1
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Randell RL, Balevic SJ, Greenberg RG, Cohen-Wolkowiez M, Thompson EJ, Venkatachalam S, Smith MJ, Bendel C, Bliss JM, Chaaban H, Chhabra R, Dammann CEL, Downey LC, Hornik C, Hussain N, Laughon MM, Lavery A, Moya F, Saxonhouse M, Sokol GM, Trembath A, Weitkamp JH, Hornik CP. Opportunistic dried blood spot sampling validates and optimizes a pediatric population pharmacokinetic model of metronidazole. Antimicrob Agents Chemother 2024; 68:e0153323. [PMID: 38477706 PMCID: PMC10994817 DOI: 10.1128/aac.01533-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Pharmacokinetic models rarely undergo external validation in vulnerable populations such as critically ill infants, thereby limiting the accuracy, efficacy, and safety of model-informed dosing in real-world settings. Here, we describe an opportunistic approach using dried blood spots (DBS) to evaluate a population pharmacokinetic model of metronidazole in critically ill preterm infants of gestational age (GA) ≤31 weeks from the Metronidazole Pharmacokinetics in Premature Infants (PTN_METRO, NCT01222585) study. First, we used linear correlation to compare 42 paired DBS and plasma metronidazole concentrations from 21 preterm infants [mean (SD): post natal age 28.0 (21.7) days, GA 26.3 (2.4) weeks]. Using the resulting predictive equation, we estimated plasma metronidazole concentrations (ePlasma) from 399 DBS collected from 122 preterm and term infants [mean (SD): post natal age 16.7 (15.8) days, GA 31.4 (5.1) weeks] from the Antibiotic Safety in Infants with Complicated Intra-Abdominal Infections (SCAMP, NCT01994993) trial. When evaluating the PTN_METRO model using ePlasma from the SCAMP trial, we found that the model generally predicted ePlasma well in preterm infants with GA ≤31 weeks. When including ePlasma from term and preterm infants with GA >31 weeks, the model was optimized using a sigmoidal Emax maturation function of postmenstrual age on clearance and estimated the exponent of weight on volume of distribution. The optimized model supports existing dosing guidelines and adds new data to support a 6-hour dosing interval for infants with postmenstrual age >40 weeks. Using an opportunistic DBS to externally validate and optimize a metronidazole population pharmacokinetic model was feasible and useful in this vulnerable population.
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Affiliation(s)
- Rachel L. Randell
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Stephen J. Balevic
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rachel G. Greenberg
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Elizabeth J. Thompson
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Michael J. Smith
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Catherine Bendel
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joseph M. Bliss
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Hala Chaaban
- Division of Neonatology, Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Rakesh Chhabra
- Division of Neonatology, Department of Pediatrics, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | | | - L. Corbin Downey
- Department of Pediatrics, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Chi Hornik
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Naveed Hussain
- Division of Neonatology, Department of Pediatrics, Connecticut Children’s, Hartford, Connecticut, USA
| | - Matthew M. Laughon
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Fernando Moya
- Division of Wilmington Pediatric Specialties, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Matthew Saxonhouse
- Division of Neonatology, Department of Pediatrics, Levine Children’s Hospital, Wake Forest School of Medicine, Charlotte campus, Atrium Healthcare, Charlotte, North Carolina, USA
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Trembath
- Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joern-Hendrik Weitkamp
- Mildred Stahlman Division of Neonatology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christoph P. Hornik
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Best Pharmaceuticals for Children Act – Pediatric Trials Network Steering Committee
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
- Division of Neonatology, Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
- Division of Neonatology, Department of Pediatrics, Hackensack University Medical Center, Hackensack, New Jersey, USA
- Department of Pediatrics, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
- Department of Pediatrics, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
- Division of Neonatology, Department of Pediatrics, Connecticut Children’s, Hartford, Connecticut, USA
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Loma Linda University, Loma Linda, California, USA
- Division of Wilmington Pediatric Specialties, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Division of Neonatology, Department of Pediatrics, Levine Children’s Hospital, Wake Forest School of Medicine, Charlotte campus, Atrium Healthcare, Charlotte, North Carolina, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Mildred Stahlman Division of Neonatology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Machut KZ, Lingappan K, Savich R, Dammann CEL. Toolkit for gender equity in pediatrics. Pediatr Res 2024; 95:594-597. [PMID: 37833527 DOI: 10.1038/s41390-023-02846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Krithika Lingappan
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Renate Savich
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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3
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Bishop CE, Machut KZ, Dammann CEL, Cuevas Guaman M, Miller ER, Lakshminrusimha S. Academic neonatologist-a species at the brink of extinction? J Perinatol 2023; 43:1526-1529. [PMID: 37872382 DOI: 10.1038/s41372-023-01803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
Neonatology is a field that is currently facing many challenges. These challenges include outdated work models in clinical environments with increasing acuity and patient workloads, physician burnout exacerbated by gender inequity and the recent COVID-19 pandemic, and inappropriate metrics to measure clinical productivity. Academic neonatologists have additional missions that include research, teaching, and scholarly productivity in the setting of an increasing clinical workload and reduced time and support for teaching and research. Within the university-based practice setting, reimbursement, and salary structure result in relatively low compensation for neonatologist clinical productivity and time. These challenges threaten the sustainability of academic neonatology as a field. Working towards potential solutions such as creation of sustainable, transparent work models, and aligned funds flow within university-based settings is imperative.
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Affiliation(s)
- Christine E Bishop
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Milenka Cuevas Guaman
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Emily R Miller
- Department of Pediatrics, Division of Neonatology, and Perinatal Institute, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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4
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Dammann CEL, Kieran K, Fromme HB, Espinosa C, Tarantino CA, Trent M, Lightdale JR, Bline K. Female Excellence and Leadership in Pediatrics Subspecialties (FLEXPeds): Creating a Network for Women Across Academic Pediatrics. J Pediatr 2023; 263:113512. [PMID: 37244585 DOI: 10.1016/j.jpeds.2023.113512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Christiane E L Dammann
- Division of Newborn Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, MA.
| | - Kathleen Kieran
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA
| | - H Barrett Fromme
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Claudia Espinosa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Morsani College of Medicine, University of South Tampa, Tampa, FL
| | - Celeste A Tarantino
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Mercy, Kansas City, MO
| | - Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Katherine Bline
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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5
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Mink RB, Carraccio CL, Herman BE, Weiss P, Turner DA, Stafford DEJ, McGann KA, Kesselheim J, Hsu DC, High PC, Fussell JJ, Curran ML, Chess PR, Sauer C, Pitts S, Myers AL, Mahan JD, Dammann CEL, Aye T, Schwartz A. Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment. BMC Med Educ 2023; 23:720. [PMID: 37789289 PMCID: PMC10548580 DOI: 10.1186/s12909-023-04689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment. OBJECTIVES We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME). METHODS In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale. RESULTS One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05). CONCLUSIONS We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.
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Affiliation(s)
- Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA.
| | | | - Bruce E Herman
- University of Utah School of Medicine, Salt Lake, UT, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Diane E J Stafford
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | | | - Pamela C High
- Alpert Medical School of Brown University, Providence, RI, USA
- Developmental-Behavioral Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
| | - Jill J Fussell
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA
| | - Megan L Curran
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cary Sauer
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Angela L Myers
- Center for Wellbeing, Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Tandy Aye
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alan Schwartz
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
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6
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Abstract
Paid family medical leave (PFML) offers infants, parents, and society at large numerous health and economic benefits. It has been shown to improve neonatal and maternal outcomes, breastfeeding rates, familial relationships, and decrease gender inequalities in the workplace. Though the economic feasibility of PFML has been well established in many countries, the USA lacks a cohesive and comprehensive federal PFML policy. Neonatal healthcare providers play a critical role in impacting neonatal health and should actively advocate for the development and promotion of a federal PFML policy, particularly one that is inclusive of both mothers and fathers and is at least 12 weeks in duration.
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Affiliation(s)
- Tamara I Arnautovic
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA.
| | - Christiane E L Dammann
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA
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7
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Myers AL, Fussell JJ, Moffatt ME, Boyer D, Ross R, Dammann CEL, Degnon L, Weiss P, Sauer C, Vinci RJ. The Importance of Subspecialty Pediatricians to the Health and Wellbeing of the Nation's Children. J Pediatr 2023:13365. [PMID: 36894130 DOI: 10.1016/j.jpeds.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
Through this review of published literature, it is clear that children benefit in measurable ways when they receive care from trained pediatric subspecialists. The improved outcomes provided by pediatric subspecialists supports the care provided in the patient's pediatric medical home and emphasizes the importance of care coordination between all components of the pediatric workforce. The AAP highlights this in a recent policy statement by stating the care provided by pediatric clinicians "encompasses diagnosis and treatment of acute and chronic health disorders; management of serious and life-threatening illnesses; and when appropriate, referral of patients with more complex conditions for medical subspecialty or surgical specialty care" Explicit in this statement is the emphasis on the role of complex care coordination between pediatric specialist and primary care pediatricians and that collaboration and guidance by the pediatrician is central to providing optimal care of patients. 65 Improving health outcomes early in life is an important public health strategy for modifying the complications from childhood chronic disease and highlights the role of pediatricians in mitigating the long-term consequences of antecedents of adult disease. 66 The recent announcement of the National Academies of Science, Engineering, and Medicine (NASEM)'s plan for a Consensus Study on The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-being is a related and exciting development, on a national scale. 67 In response to shortages and geographic maldistributions of pediatric subspecialists, the NASEM committee intends to assess the impact of current pediatric clinical workforce trends on child health and well-being, in order to develop informed strategies to ensure an adequate, high-quality pediatric workforce, with a robust research portfolio that informs those recommendations. While this large, national initiative will surely lead to a better understanding of and strategies to implement across the pediatric subspecialty workforce, more well-designed studies that specifically measure child outcomes related to access to pediatric subspecialty care, would add meaningfully to the body of pediatric literature and to our national pediatric advocacy initiatives.
