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Kelly SB, Stojanovska V, Zahra VA, Moxham A, Miller SL, Moss TJM, Hooper SB, Nold MF, Nold-Petry CA, Dean JM, Bennet L, Polglase GR, Gunn AJ, Galinsky R. Interleukin-1 blockade attenuates white matter inflammation and oligodendrocyte loss after progressive systemic lipopolysaccharide exposure in near-term fetal sheep. J Neuroinflammation 2021; 18:189. [PMID: 34465372 PMCID: PMC8408978 DOI: 10.1186/s12974-021-02238-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background Increased systemic and tissue levels of interleukin (IL)-1β are associated with greater risk of impaired neurodevelopment after birth. In this study, we tested the hypothesis that systemic IL-1 receptor antagonist (Ra) administration would attenuate brain inflammation and injury in near-term fetal sheep exposed to lipopolysaccharide (LPS). Methods Chronically instrumented near-term fetal sheep at 0.85 of gestation were randomly assigned to saline infusion (control, n = 9), repeated LPS infusions (0 h = 300 ng, 24 h = 600 ng, 48 h = 1200 ng, n = 8) or repeated LPS plus IL-1Ra infusions (13 mg/kg infused over 4 h) started 1 h after each LPS infusion (n = 9). Sheep were euthanized 4 days after starting infusions for histology. Results LPS infusions increased circulating cytokines and were associated with electroencephalogram (EEG) suppression with transiently reduced mean arterial blood pressure, and increased carotid artery perfusion and fetal heart rate (P < 0.05 vs. control for all). In the periventricular and intragyral white matter, LPS-exposure increased IL-1β immunoreactivity, numbers of caspase 3+ cells and microglia, reduced astrocyte and olig-2+ oligodendrocyte survival but did not change numbers of mature CC1+ oligodendrocytes, myelin expression or numbers of neurons in the cortex and subcortical regions. IL-1Ra infusions reduced circulating cytokines and improved recovery of EEG activity and carotid artery perfusion. Histologically, IL-1Ra reduced microgliosis, IL-1β expression and caspase-3+ cells, and improved olig-2+ oligodendrocyte survival. Conclusion IL-1Ra improved EEG activity and markedly attenuated systemic inflammation, microgliosis and oligodendrocyte loss following LPS exposure in near-term fetal sheep. Further studies examining the long-term effects on brain maturation are now needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02238-4.
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Affiliation(s)
- Sharmony B Kelly
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Vanesa Stojanovska
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Valerie A Zahra
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Alison Moxham
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Timothy J M Moss
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Marcel F Nold
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Australia
| | - Claudia A Nold-Petry
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Justin M Dean
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Alistair J Gunn
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Robert Galinsky
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright street, Melbourne, Victoria, 3168, Australia. .,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
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Tann CJ, Kohli-Lynch M, Nalugya R, Sadoo S, Martin K, Lassman R, Nanyunja C, Musoke M, Sewagaba M, Nampijja M, Seeley J, Webb EL. Surviving and Thriving: Early Intervention for Neonatal Survivors With Developmental Disability in Uganda. INFANTS AND YOUNG CHILDREN 2021; 34:17-32. [PMID: 33790497 PMCID: PMC7983078 DOI: 10.1097/iyc.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Global attention on early child development, inclusive of those with disability, has the potential to translate into improved action for the millions of children with developmental disability living in low- and middle-income countries. Nurturing care is crucial for all children, arguably even more so for children with developmental disability. A high proportion of survivors of neonatal conditions such as prematurity and neonatal encephalopathy are affected by early child developmental disability. The first thousand days of life is a critical period for neuroplasticity and an important window of opportunity for interventions, which maximize developmental potential and other outcomes. Since 2010, our group has been examining predictors, outcomes, and experiences of neonatal encephalopathy in Uganda. The need for an early child intervention program to maximize participation and improve the quality of life for children and families became apparent. In response, the "ABAaNA early intervention program," (now re-branding as 'Baby Ubuntu') a group participatory early intervention program for young children with developmental disability and their families, was developed and piloted. Piloting has provided early evidence of feasibility, acceptability, and impact and a feasibility trial is underway. Future research aims to develop programmatic capacity across diverse settings and evaluate its impact at scale.
