika infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.11.561759. [PMID: 37873381 PMCID: PMC10592731 DOI: 10.1101/2023.10.11.561759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Zika virus (ZikV) infection during pregnancy can cause congenital Zika syndrome (CZS) and neurodevelopmental delay in non-microcephalic infants, of which the pathogenesis remains poorly understood. We utilized an established pigtail macaque maternal-to-fetal ZikV infection/exposure model to study fetal brain pathophysiology of CZS manifesting from ZikV exposure in utero. We found prenatal ZikV exposure led to profound disruption of fetal myelin, with extensive downregulation in gene expression for key components of oligodendrocyte maturation and myelin production. Immunohistochemical analyses revealed marked decreases in myelin basic protein intensity and myelinated fiber density in ZikV-exposed animals. At the ultrastructural level, the myelin sheath in ZikV-exposed animals showed multi-focal decompaction consistent with perturbation or remodeling of previously formed myelin, occurring concomitant with dysregulation of oligodendrocyte gene expression and maturation. These findings define fetal neuropathological profiles of ZikV-linked brain injury underlying CZS resulting from ZikV exposure in utero. Because myelin is critical for cortical development, ZikV-related perturbations in oligodendrocyte function may have long-term consequences on childhood neurodevelopment, even in the absence of overt microcephaly.
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Affiliation(s)
- Jennifer Tisoncik-Go
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Caleb Stokes
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Leanne S Whitmore
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Daniel J Newhouse
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Kathleen Voss
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Andrew Gustin
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Cheng-Jung Sung
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Elise Smith
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Jennifer Stencel-Baerenwald
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Edward Parker
- Department of Ophthalmology, NEI Core for Vision Research, University of Washington, Seattle, Washington, USA
| | - Jessica M Snyder
- Department of Comparative Medicine, University of Washington, Seattle, Washington, USA
| | - Dennis W Shaw
- Department of Radiology, University of Washington, Seattle Washington, USA
| | - Lakshmi Rajagopal
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Raj P Kapur
- Department of Pathology, University of Washington, Seattle, Washington, USA
- Department of Pathology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kristina Adams Waldorf
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, USA
- Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Michael Gale
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, USA
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23
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Devaraju M, Li A, Ha S, Li M, Shivakumar M, Li H, Nishiguchi EP, Gérardin P, Waldorf KA, Al-Haddad BJS. Beyond TORCH: A narrative review of the impact of antenatal and perinatal infections on the risk of disability. Neurosci Biobehav Rev 2023; 153:105390. [PMID: 37708918 PMCID: PMC10617835 DOI: 10.1016/j.neubiorev.2023.105390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health disorders. There is strong evidence that TORCH infections (i.e., Treponema pallidum, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus) alter fetal neurodevelopment across multiple developmental domains and contribute to motor and cognitive disabilities. However, the impact of a broader range of viral and bacterial infections on fetal development and disability is less well understood. We performed a literature review of human studies to identify gaps in the link between maternal infections, inflammation, and several neurodevelopmental domains. We found strong and moderate evidence respectively for a higher risk of motor and cognitive delays and disabilities in offspring exposed to a range of non-TORCH pathogens during fetal life. In contrast, there is little evidence for an increased risk of language and sensory disabilities. While guidelines for TORCH infection prevention during pregnancy are common, further consideration for prevention of non-TORCH infections during pregnancy for fetal neuroprotection may be warranted.
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Affiliation(s)
- Monica Devaraju
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Amanda Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA; Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA
| | - Sandy Ha
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Miranda Li
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Megana Shivakumar
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Hanning Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Erika Phelps Nishiguchi
- University of Hawaii, Department of Pediatrics, Division of Community Pediatrics, 1319 Punahou St, Honolulu, HI, USA
| | - Patrick Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion, France; Platform for Clinical and Translational Research, Centre Hospitalier Universitaire, Saint Pierre, Réunion, France
| | - Kristina Adams Waldorf
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Benjamin J S Al-Haddad
- University of Minnesota, Department of Pediatrics, Division of Neonatology, Academic Office Building, 2450 Riverside Ave S AO-401, Minneapolis, MN 55454, USA; Masonic Institute for the Developing Brain, 2025 E River Pkwy, Minneapolis, MN 55414, USA.
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24
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Krabbe NP, Razo E, Abraham HJ, Spanton RV, Shi Y, Bhattacharya S, Bohm EK, Pritchard JC, Weiler AM, Mitzey AM, Eickhoff JC, Sullivan E, Tan JC, Aliota MT, Friedrich TC, O’Connor DH, Golos TG, Mohr EL. Control of maternal Zika virus infection during pregnancy is associated with lower antibody titers in a macaque model. Front Immunol 2023; 14:1267638. [PMID: 37809089 PMCID: PMC10556460 DOI: 10.3389/fimmu.2023.1267638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Zika virus (ZIKV) infection during pregnancy results in a spectrum of birth defects and neurodevelopmental deficits in prenatally exposed infants, with no clear understanding of why some pregnancies are more severely affected. Differential control of maternal ZIKV infection may explain the spectrum of adverse outcomes. Methods Here, we investigated whether the magnitude and breadth of the maternal ZIKV-specific antibody response is associated with better virologic control using a rhesus macaque model of prenatal ZIKV infection. We inoculated 18 dams with an Asian-lineage ZIKV isolate (PRVABC59) at 30-45 gestational days. Plasma vRNA and infectious virus kinetics were determined over the course of pregnancy, as well as vRNA burden in the maternal-fetal interface (MFI) at delivery. Binding and neutralizing antibody assays were performed to determine the magnitude of the ZIKV-specific IgM and IgG antibody responses throughout pregnancy, along with peptide microarray assays to define the breadth of linear ZIKV epitopes recognized. Results Dams with better virologic control (n= 9) cleared detectable infectious virus and vRNA from the plasma by 7 days post-infection (DPI) and had a lower vRNA burden in the MFI at delivery. In comparison, dams with worse virologic control (n= 9) still cleared detectable infectious virus from the plasma by 7 DPI but had vRNA that persisted longer, and had higher vRNA burden in the MFI at delivery. The magnitudes of the ZIKV-specific antibody responses were significantly lower in the dams with better virologic control, suggesting that higher antibody titers are not associated with better control of ZIKV infection. Additionally, the breadth of the ZIKV linear epitopes recognized did not differ between the dams with better and worse control of ZIKV infection. Discussion Thus, the magnitude and breadth of the maternal antibody responses do not seem to impact maternal virologic control. This may be because control of maternal infection is determined in the first 7 DPI, when detectable infectious virus is present and before robust antibody responses are generated. However, the presence of higher ZIKV-specific antibody titers in dams with worse virologic control suggests that these could be used as a biomarker of poor maternal control of infection and should be explored further.