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Affiliation(s)
- Angela L Myers
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Jill J Fussell
- Professor, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR
| | - Mary E Moffatt
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Debra Boyer
- DIO/Chief Medical Education Officer, Professor of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Robert Ross
- Children's Hospital of Michigan, Professor of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | | | | | - Pnina Weiss
- Professor of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Cary Sauer
- Professor of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Robert J Vinci
- Professor of Pediatrics, Boston University School of Medicine, Boston, MA
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8
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Machut KZ, Bhombal S, Escobedo M, Kataria-Hale J, Kushnir A, Lingappan K, Oji-Mmuo CN, Owens L, Savich R, Song C, Wright R, Dammann CEL. Correction to: Call to action: gender equity in neonatology. J Perinatol 2022; 42:1560. [PMID: 36195622 DOI: 10.1038/s41372-022-01511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Shazia Bhombal
- Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Marilyn Escobedo
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | | | - Alla Kushnir
- Department of Pediatrics, Cooper Children's Regional Hospital, Camden, NJ, USA
| | - Krithika Lingappan
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Lisa Owens
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Renate Savich
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Clara Song
- Southern California Permanente Medical Group, Anaheim, CA, USA
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9
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Cuevas Guaman M, Miller ER, Dammann CEL, Bishop CE, Machut KZ. Neonatologist staffing models: urgent change is needed. J Perinatol 2022; 42:1556-1557. [PMID: 36207513 PMCID: PMC9540071 DOI: 10.1038/s41372-022-01527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Milenka Cuevas Guaman
- Department of Pediatrics, Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | - Emily R Miller
- Cincinnati Children's Hospital Medical Center, Division of Neonatology, Perinatal Institute, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Christine E Bishop
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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10
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Pitts S, Schwartz A, Carraccio CL, Herman BE, Mahan JD, Sauer CG, Dammann CEL, Aye T, Myers AL, Weiss PG, Turner DA, Hsu DC, Stafford DEJ, Chess PR, Fussell JJ, McGann KA, High P, Curran ML, Mink RB. Fellow Entrustment for the Common Pediatric Subspecialty Entrustable Professional Activities Across Subspecialties. Acad Pediatr 2022; 22:881-886. [PMID: 34936942 DOI: 10.1016/j.acap.2021.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the relationship between level of supervision (LOS) ratings for the Common Pediatric Subspecialty Entrustable Professional Activities (EPAs) with their associated subcompetency milestones across subspecialties and by fellowship training year. METHODS Clinical Competency Committees (CCCs) in 14 pediatric subspecialties submitted LOS ratings for 6 Common Subspecialty EPAs and subcompetency milestone levels mapped to these EPAs. We examined associations between these subcompetency milestone levels and LOS ratings across subspecialty training year by fitting per-EPA linear mixed effects models, regressing LOS rating on milestone level and on training year. RESULTS CCCs from 211 pediatric fellowship programs provided data for 369 first, 336 second, and 331 third year fellows. Mean subcompetency milestone levels increased similarly among subspecialties for most EPAs compared with the reference, Adolescent Medicine. Mean subcompetency milestones mapped to each EPA and mean EPA LOS ratings generally increased by training year across all subspecialties. CONCLUSIONS Subcompetency milestones levels mapped to each Common Subspecialty EPA and the EPA LOS ratings increase similarly across subspecialties and by training year, providing validity evidence for using EPA LOS to assess pediatric subspecialty trainee performance. This study supports the development of tools to facilitated the CCC evaluation process across all pediatric subspecialties.
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Affiliation(s)
- Sarah Pitts
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital (S Pitts), Boston, Mass.
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, University of Illinois at Chicago College of Medicine (A Schwartz), Chicago, Ill
| | - Carol L Carraccio
- Competency-Based Medical Education, American Board of Pediatrics (CL Carraccio and DA Turner), Chapel Hill, NC
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine (BE Herman), Salt Lake City, Utah
| | - John D Mahan
- Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital (JD Mahan), Columbus, Ohio
| | - Cary G Sauer
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta (CG Sauer), Atlanta, Ga
| | | | - Tandy Aye
- Department of Pediatrics, Stanford University School of Medicine (T Aye), Los Gatos, Calif
| | - Angela L Myers
- Children's Mercy Kansas City, UMKC School of Medicine (AL Myers), Kansas City, Mo
| | - Pnina G Weiss
- Department of Pediatrics, Yale School of Medicine (PG Weiss), New Haven, Conn
| | - David A Turner
- Competency-Based Medical Education, American Board of Pediatrics (DA Turner), Chapel Hill, NC
| | - Deborah C Hsu
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital (DC Hsu), Houston, Tex
| | - Diane E J Stafford
- Department of Pediatrics, Stanford University School of Medicine, Stanford University School of Medicine, Center of Academic Medicine (DEJ Stafford), Stanford, Calif; Division of Pediatric Endocrinology (DEJ Stafford), Palo Alto, Calif
| | - Patricia R Chess
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry (PR Chess), Rochester, NY
| | - Jill J Fussell
- Department of Pediatrics, University of Arkansas for Medical Sciences (JJ Fussell), Little Rock, Ark
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center (KA McGann), Durham, NC
| | - Pamela High
- Department of Pediatrics, W. Alpert Medical School of Brown University (P High), Providence, RI
| | - Megan L Curran
- Department of Pediatrics, University of Colorado (ML Curran), Aurora, Colo
| | - Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (RB Mink); Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center (RB Mink), Torrance, Calif
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11
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Wiegel D, Dammann CEL, Nielsen HC. ErbB4 alternative splicing mediates fetal mouse alveolar type II cell differentiation in vitro. Pediatr Res 2022:10.1038/s41390-022-02013-y. [PMID: 35338350 PMCID: PMC9509489 DOI: 10.1038/s41390-022-02013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Alternative splicing (AS) creates different protein isoforms, an important mechanism regulating cell-specific function. Little is known about AS in lung development, particularly in alveolar type II (ATII) cells. ErbB4 receptor isoforms Jma and Jmb have significant and opposing functions in the brain, heart, and lung development and/or disease. However, the regulators of ErbB4 AS are unknown. ErbB4 AS regulators in fetal mouse ATII cells control its function in ATII cell maturation. METHODS Candidate ErbB4 AS regulators were found using in silico analysis. Their developmental expression was studied in fetal mouse ATII cells. The effects of splice factor downregulation and upregulation on ATII cell maturation were analyzed. RESULTS ErbB4-Jma increased significantly in ATII cells after gestation E16.5. In silico analysis found four candidate splice factors: FOX2, CUG/CELF1, TIAR, and HUB. Fetal ATII cells expressed these factors in distinct developmental profiles. HUB downregulation in E17.5 ATII cells increased Jma isoform levels and Sftpb gene expression and decreased Jmb. HUB overexpression decreased Jma and Sftpb. CONCLUSIONS ErbB4 AS is developmentally controlled by HUB in fetal ATII cells, promoting ATII differentiation. Regulated AS expression during ATII cell differentiation suggests novel therapeutic strategies to approach human disease. IMPACT Alternative splicing (AS) of the ErbB4 receptor, involving mutually exclusive exon inclusion, creates Jma and Jmb isoforms with distinct differences in receptor processing and function. The Jma isoform of ErbB4 promotes differentiation of fetal lung alveolar type II cells. The AS is mediated in part by the RNA-binding protein HUB. The molecular mechanism of AS for ErbB4 has not been previously described. The regulation of ErbB4 AS has important implications in the development of organs, such as the lung, brain, and heart, and for disease, including cancer.
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Affiliation(s)
- Dorothea Wiegel
- Hannover Medical School, 30625, Hannover, Germany
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA, 02111, USA
| | - Christiane E L Dammann
- Hannover Medical School, 30625, Hannover, Germany
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA, 02111, USA
- Graduate School for Biomedical Sciences, Tufts University, Boston, MA, USA
| | - Heber C Nielsen
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA, 02111, USA.
- Graduate School for Biomedical Sciences, Tufts University, Boston, MA, USA.
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12
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Bline K, Dammann CEL. Improving workplace culture by increasing financial transparency. Pediatr Res 2022; 92:1492-1493. [PMID: 35354929 PMCID: PMC8965538 DOI: 10.1038/s41390-022-02033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Katherine Bline
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA.
| | - Christiane E. L. Dammann
- grid.67033.310000 0000 8934 4045Division of Newborn Medicine, Department of Pediatrics, Tufts Children’s Hospital, Tufts University School of Medicine, Boston, MA USA
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13
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Weiss PG, Schwartz A, Carraccio CL, Herman BE, Turner DA, Aye T, Fussell JJ, Kesselheim J, Mahan JD, McGann KA, Myers A, Stafford DEJ, Chess PR, Curran ML, Dammann CEL, High P, Hsu DC, Pitts S, Sauer C, Srivastava S, Mink RB. Achieving Entrustable Professional Activities During Fellowship. Pediatrics 2021; 148:peds.2021-050196. [PMID: 34667096 DOI: 10.1542/peds.2021-050196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Entrustable Professional Activities (EPAs) were developed to assess pediatric fellows. We previously showed that fellowship program directors (FPDs) may graduate fellows who still require supervision. How this compares with their expectations for entrustment of practicing subspecialists is unknown. METHODS We surveyed US FPDs in 14 pediatric subspecialties through the Subspecialty Pediatrics Investigator Network between April and August 2017. For each of 7 common pediatric subspecialty EPAs, we compared the minimum level of supervision that FPDs required for graduation with the level they expected of subspecialists for safe and effective practice using the Friedman rank sum test and paired t test. We compared differences between subspecialties using linear regression. RESULTS We collected data from 660 FPDs (response rate 82%). For all EPAs, FPDs did not require fellows to reach the level of entrustment for graduation that they expected of subspecialists to practice (P < .001). FPDs expected the least amount of supervision for the EPAs consultation and handovers. Mean differences between supervision levels for graduation and practice were smaller for clinical EPAs (consultation, handovers, lead a team) when compared with nonclinical EPAs (quality improvement, management, lead the profession and scholarship; P = .001) and were similar across nearly all subspecialties. CONCLUSIONS Fellowship graduates may need continued development of clinical and nonclinical skills in their early practice period, underscoring a need for continued assessment and mentoring. Graduation readiness must be based on clear requirements, with alignment of FPD expectations and regulatory standards, to ensure quality care for patients.
