Inflammatory response in a rat model of gastroschisis is associated with an increase of NF-kappaB

Is there a role for fetal interventions in gastroschisis management? - An updated comprehensive review

We conducted a comprehensive evidence-based review on the epidemiology and current standard of care of gastroschisis management as well as the pathophysiology, rationale and feasibility of fetal therapy as a viable alternative. Gastroschisis is a periumbilical abdominal wall defect characterized by abdominal viscera herniation in utero. It affects 4 in 10 000 live births, but the prevalence has steadily increased in recent years. Gastroschisis is typically diagnosed on routine second-trimester ultrasound. The overall prognosis is favorable, but complex gastroschisis, which accounts for about 10% to 15% of cases, is associated with a higher mortality, significant disease burden and higher healthcare costs due to long- and short-term complications. The current standard of care has yet to be established but generally involves continued fetal surveillance and multidisciplinary perinatal care. Postnatal surgical repair is achieved with primary closure, staged silo closure or sutureless repair. Experimental animal studies have demonstrated the feasibility of in utero closure, antiinflammatory therapy and prenatal regenerative therapy. However, reports of early preterm delivery and amnioinfusion trials have failed to show any benefit in humans. Further experimental studies and human trials are necessary to demonstrate the potential benefit of fetal therapy in gastroschisis.

The long-term neurodevelopmental and psychological outcomes of gastroschisis: A cohort study

OBJECTIVES

Previous gastroschisis specific neurodevelopmental studies have focused on the first 3years of life. The aim of this study was to assess the intellectual, behavioral and neurological outcomes of older children and adolescents born with gastroschisis.

STUDY DESIGN

Of 99 gastroschisis survivors born in Western Australia, 1992 to 2005, and who were at least 5years old, 42 agreed to take part in this study. The study assessed: intellectual ability, with age appropriate Wechsler intelligence scales; neurological status; hearing; vision; behavioral status with the Strengths and Difficulties Questionnaire (SDQ); and parenting style with the Parenting Relationship Questionnaire (PRQ). All results were compared to normative means.

RESULTS

Median age at follow-up was 10years (range 5-17). No child had evidence of cerebral palsy or hearing loss; 1 child had amblyopia. Psychometric tests were completed in 39 children: mean full scale IQ was 98.2 (standard deviation [SD] 10.7); the working memory index was the only subscale to show a significant decrease from the normative mean (mean 95.5, SD 12.4, p=0.038). The mean SDQ behavioral scores were significantly lower for 3 of 5 domains and the Total Difficulties score. PRQ scores were significantly abnormal for 4 of 7 domains: Communication, Discipline, Satisfaction with School and Relational Frustration.

CONCLUSIONS

Overall intellectual abilities were within a normal range. The decrease in working memory index and the behavioral and parenting relationship impairments could be an effect of perinatal factors, gastroschisis management and complications or the complexity of the socio-economic environment.

Spontaneous onset of labor, not route of delivery, is associated with prolonged length of stay in babies with gastroschisis

BACKGROUND/PURPOSE

We studied obstetric delivery practices for fetal gastroschisis and correlated this with neonatal outcomes. Our objectives were to identify changes in delivery practices over time and to determine if these changes resulted in improved neonatal outcomes.

METHODS

After IRB approval, maternal and neonatal records from 219 gastroschisis births between 1990 and 2008 were reviewed. Obstetrical data and neonatal data were collected. Univariate comparisons were made between maternal delivery variables and neonatal outcomes. Significant and clinically relevant obstetrical variables were combined for multivariate linear regression modeling.

RESULTS

The practice of elective cesarean delivery (ELCS) shifted to spontaneous vaginal delivery (sVD) over time (p <0.001). Babies born by sVD had longer hospitalization than those born by ELCS (median 36.0 vs 21.6days, p <0.05). Gestational age (GA) and birth weight were similar between groups. Babies born by induced VD (iVD) had short hospitalization (median 22.5days). A linear regression model demonstrated that spontaneous onset of labor (SOL) and GA were independently related to LOS.

CONCLUSIONS

Over nearly two decades, delivery of gastroschisis babies shifted from ELCS to sVD, a practice associated with a significantly longer LOS. Regression models suggest that shorter LOS could be achieved if elective delivery modes are utilized prior to SOL.

Validation of the gastroschisis experimental model and the influence of the mother's diet enriched with glutamine in the fetal morphology

PURPOSE

To validate the gastroschisis experimental model in female rats and the effects on the glutamine fetal morphology during pregnancy.