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Affiliation(s)
- Nicholas P. Krabbe
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Elaina Razo
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Hunter J. Abraham
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rachel V. Spanton
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Yujia Shi
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Saswati Bhattacharya
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Ellie K. Bohm
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota-Twin Cities, St. Paul, MN, United States
| | - Julia C. Pritchard
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota-Twin Cities, St. Paul, MN, United States
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Ann M. Mitzey
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Jens C. Eickhoff
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Healthy, University of Wisconsin-Madison, Madison, WI, United States
| | - Eric Sullivan
- Nimble Therapeutics, Inc, Madison, WI, United States
| | - John C. Tan
- Nimble Therapeutics, Inc, Madison, WI, United States
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota-Twin Cities, St. Paul, MN, United States
| | - Thomas C. Friedrich
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - David H. O’Connor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Thaddeus G. Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Emma L. Mohr
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Williams ME, Berl MM, Corn E, Ansusinha E, Arroyave-Wessel M, Zhang A, Cure C, Mulkey SB. Positive and negative effects of the COVID-19 pandemic on families of young children in rural Colombia and implications for child outcome research. Child Care Health Dev 2023; 49:825-833. [PMID: 37012218 PMCID: PMC10524562 DOI: 10.1111/cch.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted the lives of children and families worldwide. The objective of this study is to examine exposures and impact of the COVID-19 pandemic on preschool-aged children and caregivers in the Atlántico region of Colombia. METHODS The COVID-19 Exposure and Family Impact Scales (CEFIS) questionnaire was administered in Fall 2021 to 63 caregivers of children in Sabanalarga, Colombia enrolled in a neurodevelopment study as healthy controls. The CEFIS assesses pandemic-related exposures/events and impact; higher scores indicate greater exposure and negative impact. Descriptive and correlation analyses among exposure and impact scores were conducted. RESULTS Caregivers reported a mean (standard deviation[SD]) of 11.1 (3.2) among 25 COVID-19-related exposures/events; most common types included stay-at-home orders, school closures, disruptions to living conditions and income loss. Total number of events was correlated with higher caregiver (P < .001) and child distress (P = .002). However, the mean (SD) impact score of 2.0 (0.6) suggests a trend toward more positive impact than negative. Caregivers reported improvements to sleep, exercise and family interactions. Some caregivers (n = 21) qualitatively reported negative effects including unemployment, fear/anxiety and inability to visit family, and positive effects such as unification, family closeness and spending more time with children. CONCLUSIONS This study highlights the importance of comprehensively exploring positive and negative impacts of COVID-19 and families' subsequent resilience and transformation. Using tools like the CEFIS, those seeking to mitigate negative impacts can contextualize data to better understand study outcomes and tailor services, resources and policy to families' unique needs. CEFIS data likely depend on timing, economic/public health resources and cultural values; future work should prioritize understanding the generalizability of CEFIS findings across samples.
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Affiliation(s)
| | - Madison M. Berl
- Children’s National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | | | - Anqing Zhang
- Children’s National Hospital, Washington, DC, USA
| | | | - Sarah B. Mulkey
- Children’s National Hospital, Washington, DC, USA
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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26
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Ghosh S, Salan T, Riotti J, Ramachandran A, Gonzalez IA, Bandstra ES, Reyes FL, Andreansky SS, Govind V, Saigal G. Brain MRI segmentation of Zika-Exposed normocephalic infants shows smaller amygdala volumes. PLoS One 2023; 18:e0289227. [PMID: 37506075 PMCID: PMC10381087 DOI: 10.1371/journal.pone.0289227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Infants with congenital Zika syndrome (CZS) are known to exhibit characteristic brain abnormalities. However, the brain anatomy of Zika virus (ZIKV)-exposed infants, born to ZIKV-positive pregnant mothers, who have normal-appearing head characteristics at birth, has not been evaluated in detail. The aim of this prospective study is, therefore, to compare the cortical and subcortical brain structural volume measures of ZIKV-exposed normocephalic infants to age-matched healthy controls. METHODS AND FINDINGS We acquired T2-MRI of the whole brain of 18 ZIKV-exposed infants and 8 normal controls on a 3T MRI scanner. The MR images were auto-segmented into eight tissue types and anatomical regions including the white matter, cortical grey matter, deep nuclear grey matter, corticospinal fluid, amygdala, hippocampus, cerebellum, and brainstem. We determined the volumes of these regions and calculated the total intracranial volume (TICV) and head circumference (HC). We compared these measurements between the two groups, controlling for infant age at scan, by first comparing results for all subjects in each group and secondly performing a subgroup analysis for subjects below 8 weeks of postnatal age at scan. ZIKV-exposed infants demonstrated a significant decrease in amygdala volume compared to the control group in both the group and subgroup comparisons (p<0.05, corrected for multiple comparisons using FDR). No significant volume differences were observed in TICV, HC, or any specific brain tissue structures or regions. Study limitations include small sample size, which was due to abrupt cessation of extramural funding as the ZIKV epidemic waned. CONCLUSION ZIKV-exposed infants exhibited smaller volumes in the amygdala, a brain region primarily involved in emotional and behavioral processing. This brain MRI finding may lead to poorer behavioral outcomes and warrants long-term monitoring of pediatric cases of infants with gestational exposure to Zika virus as well as other neurotropic viruses.
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Affiliation(s)
- Shanchita Ghosh
- Department of Radiology, University of California Davis, Sacramento, California, United States of America
| | - Teddy Salan
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Jessica Riotti
- Department of Radiology, Jackson Memorial Hospital, Miami, Florida, United States of America
| | - Amrutha Ramachandran
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Ivan A Gonzalez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Emmalee S Bandstra
- Division of Neonatology, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Fiama L Reyes
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Samita S Andreansky
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Varan Govind
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Gaurav Saigal
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
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Roth NM, Delgado-López C, Wiggins LD, Muñoz NN, Mulkey SB, Nieves-Ferrer L, Woodworth KR, Rosario GM, Huertas MM, Moore CA, Tong VT, Gilboa SM, Valencia-Prado M. Notes from the Field: Autism Spectrum Disorder Among Children with Laboratory Evidence of Prenatal Zika Virus Exposure - Puerto Rico, 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:802-804. [PMID: 37471268 PMCID: PMC10360653 DOI: 10.15585/mmwr.mm7229a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
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Fernandes M, Evans R, Cheng M, Landon B, Noël T, Macpherson C, Cudjoe N, Burgen KS, Waechter R, LaBeaud AD, Blackmon K. Does Intra-Uterine Exposure to the Zika Virus Increase Risks of Cognitive Delay at Preschool Ages? Findings from a Zika-Exposed Cohort from Grenada, West Indies. Viruses 2023; 15:1290. [PMID: 37376590 PMCID: PMC10304152 DOI: 10.3390/v15061290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Maternal infection with Zika virus (ZIKV) is associated with a distinct pattern of birth defects, known as congenital Zika syndrome (CZS). In ZIKV-exposed children without CZS, it is often unclear whether they were protected from in utero infection and neurotropism. Early neurodevelopmental assessment is essential for detecting neurodevelopmental delays (NDDs) and prioritizing at-risk children for early intervention. We compared neurodevelopmental outcomes between ZIKV-exposed and unexposed children at 1, 3 and 4 years to assess exposure-associated NDD risk. A total of 384 mother-child dyads were enrolled during a period of active ZIKV transmission (2016-2017) in Grenada, West Indies. Exposure status was based on laboratory assessment of prenatal and postnatal maternal serum. Neurodevelopment was assessed using the Oxford Neurodevelopment Assessment, the NEPSY® Second Edition and Cardiff Vision Tests, at 12 (n = 66), 36 (n = 58) and 48 (n = 59) months, respectively. There were no differences in NDD rates or vision scores between ZIKV-exposed and unexposed children. Rates of microcephaly at birth (0.88% vs. 0.83%, p = 0.81), and childhood stunting and wasting did not differ between groups. Our results show that Grenadian ZIKV-exposed children, the majority of whom were without microcephaly, had similar neurodevelopmental outcomes to unexposed controls up to at least an age of 4 years.