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Affiliation(s)
- Pnina G Weiss
- Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - Bruce E Herman
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Tandy Aye
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Jill J Fussell
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer Kesselheim
- Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - John D Mahan
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kathleen A McGann
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Angela Myers
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Diane E J Stafford
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | | | - Megan L Curran
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | | | - Pamela High
- Department of Pediatrics, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Deborah C Hsu
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Sarah Pitts
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Cary Sauer
- Department of Pediatrics, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.,The Lundquist Institute for Biomedical Innovation, Harbor-University of California, Los Angeles Medical Center, Torrance, California
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14
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Sawyer T, Stavroudis TA, Ades A, Dadiz R, Dammann CEL, Halamek LP, Moussa A, Soghier L, Gupta A, Aliaga S, Umoren R, French H. Simulation in Neonatal-Perinatal Medicine Fellowship Programs. Am J Perinatol 2020; 37:1258-1263. [PMID: 31307105 DOI: 10.1055/s-0039-1693465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the use of simulation in neonatal-perinatal medicine (NPM) fellowship programs. STUDY DESIGN This was a cross-sectional survey of program directors (PDs) and simulation educators in Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowship programs. RESULTS Responses were received from 59 PDs and 52 simulation educators, representing 60% of accredited programs. Of responding programs, 97% used simulation, which most commonly included neonatal resuscitation (94%) and procedural skills (94%) training. The time and scope of simulation use varied significantly. The majority of fellows (51%) received ≤20 hours of simulation during training. The majority of PDs (63%) wanted fellows to receive >20 hours of simulation. Barriers to simulation included lack of faculty time, experience, funding, and curriculum. CONCLUSION While the majority of fellowship programs use simulation, the time and scope of fellow exposure to simulation experiences are limited. The creation of a standardized simulation curriculum may address identified barriers to simulation.
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Affiliation(s)
- Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Theodora A Stavroudis
- Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, Fetal and Neonatal Institute, University of Southern California, Los Angeles, California
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Christiane E L Dammann
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ahmed Moussa
- Division of Neonatology, Department of Pediatrics, Sainte-Justine Hospital University Center, University of Montreal, Montreal, Canada
| | - Lamia Soghier
- Department of Neonatology, Children's National Health System, Washington, District of Columbia
| | - Arika Gupta
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sofia Aliaga
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Heather French
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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15
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Schmiedl A, Bokel K, Huhn V, Ionescu L, Zscheppang K, Dammann CEL. Bone marrow stem cells accelerate lung maturation and prevent the LPS-induced delay of morphological and functional fetal lung development in the presence of ErbB4. Cell Tissue Res 2020; 380:547-564. [PMID: 32055958 DOI: 10.1007/s00441-019-03145-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/18/2019] [Indexed: 12/28/2022]
Abstract
ErbB4 is a regulator in lung development and disease. Prenatal infection is an important risk factor for the delay of morphologic lung development, while promoting the maturation of the surfactant system. Bone marrow-derived mesenchymal stem cells (BMSCs) have the potential to prevent lung injury. We hypothesized that BMSCs in comparison with hematopoietic control stem cells (HPSCs) minimize the lipopolysaccharide (LPS)-induced lung injury only when functional ErbB4 receptor is present. We injected LPS and/or murine green fluorescent protein-labeled BMSCs or HPSCs into the amniotic cavity of transgenic ErbB4heart mothers at gestational day 17. Fetal lungs were analyzed 24 h later. BMSCs minimized significantly LPS-induced delay in morphological lung maturation consisting of a stereologically measured increase in mesenchyme and septal thickness and a decrease of future airspace and septal surface. This effect was more prominent and significant in the ErbB4heart+/- lungs, suggesting that the presence of functioning ErbB4 signaling is required. BMSC also diminished the LPS induced increase in surfactant protein (Sftp)a mRNA and decrease in Sftpc mRNA is only seen if ErbB4 is present. The reduction of morphological delay of lung development and of levels of immune-modulating Sftp was more pronounced in the presence of the ErbB4 receptor. Thus, ErbB4 may be required for the protective signaling of BMSCs.
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Affiliation(s)
- Andreas Schmiedl
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center of Lung Research (DZL), Hannover, Germany.
| | - Kyra Bokel
- Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Verena Huhn
- Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Lavinia Ionescu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Katja Zscheppang
- Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christiane E L Dammann
- Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
- Graduate School for Biomedical Sciences, Tufts University, Boston, MA, USA
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16
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Mink R, Herman BE, Carraccio C, Aye T, Baffa JM, Chess PR, Fussell JJ, Sauer CG, Stafford DEJ, Weiss P, Curran ML, Dammann CEL, High PC, Hsu D, Kesselheim JC, Mahan JD, McGann KA, Myers AL, Pitts S, Turner DA, Schwartz A. Agreement of Program Directors With Clinical Competency Committees for Fellow Entrustment. J Med Educ Curric Dev 2020; 7:2382120520936613. [PMID: 32844115 PMCID: PMC7418246 DOI: 10.1177/2382120520936613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/29/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Fellowship program directors (FPD) and Clinical Competency Committees (CCCs) both assess fellow performance. We examined the association of entrustment levels determined by the FPD with those of the CCC for 6 common pediatric subspecialty entrustable professional activities (EPAs), hypothesizing there would be strong correlation and minimal bias between these raters. METHODS The FPDs and CCCs separately assigned a level of supervision to each of their fellows for 6 common pediatric subspecialty EPAs. For each EPA, we determined the correlation between FPD and CCC assessments and calculated bias as CCC minus FPD values for when the FPD was or was not a member of the CCC. In addition, we examined the effect of program size, FPD understanding of EPAs, and subspecialty on the correlations. Data were obtained in fall 2014 and spring 2015. RESULTS A total of 1040 fellows were assessed in the fall and 1048 in the spring. In both periods and for each EPA, there was a strong correlation between FPD and CCC supervision levels (P < .001). The correlation was somewhat lower when the FPD was not a CCC member (P < .001). Overall bias in both periods was small. CONCLUSIONS The correlation between FPD and CCC assignment of EPA supervision levels is strong. Although slightly weaker when the FPD is not a CCC member, bias is small, so this is likely unimportant in determining fellow entrustment level. The similar performance ratings of FPDs and CCCs support the validity argument for EPAs as competency-based assessment tools.
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Affiliation(s)
- Richard Mink
- Department of Pediatrics, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA, USA
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Tandy Aye
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeanne M Baffa
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Patricia R Chess
- Department of Pediatrics and Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Jill J Fussell
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cary G Sauer
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Diane E J Stafford
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Megan L Curran
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Pamela C High
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Deborah Hsu
- Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer C Kesselheim
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - John D Mahan
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Angela L Myers
- Department of Pediatrics, Children’s Mercy, School of Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Sarah Pitts
- Divisions of Adolescent Medicine and of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Turner
- Department of Pediatrics, Division of Pediatric Critical Care, Duke Children’s Hospital, Durham, NC, USA
| | - Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL, USA; Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN)
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17
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Abstract
Objective: To evaluate the association between morbidities preceding and following neonatal intensive care unit (NICU) admission with hypothermia.Study design: NICU admission temperatures for 1271 infants admitted to the NICU at Tufts Medical Center (TMC) between 2012 and 2015 were compared to all Vermont Oxford Network (VON) centers in 2014. We analyzed demographic data, prevalence of hypothermia, and associations with prenatal and neonatal morbidities.Result: Prevalence of hypothermia at TMC was 19% compared to 25% in the VON. We found a significant association between hypothermia and maternal race, birth weight, gestational age, antenatal steroids, chorioamnionitis, mode of delivery, and Apgar scores.Conclusion: Continued emphasis should be placed on avoiding neonatal hypothermia during the first hours of postnatal life.
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Affiliation(s)
| | - Kristyn S Beam
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
| | - Olaf Dammann
- Tufts University School of Medicine, Boston, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.,Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany
| | - Christiane E L Dammann
- Tufts University School of Medicine, Boston, MA, USA.,Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
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18
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Ricard CA, Dammann CEL, Dammann O. Screening Tool for Early Postnatal Prediction of Retinopathy of Prematurity in Preterm Newborns (STEP-ROP). Neonatology 2017; 112:130-136. [PMID: 28501874 DOI: 10.1159/000464459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/23/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a disorder of the preterm newborn characterized by neurovascular disruption in the immature retina that may cause visual impairment and blindness. OBJECTIVE To develop a clinical screening tool for early postnatal prediction of ROP in preterm newborns based on risk information available within the first 48 h of postnatal life. METHODS Using data submitted to the Vermont Oxford Network (VON) between 1995 and 2015, we created logistic regression models based on infants born <28 completed weeks gestational age. We developed a model with 60% of the data and identified birth weight, gestational age, respiratory distress syndrome, non-Hispanic ethnicity, and multiple gestation as predictors of ROP. We tested the model in the remaining 40%, performed tenfold cross-validation, and tested the score in ELGAN study data. RESULTS Of the 1,052 newborns in the VON database, 627 recorded an ROP status. Forty percent had no ROP, 40% had mild ROP (stages 1 and 2), and 20% had severe ROP (stages 3-5). We created a weighted score to predict any ROP based on the multivariable regression model. A cutoff score of 5 had the best sensitivity (95%, 95% CI 93-97), while maintaining a strong positive predictive value (63%, 95% CI 57-68). When applied to the ELGAN data, sensitivity was lower (72%, 95% CI 69-75), but PPV was higher (80%, 95% CI 77-83). CONCLUSIONS STEP-ROP is a promising screening tool. It is easy to calculate, does not rely on extensive postnatal data collection, and can be calculated early after birth. Early ROP screening may help physicians limit patient exposure to additional risk factors, and may be useful for risk stratification in clinical trials aimed at reducing ROP.