METHODS

Twelve pregnant rats Wistar were separated in two groups: Group I (n = 6 rats, 71 fetuses) took glutamine and Group II (n = 6 rats, 75 fetuses) took isocaloric supplementation. At the 18th day of pregnancy, female rats were taken to hysterotomy and the fetuses which were selected for the act of gastroschisis were partially removed from the womb and by the laparotomy technique, the exclusion of the intestine was done. After that, fetuses were put in the womb cavity again and the rats' abdomen sutured. At the 21st day of pregnancy, date before delivery, by C-section ordinary animals and the ones with gastroschisis were removed and studied separately. The morphometrical parameters studied were the body weight (PC); the intestine weight (PI); the intestine length (CI) and its relations (PI/PC, PI/CI e PC-PI).

RESULTS

The intestine weight (PI) and the intestine length (CI) were different in fetuses with gastroschisis (p<0.05), however no difference between the groups regarding supplementation with glutamine.

CONCLUSIONS

The gastroschisis experimental model is valid and reproducible. The nutritional therapy with glutamine did not change the morphometrical parameters.

The role of gut-liver axis in the restriction of intrauterine growth in a model of experimental gastroschisis

PURPOSE

To evaluate the intrauterine growth restriction (IUGR) by the expression of IR-β, IRS-1, IRS-2, IGF-IRβ and Ikappaβ in experimental model of gastroschisis.

METHODS

Pregnant rats at 18.5 days of gestation were submitted to surgery to create experimental fetal gastroschisis (term = 22 days) were divided in three groups: gastroschisis (G), control (C) and sham (S). Fetuses were evaluated for body weight (BW), intestinal (IW), liver (LW) and their relations IW/BW and LW/BW. IR-β and IGF-IRβ receptors, IRS-1 and IRS-2 substrates and Ikappaβ protein were analyzed by western blotting.

RESULTS

BW was lower in G, the IW and IW / BW were greater than C and S (p<0.05) groups. The liver showed no differences between groups. In fetuses with gastroschisis, compared with control fetuses, the expression of IGF-IRβ (p<0.001) and Ikappaβ (p<0.001) increased in the liver and intestine, as well as IR-β (p<0.001) which decreased in both. In contrast to the intestine, IRS-1 (p<0.001) increased in the liver and IRS-2 decreased (p<0.01).

CONCLUSION

The axis of the intestine liver has an important role in inflammation, with consequent changes in the metabolic pathway of glucose can contribute to the IUGR in fetuses with gastroschisis.

Gastric contractility in experimental gastroschisis

BACKGROUND/PURPOSE

The mechanism of fetal gastric dilation in gastroschisis is controversial. This study was designed to characterize changes in the contractile profile of strips of stomach from rats following experimental gastroschisis.

METHODS

Pregnant Wistar rats were operated on day 18.5. Fetuses were divided into three groups: gastroschisis (G), sham (S), and control (C). On day 21.5, gastric fundus and antrum strips were obtained and suspended to a force transducer connected to a digital data acquisition system. They were submitted to increasing concentrations of carbachol (CCh) and weighed at the end of each procedure. Frequency and amplitude of each contraction were evaluated.

RESULTS

Under basal conditions, spontaneous oscillatory contractions of antrum and fundus strips of G, S, and C were similar (P>0.05; ANOVA). However, cumulative concentrations of CCh (0.01-100 μM) produced different effects in all groups and were characterized by a significant increase in amplitude and frequency of spontaneous contractions in antral smooth muscle and a sustained increase in tonus in fundic strips. Upon analysis, no significant difference in frequency or amplitude was noted in antral tissues comparing C to G and to S (P>0.05). No significant contractility difference was noted in fundic smooth muscle (comparing all groups, P>0.05), with the CCh-induced curve following a typical sigmoidal format, dependent on increasing concentrations (P<0.001).

CONCLUSIONS

Gastric contractile responses to CCh are preserved in experimental gastroschisis. These results do not support the theory that gastric dilation occurs secondary to intestinal inflammation alone.

Corticosteroid effect upon intestinal and hepatic interleukin profile in a gastroschisis rat model

PURPOSE: To evaluate the effect of corticosteroids on intestinal and liver interleukin profile in an experimental model of gastroschisis in fetal rats. METHODS: Sprague-Dawley rats at 19.5 days of gestation had its fetuses operated for the creation of gastroschisis. Two groups of fetuses were studied with and without maternal administration of dexamethasone. Each group was composed of fetuses who underwent gastroschisis (G), control fetuses without manipulation (C) and sham fetuses (S). A dosage of the following interleukins was carried out in fetal intestinal and liver tissues: IL-1, IL-6, IL-10, tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ). The differences between the groups and subgroups were tested by ANOVA with Tukey post-test, with significant values of p<0.05. RESULTS: Dexamethasone led to an increase in intestinal and liver IL-6 (p<0.05) and a decrease in intestinal TNF-α (p<0.001) in fetuses with gastroschisis. CONCLUSION: Corticosteroids had an effect on the intestinal interleukin profile and a small effect on the liver interleukin profile due to immunological immaturity of the fetus, and also of fetuses with gastroschisis. The steroid action may not be exclusively anti-inflammatory, but also pro-inflammatory, varying with time of pregnancy.