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Affiliation(s)
- Michelle Fernandes
- MRC Lifecourse Epidemiology Centre, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Nuffield Department of Women’s Productive Health, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
| | - Roberta Evans
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
| | - Mira Cheng
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Barbara Landon
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
| | - Trevor Noël
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
| | - Calum Macpherson
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
| | - Nikita Cudjoe
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
| | - Kemi S. Burgen
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
| | - Randall Waechter
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
- Department of Physiology, Neuroscience, and Behavioral Science, School of Medicine, St. George’s University, St. George P.O. Box 7, Grenada
| | - A. Desiree LaBeaud
- Caribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, St. George P.O. Box 7, Grenada
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Karen Blackmon
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL 32224, USA
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29
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Coler B, Wu TY, Carlson L, Burd N, Munson J, Dacanay M, Cervantes O, Esplin S, Kapur RP, Feltovich H, Adams Waldorf KM. Diminished antiviral innate immune gene expression in the placenta following a maternal SARS-CoV-2 infection. Am J Obstet Gynecol 2023; 228:463.e1-463.e20. [PMID: 36126729 PMCID: PMC9482164 DOI: 10.1016/j.ajog.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 is caused by the SARS-CoV-2 virus and is associated with critical illness requiring hospitalization, maternal mortality, stillbirth, and preterm birth. SARS-CoV-2 has been shown to induce placental pathology. However, substantial gaps exist in our understanding of the pathophysiology of COVID-19 disease in pregnancy and the long-term impact of SARS-CoV-2 on the placenta and fetus. To what extent a SARS-CoV-2 infection of the placenta alters the placental antiviral innate immune response is not well understood. A dysregulated innate immune response in the setting of maternal COVID-19 disease may increase the risk of inflammatory tissue injury or placental compromise and may contribute to deleterious pregnancy outcomes. OBJECTIVE We sought to determine the impact of a maternal SARS-CoV-2 infection on placental immune response by evaluating gene expression of a panel of 6 antiviral innate immune mediators that act as biomarkers of the antiviral and interferon cytokine response. Our hypothesis was that a SARS-CoV-2 infection during pregnancy would result in an up-regulated placental antiviral innate immune response. STUDY DESIGN We performed a case-control study on placental tissues (chorionic villous tissues and chorioamniotic membrane) collected from pregnant patients with (N=140) and without (N=24) COVID-19 disease. We performed real-time quantitative polymerase chain reaction and immunohistochemistry, and the placental histopathology was evaluated. Clinical data were abstracted. Fisher exact test, Pearson correlations, and linear regression models were used to examine proportions and continuous data between patients with active (<10 days since diagnosis) vs recovered COVID-19 (>10 days since diagnosis) at the time of delivery. Secondary regression models adjusted for labor status as a covariate and evaluated potential correlation between placental innate immune gene expression and other variables. RESULTS SARS-CoV-2 viral RNA was detected in placental tissues from 5 women with COVID-19 and from no controls (0/24, 0%). Only 1 of 5 cases with detectable SARS-CoV-2 viral RNA in placental tissues was confirmed to express SARS-CoV-2 nucleocapsid and spike proteins in syncytiotrophoblast cells. We detected a considerably lower gene expression of 5 critical innate immune mediators (IFNB, IFIT1, MXA, IL6, IL1B) in the chorionic villi and chorioamniotic membranes from women with active or recovered COVID-19 than controls, which remained significant after adjustment for labor status. There were minimal correlations between placental gene expression and other studied variables including gestational age at diagnosis, time interval between COVID-19 diagnosis and delivery, prepregnancy body mass index, COVID-19 disease severity, or placental pathology. CONCLUSION A maternal SARS-CoV-2 infection was associated with an impaired placental innate immune response in chorionic villous tissues and chorioamniotic membranes that was not correlated with gestational age at COVID-19 diagnosis, time interval from COVID-19 diagnosis to delivery, maternal obesity, disease severity, or placental pathology.
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Affiliation(s)
- Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Tsung-Yen Wu
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Lindsey Carlson
- Women and Newborn Research, Intermountain Health Care, Salt Lake City, UT
| | - Nicole Burd
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Jeff Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matthew Dacanay
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Sean Esplin
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT
| | - Raj P Kapur
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA; Department of Pathology, Seattle Children's Hospital, Seattle, WA
| | - Helen Feltovich
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT.
| | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA.
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30
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Zepeda O, Espinoza DO, Martinez E, Cross KA, Becker-Dreps S, de Silva AM, Bowman NM, Premkumar L, Stringer EM, Bucardo F, Collins MH. Antibody Immunity to Zika Virus among Young Children in a Flavivirus-Endemic Area in Nicaragua. Viruses 2023; 15:796. [PMID: 36992504 PMCID: PMC10052059 DOI: 10.3390/v15030796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 03/31/2023] Open
Abstract
Objective: To understand the dynamics of Zika virus (ZIKV)-specific antibody immunity in children born to mothers in a flavivirus-endemic region during and after the emergence of ZIKV in the Americas. Methods: We performed serologic testing for ZIKV cross-reactive and type-specific IgG in two longitudinal cohorts, which enrolled pregnant women and their children (PW1 and PW2) after the beginning of the ZIKV epidemic in Nicaragua. Quarterly samples from children over their first two years of life and maternal blood samples at birth and at the end of the two-year follow-up period were studied. Results: Most mothers in this dengue-endemic area were flavivirus-immune at enrollment. ZIKV-specific IgG (anti-ZIKV EDIII IgG) was detected in 82 of 102 (80.4%) mothers in cohort PW1 and 89 of 134 (66.4%) mothers in cohort PW2, consistent with extensive transmission observed in Nicaragua during 2016. ZIKV-reactive IgG decayed to undetectable levels by 6-9 months in infants, whereas these antibodies were maintained in mothers at the year two time point. Interestingly, a greater contribution to ZIKV immunity by IgG3 was observed in babies born soon after ZIKV transmission. Finally, 43 of 343 (13%) children exhibited persistent or increasing ZIKV-reactive IgG at ≥9 months, with 10 of 30 (33%) tested demonstrating serologic evidence of incident dengue infection. Conclusions: These data inform our understanding of protective and pathogenic immunity to potential flavivirus infections in early life in areas where multiple flaviviruses co-circulate, particularly considering the immune interactions between ZIKV and dengue and the future possibility of ZIKV vaccination in women of childbearing potential. This study also shows the benefits of cord blood sampling for serologic surveillance of infectious diseases in resource-limited settings.
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Affiliation(s)
- Omar Zepeda
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Daniel O. Espinoza
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Evelin Martinez
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Kaitlyn A. Cross
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sylvia Becker-Dreps
- Department of Family Medicine and Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Aravinda M. de Silva
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Natalie M. Bowman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Elizabeth M. Stringer
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Filemón Bucardo
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Matthew H. Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
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Peroxisome Proliferator-Activated Receptor-Targeted Therapies: Challenges upon Infectious Diseases. Cells 2023; 12:cells12040650. [PMID: 36831317 PMCID: PMC9954612 DOI: 10.3390/cells12040650] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Peroxisome proliferator-activated receptors (PPARs) α, β, and γ are nuclear receptors that orchestrate the transcriptional regulation of genes involved in a variety of biological responses, such as energy metabolism and homeostasis, regulation of inflammation, cellular development, and differentiation. The many roles played by the PPAR signaling pathways indicate that PPARs may be useful targets for various human diseases, including metabolic and inflammatory conditions and tumors. Accumulating evidence suggests that each PPAR plays prominent but different roles in viral, bacterial, and parasitic infectious disease development. In this review, we discuss recent PPAR research works that are focused on how PPARs control various infections and immune responses. In addition, we describe the current and potential therapeutic uses of PPAR agonists/antagonists in the context of infectious diseases. A more comprehensive understanding of the roles played by PPARs in terms of host-pathogen interactions will yield potential adjunctive personalized therapies employing PPAR-modulating agents.
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Gilbert RK, Petersen LR, Honein MA, Moore CA, Rasmussen SA. Zika virus as a cause of birth defects: Were the teratogenic effects of Zika virus missed for decades? Birth Defects Res 2023; 115:265-274. [PMID: 36513609 PMCID: PMC10552063 DOI: 10.1002/bdr2.2134] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022]
Abstract
Zika virus (ZIKV) was identified as a teratogen in 2016 when an increase in severe microcephaly and other brain defects was observed in fetuses and newborns following outbreaks in French Polynesia (2013-2014) and Brazil (2015-2016) and among travelers to other countries experiencing outbreaks. Some have questioned why ZIKV was not recognized as a teratogen before these outbreaks: whether novel genetic changes in ZIKV had increased its teratogenicity or whether its association with birth defects had previously been undetected. Here we examine the evidence for these two possibilities. We describe evidence for specific mutations that arose before the French Polynesia outbreak that might have increased ZIKV teratogenicity. We also present information on children born with findings consistent with congenital Zika syndrome (CZS) as early as 2009 and epidemiological evidence that suggests increases in CZS-type birth defects before 2013. We also explore reasons why a link between ZIKV and birth defects might have been missed, including issues with surveillance of ZIKV infections and of birth defects, challenges to ZIKV diagnostic testing, and the susceptibility of different populations to ZIKV infection at the time of pregnancy. Although it is not possible to prove definitively that ZIKV had teratogenic properties before 2013, several pieces of evidence support the hypothesis that its teratogenicity had been missed in the past. These findings emphasize the need for further investments in global surveillance for emerging infections and for birth defects so that infectious teratogens can be identified more expeditiously in the future.