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Affiliation(s)
- Caroline A Ricard
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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19
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Kerk J, Dördelmann M, Bartels DB, Brinkhaus MJ, Dammann CEL, Dörk T, Dammann O. MUltiplex Measurement of Cytokine/Receptor Gene Polymorphisms and interaction Between Interleukin-10 (-1082) Genotype and Chorioamnionitis in Extreme Preterm Delivery. ACTA ACUST UNITED AC 2016; 13:350-6. [PMID: 16814164 DOI: 10.1016/j.jsgi.2006.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To establish a multiplex amplification refractory mutation system (ARMS) in fluid and dried whole blood, and to perform a pilot study to examine the role for single-nucleotide polymorphisms (SNPs) of inflammation-associated genes (interleukin [IL]-1 and -10, tumor necrosis factor-alpha [TNFA], and toll-like receptor-4 [TLR4]) and their interaction with clinical chorioamnionitis (CAM) in prematurity. METHODS We established a quadruplex ARMS to detect the four above SNPs. Fifty-four women delivered at gestational age less than 32 weeks and 83 healthy female volunteers were genotyped. We compared (1) mothers of preterm infants with volunteers, and (2) women delivered before 29 weeks' gestation (n = 29) with those delivered at 29 to 31 completed weeks (n = 25). RESULTS Multiplex ARMS is feasible using both fluid and dried whole blood. We found no overall differences in genotype and allele frequencies between mothers of preterm infants and volunteers. Among women who had a preterm delivery, those with both CAM and IL10(-1082)*G allele, the risk for delivery before 29 weeks was markedly increased (odds ratio [OR] 22, 95% confidence interval [CI] 2.5 - 191). CONCLUSION The presence of both CAM and IL10(-1082)*G might play a role in extreme preterm delivery less than 29 weeks.
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Affiliation(s)
- Julia Kerk
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
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20
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Marten E, Nielsen HC, Dammann CEL. Interdependent TTF1 - ErbB4 interactions are critical for surfactant protein-B homeostasis in primary mouse lung alveolar type II cells. J Cell Commun Signal 2015. [PMID: 26198867 DOI: 10.1007/s12079-015-0299-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
ErbB4 receptor and thyroid transcription factor (TTF)-1 are important modulators of fetal alveolar type II (ATII) cell development and injury. ErbB4 is an upstream regulator of TTF-1, promoting its expression in MLE-12 cells, an ATII cell line. Both proteins are known to promote surfactant protein-B gene (SftpB) and protein (SP-B) expression, but their feedback interactions on each other are not known. We hypothesized that TTF-1 expression has a feedback effect on ErbB4 expression in an in-vitro model of isolated mouse ATII cells. We tested this hypothesis by analyzing the effects of overexpressing HER4 and Nkx2.1, the genes of ErbB4 and TTF-1 on TTF-1 and ErbB4 protein expression, respectively, as well as SP-B protein expression in primary fetal mouse lung ATII cells. Transient ErbB4 protein overexpression upregulated TTF-1 protein expression in primary fetal ATII cells, similarly to results previously shown in MLE-12 cells. Transient TTF-1 protein overexpression down regulated ErbB4 protein expression in both cell types. TTF-1 protein was upregulated in primary transgenic ErbB4-depleted adult ATII cells, however SP-B protein expression in these adult transgenic ATII cells was not affected by the absence of ErbB4. The observation that TTF-1 is upregulated in fetal ATII cells by ErbB4 overexpression and also in ErbB4-deleted adult ATII cells suggests additional factors interact with ErbB4 to regulate TTF-1 levels. We conclude that the interdependency of TTF-1 and ErbB4 is important for surfactant protein levels. The interactive regulation of ErbB4 and TTF-1 needs further elucidation.
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Affiliation(s)
- Elger Marten
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.,Hannover Medical School, Hannover, 30625, Germany
| | - Heber C Nielsen
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.,Sackler School for Biomedical Sciences, Tufts University, Boston, MA, 02111, USA
| | - Christiane E L Dammann
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA. .,Hannover Medical School, Hannover, 30625, Germany. .,Sackler School for Biomedical Sciences, Tufts University, Boston, MA, 02111, USA.
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21
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Vogelgesang A, Scapin C, Barone C, Tam E, Blumental Perry A, Dammann CEL. Cigarette smoke exposure during pregnancy alters fetomaternal cell trafficking leading to retention of microchimeric cells in the maternal lung. PLoS One 2014; 9:e88285. [PMID: 24832066 PMCID: PMC4022454 DOI: 10.1371/journal.pone.0088285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 01/07/2014] [Indexed: 01/09/2023] Open
Abstract
Cigarette smoke exposure causes chronic oxidative lung damage. During pregnancy, fetal microchimeric cells traffic to the mother. Their numbers are increased at the site of acute injury. We hypothesized that milder chronic diffuse smoke injury would attract fetal cells to maternal lungs. We used a green-fluorescent-protein (GFP) mouse model to study the effects of cigarette smoke exposure on fetomaternal cell trafficking. Wild-type female mice were exposed to cigarette smoke for about 4 weeks and bred with homozygote GFP males. Cigarette smoke exposure continued until lungs were harvested and analyzed. Exposure to cigarette smoke led to macrophage accumulation in the maternal lung and significantly lower fetal weights. Cigarette smoke exposure influenced fetomaternal cell trafficking. It was associated with retention of GFP-positive fetal cells in the maternal lung and a significant reduction of fetal cells in maternal livers at gestational day 18, when fetomaternal cell trafficking peaks in the mouse model. Cells quickly clear postpartum, leaving only a few, difficult to detect, persisting microchimeric cells behind. In our study, we confirmed the postpartum clearance of cells in the maternal lungs, with no significant difference in both groups. We conclude that in the mouse model, cigarette smoke exposure during pregnancy leads to a retention of fetal microchimeric cells in the maternal lung, the site of injury. Further studies will be needed to elucidate the effect of cigarette smoke exposure on the phenotypic characteristics and function of these fetal microchimeric cells, and confirm its course in cigarette smoke exposure in humans.
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Affiliation(s)
- Anja Vogelgesang
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, United States of America
- Hanover Medical School, Hanover, Germany
| | - Cristina Scapin
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, United States of America
- Genetic and Cellular Biology Division, Dibit. San Raffaele Scientific Institute, Milan, Italy
| | - Caroline Barone
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Elaine Tam
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Anna Blumental Perry
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, United States of America
- Department of Biomedical Sciences, Mercer School of Medicine and Department of Laboratory Oncology Research, Anderson Cancer Institute, Memorial University Medical Center, Savannah, Georgia, United States of America
| | - Christiane E. L. Dammann
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, United States of America
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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22
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Parker TA, Aucott SW, Bendel CM, Dammann CEL, Rice WR, Savich RD, Wertheimer FB, Barry JS, Barry JS. The new 6-unit individualized curriculum for pediatric residents: the perspective of neonatology fellowship program directors. J Perinatol 2013; 33:910-3. [PMID: 23970207 DOI: 10.1038/jp.2013.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 07/12/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Starting in 2013, all pediatric residents entering fellowship must be provided six educational units whose structure is to be determined by their individual career plans. We sought to determine whether (1) neonatology fellowship program directors (PDs) consistently identify certain weaknesses among incoming fellows and (2) neonatology fellowship PDs agree on the most beneficial activities in which pediatric residents should participate to improve preparation for entry into neonatology fellowships. STUDY DESIGN We sent a 21-question survey focused on the structure and implementation of the 6-unit curriculum to all members of the Organization of Neonatology Training Program Directors. RESULTS Sixty-seven percent of PDs responded. Seventy-five percent cited insufficient procedural skills as the primary weakness of incoming fellows. More than 80% rated additional training in clinical neonatology, including procedural and resuscitation training, as 'beneficial' or 'highly beneficial'. In contrast, fewer than 40% of PDs gave the same positive ratings to activities broadly focused on scholarship. CONCLUSIONS The results of the survey may help guide pediatric residency programs as they undertake development of these new curricular initiatives for individual residents entering neonatology.
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Affiliation(s)
- T A Parker
- University of Colorado School of Medicine, Aurora, CO, USA
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Zscheppang K, Giese U, Hoenzke S, Wiegel D, Dammann CEL. ErbB4 is an upstream regulator of TTF-1 fetal mouse lung type II cell development in vitro. Biochim Biophys Acta 2013; 1833:2690-2702. [PMID: 23845988 DOI: 10.1016/j.bbamcr.2013.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 02/07/2023]
Abstract
TTF-1 is an important transcription factor in lung development and lung disease and is essential for lung cell differentiation, specifically surfactant protein (Sftp) expression. The molecular mechanisms that drive the expression and transcriptional control of TTF-1 are not fully understood. In the fetal lung, ErbB4 functions as a transcriptional co-factor and regulates the timely onset of fetal Sftp expression. We speculate that ErbB4 is an upstream regulator of TTF-1 and regulates Sftpb expression via this pathway in alveolar type II cells. Neuregulin-induced ErbB4 and TTF-1 signaling interactions were studied by co-immunoprecipitation and confocal microscopy. Overexpression of ErbB4 and TTF-1 was analyzed in its effect on cell viability, Sftpb expression, TTF-1 expression, and Sftpb and TTF-1 promoter activity. The effect of ErbB4 deletion and ErbB4 nuclear translocation on TTF-1 expression was studied in primary fetal type II epithelial cells, isolated from transgenic HER4(heart(-/-)) mice. ErbB4 ligand neuregulin induces ErbB4 and TTF-1 co-precipitation and nuclear colocalization. Combined ErbB4 and TTF-1 overexpression inhibits cell viability, while promoting Sftpb expression more than single overexpression of each protein. NRG stimulates TTF-1 expression in ErbB4-overexpressing epithelial cells, while this effect is absent in ErbB4-depleted cells. In primary fetal type II cells, ErbB4 nuclear translocation is critical for its regulation of TTF-1-induced Sftpb upregulation. TTF-1 overexpression did not overcome this important requirement. We conclude that ErbB4 is a critical upstream regulator of TTF-1 in type II epithelial cells and that this interaction is important for Sftpb regulation.
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Affiliation(s)
- Katja Zscheppang
- Department of Pediatrics, Hannover Medical School, Hannover 30625, Germany; Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA
| | - Ulrike Giese
- Department of Pediatrics, Hannover Medical School, Hannover 30625, Germany
| | - Stefan Hoenzke
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA
| | - Dorothea Wiegel
- Department of Pediatrics, Hannover Medical School, Hannover 30625, Germany; Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA
| | - Christiane E L Dammann
- Department of Pediatrics, Hannover Medical School, Hannover 30625, Germany; Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA; Sackler School for Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USA.
