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Oosting A, Harvey L, Ringler S, van Dijk G, Schipper L. Beyond ingredients: Supramolecular structure of lipid droplets in infant formula affects metabolic and brain function in mouse models. PLoS One 2023; 18:e0282816. [PMID: 37531323 PMCID: PMC10395839 DOI: 10.1371/journal.pone.0282816] [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: 02/22/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Human milk beneficially affects infant growth and brain development. The supramolecular structure of lipid globules in human milk i.e., large lipid globules covered by the milk fat globule membrane, is believed to contribute to this effect, in addition to the supply of functional ingredients. Three preclinical (mouse) experiments were performed to study the effects of infant formula mimicking the supramolecular structure of human milk lipid globules on brain and metabolic health outcomes. From postnatal day 16 to 42, mouse offspring were exposed to a diet containing infant formula with large, phospholipid-coated lipid droplets (structure, STR) or infant formula with the same ingredients but lacking the unique structural properties as observed in human milk (ingredient, ING). Subsequently, in Study 1, the fatty acid composition in liver and brain membranes was measured, and expression of hippocampal molecular markers were analyzed. In Study 2 and 3 adult (Western-style diet-induced) body fat accumulation and cognitive function were evaluated. Animals exposed to STR compared to ING showed improved omega-3 fatty acid accumulation in liver and brain, and higher expression of brain myelin-associated glycoprotein. Early exposure to STR reduced fat mass accumulation in adulthood; the effect was more pronounced in animals exposed to a Western-style diet. Additionally, mice exposed to STR demonstrated better memory performance later in life. In conclusion, early life exposure to infant formula containing large, phospholipid-coated lipid droplets, that are closer to the supramolecular structure of lipid globules in human milk, positively affects adult brain and metabolic health outcomes in pre-clinical animal models.
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Affiliation(s)
| | | | | | - Gertjan van Dijk
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Lidewij Schipper
- Danone Nutricia Research, Utrecht, The Netherlands
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
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2
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Reemst K, Broos JY, Abbink MR, Cimetti C, Giera M, Kooij G, Korosi A. Early-life stress and dietary fatty acids impact the brain lipid/oxylipin profile into adulthood, basally and in response to LPS. Front Immunol 2022; 13:967437. [PMID: 36131915 PMCID: PMC9484596 DOI: 10.3389/fimmu.2022.967437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/04/2022] [Indexed: 01/06/2023] Open
Abstract
Brain lipid dysregulation is a hallmark of depression and Alzheimer's disease, also marked by chronic inflammation. Early-life stress (ELS) and dietary intake of polyunsaturated fatty acids (PUFAs) are risk factors for these pathologies and are known to impact inflammatory processes. However, if these early-life factors alter brain lipid homeostasis on the long-term and thereby contribute to this risk remains to be elucidated. We have recently shown that an early diet enriched in omega(ω)-3 PUFAs protected against the long-term negative effects of ELS on cognition and neuroinflammation. Here, we aim to understand if modulation of brain lipid and oxylipin profiles contributes to the detrimental effects of ELS and the protective ones of the diet. We therefore studied if and how ELS and early dietary PUFAs modulate the brain lipid and oxylipin profile, basally as well as in response to an inflammatory challenge, to unmask possible latent effects. Male mice were exposed to ELS via the limited bedding and nesting paradigm, received an early diet with high or low ω6/ω3 ratio (HRD and LRD) and were injected with saline or lipopolysaccharide (LPS) in adulthood. Twenty-four hours later plasma cytokines (Multiplex) and hypothalamic lipids and oxylipins (liquid chromatography tandem mass spectrometry) were measured. ELS exacerbated the LPS-induced increase in IL-6, CXCL1 and CCL2. Both ELS and diet affected the lipid/oxylipin profile long-term. For example, ELS increased diacylglycerol and LRD reduced triacylglycerol, free fatty acids and ceramides. Importantly, the ELS-induced alterations were strongly influenced by the early diet. For example, the ELS-induced decrease in eicosapentaenoic acid was reversed when fed LRD. Similarly, the majority of the LPS-induced alterations were distinct for control and ELS exposed mice and unique for mice fed with LRD or HRD. LPS decreased ceramides and lysophosphotidylcholine, increased hexosylceramides and prostaglandin E2, reduced triacylglycerol species and ω6-derived oxylipins only in mice fed LRD and ELS reduced the LPS-induced increase in phosphatidylcholine. These data give further insights into the alterations in brain lipids and oxylipins that might contribute to the detrimental effects of ELS, to the protective ones of LRD and the possible early-origin of brain lipid dyshomeostasis characterizing ELS-related psychopathologies.