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Affiliation(s)
- Rachel K. Gilbert
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lyle R. Petersen
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Margaret A. Honein
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Goldbelt Professional Services, LLC, Chesapeake, Virginia, USA
| | - Sonja A. Rasmussen
- Departments of Pediatrics and Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
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Fialho EMS, Veras EM, de Jesus CM, Khouri R, Sousa PS, Ribeiro MRC, Costa LC, Gomes LN, Nascimento FRF, Silva AAM, Soeiro-Pereira PV. Maternal Immune Response to ZIKV Triggers High-Inflammatory Profile in Congenital Zika Syndrome. Viruses 2023; 15:220. [PMID: 36680261 PMCID: PMC9866085 DOI: 10.3390/v15010220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The immunological mechanisms involved in the development of congenital Zika syndrome (CZS) have yet to be fully clarified. This study aims to assess the immuno-inflammatory profile of mothers and their children who have been diagnosed with CZS. Blood samples, which were confirmed clinically using the plaque reduction neutralization test (PRNT), were collected from children with CZS and their mothers (CZS+ group). Samples were also collected from children who did not develop CZS and had a negative PRNT result and from their mothers (CZS- group). The data demonstrated a correlation between the leukocyte profile of CZS+ children and their mothers, more evident in monocytes. Monocytes from mothers of CZS+ children showed low expression of HLA and elevated hydrogen peroxide production. CZS+ children presented standard HLA expression and a higher hydrogen peroxide concentration than CZS- children. Monocyte superoxide dismutase activity remained functional. Moreover, when assessing the monocyte polarization, it was observed that there was no difference in nitrite concentrations; however, there was a decrease in arginase activity in CZS+ children. These data suggest that ZIKV infection induces a maternal immuno-inflammatory background related to the child's inflammatory response after birth, possibly affecting the development and progression of congenital Zika syndrome.
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Affiliation(s)
- Eder M. S. Fialho
- Health Sciences Graduate Program, Federal University of Maranhão, São Luís 65080-805, MA, Brazil
| | - Emanoel M. Veras
- Medical School, Federal University of Maranhão, São Luís 65080-805, MA, Brazil
| | - Caroline M. de Jesus
- Health and Technology Graduate Program, Federal University of Maranhão, São Luís 65080-805, MA, Brazil
| | - Ricardo Khouri
- Gonçalo Moniz Research Institute, FIOCRUZ-Bahia, Salvador 40296-710, BA, Brazil
| | - Patrícia S. Sousa
- Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children/NINAR–State Department of Health of the State of Maranhão, São Luís 65077-357, MA, Brazil
| | | | - Luciana C. Costa
- Department of Public Health, Federal University of Maranhão, São Luís 65020-060, MA, Brazil
| | - Líllian N. Gomes
- Department of Immunology, University of São Paulo, São Paulo 05508-000, SP, Brazil
| | - Flávia R. F. Nascimento
- Health Sciences Graduate Program, Federal University of Maranhão, São Luís 65080-805, MA, Brazil
- Department of Pathology, Federal University of Maranhão, São Luís 65065-545, MA, Brazil
| | - Antônio A. M. Silva
- Department of Public Health, Federal University of Maranhão, São Luís 65020-060, MA, Brazil
| | - Paulo V. Soeiro-Pereira
- Health Sciences Graduate Program, Federal University of Maranhão, São Luís 65080-805, MA, Brazil
- Department of Pathology, Federal University of Maranhão, São Luís 65065-545, MA, Brazil
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Kadawathagedara M, Muckle G, Quénel P, Michineau L, Le Bot B, Hoen B, Tressieres B, Multigner L, Chevrier C, Cordier S. Infant neurodevelopment and behavior in Guadeloupe after lead exposure and Zika maternal infection during pregnancy. Neurotoxicology 2023; 94:135-146. [PMID: 36402195 DOI: 10.1016/j.neuro.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prenatal lead exposure is known to have neurotoxic effects on the developing fetus, while some viral infections may have a tropism for the central nervous system. Our objective was to study whether the effects of prenatal lead exposure on infant development and behaviors at 18 months of age are modified by the occurrence of a maternal infection to Zika virus (ZIKV) during pregnancy. METHODS During the ZIKV epidemic in Guadeloupe in 2016 a cohort of pregnant women was set up. Blood samples (pregnancy, childbirth and cord) (n = 297) enabled us to measure blood lead levels aimed to determine prenatal lead exposure and the likelihood of maternal infection during pregnancy (ZIKV status + vs -). The 18 months "Ages and Stages Questionnaire" (ASQ) was used to generate scores for global development, fine and gross motor skills, communication, problem solving, and personal-social skills. The questions from a longitudinal cohort study conducted in Canada (Québec) were used to generate hyperactivity, opposition, inattention and physical aggression scores. Associations were tested by multivariate linear regressions. RESULTS Prenatal lead exposure was associated with delays in neurodevelopment at 18 months, reflected by lower scores in ASQ totals, and in the fine motor and problem-solving domains. Some of these associations appeared to be sex-specific, observed almost exclusively in boys (ASQ total, fine motor and personal-social scores). Prenatal lead exposure was not associated with behavioral scores. ZIKV infection during pregnancy was associated with a lower fine motor ASQ score, and higher scores for hyperactivity, opposition and physical aggression. Significant interaction between prenatal lead exposure and ZIKV status was observed with a lower personal-social score in ZIKV (-) only, and for hyperactivity and inattention scores, though some of these interactions (ASQ personal-social score, inattention score) were no longer significant when children with microcephaly were excluded from the analyses. DISCUSSION/CONCLUSION Our study confirms previous findings of associations between prenatal exposure to lead at low levels and adverse neurodevelopmental outcomes during infancy and the particular vulnerability of boys. It suggests associations between ZIKV infection during pregnancy and adverse effects on a number of neurodevelopmental functions (fine motor function) and behaviors (opposition, hyperactivity), that need to be confirmed at later age. There is no strong evidence of interaction between ZIKV infection and lead exposure but both prenatal risk factors may affect fine motor function.
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Affiliation(s)
- M Kadawathagedara
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-35000 Rennes, France
| | - G Muckle
- École de psychologie, Université Laval, et Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - P Quénel
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-35000 Rennes, France
| | - L Michineau
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-35000 Rennes, France
| | - B Le Bot
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-35000 Rennes, France
| | - B Hoen
- Centre d'Investigation Clinique Antilles Guyane CIC 1424 Inserm, CHU de Guadeloupe, 97159 Pointe-à-Pitre, France
| | - B Tressieres
- Centre d'Investigation Clinique Antilles Guyane CIC 1424 Inserm, CHU de Guadeloupe, 97159 Pointe-à-Pitre, France
| | - L Multigner
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-35000 Rennes, France
| | - C Chevrier
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-35000 Rennes, France
| | - S Cordier
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-35000 Rennes, France.