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24
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Schmiedl A, Behrens J, Zscheppang K, Purevdorj E, von Mayersbach D, Liese A, Dammann CEL. Lipopolysaccharide-induced injury is more pronounced in fetal transgenic ErbB4-deleted lungs. Am J Physiol Lung Cell Mol Physiol 2011; 301:L490-9. [PMID: 21724861 DOI: 10.1152/ajplung.00131.2010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pulmonary ErbB4 deletion leads to a delay in fetal lung development, alveolar simplification, and lung function disturbances in adult mice. We generated a model of intrauterine infection in ErbB4 transgenic mice to study the additive effects of antenatal LPS administration and ErbB4 deletion during fetal lung development. Pregnant mice were treated intra-amniotically with an LPS dose of 4 μg at E17 of gestation. Lungs were analyzed 24 h later. A significant influx of inflammatory cells was seen in all LPS-treated lungs. In heterozygote control lungs, LPS treatment resulted in a delay of lung morphogenesis characterized by a significant increase in the fraction of mesenchyme, a decrease in gas exchange area, and disorganization of elastic fibers. Surfactant protein (Sftp)b and Sftpc were upregulated, but mRNA of Sftpb and Sftpc was downregulated compared with non-LPS-treated controls. The mRNA of Sftpa1 and Sftpd was upregulated. In ErbB4-deleted lungs, the LPS effects were more pronounced, resulting in a further delay in morphological development, a more pronounced inflammation in the parenchyma, and a significant higher increase in all Sftp. The effect on Sftpb and Sftpc mRNA was somewhat different, resulting in a significant increase. These results imply a major role of ErbB4 in LPS-induced signaling in structural and functional lung development.
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Affiliation(s)
- Andreas Schmiedl
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
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25
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Zscheppang K, Dörk T, Schmiedl A, Jones FE, Dammann CEL. Neuregulin receptor ErbB4 functions as a transcriptional cofactor for the expression of surfactant protein B in the fetal lung. Am J Respir Cell Mol Biol 2011; 45:761-7. [PMID: 21317380 DOI: 10.1165/rcmb.2010-0179oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Sufficient pulmonary surfactant production is required for the fetal-neonatal transition, especially in preterm infants. Neuregulin (NRG) and its transmembrane receptor ErbB4 positively regulate the onset of fetal surfactant synthesis. Details of this signaling process remain to be elucidated. ErbB4 is known to regulate gene expression in the mammary gland, where the receptor associates with the signal transducer and activator of transcription Stat5a to transactivate the β-casein gene promoter. We hypothesized that in the fetal lung, ErbB4 functions as a transcriptional regulator for surfactant protein B (Sftpb), the most critical surfactant protein gene. Re-expressing full-length ErbB4 in primary fetal ErbB4-depleted Type II epithelial cells led to an increased expression of Sftpb mRNA. This stimulatory effect required the nuclear translocation of ErbB4 and association with Stat5a, with the resultant binding to and activation of the Sftpb promoter. We conclude that ErbB4 directly regulates important aspects of fetal lung maturation that help prepare for the fetal-neonatal transition.
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Affiliation(s)
- Katja Zscheppang
- Department of Pediatrics, Hannover Medical School, Hannover, Germany
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Chen M, Citil A, McCabe F, Leicht KM, Fiascone J, Dammann CEL, Dammann O. Infection, oxygen, and immaturity: interacting risk factors for retinopathy of prematurity. Neonatology 2011; 99:125-32. [PMID: 20733333 PMCID: PMC2939989 DOI: 10.1159/000312821] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/06/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interactions among known risk factors for retinopathy of prematurity (ROP) remain to be clarified. OBJECTIVES The aim of this study was to identify risk factors associated with ROP and to explore the interrelationships between prominent risk factors for ROP. METHODS From an institutional cohort of 1,646 very preterm newborns with gestational age <30 weeks or birth weight <1,501 g, we selected infants with a gestational age <30 weeks who met the criteria for ROP screening (n = 622) for a nested case-control analysis. RESULTS Of the 622 eligible newborns, 293 (47%) were diagnosed with ROP. From multivariable analyses, gestational age <26 weeks (OR 2.9, CI 1.7-4.9), oxygen exposure at 28 days (OR 1.7, CI 1.0-2.7), and neonatal sepsis (OR 2.1, CI 1.4-3.2) emerged as prominent risk factors for ROP. Oxygen- associated ROP risk was more prominent among infants of 23-25 weeks' gestational age, while infection-associated ROP risk was higher among infants born at 28-29 weeks. The OR for the joint effect of all 3 risk factors (23.5) was higher than would have been expected under the additive (8.6) and the multiplicative (16.5) patterns of interaction. CONCLUSIONS Our study suggests that neonatal sepsis, oxygen exposure, and low gestational age are not only independently associated with a significantly increased risk of ROP, but also interact beyond additive and even multiplicative patterns.
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Affiliation(s)
- Minghua Chen
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111-1526, USA.
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27
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Hoeing K, Zscheppang K, Mujahid S, Murray S, Volpe MV, Dammann CEL, Nielsen HC. Presenilin-1 processing of ErbB4 in fetal type II cells is necessary for control of fetal lung maturation. Biochim Biophys Acta 2010; 1813:480-91. [PMID: 21195117 DOI: 10.1016/j.bbamcr.2010.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 11/29/2010] [Accepted: 12/21/2010] [Indexed: 11/19/2022]
Abstract
Maturation of pulmonary fetal type II cells to initiate adequate surfactant production is crucial for postnatal respiratory function. Little is known about specific mechanisms of signal transduction controlling type II cell maturation. The ErbB4 receptor and its ligand neuregulin (NRG) are critical for lung development. ErbB4 is cleaved at the cell membrane by the γ-secretase enzyme complex whose active component is either presenilin-1 (PSEN-1) or presenilin-2. ErbB4 cleavage releases the 80kDa intracellular domain (4ICD), which associates with chaperone proteins such as YAP (Yes-associated protein) and translocates to the nucleus to regulate gene expression. We hypothesized that PSEN-1 and YAP have a development-specific expression in fetal type II cells and are important for ErbB4 signaling in surfactant production. In primary fetal mouse E16, E17, and E18 type II cells, PSEN-1 and YAP expression increased at E17 and E18 over E16. Subcellular fractionation showed a strong cytosolic and a weaker membrane location of both PSEN-1 and YAP. This was enhanced by NRG stimulation. Co-immunoprecipitations showed ErbB4 associated separately with PSEN-1 and with YAP. Their association, phosphorylation, and co-localization were induced by NRG. Confocal immunofluorescence and nuclear fractionation confirmed these associations in a time-dependent manner after NRG stimulation. Primary ErbB4-deleted E17 type II cells were transfected with a mutant ErbB4 lacking the γ-secretase binding site. When compared to transfection with wild-type ErbB4, the stimulatory effect of NRG on surfactant protein mRNA expression was lost. We conclude that PSEN-1 and YAP have crucial roles in ErbB4 signal transduction during type II cell maturation.
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Affiliation(s)
- Kristina Hoeing
- Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, 800 Washington Street, Box 097, Boston, MA 02111, USA
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28
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Hoffmann I, Bueter W, Zscheppang K, Brinkhaus MJ, Liese A, Riemke S, Dörk T, Dammann O, Dammann CEL. Neuregulin-1, the fetal endothelium, and brain damage in preterm newborns. Brain Behav Immun 2010; 24:784-91. [PMID: 19733651 PMCID: PMC2885532 DOI: 10.1016/j.bbi.2009.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 08/25/2009] [Accepted: 08/26/2009] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the potential role for Neuregulin-1 (NRG1) as a systemic endogenous protector in the setting of perinatal inflammatory brain damage. METHODS We measured NRG1-protein and mRNA levels in human umbilical venous endothelial cells (HUVECs) of different gestational ages at various durations of exposure to lipopolysaccharide (LPS). In parallel, we genotyped the donor individuals for SNP8NRG221533, a disease-related single nucleotide polymorphism in the 5' region upstream of the NRG1 sequence. Intracellular NRG1 localization was visualized by confocal microscopy. Furthermore we analyzed the relationship between SNP8NRG221533 genotype and neurodevelopmental outcome in children born preterm. RESULTS We observed a positive dose-response-relationship between NRG1-mRNA and intracellular protein levels with both advancing gestational age and duration of LPS exposure in HUVECs. The presence of allele C at the SNP8NRG221533 locus was associated with an increased cellular production of NRG1 in HUVECs, and with a significantly reduced risk for cerebral palsy and developmental delay in children born preterm. INTERPRETATION In conclusion, our data indicate that gestational age, duration of LPS exposure, and the SNP8NRG221533 genotype affect NRG1 levels. Our results support the hypothesis that NRG1 may qualify as an endogenous protector during fetal development.
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Affiliation(s)
- Insa Hoffmann
- Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Wolfgang Bueter
- Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany
| | - Katja Zscheppang
- Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany
| | | | - Andrea Liese
- Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Stefan Riemke
- Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Olaf Dammann
- Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany,Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA,Neuroepidemiology Unit, Children's Hospital, Boston, MA, USA
| | - Christiane E. L. Dammann
- Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany,Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA, USA
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29
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Abstract
CONTEXT Low oxygen saturation appears to decrease the risk of severe retinopathy of prematurity (ROP) in preterm newborns when administered during the first few weeks after birth. High oxygen saturation seems to reduce the risk at later postmenstrual ages (PMAs). However, previous clinical studies are not conclusive individually. OBJECTIVE To perform a systematic review and meta-analysis to report the association between severe ROP incidence of premature infants with high or low target oxygen saturation measured by pulse oximetry. METHODS Studies were identified through PubMed and Embase literature searches through May 2009 by using the terms "retinopathy of prematurity and oxygen" or "retinopathy of prematurity and oxygen therapy." We selected 10 publications addressing the association between severe ROP and target oxygen saturation measured by pulse oximetry. Using a random-effects model we calculated the summary-effect estimate. We visually inspected funnel plots to examine possible publication bias. RESULTS Low oxygen saturation (70%-96%) in the first several postnatal weeks was associated with a reduced risk of severe ROP (risk ratio [RR]: 0.48 [95% confidence interval (CI): 0.31-0.75]). High oxygen saturation (94%-99%) at > or = 32 weeks' PMA was associated with a decreased risk for progression to severe ROP (RR: 0.54 [95% CI: 0.35-0.82]). CONCLUSIONS Among preterm infants with a gestational age of < or = 32 weeks, early low and late high oxygen saturation were associated with a reduced risk for severe ROP. We feel that a large randomized clinical trial with long-term developmental follow-up is warranted to confirm this meta-analytic result.