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Affiliation(s)
- Kitty Reemst
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Science Park, Amsterdam, Netherlands
| | - Jelle Y. Broos
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Molecular Cell Biology and Immunology, Amsterdam Neuroscience, Multiple Sclerosis (MS) Center Amsterdam, Amsterdam, Netherlands,Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Maralinde R. Abbink
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Science Park, Amsterdam, Netherlands
| | - Chiara Cimetti
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Science Park, Amsterdam, Netherlands
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, Netherlands
| | - Gijs Kooij
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Molecular Cell Biology and Immunology, Amsterdam Neuroscience, Multiple Sclerosis (MS) Center Amsterdam, Amsterdam, Netherlands
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Science Park, Amsterdam, Netherlands,*Correspondence: Aniko Korosi,
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Hokkanen S, Frey AD, Yang B, Linderborg KM. Similarity Index for the Fat Fraction between Breast Milk and Infant Formulas. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:6191-6201. [PMID: 35543583 PMCID: PMC9136929 DOI: 10.1021/acs.jafc.1c08029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/15/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
The similarity of the fat fraction in infant formulas rich in either bovine milk fat (MF) or vegetable oil (VO) to breast milk was evaluated by analyzing their lipid composition. Milk fat-rich formulas were highly similar (average similarity index 0.68) to breast milk compared to the VO-rich formulas (average similarity index 0.56). The highest difference in the indices was found in the contents of cholesterol (0.66 vs 0.28 in MF- and VO-rich formulas, respectively, on average) and polar lipids (0.84 vs 0.53), the positional distribution of fatty acids in the sn-2 position of triacylglycerols (0.53 vs 0.28), and fatty acid composition (0.72 vs 0.54). The VO-based formulas were superior in similarity in n - 6 PUFA. Thus, the addition of bovine MF fractions is an effective way to increase the similarity between the lipid composition of infant formulas and human milk.
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Affiliation(s)
- Sanna Hokkanen
- Molecular
Biotechnology, Department of Bioproducts and Biosystems, School of
Chemical Engineering, Aalto University, 02150 Espoo, Finland
| | - Alexander D. Frey
- Molecular
Biotechnology, Department of Bioproducts and Biosystems, School of
Chemical Engineering, Aalto University, 02150 Espoo, Finland
| | - Baoru Yang
- Food
Chemistry and Food Development, Department of Life Technologies, University of Turku, 20500 Turku, Finland
| | - Kaisa M. Linderborg
- Food
Chemistry and Food Development, Department of Life Technologies, University of Turku, 20500 Turku, Finland
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Carlson SE, Schipper L, Brenna JT, Agostoni C, Calder PC, Forsyth S, Legrand P, Abrahamse-Berkeveld M, van de Heijning BJM, van der Beek EM, Koletzko BV, Muhlhausler B. Perspective: Moving Toward Desirable Linoleic Acid Content in Infant Formula. Adv Nutr 2021; 12:2085-2098. [PMID: 34265035 PMCID: PMC8634410 DOI: 10.1093/advances/nmab076] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
Infant formula should provide the appropriate nutrients and adequate energy to facilitate healthy infant growth and development. If conclusive data on quantitative nutrient requirements are not available, the composition of human milk (HM) can provide some initial guidance on the infant formula composition. This paper provides a narrative review of the current knowledge, unresolved questions, and future research needs in the area of HM fatty acid (FA) composition, with a particular focus on exploring appropriate intake levels of the essential FA linoleic acid (LA) in infant formula. The paper highlights a clear gap in clinical evidence as to the impact of LA levels in HM or formula on infant outcomes, such as growth, development, and long-term health. The available preclinical information suggests potential disadvantages of high LA intake in the early postnatal period. We recommend performing well-designed clinical intervention trials to create clarity on optimal levels of LA to achieve positive impacts on both short-term growth and development and long-term functional health outcomes.