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Kadawathagedara M, Muckle G, Cordier S, Michineau L, Tressieres B, Mallard A, Kovacic L, Multigner L, Quénel P, Chevrier C. Simultaneous exposure to both Zika virus and household insecticides during pregnancy, and fetal growth and infant developmental behavior outcomes at 18 months, in Guadeloupe. ENVIRONMENTAL RESEARCH 2022; 215:114256. [PMID: 36096163 DOI: 10.1016/j.envres.2022.114256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/22/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Perinatal infection with Zika virus (ZIKV) could result in adverse growth, developmental and behavioral outcomes, while insecticides used to control mosquitoes are neurotoxic. OBJECTIVES We aim to study the role played by exposure during pregnancy to both ZIKV and household insecticides in newborn health, development and behavior at age of 18 months. METHODS Maternal and cord blood samples from a cohort of pregnant women (created during Guadeloupe's Zika epidemic of 2016) were used to identify ZIKV infection during pregnancy. A self-administered questionnaire at birth documented prenatal household use of insecticides. Birth weight and head circumference were collected from maternity records (n = 708). Infant development and behaviors were documented at 18 months of age through the Ages and Stages Questionnaire and the Quebec Longitudinal Study of Child Development (n = 409). Logistic and linear regression models were performed, taking into account confounding factors. RESULTS Use of household insecticides was associated with smaller head circumference and lower birth weight among newborns from mothers not exposed to ZIKV: 0.3 cm (95% CI: 0.6, 0) and -82 g (95% CI: 165, 0), respectively. Similar decreases were observed with ZIKV exposure among mothers not reporting household insecticides use, and with presence of both exposures. The combined presence of ZIKV exposure and insecticide use was associated with lower ASQ fine motor scores (-3.9; 95% CI: 7.3, -0.4), and higher hyperactivity scores (0.8; 95% CI: 0.0, 1.5), compared to no exposure to either. A higher opposition score was observed in association with ZIKV exposure among non-users of insecticide (0.6; 95% CI: 0.0, 1.2). CONCLUSION Adverse neurodevelopmental outcomes at 18 months of age were observed with prenatal ZIKV exposure, and with higher magnitude when mothers reported use of household insecticides. At birth, rates of adverse fetal growth were however similar for the combined presence of exposure and either of the exposures.
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Affiliation(s)
- M Kadawathagedara
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-3500, Rennes, France.
| | - G Muckle
- École de Psychologie, Université Laval, et Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
| | - S Cordier
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-3500, Rennes, France
| | - L Michineau
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-3500, Rennes, France
| | - B Tressieres
- Centre d'Investigation Clinique Antilles Guyane, Inserm, CIC 1424, 97159 Pointe-à-Pitre, France
| | - A Mallard
- Centre d'Investigation Clinique Antilles Guyane, Inserm, CIC 1424, 97159 Pointe-à-Pitre, France
| | - L Kovacic
- Centre d'Investigation Clinique Antilles Guyane, Inserm, CIC 1424, 97159 Pointe-à-Pitre, France
| | - L Multigner
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-3500, Rennes, France
| | - P Quénel
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-3500, Rennes, France
| | - C Chevrier
- Univ Rennes, EHESP, Inserm, IRSET UMR_S 1085, F-3500, Rennes, France
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Mulkey SB, Williams ME, Jadeed N, Zhang A, Israel S, DeBiasi RL. Neurodevelopment in infants with antenatal or early neonatal exposure to SARS-CoV-2. Early Hum Dev 2022; 175:105694. [PMID: 36402122 DOI: 10.1016/j.earlhumdev.2022.105694] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Antenatal and neonatal viral exposure may put the developing brain at risk for abnormal neurodevelopment. A clinical program at Children's National Hospital provides detailed follow-up of infants with in utero or neonatal SARS-CoV-2 exposure. AIMS To determine impact of early SARS-CoV-2 exposure on neurodevelopment. STUDY DESIGN We performed a prospective observational study of infant evaluations between 3/2020 and 11/2021. Demographics, pregnancy and birth details, SARS-CoV-2 data, specialty consultations, and NICU records were extracted from infants' medical records. Infants had neurologic exams and developmental screening with Ages and Stages Questionnaire (ASQ). Correlations between SARS-CoV-2 exposure type and neurodevelopmental outcomes were analyzed. SUBJECTS Thirty-four infants evaluated in the SARS-CoV-2 follow-up program. OUTCOME MEASURES Abnormal neurologic exams or ASQ scores near or below suggested cut-offs. RESULTS Infants received up to three evaluations. Most (28/34; 82 %) were exposed in utero - 16 to symptomatic mothers (IU-S) and 12 to asymptomatic mothers (IU-A). Six were exposed only as a neonate. IU-S had abnormal neurologic exams at mean (SD) age 112 (24) days and ASQ scores near or below cut-offs for all domains more frequently than IU-A or neonatally exposed infants. IU-S were more likely to score below any ASQ cutoff compared to IU-A (P = .04); differences were significant for Fine Motor (P = .01) and Personal-Social (P = .02) domains. CONCLUSIONS Early SARS-CoV-2 exposure may impact neurodevelopment, especially among infants exposed in utero to symptomatic gestational parents. Vaccination and other precautions to reduce early-in-life infection may protect against neurodevelopmental delays. Children with early SARS-CoV-2 exposure should have additional longitudinal screening for neurodevelopmental delays.
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Affiliation(s)
- Sarah B Mulkey
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States; Department of Neurology, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States.
| | - Meagan E Williams
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Nadia Jadeed
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Anqing Zhang
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Smitha Israel
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States
| | - Roberta L DeBiasi
- Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States; Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20037, United States
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Ribeiro MFM, Queiróz KBPD, Prudente COM. Motor development of children exposed to the zika virus: systematic reviews. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract Objectives: to describe the motor development, in the first two years of life, of children with evidence of congenital Zika virus syndrome (CZS) at birth and of children exposed to the Zika virus (ZIKV) during pregnancy, but without evidence of CZS. Methods: systematic review, according to the recommendations of the Preferred Reporting Items for Systematic Reviews (PRISMA). The search took place in the VHL/LILACS interface and BIREME/ PubMed interface databases until March 2020. Two researchers analyzed the quality of the studies using the Johanna Briggs Institute methodology. Results: 21 articles were selected. Children with CZS have severe impairment of motor functions and a high prevalence of spastic cerebral palsy. At two years of life, most reached only early levels of motor development; with impaired vision, hearing, language, cognition, behavior, and social interaction. On the other hand, children exposed to ZIKV, but without evidence of CZS, are at lower risk, about 20% have late manifestations of delay and/or neurodevelopmental disorder. Variables associated with greater motor impairment are early maternal infection, preterm birth, lower head circumference, abnormal imaging, use of anticonvulsant, increasing age, arthrogryposis, epilepsy, deficits in vision, language, cognition, and lower income. Conclusion: Most children with CZS show severe motor impairment; a small part of those exposed to ZIKV, without evidence of the syndrome at birth, have alteration in neurodevelopment. Those children should be followed in the long-term, since some manifestations may occur belatedly.
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Preschool neurodevelopment in Zika virus-exposed children without congenital Zika syndrome. Pediatr Res 2022:10.1038/s41390-022-02373-5. [PMID: 36446920 PMCID: PMC10227180 DOI: 10.1038/s41390-022-02373-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Children with in utero Zika virus (ZIKV) exposure without congenital Zika syndrome (CZS) are at risk for abnormal neurodevelopment. Preschool-age outcomes for children with antenatal ZIKV exposure have not yet been established. METHODS Children with in utero ZIKV exposure and non-exposed controls had neurodevelopmental evaluations at age 3-5 years in Sabanalarga, Colombia. Cases did not have CZS and were previously evaluated prenatally through age 18 months. Controls were born before ZIKV arrival to Colombia. Neurodevelopmental assessments included Pediatric Evaluation of Disability Inventory (PEDI-CAT), Behavior Rating Inventory of Executive Function (BRIEF-P), Bracken School Readiness Assessment (BSRA), and Movement Assessment Battery for Children (MABC). Family demographics and child medical history were recorded. RESULTS Fifty-five ZIKV-exposed children were evaluated at mean age 3.6 years and 70 controls were evaluated at 5.2 years. Family demographics were similar between groups. BRIEF-P t-scores were higher for cases than controls in shift and flexibility domains. Cases had lower PEDI-CAT mobility t-scores compared to controls. There was no difference in MABC between groups. In 11% of cases and 1% of controls, parents reported child mood problems. CONCLUSIONS Children with in utero ZIKV exposure without CZS may demonstrate emerging differences in executive function, mood, and adaptive mobility that require continued evaluation. IMPACT Preschool neurodevelopmental outcome in children with in utero Zika virus exposure is not yet known, since the Zika virus epidemic occurred in 2015-2017 and these children are only now entering school age. This study finds that Colombian children with in utero Zika virus exposure without congenital Zika syndrome are overall developing well but may have emerging differences in executive function, behavior and mood, and adaptive mobility compared to children without in utero Zika virus exposure. Children with in utero Zika virus exposure require continued multi-domain longitudinal neurodevelopmental evaluation through school age.