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Affiliation(s)
- Minghua L. Chen
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Lei Guo
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,School of Medicine, Zhejiang University, Hangzhou, China
| | - Lois E. H. Smith
- Department of Ophthalmology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christiane E. L. Dammann
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts,Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Olaf Dammann
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts,Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany,Neuroepidemiology Unit, Department of Neurology, Children’s Hospital Boston, Boston, Massachusetts
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30
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Pleickhardt EP, Celandine A, Davis JM, Chen M, Schürmann P, Dörk T, Dammann CEL, Dammann O. Neuregulin-1 high-producer genotype is associated with a decreased risk of admission to the neonatal intensive care unit. Early Hum Dev 2010; 86:299-304. [PMID: 20472376 DOI: 10.1016/j.earlhumdev.2010.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 03/12/2010] [Accepted: 03/15/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neuregulin (NRG1) is a developmental growth factor and homozygous C allele carriers at the NRG221533 locus are at reduced risk for developmental disability. AIMS To explore whether 1) the NRG221533 CC genotype is associated with a decreased likelihood of neonatal intensive care unit (NICU) admission; 2) NRG1 is present in the infant's systemic circulation; and 3) to comparatively investigate two additional proposed high-producer single nucleotide polymorphisms (SNPs) for the cytokines interleukin 6 (-572) and interleukin 10 (-1082), examining both gene product and the association for admission to the NICU. STUDY DESIGN IL6 and IL10 protein was measured in umbilical cord blood by a multiplex sandwich immunoassay and NRG1 by ELISA. Infants were screened for SNPs IL6 (-572), IL10 (-1082), and NRG221533. We defined IL6 (C), IL10 (G) and NRG1 (C) as high-producer alleles based on published data. SUBJECTS Unselected single-center convenience sample of 97 newborns with a gestational age of 25-33 weeks (N=18), 34-36 weeks (N=17), 37-38 weeks (N=28), and 39-41 weeks (N=34). OUTCOME MEASURES Prematurity (<37 completed weeks) and admission to NICU. RESULTS The SNP NRG221533 CC genotype was associated with reduced admission to the NICU, even after adjustment for confounders. Adjustment for high IL6 levels reduced the protective effect. NRG1 levels tended to increase with advancing gestational age. Unexpectedly, we found lower IL6 and IL10 levels in infants homozygous for the IL6 (C) and IL10 (G) alleles, and no associations between IL10 (-1082) and IL6 (-572) genotype and prematurity or admission to NICU. CONCLUSIONS The NRG221533 CC genotype might be protective in newborns. The protective effect might not be directly related to increased systemic NRG levels.
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Affiliation(s)
- Elizabeth P Pleickhardt
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA
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Liu W, Purevdorj E, Zscheppang K, von Mayersbach D, Behrens J, Brinkhaus MJ, Nielsen HC, Schmiedl A, Dammann CEL. ErbB4 regulates the timely progression of late fetal lung development. Biochim Biophys Acta 2010; 1803:832-9. [PMID: 20303366 DOI: 10.1016/j.bbamcr.2010.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 03/02/2010] [Accepted: 03/03/2010] [Indexed: 02/07/2023]
Abstract
The ErbB4 receptor has an important function in fetal lung maturation. Deletion of ErbB4 leads to alveolar hypoplasia and hyperreactive airways similar to the changes in bronchopulmonary dysplasia (BPD). BPD is a chronic pulmonary disorder affecting premature infants as a consequence of lung immaturity, lung damage, and abnormal repair. We hypothesized that proper ErbB4 function is needed for the timely progression of fetal lung development. An ErbB4 transgenic cardiac rescue mouse model was used to study the effect of ErbB4 deletion on fetal lung structure, surfactant protein (SP) expression, and synthesis, and inflammation. Morphometric analyses revealed a delayed structural development with a significant decrease in saccular size at E18 and more pronounced changes at E17, keeping these lungs in the canalicular stage. SP-B mRNA expression was significantly down regulated at E17 with a subsequent decrease in SP-B protein expression at E18. SP-D protein expression was significantly decreased at E18. Surfactant phospholipid synthesis was significantly decreased on both days, and secretion was down regulated at E18. We conclude that pulmonary ErbB4 deletion results in a structural and functional delay in fetal lung development, indicating a crucial regulatory role of ErbB4 in the timely progression of fetal lung development.
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Affiliation(s)
- Washa Liu
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA
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32
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Hassan S, Bueter W, Acevedo C, Dammann CEL, Dammann O. Simulation of intra-amniotic infection and the fetal inflammatory response in a novel ex-vivo human umbilical cord perfusion model. Reprod Sci 2010; 17:426-33. [PMID: 20224107 DOI: 10.1177/1933719110361386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to design and test an ex-vivo human umbilical cord (HUC) perfusion model simulating a fetal inflammatory response (FIR) during intra-amniotic infection. STUDY DESIGN A 2-chamber model was designed to accommodate 2 pieces of umbilical cord. Cord perfusion was performed with placental blood. Intra-amniotic exposure to infectious organisms was simulated by adding lipopolysaccharide to the artificial amniotic fluid (AAF) compartment. As a measure of inflammatory response, we used interleukin 8 (IL-8) concentration in AAF and plasma by enzyme-linked immunosorbent assay (ELISA). Wilcoxon signed rank test was used for statistical analysis. RESULTS We established a stable physiological setup. Results revealed significantly elevated plasma IL-8 concentrations (n = 6, P < .05) in the blood compartment of umbilical cords exposed to lipopolysaccharide. Concentrations within AAF were not significantly elevated (n = 6, P = .3095). CONCLUSION Simulation of a FIR in an ex-vivo model of HUC perfusion under physiological conditions is possible. Further work is necessary to establish histological funisitis.
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Affiliation(s)
- Sarah Hassan
- Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany
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33
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Dammann O, Brinkhaus MJ, Bartels DB, Dördelmann M, Dressler F, Kerk J, Dörk T, Dammann CEL. Immaturity, perinatal inflammation, and retinopathy of prematurity: a multi-hit hypothesis. Early Hum Dev 2009; 85:325-9. [PMID: 19217727 DOI: 10.1016/j.earlhumdev.2008.12.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 12/08/2008] [Accepted: 12/16/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the relationship among markers of infection/inflammation in their association with retinopathy of prematurity (ROP). METHODS We studied clinical characteristics and 4 single nucleotide polymorphisms in infection/inflammation-associated genes in a group of 73 children with a gestational age<32 weeks. Forty-four children (60%) had ROP, of whom 13 (30% of those with ROP) progressed to stage 3 ROP. No child had grade 4 or 5 ROP. We employed both descriptive and analytic statistical methods. RESULTS Clinical variables of infection/inflammation were consistently associated with an increased risk of ROP. Among infants with ROP, they were also associated with progression to ROP grade 3. Genetic markers were not associated with ROP occurrence, but with progression to high grade disease. In tri-variable analyses exploring the effects of gestational age <29 weeks, clinical chorioamnionitis (CAM) and neonatal systemic inflammatory response syndrome (SIRS) on ROP occurrence, low gestational age was the most important antecedent, while additional individual or joint exposure to SIRS and CAM add appreciably to this risk of progression to high grade disease. CONCLUSION Both antenatal and neonatal exposure to inflammation appear to contribute to the increased ROP risk in preterm infants.
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Affiliation(s)
- Olaf Dammann
- Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, USA.
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34
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Liu W, Volpe MAV, Zscheppang K, Nielsen HC, Dammann CEL. ErbB4 regulates surfactant synthesis and proliferation in adult rat pulmonary epithelial cells. Exp Lung Res 2009; 35:29-47. [PMID: 19191103 DOI: 10.1080/01902140802395757] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ErbB4 is a predominant heterodimer for other ErbB receptors in late fetal lung development where it participates in regulating type II cell surfactant synthesis. To further elucidate the role of ErbB4 in pulmonary alveolar epithelial cell function, the authors hypothesized that ErbB4 participates in maintaining adult lung type II cell homeostasis. The authors used small interfering RNA (siRNA) to down-regulate endogenous, ErbB4 receptors in the adult rat lung epithelial L2 cell line and measured neuregulin 1beta (NRG1beta)-, and fibroblast conditioned medium (FCM)-induced effects on L2 cell surfactant phospholipid synthesis and proliferation. Under control conditions, total and phosphorylated ErbB4 were significantly increased after both NRG1beta and FCM treatment, as were surfactant phospholipids synthesis and cell proliferation. Down-regulation of ErbB4 with siRNA reduced stimulation of NRG1beta- and FCM-induced ErbB4 phosphorylation, decreased endogenous surfactant phospholipid synthesis, and blocked NRG1beta- and FCM-stimulated surfactant phospholipid synthesis. NRG1beta- and FCM-induced cell proliferation was not affected. The authors conclude that ErbB4 participates in maintaining adult lung alveolar epithelial cell surfactant synthesis and proliferation with development-specific functions.
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Affiliation(s)
- Washa Liu
- Newborn Medicine, Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts 02111, USA.
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Abstract
Bronchopulmonary dysplasia (BPD) is the most common, serious sequela of premature birth. Inflammation is a major contributor to the pathogenesis of BPD. Often initiated by a pulmonary fetal inflammatory response, lung inflammation is exacerbated by mechanical ventilation and exposure to supplemental oxygen. In response to these initiators of injury, a complex interaction occurs between proteins that attract inflammatory cells (ie, chemokines), proteins that facilitate the transendothelial migration of inflammatory cells from blood vessels (ie, adhesion molecules), proteins that promote tissue damage (ie, pro-inflammatory cytokines and proteases), and proteins that modulate the process (eg, anti-inflammatory cytokines, binding proteins and receptor antagonists). In addition, during recovery from inflammatory injury, growth factors and other substances that control normal lung growth and mediate repair influence subsequent lung structure. In this review, we discuss the role of each aspect of the inflammatory process in the development of BPD. This discussion will include data from measurements of biomarkers in samples of fluid aspirated from the airways of human infants relevant to each phase of inflammation. Despite their limitations, these measurements provide some insight into the role of inflammation in the development of BPD and may be useful in identifying infants at risk for the disease.