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Affiliation(s)
| | | | - J Thomas Brenna
- Department of Pediatrics, University of Texas at Austin, Austin, TX, USA,Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Carlo Agostoni
- Pediatric Area, Fondazione IRCCS Ca’Granda- Ospedale Maggiore Policlinico, Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Philip C Calder
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Philippe Legrand
- Laboratoire de Biochimie-Nutrition Humaine, Agrocampus–French National Institute of Health and Medical Research, Rennes, France
| | | | | | - Eline M van der Beek
- Danone Nutricia Research, Utrecht, The Netherlands,Department of Pediatrics, University Medical Center, Groningen, The Netherlands
| | - Berthold V Koletzko
- Ludwig-Maximilians-Universität Munich, Department of Paediatrics, Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Beverly Muhlhausler
- Nutrition and Health Program, Health and Biosecurity, CSIRO, Adelaide, Australia,School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, Australia
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Adan RAH, van der Beek EM, Buitelaar JK, Cryan JF, Hebebrand J, Higgs S, Schellekens H, Dickson SL. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol 2019; 29:1321-1332. [PMID: 31735529 DOI: 10.1016/j.euroneuro.2019.10.011] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/08/2019] [Accepted: 10/29/2019] [Indexed: 12/26/2022]
Abstract
Does it matter what we eat for our mental health? Accumulating data suggests that this may indeed be the case and that diet and nutrition are not only critical for human physiology and body composition, but also have significant effects on mood and mental wellbeing. While the determining factors of mental health are complex, increasing evidence indicates a strong association between a poor diet and the exacerbation of mood disorders, including anxiety and depression, as well as other neuropsychiatric conditions. There are common beliefs about the health effects of certain foods that are not supported by solid evidence and the scientific evidence demonstrating the unequivocal link between nutrition and mental health is only beginning to emerge. Current epidemiological data on nutrition and mental health do not provide information about causality or underlying mechanisms. Future studies should focus on elucidating mechanism. Randomized controlled trials should be of high quality, adequately powered and geared towards the advancement of knowledge from population-based observations towards personalized nutrition. Here, we provide an overview of the emerging field of nutritional psychiatry, exploring the scientific evidence exemplifying the importance of a well-balanced diet for mental health. We conclude that an experimental medicine approach and a mechanistic understanding is required to provide solid evidence on which future policies on diet and nutrition for mental health can be based.
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Affiliation(s)
- Roger A H Adan
- Department of Translational Neurosciences, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Medicinaregatan 11, SE-405 30 Gothenburg, Sweden.
| | - Eline M van der Beek
- Danone Nutricia Research, Utrecht, the Netherlands; Department of Pediatrics, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry, Nijmegen, the Netherlands
| | - John F Cryan
- Department of Anatomy & Neuroscience and APC Microbiome Ireland, University College Cork, Ireland
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Suzanne Higgs
- Suzanne Higgs School of Psychology, University of Birmingham, Birmingham, UK
| | - Harriet Schellekens
- Department of Anatomy & Neuroscience and APC Microbiome Ireland, University College Cork, Ireland
| | - Suzanne L Dickson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Medicinaregatan 11, SE-405 30 Gothenburg, Sweden.