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Carabali M, Maxwell L, Levis B, Shreedhar P. Heterogeneity of Zika virus exposure and outcome ascertainment across cohorts of pregnant women, their infants and their children: a metadata survey. BMJ Open 2022; 12:e064362. [PMID: 36414312 PMCID: PMC9685007 DOI: 10.1136/bmjopen-2022-064362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To support the Zika virus (ZIKV) Individual Participant Data (IPD) Consortium's efforts to harmonise and analyse IPD from ZIKV-related prospective cohort studies and surveillance-based studies of pregnant women and their infants and children; we developed and disseminated a metadata survey among ZIKV-IPD Meta-Analysis (MA) study participants to identify and provide a comprehensive overview of study-level heterogeneity in exposure, outcome and covariate ascertainment and definitions. SETTING Cohort and surveillance studies that measured ZIKV infection during pregnancy or at birth and measured fetal, infant, or child outcomes were identified through a systematic search and consultations with ZIKV researchers and Ministries of Health from 20 countries or territories. PARTICIPANTS Fifty-four cohort or active surveillance studies shared deidentified data for the IPD-MA and completed the metadata survey, representing 33 061 women (11 020 with ZIKV) and 18 281 children. PRIMARY AND SECONDARY OUTCOME MEASURES Study-level heterogeneity in exposure, outcome and covariate ascertainment and definitions. RESULTS Median study sample size was 268 (IQR=100, 698). Inclusion criteria, follow-up procedures and exposure and outcome ascertainment were highly heterogenous, differing meaningfully across regions and multisite studies. Enrolment duration and follow-up for children after birth varied before and after the declaration of the Public Health Emergency of International Concern (PHEIC) and according to the type of funding received. CONCLUSION This work highlights the logistic and statistical challenges that must be addressed to account for the multiple sources of within-study and between-study heterogeneity when conducting IPD-MAs of data collected in the research response to emergent pathogens like ZIKV.
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Affiliation(s)
- Mabel Carabali
- Departement de Médecine Sociale et Préventive, Université de Montréal, Montreal, Quebec, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Maxwell
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
- Heidelberger Institut für Global Health, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, Staffordshire, UK
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Romaní N, Pieras M, Frick MA, Sulleiro E, Rodó C, Silgado A, Suy A, Espiau M, Thorne C, Giaquinto C, Felipe-Rucián A, Soler-Palacín P, Soriano-Arandes A. Neurological Short-Term Outcomes of a Cohort of Children Born to Zika Virus-Infected Mothers in Barcelona. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101537. [PMID: 36291474 PMCID: PMC9599986 DOI: 10.3390/children9101537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
Zika virus (ZIKV) is a vector-borne flavivirus with a known teratogenic effect, yet the full spectrum has not been delineated. Studies on endemic areas tried to characterize the clinical outcomes of ZIKV intrauterine exposure. We aimed to describe early neurodevelopmental outcomes on prenatally ZIKV-exposed children in a non-endemic ZIKV area. This is a prospective observational cohort study conducted from May 2016 to December 2021 at Hospital Universitari Vall d’Hebron in Barcelona, Catalonia, Spain. We monitored for up to 24 months 152 children extracted from a pregnant women cohort with suspected ZIKV infection; eleven women (11/150; 7.3%) fulfilled the criteria for a confirmed ZIKV infection. Among the 152 children included, we describe two cases of congenital ZIKV syndrome (CZS) born from women with a confirmed ZIKV infection. Additionally, we describe five cases of other potentially ZIKV-related outcomes (OPZROs), all with normal birth cranial circumference and born to women with probable ZIKV infection. The low exposed prevalence of adverse outcomes in asymptomatic children at birth in a non-endemic area suggests that close follow-up should be addressed by primary care pediatricians instead of pediatric specialists. Further studies are needed to assess the effects of ZIKV intrauterine exposure beyond two years of life.
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Affiliation(s)
- Natàlia Romaní
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Maria Pieras
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Marie Antoinette Frick
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Elena Sulleiro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Department of Microbiology, Instituto de Salud Carlos III, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Carlota Rodó
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Aroa Silgado
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Department of Microbiology, Instituto de Salud Carlos III, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Anna Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Maria Espiau
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Claire Thorne
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University-Hospital of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Ana Felipe-Rucián
- Pediatric Neurology Section, Pediatric Neurology Research Group, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
- Correspondence:
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Lum FM, Torres-Ruesta A, Tay MZ, Lin RTP, Lye DC, Rénia L, Ng LFP. Monkeypox: disease epidemiology, host immunity and clinical interventions. Nat Rev Immunol 2022; 22:597-613. [PMID: 36064780 PMCID: PMC9443635 DOI: 10.1038/s41577-022-00775-4] [Citation(s) in RCA: 184] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 12/11/2022]
Abstract
Monkeypox virus (MPXV), which causes disease in humans, has for many years been restricted to the African continent, with only a handful of sporadic cases in other parts of the world. However, unprecedented outbreaks of monkeypox in non-endemic regions have recently taken the world by surprise. In less than 4 months, the number of detected MPXV infections has soared to more than 48,000 cases, recording a total of 13 deaths. In this Review, we discuss the clinical, epidemiological and immunological features of MPXV infections. We also highlight important research questions and new opportunities to tackle the ongoing monkeypox outbreak.
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Affiliation(s)
- Fok-Moon Lum
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Anthony Torres-Ruesta
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Matthew Z Tay
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Raymond T P Lin
- National Public Health Laboratory, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Laurent Rénia
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Lisa F P Ng
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
- National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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Cortical Auditory Evoked Potentials in Children with Prenatal Exposure to Zika Virus. Viruses 2022; 14:v14091923. [PMID: 36146729 PMCID: PMC9502411 DOI: 10.3390/v14091923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Prenatal exposure to ZIKV can cause neurologic and auditory damage. The electrophysiological responses obtained by Cortical Auditory Evoked Potentials (CAEP) may provide an objective method to investigate the function of cortical auditory pathways in children exposed to ZIKV. This case series analyzed the findings of CAEP in prenatal-period ZIKV-exposed children with and without microcephaly. The CAEP was performed in a total of 24 children. Five magnetic resonance imaging (MRI) images of the inner ear and brain of microcephalic children were analyzed and compared with CAEP measurements. Ventriculomegaly (80%), cortical/subcortical calcification (80%), and brain reduction (60%) were the most common alterations in the MRI. The P1-N1-P2 complex of the CAEP was observed in all children evaluated. The peak N2 was absent in two children. In the comparison of the CAEP measurements between the groups, children with microcephaly presented a higher amplitude of P2 (p = 0.017), which may reflect immaturity of the auditory pathways. Microcephalic and normocephalic children with prenatal exposure to ZIKV presented with the mandatory components of the CAEPs, regardless of changes in the CNS, suggesting that this population has, to some extent, the cortical ability to process sound stimuli preserved.