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Affiliation(s)
- C L Bose
- Division of Neonatal-Perinatal Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
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Purevdorj E, Zscheppang K, Hoymann HG, Braun A, von Mayersbach D, Brinkhaus MJ, Schmiedl A, Dammann CEL. ErbB4 deletion leads to changes in lung function and structure similar to bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2008; 294:L516-22. [DOI: 10.1152/ajplung.00423.2007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neuregulin is an important growth factor in fetal surfactant synthesis, and downregulation of its receptor, ErbB4, impairs fetal surfactant synthesis. We hypothesized that pulmonary ErbB4 deletion will affect the developing lung leading to an abnormal postnatal lung function. ErbB4-deleted lungs of 11- to 14-wk-old adult HER4heart mice, rescued from their lethal cardiac defects, were studied for the effect on lung function, alveolarization, and the surfactant system. ErbB4 deletion impairs lung function and structure in HER4heart mice resulting in a hyperreactive airway system and alveolar simplification, as seen in preterm infants with bronchopulmonary dysplasia. It also leads to a downregulation of surfactant protein D expression and an underlying chronic inflammation in these lungs. Our findings suggest that this animal model could be used to further study the pathogenesis of bronchopulmonary dysplasia and might help design protective interventions.
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Abstract
Brain white matter damage, an important antecedent of long-term disabilities among preterm infants, has both endogenous and exogenous components. One of the endogenous components is the paucity of developmentally regulated protectors. Here we expand on this component, discussing the potential roles of one putative protector, neuregulin (NRG)-1, in brain development and damage. We outline how NRG-1 might be involved in perinatal brain damage pathomechanisms and suggest that NRG-1 might be one target for intervention.
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Affiliation(s)
- Olaf Dammann
- Division of Newborn Medicine, Department of Pediatrics, Tufts-New England Medical Center, Boston, Mass., USA.
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Zscheppang K, Liu W, Volpe MV, Nielsen HC, Dammann CEL. ErbB4 regulates fetal surfactant phospholipid synthesis in primary fetal rat type II cells. Am J Physiol Lung Cell Mol Physiol 2007; 293:L429-35. [PMID: 17545485 DOI: 10.1152/ajplung.00451.2006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Insufficient fetal surfactant production leads to respiratory distress syndrome among preterm infants. Neuregulin signals the onset of fetal surfactant phospholipid synthesis through formation of erbB receptor dimers. We hypothesized that erbB4 downregulation in fetal type II epithelial cells will downregulate not only fetal surfactant phospholipid synthesis, but also affect proliferation and erbB receptor localization. We tested these hypotheses using small interfering RNA (siRNA) directed against the erbB4 gene to silence erbB4 receptor function in cultures of primary day 19 fetal rat lung type II cells. ErbB4 siRNA treatment inhibited erbB4 receptor protein expression, fibroblast-conditioned medium induced erbB4 phosphorylation, and fetal surfactant phospholipid synthesis. Cell proliferation, measured as thymidine incorporation, was also inhibited by erbB4 siRNA treatment. Downregulation of erbB4 receptor protein changed erbB1 localization at baseline and after stimulation, as determined by confocal microscopy and subcellular fractionation. We conclude that erbB4 is an important receptor in the control of fetal lung type II cell maturation.
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Affiliation(s)
- Katja Zscheppang
- Department of Pediatrics, Division of Newborn Medicine, Tufts University and Floating Hospital for Children, Boston, Massachusetts, USA
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Liu W, Zscheppang K, Murray S, Nielsen HC, Dammann CEL. The ErbB4 receptor in fetal rat lung fibroblasts and epithelial type II cells. Biochim Biophys Acta Mol Basis Dis 2007; 1772:737-47. [PMID: 17553674 PMCID: PMC2144912 DOI: 10.1016/j.bbadis.2007.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 04/23/2007] [Accepted: 04/24/2007] [Indexed: 02/06/2023]
Abstract
ErbB receptors are important regulators of fetal organ development, including the fetal lung. They exhibit diversity in signaling potential, acting through homo- and heterodimers to cause different biological responses. We hypothesized that ErbB receptors show cell-specific and stimuli-specific activation, heterodimerization, and cellular localization patterns in fetal lung. We investigated this using immunoblotting, co-immunoprecipitation, and confocal microscopy in primary isolated E19 fetal rat lung fibroblasts and epithelial type II cells, stimulated with epidermal growth factor, transforming growth factor alpha, neuregulin 1beta, or treated with conditioned medium (CM) from the respective other cell type. Fetal type II cells expressed significantly more ErbB1, ErbB2, and ErbB3 protein than fibroblasts. ErbB4 was consistently identified by co-immunoprecipitation of all other ErbB receptors in both cell types independent of the treatments. Downregulation of ErbB4 in fibroblasts initiated cell-cell communication that stimulated surfactant phospholipid synthesis in type II cells. Confocal microscopy in type II cells revealed nuclear localization of all receptors, most prominently for ErbB4. Neuregulin treatment resulted in relocation to the extra-nuclear cytoplasmic region, which was distinct from fibroblast CM treatment which led to nuclear localization of ErbB4 and ErbB2, inducing co-localization of both receptors. We speculate that ErbB4 plays a prominent role in fetal lung mesenchyme-epithelial communication.
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Affiliation(s)
- Washa Liu
- Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts-New England Medical Center, Boston, MA 02111, USA.
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Bueter W, Dammann O, Zscheppang K, Korenbaum E, Dammann CEL. ErbB receptors in fetal endothelium--a potential linkage point for inflammation-associated neonatal disorders. Cytokine 2007; 36:267-75. [PMID: 17379533 PMCID: PMC2002570 DOI: 10.1016/j.cyto.2007.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Revised: 01/28/2007] [Accepted: 02/05/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE ErbB receptors and their ligands play crucial roles in development. During late gestation, they might also be involved in the pathogenesis of prematurity-associated disorders. ErbB receptor dimerization leads to a diversity of biologic signals. We studied the expression and localization patterns of erbB receptors in the developing human umbilical endothelial cell system. It is still unclear, whether expression patterns might be developmentally regulated and depend on the cell type studied. METHODS Primary human umbilical venous endothelial cells (HUVEC) and arterial endothelial cells (HUAEC) were isolated between 24 and 42 weeks of gestation and used for immunoprecipitation, Western blotting, and confocal microscopy. RESULTS All four erbB receptors were present in HUVEC and HUAEC. Expression patterns were similar for cell types at gestational ages examined. ErbB4 always co-precipitated with erbB1 in both cell types independent of the gestational age. Confocal microscopy revealed that all erbB receptors were localized in the nucleus, erbB1 and erbB3 in the nucleoli, while erbB2 and erbB4 spared the nucleolar region. All receptors showed a tendency to co-localize. Growth factor stimulation altered localization patterns. Cellular subfractionation experiments for erbB4 largely confirmed microscopy results. Pretreatment with lipopolysaccharide enhanced this nuclear localization of erbB4, particularly of its intracellular domain. CONCLUSIONS All erbB receptors are present in both HUVEC and HUAEC at all gestational ages tested. ErbB receptor expression patterns were independent of the developmental stage of the endothelial cell, at least in the third trimester. We speculate that endothelial erbB receptors might play a role in normal development in mid and late gestation. We also speculate that these findings, together with the known involvement of erbB receptors in development, inflammation, and angiogenesis, will open new avenues for erbB receptor-related research in the pathogenesis of fetal and neonatal inflammation-associated disorders.
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Affiliation(s)
- Wolfgang Bueter
- Department of Pediatrics, Hannover Medical School, Carl-Neuberg-Str.1, 30623 Hannover, Germany
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Zscheppang K, Korenbaum E, Bueter W, Ramadurai SM, Nielsen HC, Dammann CEL. ErbB receptor dimerization, localization, and co-localization in mouse lung type II epithelial cells. Pediatr Pulmonol 2006; 41:1205-12. [PMID: 17063476 DOI: 10.1002/ppul.20518] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ErbB receptors are crucial for embryonic neuronal and cardiac development. ErbB receptor ligands neuregulin (NRG) and epidermal growth factor (EGF) play a major role in the developing lung, specifically in mesenchymal induced fetal surfactant synthesis by type II epithelial cells. Different erbB receptor ligands cause diverse biologic effects by stimulating specific erbB-dimers. It is not known how dimerization, cellular localization, and co-localization of erbB dimers are regulated in type II epithelial cells. We hypothesized that erbB receptors have a distinct dimerization, localization, and co-localization pattern in type II cells. In mouse type II epithelial cells, which express all four erbB receptors, erbB1 and erbB4 were the preferred dimerization partners. These dimerization patterns were ligand independent. Confocal microscopy showed these transmembrane receptors exhibited a strong nuclear localization. In non-stimulated cells, both erbB1 and erbB2 were predominantly localized to the nucleus and less intensely to the cytoplasm. However, erbB1 was mainly found in the nucleoli, whereas erbB2 spared the nucleolar region. ErbB3 was exclusively located in the nucleoli. ErbB4 was diffusely located in nucleus and cytoplasm, and like erbB2 spared the nucleolar region. Short stimulation with either EGF or NRG led to a more pronounced nuclear staining for erbB1, erbB2, and erbB4. All four receptors co-localized with each other after stimulation, but with varying intensity. The two known stimulators of fetal surfactant synthesis, NRG and NRG-containing fibroblast conditioned medium, changed cellular localization of the dimerization partners erbB4 and erbB2 in a distinct fashion. We conclude that erbB receptors have a receptor-specific localization and dimerization pattern in type II epithelial cells.
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Affiliation(s)
- Katja Zscheppang
- Department of Pediatrics, Hannover Medical School, Hannover, Germany.