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Comparison of bovine milk fat and vegetable fat for infant formula: Implications for infant health. Int Dairy J 2019. [DOI: 10.1016/j.idairyj.2019.01.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Yam K, Schipper L, Reemst K, Ruigrok SR, Abbink MR, Hoeijmakers L, Naninck EFG, Zarekiani P, Oosting A, Van Der Beek EM, Lucassen PJ, Korosi A. Increasing availability of ω‐3 fatty acid in the early‐life diet prevents the early‐life stress‐induced cognitive impairments without affecting metabolic alterations. FASEB J 2019; 33:5729-5740. [DOI: 10.1096/fj.201802297r] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Kit‐Yi Yam
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | | | - Kitty Reemst
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | - Silvie R. Ruigrok
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | - Maralinde R. Abbink
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | - Lianne Hoeijmakers
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | - Eva F. G. Naninck
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | - Parand Zarekiani
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | | | - Eline M. Van Der Beek
- Danone Nutricia Research Utrecht The Netherlands
- Department of PediatricsUniversity Medical Centre GroningenUniversity of Groningen Groningen The Netherlands
| | - Paul J. Lucassen
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
| | - Aniko Korosi
- Centre for NeuroscienceSwammerdam Institute for Life SciencesUniversity of Amsterdam Amsterdam The Netherlands
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Alashmali SM, Kitson AP, Lin L, Lacombe RJS, Bazinet RP. Maternal dietary n-6 polyunsaturated fatty acid deprivation does not exacerbate post-weaning reductions in arachidonic acid and its mediators in the mouse hippocampus. Nutr Neurosci 2017; 22:223-234. [PMID: 28903622 DOI: 10.1080/1028415x.2017.1372160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The present study examines how lowering maternal dietary n-6 polyunsaturated fatty acids (PUFA) (starting from pregnancy) compared to offspring (starting from post-weaning) affect the levels of n-6 and n-3 fatty acids in phospholipids (PL) and lipid mediators in the hippocampus of mice. METHODS Pregnant mice were randomly assigned to consume either a deprived or an adequate n-6 PUFA diet during pregnancy and lactation (maternal exposure). On postnatal day (PND) 21, half of the male pups were weaned onto the same diet as their dams, and the other half were switched to the other diet for 9 weeks (offspring exposure). At PND 84, upon head-focused high-energy microwave irradiation, hippocampi were collected for PL fatty acid and lipid mediator analyses. RESULTS Arachidonic acid (ARA) concentrations were significantly decreased in both total PL and PL fractions, while eicosapentaenoic acid (EPA) concentrations were increased only in PL fractions upon n-6 PUFA deprivation of offspring, regardless of maternal exposure. Several ARA-derived eicosanoids were reduced, while some of the EPA-derived eicosanoids were elevated by n-6 PUFA deprivation in offspring. There was no effect of diet on docosahexaenoic acid (DHA) or DHA-derived docosanoids concentrations under either maternal or offspring exposure. DISCUSSION These results indicate that the maternal exposure to dietary n-6 PUFA may not be as important as the offspring exposure in regulating hippocampal ARA and some lipid mediators. Results from this study will be helpful in the design of experiments aimed at testing the significance of altering brain ARA levels over different stages of life.