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Guardado K, Varela-Cardoso M, Pérez-Roa VO, Morales-Romero J, Zenteno-Cuevas R, Ramos-Ligonio Á, Guzmán-Martínez O, Sampieri CL, Ortiz-Chacha CS, Pérez-Varela R, Mora-Turrubiate CF, Montero H. Evaluation of Anomalies and Neurodevelopment in Children Exposed to ZIKV during Pregnancy. CHILDREN 2022; 9:children9081216. [PMID: 36010106 PMCID: PMC9406591 DOI: 10.3390/children9081216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/23/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Zika virus (ZIKV) infection in pregnancy is associated with birth and developmental alterations in infants. In this study, clinical records of 47 infants whose mothers had Zika during pregnancy or clinical manifestations compatible with Zika were reviewed. A description of the infants’ anomalies was established, and a neurodevelopmental assessment was performed on 18 infants, using the Evaluation of Infant Development (EDI for its initialism in Spanish) and DDST-II (Denver Developmental Screening Test II) tests. From his sample, 74.5% of the infants evaluated had major anomalies and 51.9% had minor anomalies. The incidence of major anomalies, related to trimester of pregnancy, was 84.2% for the first trimester, 77.8% for the second trimester, and 37.5% in the third trimester. A similar trend was observed in the frequency of infants without anomalies and was less evident in the incidence of minor anomalies (p = 0.016). Through neurodevelopmental assessments, EDI identified 27.8% of infants as having normal development, while 55.5% of affected infants had developmental delay, and 16.7% were at risk for developmental delay. The DDSST-II showed that 77.7% infants had delay in the gross motor and language area, 88.8% in the fine-adaptative motor area, and 72.2% in the personal–social area. In this work, children of mothers with ZIKV infection during pregnancy may have major or minor anomalies regardless of the trimester of pregnancy in which the infection occurred. The neurodevelopmental assessment shows that ZIKV can cause a developmental delay in infants with the fine-adaptative motor area being the most affected.
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Affiliation(s)
- Kathia Guardado
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa 91090, Mexico
| | | | | | | | | | - Ángel Ramos-Ligonio
- LADISER Inmunología y Biología Molecular, Facultad de Ciencias Químicas, Universidad Veracruzana, Orizaba 94340, Mexico
| | - Oscar Guzmán-Martínez
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa 91090, Mexico
| | - Clara L. Sampieri
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
| | | | | | | | - Hilda Montero
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
- Correspondence: ; Tel.: +52-22-88-41-89-00 (ext. 13323)
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Alvarado-Domenech LI, Rivera-Amill V, Appleton AA, Rosario-Villafañe V, Repollet-Carrer I, Borges-Rodríguez M, Pérez-Rodríguez NM, Olivieri-Ramos O, González M, González-Montalvo C, Muñiz-Forestier W, Vargas-Lasalle L, Pérez-Padilla J, Paz-Bailey G, Rodríguez-Rabassa M. Early Childhood Neurodevelopmental Outcomes in Children with Prenatal Zika Virus Exposure: A Cohort Study in Puerto Rico. J Pediatr 2022; 247:38-45.e5. [PMID: 35577118 PMCID: PMC10188121 DOI: 10.1016/j.jpeds.2022.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe anthropometric, sensory, and neurodevelopmental outcomes of children who were Zika virus-exposed from birth to 36 months. STUDY DESIGN The study cohort included 114 children born to mothers with confirmed and probable Zika virus pregnancy infection in 2016-2017. Children attending study visits from May 2017 through February 2020 underwent physical/neurologic, sensory examinations, and neurodevelopmental assessments with the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and Ages and Stages Questionnaires, Third Edition (ASQ-3). RESULTS Three of the 114 children (2.6%) had microcephaly (z-score for head circumference ≤-2) at birth, 19 of 35 (54.3%) had posterior eye abnormalities in retinal images, and 11 of 109 (10.1%) had nonspecific findings on brain ultrasound. Three of 107 children (2.8%) failed hearing screening at birth. Of those children with follow-up data, 17 of 97 (17.5%) failed age-appropriate vision screening. The BSID-III identified developmental delay in at least 1 domain in at least one-third of children, with higher prevalence in the language domain. ASQ-3 screen positive delay peaked at around 24 or 36 months, with some domains showing a decrease at older ages. Correlations among BSID-III and ASQ-3 scores were observed, representing professional and parental perspectives at 24 and 36 months (r = 0.32-0.78; P < .05). CONCLUSIONS The presence of neurodevelopmental sequelae in early childhood suggests that identification of long-term impairment remains critical to attaining optimal child development. Long-term follow-up highlights vulnerability in the language domain, which likely could be influenced by early intervention, promoting cognitive development and school readiness in exposed children.
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Affiliation(s)
| | | | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | | | | | | | | | | | - Marielly González
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR
| | | | | | | | - Janice Pérez-Padilla
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
| | - Gabriela Paz-Bailey
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR
| | - Mary Rodríguez-Rabassa
- RCMI Center for Research Resources, Ponce Health Sciences University, Ponce, PR; Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR
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Mulkey SB, DeBiasi RL. New Insights into Zika in Infants and Children. Trop Med Infect Dis 2022; 7:tropicalmed7080158. [PMID: 36006250 PMCID: PMC9412678 DOI: 10.3390/tropicalmed7080158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
In the original article [...].
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Affiliation(s)
- Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Correspondence: (S.B.M.); (R.L.D.)
| | - Roberta L. DeBiasi
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Division of Pediatric Infectious Diseases, Children’s National Hospital, Washington, DC 20010, USA
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Correspondence: (S.B.M.); (R.L.D.)
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46
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Susceptibility to endemic Aedes-borne viruses among pregnant women in Risaralda, Colombia. Int J Infect Dis 2022; 122:832-840. [PMID: 35817285 DOI: 10.1016/j.ijid.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Aedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. METHODS A cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood was obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. RESULTS Most women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016, but only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. CONCLUSIONS Hence, a high proportion pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating risk for future epidemics in this region.
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Casazza RL, Philip DT, Lazear HM. Interferon Lambda Signals in Maternal Tissues to Exert Protective and Pathogenic Effects in a Gestational Stage-Dependent Manner. mBio 2022; 13:e0385721. [PMID: 35471083 PMCID: PMC9239100 DOI: 10.1128/mbio.03857-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/28/2022] [Indexed: 01/10/2023] Open
Abstract
Interferon lambda (IFN-λ) (type III IFN) is constitutively secreted from human placental cells in culture and reduces Zika virus (ZIKV) transplacental transmission in mice. However, the roles of IFN-λ during healthy pregnancy and in restricting congenital infection remain unclear. Here, we used mice lacking the IFN-λ receptor (Ifnlr1-/-) to generate pregnancies lacking either maternal or fetal IFN-λ responsiveness and found that the antiviral effect of IFN-λ resulted from signaling exclusively in maternal tissues. This protective effect depended on gestational stage, as infection earlier in pregnancy (E7 rather than E9) resulted in enhanced transplacental transmission of ZIKV. In Ifnar1-/- dams, which sustain robust ZIKV infection, maternal IFN-λ signaling caused fetal resorption and intrauterine growth restriction. Pregnancy pathology elicited by poly(I·C) treatment also was mediated by maternal IFN-λ signaling, specifically in maternal leukocytes, and also occurred in a gestational stage-dependent manner. These findings identify an unexpected effect of IFN-λ signaling, specifically in maternal (rather than placental or fetal) tissues, which is distinct from the pathogenic effects of IFN-αβ (type I IFN) during pregnancy. These results highlight the complexity of immune signaling at the maternal-fetal interface, where disparate outcomes can result from signaling at different gestational stages. IMPORTANCE Pregnancy is an immunologically complex situation, which must balance protecting the fetus from maternal pathogens with preventing maternal immune rejection of non-self fetal and placental tissue. Cytokines, such as interferon lambda (IFN-λ), contribute to antiviral immunity at the maternal-fetal interface. We found in a mouse model of congenital Zika virus infection that IFN-λ can have either a protective antiviral effect or cause immune-mediated pathology, depending on the stage of gestation when IFN-λ signaling occurs. Remarkably, both the protective and pathogenic effects of IFN-λ occurred through signaling exclusively in maternal immune cells rather than in fetal or placental tissues or in other maternal cell types, identifying a new role for IFN-λ at the maternal-fetal interface.