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Abstract
Glucocorticoids stimulate foetal surfactant synthesis. Therefore, they are used in impending pre-term birth. One mechanism of action on surfactant synthesis is through the induction of neuregulin (NRG) secretion by foetal lung fibroblasts. The direct effects on signalling pathways, and specifically on erbB receptors in foetal type II cell surfactant synthesis, are less well understood. The present authors studied the effect of known promoters of foetal surfactant synthesis (namely dexamethasone and mature (i.e. NRG-containing) fibroblast-conditioned medium (FCM)) on erbB receptor activation, protein content and dimerisation patterns in foetal mouse lung type II cells. Dexamethasone inhibited surfactant synthesis in immature type II cells at day (d)16 of gestation, while the mature FCM had stimulatory effects. Both treatments directly stimulated surfactant synthesis in more mature (d17) cells. At this gestational day, dexamethasone had only a small effect on phosphorylation, but it stimulated the protein levels of all four erbB receptors. Dexamethasone effects were distinct from those of mature FCM, which stimulated both protein content and phosphorylation of all erbB receptors and of the signalling intermediate phospholipase Cgamma. Dexamethasone modulated erbB receptor dimerisation patterns, such that erbB2 became the main dimerisation partner for erbB4. In conclusion, dexamethasone signalling involves erbB receptors in foetal type II cells, in a manner similar to, but distinct from, neuregulin-containing fibroblast-conditioned medium signalling.
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Affiliation(s)
- C E L Dammann
- Division of Newborn Medicine, Tufts University and Floating Hospital for Children, Boston, MA, USA.
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Dördelmann M, Kerk J, Dressler F, Brinkhaus MJ, Bartels DB, Dammann CEL, Dörk T, Dammann O. Interleukin-10 high producer allele and ultrasound-defined periventricular white matter abnormalities in preterm infants: a preliminary study. Neuropediatrics 2006; 37:130-6. [PMID: 16967363 DOI: 10.1055/s-2006-924554] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Inflammation plays a role in prematurity, in neonatal disorders of the brain, lung, eye, bowel, and in developmental disability among preterm infants. We initiated a pilot study in preterm children to determine the prevalence of single nucleotide polymorphisms (SNPs) in the infection/inflammation-associated genes for interleukin (IL)-10 (- 1082 G/A), IL-1beta (+ 3953 C/T), tumor necrosis factor (TNF)-alpha (- 308 G/A) and toll-like receptor 4 (TLR-4) (Asp299Gly) and whether these SNPs affect the risk for neonatal disorders. STUDY DESIGN We genotyped 73 children >/= 2 years of age whose gestational age at birth was < 32 weeks, and explored the associations between genotypes and neonatal disorders and developmental status at age 2 + years. RESULTS Infants homozygous for the high IL-10 producer - 1082 G-allele (n = 15) were significantly less likely to develop ultrasound-defined periventricular echodensities. A non-significant, but prominent, risk reduction for bronchopulmonary dysplasia, high-grade retinopathy, cerebral palsy, and developmental delay at age 2 + years was present. Polymorphisms in the IL-1beta, TNF-alpha, and TLR-4 genes were too infrequent in our pilot sample to allow for reasonable analysis. CONCLUSION Infants homozygous for the IL-10 high producer - 1082 G allele might be at reduced risk for prematurity-associated disorders.
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Affiliation(s)
- M Dördelmann
- Dept. of Pediatric Pneumology and Neonatology, OE 6710, Hannover Medical School, Hannover, Germany.
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Dammann CEL, Meyer M, Dammann O, von Neuhoff N. Protein Detection in Dried Blood by Surface-Enhanced Laser Desorption/Ionization-Time of Flight Mass Spectrometry (SELDI-TOF MS). Neonatology 2006; 89:126-32. [PMID: 16210847 DOI: 10.1159/000088716] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 07/19/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The rapid and reliable identification of biomarkers in the smallest possible amount of blood remains a challenge in biomarker epidemiological research involving preterm newborns. OBJECTIVE We wanted to explore whether the proteomics approach of 'surface-enhanced laser desorption/ionization-time of flight mass spectrometry' (SELDI-TOF MS) is possible and feasible in whole cord blood previously dried on filter paper. METHODS Umbilical cord blood from 7 healthy newborns was frozen as serum, whole blood (with or without additives), or dried on filter paper (with or without additives). We used the SELDI-TOF MS technique for protein detection on the ProteinChip arrays: weak cationic exchange array (CM10), hydrophobic array (H50), and strong anion exchange array (Q10). Profiles were compared in terms of peak intensity and number of resolved peaks. RESULTS Dried neonatal blood, eluted from filter paper, revealed profiles similar to the profiles derived from serum at a protein range of 3-10 kDa. Among additives, heparin led to highest peak intensities for both blood and dried blood. Spectra from heparinized whole blood and heparinized dried blood from the umbilical cord of 8 different healthy newborns on three different types of ProteinChip arrays were very similar. CONCLUSION We conclude that it is possible and feasible to use SELDI-TOF MS for recovery and detection of whole proteins from dried blood collected on filter paper. The method is easy to perform in large groups of newborns, minimizing the amount of blood needed for biomarker studies. The validity and reproducibility of this method needs to be studied in detail.
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Affiliation(s)
- Christiane E L Dammann
- Department of Pediatric Pulmonology and Neonatology, Hannover Medical School, Hannover, Germany.
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Dammann O, Leviton A, Gappa M, Dammann CEL. Lung and brain damage in preterm newborns, and their association with gestational age, prematurity subgroup, infection/inflammation and long term outcome. BJOG 2005; 112 Suppl 1:4-9. [PMID: 15715586 DOI: 10.1111/j.1471-0528.2005.00576.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Compared with those born at term, preterm newborns are at an increased risk of short term disorders of the lung (bronchopulmonary dysplasia; BPD) and the brain (white matter damage; WMD), and of long term developmental and pulmonary dysfunctions. Although all of these adverse outcomes are associated with low gestational age, brain, but not lung, damage appears to be associated with the prematurity subgroup [spontaneous preterm labour and/or preterm prelabour rupture of membranes (PPROM) vs pregnancy-induced hypertension (PIH)]. Part of the association between brain damage and prematurity subgroup might be due to a differential exposure of members of these subgroups to perinatal infection/inflammation. There is a lack of studies evaluating the association of antenatal and perinatal risk factors with late childhood pulmonary dysfunction among those born during the second trimester. In this paper we discuss the complexities that paediatricians, perinatologists and perinatal epidemiologists face as they try to understand the contributions of factors associated with preterm birth to neonatal and childhood disorders.
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Affiliation(s)
- Olaf Dammann
- Perinatal Infectious Disease Epidemiology Unit, Department of Obstetrics and Pediatrics, OE 6415 Hannover Medical School, 30623 Hannover, Germany
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Zscheppang K, Korenbaum E, Ramadurai SM, Nielsen HC, Dammann CEL. ErbB Receptor Cross-talk and Co-localization in Mouse Lung Epithelial Cells. Pneumologie 2005. [DOI: 10.1055/s-2005-862730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The relationships among bronchopulmonary dysplasia (BPD), brain white matter damage (WMD) and cerebral palsy (CP) are far from simple. Apparently, BPD and WMD are not associated, while BPD and CP are. The most likely explanation for this paradox is that ultrasound imaging does not identify all the WMD that might lead to CP ('tip-of-the-iceberg effect'). We discuss further methodological inconsistencies, etiological peculiarities related to antenatal infection/inflammation, and intervention-related issues. In particular, we expand on the multiple-hit scenario in the etiology of BPD and offer support for the hypothesis that it is not lung disease, but factors associated with lung disease (e.g. postnatal steroid exposure) that increase the risk for developmental disability in childhood.
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Affiliation(s)
- Olaf Dammann
- Departments of Obstetrics and Pediatrics, Perinatal Infectious Disease Epidemiology Unit, Hannover Medical School, Hannover, Germany.
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Abstract
Neuregulins play a critical role in the developing heart, nervous, and mammary systems. Neuregulin-1-induced cardiac, neuronal, and mammary differentiation is based on a cell-cell communication model, where the ligand neuregulin-1 is produced and secreted by one cell type, which does not express its receptors erbB3 and erbB4 and acts on neighboring cell types that do express these receptors. We proposed that neuregulin-1 affects fetal lung maturation through a similar mechanism. Immunostaining showed neuregulin-1 in fetal lung that increased in fibroblasts at the onset of surfactant synthesis. Neuregulin-1 beta was found to be secreted by the fetal lung fibroblast and stimulated type II cell surfactant synthesis. Both fetal lung fibroblast-conditioned media and neuregulin-1 stimulated erbB2 receptor phosphorylation in type II cells. The effects of neuregulin-1 and of fibroblast-conditioned media on both surfactant synthesis and type II cell erbB2 phosphorylation were specifically blocked by antibody to neuregulin-1. Thus, neuregulin-1 beta may control fetal lung maturation through mesenchymal-epithelial interactions in a paracrine mechanism similar to that described for the developing heart, brain, and mammary systems.
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Affiliation(s)
- Christiane E L Dammann
- Department of Pediatrics, Division of Newborn Medicine, Floating Hospital for Children at Tufts-New England Medical Center, 750 Washington Street, Boston, MA, USA.
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Ramadurai SM, Chen WY, Yerozolimsky GB, Zagami M, Dammann CEL, Nielsen HC. Cell-specific and developmental expression of phospholipase C-gamma and diacylglycerol in fetal lung. Am J Physiol Lung Cell Mol Physiol 2003; 284:L808-16. [PMID: 12505868 DOI: 10.1152/ajplung.00117.2002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Epidermal growth factor (EGF) receptor (EGFR) regulates development of cell-cell communication in fetal lung, but the signal transduction mechanisms involved are unknown. We hypothesized that, in late-gestation fetal rat lung, phospholipase C-gamma (PLC-gamma) expression and activation by EGF is cell specific and developmentally regulated. PLC-gamma immunolocalized to cuboidal epithelium and mesenchymal clusters underlying developing saccules. PLC-gamma protein increased from day 17 to day 19 and then decreased. In cultured fetal lung fibroblasts, EGF stimulated PLC-gamma phosphorylation 2.6-fold (day 17), 10.8-fold (day 19), and 4.2-fold (day 21). EGF stimulated (3)H-labeled diacylglycerol production in fibroblasts (beginning on day 18 in female and on day 19 in male rats), but not in type II cells at any time during gestation. EGFR blockade abrogated the observed stimulation of PLC-gamma phosphorylation by EGF. In conclusion, PLC-gamma expression and activation by EGF in fetal lung are cell specific, corresponding to the development of EGFR expression. EGF induces diacylglycerol production in a cell- and gestation-specific manner. PLC-gamma activation by EGFR in fetal lung fibroblasts may be involved in EGF control of lung development.
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Affiliation(s)
- Sujatha M Ramadurai
- Division of Newborn Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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