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Affiliation(s)
- Shoug M Alashmali
- a Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Alex P Kitson
- a Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Lin Lin
- a Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto , Canada
| | - R J Scott Lacombe
- a Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Richard P Bazinet
- a Department of Nutritional Sciences, Faculty of Medicine , University of Toronto , Toronto , Canada
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Tenorio‐Lopes L, Baldy C, Jochmans‐Lemoine A, Mercier O, Pothier‐Piccinin O, Seaborn T, Joseph V, Marc I, Kinkead R. Consequences of maternal omega-3 polyunsaturated fatty acid supplementation on respiratory function in rat pups. J Physiol 2017; 595:1637-1655. [PMID: 27861919 PMCID: PMC6426158 DOI: 10.1113/jp273471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/04/2016] [Indexed: 01/22/2023] Open
Abstract
KEY POINTS Incomplete development of the neural circuits that control breathing contributes to respiratory disorders in pre-term infants. Manifestations include respiratory instability, prolonged apnoeas and poor ventilatory responses to stimuli. Based on evidence suggesting that omega-3 polyunsaturated fatty acids (n-3 PUFA) improves brain development, we determined whether n-3 PUFA supplementation (via the maternal diet) improves respiratory function in 10-11-day-old rat pups. n-3 PUFA treatment prolonged apnoea duration but augmented the relative pulmonary surface area and the ventilatory response to hypoxia. During hypoxia, the drop in body temperature measured in treated pups was 1 °C less than in controls. n-3 PUFA treatment also reduced microglia cell density in the brainstem. Although heterogeneous, the results obtained in rat pups constitute a proof of concept that n-3 PUFA supplementation can have positive effects on neonatal respiration. This includes a more sustained hypoxic ventilatory response and a decreased respiratory inhibition during laryngeal chemoreflex. ABSTRACT Most pre-term infants present respiratory instabilities and apnoeas as a result of incomplete development of the neural circuits that control breathing. Because omega-3 polyunsaturated fatty acids (n-3 PUFA) benefit brain development, we hypothesized that n-3 PUFA supplementation (via the maternal diet) improves respiratory function in rat pups. Pups received n-3 PUFA supplementation from an enriched diet (13 g kg-1 of n-3 PUFA) administered to the mother from birth until the experiments were performed (postnatal days 10-11). Controls received a standard diet (0.3 g kg-1 of n-3 PUFA). Breathing was measured in intact pups at rest and during hypoxia (FiO2 = 0.12; 20 min) using whole body plethysmography. The duration of apnoeas induced by stimulating the laryngeal chemoreflex (LCR) was measured under anaesthesia. Lung morphology was compared between groups. Maternal n-3 PUFA supplementation effectively raised n-3 PUFA levels above control levels both in the blood and brainstem of pups. In intact, resting pups, n-3 PUFA increased the frequency and duration of apnoeas, especially in females. During hypoxia, n-3 PUFA supplemented pups hyperventilated 23% more than controls; their anapyrexic response was 1 °C less than controls. In anaesthetized pups, n-3 PUFA shortened the duration of LCR-induced apnoeas by 32%. The relative pulmonary surface area of n-3 PUFA supplemented pups was 12% higher than controls. Although n-3 PUFA supplementation augments apnoeas, there is no clear evidence of deleterious consequences on these pups. Based on the improved lung architecture and responses to respiratory challenges, this neonatal treatment appears to be beneficial to the offspring. However, further experiments are necessary to establish its overall safety.
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Affiliation(s)
- Luana Tenorio‐Lopes
- Department of Pediatrics, Université LavalCentre de Recherche du CHU de QuébecQuébecQCCanada
| | - Cécile Baldy
- Department of Pediatrics, Université LavalCentre de Recherche du CHU de QuébecQuébecQCCanada
| | | | - Océane Mercier
- Department of Pediatrics, Université LavalCentre de Recherche du CHU de QuébecQuébecQCCanada
| | | | - Tommy Seaborn
- Department of Pediatrics, Université LavalCentre de Recherche du CHU de QuébecQuébecQCCanada
| | - Vincent Joseph
- Department of Pediatrics, Université LavalCentre de Recherche du CHU de QuébecQuébecQCCanada
| | - Isabelle Marc
- Department of Pediatrics, Université LavalCentre de Recherche du CHU de QuébecQuébecQCCanada
| | - Richard Kinkead
- Department of Pediatrics, Université LavalCentre de Recherche du CHU de QuébecQuébecQCCanada
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