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Affiliation(s)
- Rebecca L. Casazza
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Drake T. Philip
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Helen M. Lazear
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Marbán-Castro E, Vazquez Guillamet LJ, Pantoja PE, Casellas A, Maxwell L, Mulkey SB, Menéndez C, Bardají A. Neurodevelopment in Normocephalic Children Exposed to Zika Virus in Utero with No Observable Defects at Birth: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127319. [PMID: 35742566 PMCID: PMC9223424 DOI: 10.3390/ijerph19127319] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022]
Abstract
Zika virus (ZIKV) infection during pregnancy is a cause of pregnancy loss and multiple clinical and neurological anomalies in children. This systematic review aimed to assess the effect of ZIKV exposure in utero on the long-term neurodevelopment of normocephalic children born to women with ZIKV infection in pregnancy. This review was conducted according to the PRISMA guidelines for systematic reviews and meta-analyses. We performed a random effects meta-analysis to estimate the cross-study prevalence of neurodevelopmental delays in children using the Bayley Scales for Infant and Toddler Development (BSID-III). The risk of bias was assessed using Cochrane’s Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Full-text reviews were performed for 566 articles, and data were extracted from 22 articles corresponding to 20 studies. Nine articles including data from 476 children found 6.5% (95% CI: 4.1–9.3) of infants and children to have any type of non-language cognitive delay; 29.7% (95% CI: 21.7–38.2) to have language delay; and 11.5% (95% CI: 4.8–20.1) to have any type of motor delay. The pooled estimates had a high level of heterogeneity; thus, results should be interpreted with caution. Larger prospective studies that include a non-exposed control group are needed to confirm whether ZIKV exposure in utero is associated with adverse child neurodevelopmental outcomes.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Correspondence: ; Tel.: +34-932-271851
| | - Laia J. Vazquez Guillamet
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
| | - Percy Efrain Pantoja
- Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Aina Casellas
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
| | - Lauren Maxwell
- Heidelberg Institute for Global Health, Heidelberg University, 69120 Heidelberg, Germany;
| | - Sarah B. Mulkey
- Children’s National Hospital, Washington, DC 20010, USA;
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Clara Menéndez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigaçâo em Saúde de Manhiça (CISM), Rua 12, Cambeve CP 1929, Maputo 1929, Mozambique
| | - Azucena Bardají
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigaçâo em Saúde de Manhiça (CISM), Rua 12, Cambeve CP 1929, Maputo 1929, Mozambique
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Díaz-Martínez LA, Rojas MA, Pinilla-García LS, Becerra-Mojica CH, Pérez-Vera LA, Gutiérrez-Sánchez LÁ, Contreras-García GA, Rueda-Ordoñez CG, Villar L. Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women. PLoS Negl Trop Dis 2022; 16:e0009854. [PMID: 35255097 PMCID: PMC8929705 DOI: 10.1371/journal.pntd.0009854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/17/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration:www.clinicaltrials.gov, NCT02943304. Previous studies have identified a cause-effect relationship between fetal exposure to the Zika virus (ZIKV) and the development of central nervous system (CNS) anomalies and variable degrees of neurodevelopmental delay. This study aimed to compare the neurodevelopmental outcome of infants without CNS anomalies from two groups. One born to symptomatic ZIKV exposed women and another to asymptomatic ZIKV unexposed women. The ZIKV-exposed women were older, had a higher percentage of women in middle-class socioeconomic strata, had a higher level of education, were more likely to be single, and had higher rates of pregnancy comorbidity and premature births compared to ZIKV unexposed women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). Infants born to symptomatic ZIKV exposed women had higher motor and cognitive scores at 12 and 24 months CA, respectively, than infants born to ZIKV unexposed women. We conclude that infants without CNS anomalies born to ZIKV exposed women had normal neurodevelopment up to 24 months of CA than infants born to ZIKV unexposed women, supporting an all-or-nothing effect with maternal ZIKV exposure. School performance evaluation is required.
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Affiliation(s)
| | - Mario Augusto Rojas
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Colombian Association of Neonatology (ASCON), Colombian Neonatal Research Network (CNRN), Bogotá, Colombia
- * E-mail:
| | | | - Carlos Hernán Becerra-Mojica
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Maternal-fetal Medicine Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
| | - Luis Alfonso Pérez-Vera
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Colombian Association of Neonatology (ASCON), Colombian Neonatal Research Network (CNRN), Bogotá, Colombia
- Neonatal Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
| | - Luz Ángela Gutiérrez-Sánchez
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Maternal-fetal Medicine Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
- Clínica Materno Infantil San Luis, Bucaramanga, Colombia
| | | | | | - Luis Villar
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- ZIKAlliance Consortium, Bucaramanga, Colombia
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50
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Waechter R, Burgen KS, Punch B, Evans R, Blackmon K, Noël T, Fernandes M, Landon B. Improving neurodevelopment in Zika-exposed children: A randomized controlled trial. PLoS Negl Trop Dis 2022; 16:e0010263. [PMID: 35259172 PMCID: PMC8903297 DOI: 10.1371/journal.pntd.0010263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/16/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND While microcephaly is a significant adverse outcome of prenatal exposure to the Zika virus (ZIKV), subtle malformations of cortical development (MCD) have been observed in Zika-exposed children (ZEC), including delays in language, cognition, and motor domains, and visual acuity deficits. Interventions within the first 1,000 days of life can significantly improve developmental outcomes. This study examined a 12-week Responsive Caregiving Intervention on neurodevelopmental outcomes in 24-30-month-old ZEC. METHODOLOGY/PRINCIPAL FINDINGS A randomized controlled trial was implemented in Grenada, West Indies using an existing ZIKV cohort surveillance study. When children in that study turned 24 months, baseline child neurodevelopmental measures and caregiver interviews were administered. Caregivers who agreed to participate in the 12-week Responsive Caregiving Intervention, implemented when children were 24-30 months of age, were randomly assigned to the Intervention or Waitlist Control group. Children in both groups were re-assessed on the neurodevelopmental measures post-intervention. CONCLUSIONS/SIGNIFICANCE 233 children from the ZIKV surveillance study met inclusion criteria, of which n = 80 declined participation, n = 42 did not complete the Intervention, and n = 72 missed follow-up assessments given strict timelines in the study design. The final sample for analysis was N = 13 children in the Intervention group and N = 26 children in the Control group. A GEE model analysis showed significantly higher language (p = 0.021) and positive behaviour (p = 0.005) scores for children in the Intervention group compared to the Control group. The Intervention had a medium effect on child language (d = 0.66) and a large effect on positive behaviour (d = 0.83). A 12-week Responsive Caregiving Intervention Programme significantly improves language and positive behaviour scores in 30-month-old normocephalic children who were exposed to ZIKV in utero. The programme provides an option for mothers of ZIKV-exposed children who are seeking an evidence-based neurodevelopmental intervention regardless of known impact of the virus on cortical formation. TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT04697147).
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Affiliation(s)
- Randall Waechter
- Department of Neuroscience, Physiology, and Behavioral Sciences; School of Medicine; St George’s University; Grenada, West Indies
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
| | - Kemi S. Burgen
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
| | - Bianca Punch
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
| | - Roberta Evans
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
| | - Karen Blackmon
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Mayo Clinic; Department of Psychiatry and Psychology; Jacksonville, Florida, United States of America
| | - Trevor Noël
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Office of Research; St. George’s University; Grenada, West Indies
| | - Michelle Fernandes
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Faculty of Medicine; Department of Paediatrics; University Hospitals Southampton; University of Southampton; Southampton, United Kingdom
- Nuffield Department of Women’s & Reproductive Health; John Radcliffe Hospital; University of Oxford; Oxford, United Kingdom
| | - Barbara Landon
- Windward Islands Research and Education Foundation; St. George’s University; Grenada, West Indies
- Caribbean Center for Child Neurodevelopment at WINDREF; Grenada, West Indies
- School of Graduate Studies; St. George’s University; Grenada, West Indies
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