Significance of RhoC and IQGAP1 expression in hepatocellular carcinoma

AIM: To detect the expression of RhoC and IQGAP1 proteins in hepatocellular carcinoma (HCC) and to analyze their clinicopathological significance.

METHODS: The expression of RhoC and IQGAP1 proteins was detected by immunohistochemistry in 56 HCC specimens and 15 normal liver specimens. The association of RhoC and IQGAP1 protein expression with clinicopathologicalparamters was analyzed.

RESULTS: The positive rates of RhoC and IQGAP1 expression were significantly higher in HCC than in normal liver tissue (66% vs 20%; 75% vs 13%, both P < 0.05). The expression of RhoC and IQGAP1 proteins was related to tumor differentiation and invasion in HCC (both P < 0.05). A positive correlation was noted between the expression of RhoC and that of IQGAP1 in HCC(r = 0.631, P < 0.05).

CONCLUSION: RhoC and IQGAP1 play significant roles in promoting the progression of HCC. Expression of RhoC and IQGAP1 can be used as useful parameters for clinical assessment of biological behavior and prognosis of HCC.

Treatment of murine colitis with IL-10-secreting Escherichia coli

AIM: To evaluate the therapeutic effect of interleukin-10 (IL-10)-secreting Escherichia coli (E. coli) on murine colitis.

METHODS: Sixty 6-8-wk-old female BALB/c mice were divided into six groups: normal control group, dextran sulfate sodium (DSS) group, empty plasmid-transformed E.coli (E.coli0) group, IL-10 gene-transformed E.coli (E.coli/mIL-10) group, DSS + E.coli0 group, and DSS + E.coli/mIL-10 group. The DSS, DSS + E.coli0, and DSS + E.coli/mIL-10 groups were fed 5 % DSS solution for 7 d to induce colitis, while the other groups were given normal tap water. The E.coli0 and DSS + E.coli0 groups were intragastrically given E.coli0; the E.coli/mIL-10 and DSS + E.coli/mIL-10 groups were given recombinant E.coli/mIL-10; and the DSS and normal control groups were given LB (Luria-Bertain) medium. The treatment lasted for 8 days. Disease activity index (DAI) was recorded each day. The expression of TNF-α, NF-κB p65 and myeloperoxidase (MPO) in the colon was measured at the end of the experiment.

RESULTS: Mice in the DSS + E.coli/mIL-10 group showed a lower DAI than those in the DSS and DSS + E.coli0 groups from day 4 to the end of the experiment. The levels of TNF-α and MPO in the colon and the expression of NF-κB P65 in the nuclei of inflammatory cells were lower in the DSS + E.coli/mIL-10 group (172.46 pg/g ± 22.23 pg/g, 2.35 U/g ± 0.15 U/g) than in the DSS (237.85 pg/g ± 14.86 pg/g, 4.15 U/g ± 0.29 U/g) and DSS + E.coli0 groups (239.81 pg/g ± 50.38 pg/g, 3.5 U/g ±1.23 U/g) at the end of experiment. No colonic injury was observed in mice in the normal control, E.coli/IL-10 and E.coli0 groups.

CONCLUSION: Local delivery of IL-10 gene-transformed E.coli ameliorates DSS-inducd murine colitis possibly by decreasing proinflammatory cytokine production and inhibiting NF-κB activation. Gene therapy strategies using engineered E.coli encoding immunoregulatory cytokines may provide a potential approach for treatment of inflammatory bowel disease.

Gastroschisis with extracorporeal liver and stomach associated with sacrococcygeal teratoma and limb abnormalities

Gastroschisis is the herniation of abdominal viscera through a paramedian abdominal wall fusion defect without involvement of the umbilical cord. Evisceration usually contains intestinal loops and has no surrounding membrane. Rarely, herniation of other major viscera such as stomach and liver occurs, which makes the prognosis worse. Gastroschisis is usually not associated with sacrococcygeal teratoma. In the present report, a very rare case of gastroschisis associated with sacrococcygeal teratoma is described. The gastroschisis had complete evisceration of the stomach, bowel and extracorporeal liver. A large sacrococcygeal mass was located on the posteroinferior part of the trunk and gluteal region, and was completely external. The fetus also showed a malrotated lower limb and talipes equinovarus.