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Affiliation(s)
- Cally J. Tann
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Maya Kohli-Lynch
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Ruth Nalugya
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Samantha Sadoo
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Karen Martin
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Rachel Lassman
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Carol Nanyunja
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Margaret Musoke
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Margaret Sewagaba
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Margaret Nampijja
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Janet Seeley
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
| | - Emily L. Webb
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, England (Dr Tann and Dr Sadoo); Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda (Drs Tann, Nampijja, and Professor Seeley and Mss Nalugya, Nanyunja, Musoke, and Sewagaba); Institute for Women's Health, University College London, London, England (Dr Tann and Dr Martin); Centre for Academic Child Health, University of Bristol, Bristol, England (Dr Kohli-Lynch); Alder Hey Children's NHS Foundation Trust, Liverpool, England (Dr Martin); Kyaninga Child Development Centre, Fort Portal, Uganda (Ms Lassman); African Population and Health Research Center, Nairobi, Kenya (Dr Nampijja); Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England (Dr Seeley); and MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England (Dr Webb)
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Tann CJ, Webb EL, Lassman R, Ssekyewa J, Sewegaba M, Musoke M, Burgoine K, Hagmann C, Deane-Bowers E, Norman K, Milln J, Kurinczuk JJ, Elliott AM, Martinez-Biarge M, Nakakeeto M, Robertson NJ, Cowan FM. Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study. EClinicalMedicine 2018; 6:26-35. [PMID: 30740596 PMCID: PMC6358042 DOI: 10.1016/j.eclinm.2018.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neonatal encephalopathy (NE) is a leading cause of global child mortality. Survivor outcomes in low-resource settings are poorly described. We present early childhood outcomes after NE in Uganda. METHODS We conducted a prospective cohort study of term-born infants with NE (n = 210) and a comparison group of term non-encephalopathic (non-NE) infants (n = 409), assessing neurodevelopmental impairment (NDI) and growth at 27-30 months. Relationships between early clinical parameters and later outcomes were summarised using risk ratios (RR). FINDINGS Mortality by 27-30 months was 40·3% after NE and 3·8% in non-NE infants. Impairment-free survival occurred in 41·6% after NE and 98·7% of non-NE infants. Amongst NE survivors, 29·3% had NDI including 19·0% with cerebral palsy (CP), commonly bilateral spastic CP (64%); 10·3% had global developmental delay (GDD) without CP. CP was frequently associated with childhood seizures, vision and hearing loss and mortality. NDI was commonly associated with undernutrition (44·1% Z-score < - 2) and microcephaly (32·4% Z-score < - 2). Motor function scores were reduced in NE survivors without CP/GDD compared to non-NE infants (median difference - 8·2 (95% confidence interval; - 13·0, - 3·7)). Neonatal clinical seizures (RR 4.1(2.0-8.7)), abnormalities on cranial ultrasound, (RR 7.0(3.8-16.3), nasogastric feeding at discharge (RR 3·6(2·1-6·1)), and small head circumference at one year (Z-score < - 2, RR 4·9(2·9-5·6)) increased the risk of NDI. INTERPRETATION In this sub-Saharan African population, death and neurodevelopmental disability after NE were common. CP was associated with sensorineural impairment, malnutrition, seizures and high mortality by 2 years. Early clinical parameters predicted impairment outcomes.
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Affiliation(s)
- Cally J Tann
- Department of Infectious Disease Epidemiology, School of Hygiene and Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Institute for Women's Health, University College London, London, UK
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Julius Ssekyewa
- Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Margaret Sewegaba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Margaret Musoke
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Kathy Burgoine
- Department of Paediatrics and Child Health, Mbale Regional Referral Hospital, and Mbale Clinical Research Institute, Mbale, Uganda
| | - Cornelia Hagmann
- University Children Hospital of Zurich and Children's Research Center, Zurich, Switzerland
| | | | - Kerstin Norman
- Uganda Maternal and Newborn Hub, Knowledge for Change, UK
| | - Jack Milln
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Clinical Research Department, Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | | | | | | | - Frances M Cowan
- Department of Paediatrics, Imperial College London, London, UK
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