Effect of a neuroactive steroid infused into the cerebral ventricles of fetal sheep in utero using small infusion volumes

Intrathecal drug delivery in the era of nanomedicine

Administration of substances directly into the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord is one approach that can circumvent the blood-brain barrier to enable drug delivery to the central nervous system (CNS). However, molecules that have been administered by intrathecal injection, which includes intraventricular, intracisternal, or lumbar locations, encounter new barriers within the subarachnoid space. These barriers include relatively high rates of turnover as CSF clears and potentially inadequate delivery to tissue or cellular targets. Nanomedicine could offer a solution. In contrast to the fate of freely administered drugs, nanomedicine systems can navigate the subarachnoid space to sustain delivery of therapeutic molecules, genes, and imaging agents within the CNS. Some evidence suggests that certain nanomedicine agents can reach the parenchyma following intrathecal administration. Here, we will address the preclinical and clinical use of intrathecal nanomedicine, including nanoparticles, microparticles, dendrimers, micelles, liposomes, polyplexes, and other colloidalal materials that function to alter the distribution of molecules in tissue. Our review forms a foundational understanding of drug delivery to the CSF that can be built upon to better engineer nanomedicine for intrathecal treatment of disease.

The importance of ‘awareness’ for understanding fetal pain

Our understanding of when the fetus can experience pain has been largely shaped by neuroanatomy. However, completion of the cortical nociceptive connections just after mid-gestation is only one part of the story. In addition to critically reviewing evidence for whether the fetus is ever awake or aware, and thus able to truly experience pain, we examine the role of endogenous neuro-inhibitors, such as adenosine and pregnanolone, produced within the feto-placental unit that contribute to fetal sleep states, and thus mediate suppression of fetal awareness. The uncritical view that the nature of presumed fetal pain perception can be assessed by reference to the prematurely born infant is challenged. Rigorously controlled studies of invasive procedures and analgesia in the fetus are required to clarify the impact of fetal nociception on postnatal pain sensitivity and neural development, and the potential benefits or harm of using analgesia in this unique setting.

Responsiveness, behavioural arousal and awareness in fetal and newborn lambs: experimental, practical and therapeutic implications

This review distinguishes between physical responsiveness, behavioural arousal and awareness in fetal and newborn lambs, and summarises the physical and physiological factors which activate and suppress behavioural arousal. Important activators include: rising blood oestrogen concentrations just before birth; physical stimuli during delivery; exposure to cold on delivery, and; elevation in blood oxygen levels following the onset of pulmonary respiration. Suppressors of behavioural arousal and awareness are: low oxygen levels and high concentrations of progesterone and its metabolites in the fetal circulation, and; exposure to a warm intrauterine environment and to a circulating placental factor that inhibits activity including breathing.</br> In view of the relatively high levels of oxygen required to sustain awareness in adult animals, the low levels in fetal circulation, and the actions of other suppressors, it is unlikely that awareness occurs in the fetus. Nevertheless, fetuses perform a range of physical acts that would be supported or initiated by brainstem activity. In addition they show physical responses to potentially painful stimuli during late gestation, but it has yet to be demonstrated that these are linked to perception of pain. It is postulated that perception of pain could only occur once there is a level of oxygenation that supports overall awareness, and under normal circumstances this would only occur once the newborn starts breathing air. The implications for the welfare of fetal lambs and calves during experimental surgery, slaughter of the pregnant dam, collection of blood (serum) from fetuses at slaughter, and during fetotomy are favourable, indicating that current practices, when carefully undertaken, are humane.</br>

Maturation of respiratory control in the behaving mammal

Whereas in vitro techniques have contributed greatly to our understanding of detailed neuronal mechanisms of respiratory control, the integrated function of respiratory behavior requires studying conscious, unsedated subjects. Noninvasive approaches, meticulous chronic instrumentation for the recording of multiple respiratory indices, and correlations with brain studies performed after physiological manipulations in vivo can all be employed to get to some understanding of the maturation of respiratory control in the mammal. This article is a selective and critical overview of recent literature on methodologies that can be used in behaving subjects, the relationship of respiration to sleep-wake states, respiratory patterns during normoxia, and on respiratory responsiveness to hypercarbia and hypoxia, all emphasizing processes during development. It is hoped that this review will encourage new investigators interested in the regulation of breathing to resort to experimental approaches that will reveal the mysteries of respiratory behavior in the integrated organism.

Prostaglandin D synthase in the prenatal ovine brain and effects of its inhibition with selenium chloride on fetal sleep/wake activity in utero

It has been proposed that prostaglandin (PG) D(2) induces physiological sleep in mammals by acting on sleep centers located in the anterior hypothalamus. In fetal sheep, definitive rapid-eye-movement and non-rapid-eye-movement sleep states appear at approximately 125 d gestation (term is approximately 147 d). In adult animals, PGD synthase (PGDS) (functionally and structurally homologous to beta-trace protein) is secreted into CSF with a circadian pattern, with the highest concentrations present during sleep. In this study we show that PGDS/beta-trace protein is present in fetal sheep CSF at 125 and 135 d gestation but not at 90 d gestation. SeCl(4), a specific inhibitor of PGDS, was given to unanesthetized fetal sheep (130-140 d gestation) by intracerebroventricular infusion at a dose of 25, 100, 500, or 1000 pmol/min for 4 hr. Artificial CSF was infused in control experiments. Arousal behavior, defined as the presence of nuchal muscle electromyogram activity, electro-ocular activity, and breathing movements during low-amplitude electrocortical activity, increased from 3.8 +/- 1 min/hr to 6.6 +/- 0.5 and 7.0 +/- 0.3 min/hr at doses of 100 and 500 pmol/min, respectively (p < 0.05). SeCl(4) at 25 and 1000 pmol/min had no significant effect on arousal activity. Infusion of PGD(2) at 500 pmol/min intracerebroventricularly for 4 hr decreased the incidence of arousal from 3.8 +/- 0.5 min/hr to 0.7 +/- 0.3 min/hr (p < 0.05). When 500 pmol/min PGD(2) was infused immediately after a 4 hr infusion of SeCl(4) (500 pmol/min), the SeCl(4)-induced increase in arousal behavior was abolished. Together, the presence of PGDS/beta-trace protein in fetal CSF in late gestation and the effects of SeCl(4) in increasing the incidence of arousal-like behavior suggest that PGD(2) has a role in the induction and maintenance of prenatal sleep.