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Morisson L, Nadeau-Vallée M, Espitalier F, Laferrière-Langlois P, Idrissi M, Lahrichi N, Gélinas C, Verdonck O, Richebé P. Prediction of acute postoperative pain based on intraoperative nociception level (NOL) index values: the impact of machine learning-based analysis. J Clin Monit Comput 2023; 37:337-344. [PMID: 35925430 DOI: 10.1007/s10877-022-00897-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/19/2021] [Accepted: 07/07/2022] [Indexed: 01/24/2023]
Abstract
The relationship between intraoperative nociception and acute postoperative pain is still not well established. The nociception level (NOL) Index (Medasense, Ramat Gan, Israel) uses a multiparametric approach to provide a 0-100 nociception score. The objective of the ancillary analysis of the NOLGYN study was to evaluate the ability of a machine-learning aglorithm to predict moderate to severe acute postoperative pain based on intraoperative NOL values. Our study uses the data from the NOLGYN study, a randomized controlled trial that evaluated the impact of NOL-guided intraoperative administration of fentanyl on overall fentanyl consumption compared to standard of care. Seventy patients (ASA class I-III, aged 18-75 years) scheduled for gynecological laparoscopic surgery were enrolled. Variables included baseline demographics, NOL reaction to incision or intubation, median NOL during surgery, NOL time-weighted average (TWA) above or under manufacturers' recommended thresholds (10-25), and percentage of surgical time spent with NOL > 25 or < 10. We evaluated different machine learning algorithms to predict postoperative pain. Performance was assessed using cross-validated area under the ROC curve (CV-AUC). Of the 66 patients analyzed, 42 (63.6%) experienced moderate to severe pain. NOL post-intubation (42.8 (31.8-50.6) vs. 34.8 (25.6-41.3), p = 0.05), median NOL during surgery (13 (11-15) vs. 11 (8-13), p = 0.027), percentage of surgical time spent with NOL > 25 (23% (18-18) vs. 20% (15-24), p = 0.036), NOL TWA < 10 (2.54 (2.1-3.0) vs. 2.86 (2.48-3.62), p = 0.044) and percentage of surgical time spent with NOL < 10 (41% (36-47) vs. 47% (40-55), p = 0.022) were associated with moderate to severe PACU pain. Corresponding ROC AUC for the prediction of moderate to severe PACU pain were 0.65 [0.51-0.79], 0.66 [0.52-0.81], 0.66 [0.52-0.79], 0.65 [0.51-0.79] and 0.67 [0.53-0.81]. Penalized logistic regression achieved the best performance with a 0.753 (0.718-0.788) CV-AUC. Our results, even if limited by the small number of patients, suggest that acute postoperative pain is better predicted by a multivariate machine-learning algorithm rather than individual intraoperative nociception variables. Further larger multicentric trials are highly recommended to better understand the relationship between intraoperative nociception and acute postoperative pain.Trial registration Registered on ClinicalTrials.gov in October 2018 (NCT03776838).
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Affiliation(s)
- Louis Morisson
- Department of Anesthesiology and Pain Medicine, CIUSSS de l'Est de l'Ile de Montréal, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada.
- Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada.
| | - Mathieu Nadeau-Vallée
- Department of Anesthesiology and Pain Medicine, CIUSSS de l'Est de l'Ile de Montréal, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
| | - Fabien Espitalier
- Department of Anesthesiology and Intensive Care, University Hospitals of Tours, Tours, France
| | - Pascal Laferrière-Langlois
- Department of Anesthesiology and Pain Medicine, CIUSSS de l'Est de l'Ile de Montréal, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
| | - Moulay Idrissi
- Department of Anesthesiology and Pain Medicine, CIUSSS de l'Est de l'Ile de Montréal, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
| | - Nadia Lahrichi
- Department of Mathematical and Industrial Engineering, Polytechnique Montréal, Montréal, Québec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine, CIUSSS de l'Est de l'Ile de Montréal, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, CIUSSS de l'Est de l'Ile de Montréal, Maisonneuve-Rosemont Hospital, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
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Ghiyasinasab M, Morisson L, Laferrière-Langlois P, Geraldo-Demers MA, Gélinas C, Nadeau-Vallée M, Verdonck O, Lahrichi N, Richebé P. Identification of the intraoperative antinociceptive effect of intravenous fentanyl using the Nociception Level (NOL) index versus clinical parameters in patients undergoing gynecological laparoscopic surgery: A secondary analysis of the NOLGYN study. Anaesth Crit Care Pain Med 2022; 41:101102. [PMID: 35643392 DOI: 10.1016/j.accpm.2022.101102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND While we typically assess nociception balance during general anaesthesia through clinical parameters such as heart rate (HR) and mean arterial pressure (MAP) variation, these parameters are not specific to nociception. OBJECTIVE We hypothesized that using the Nociception Level (NOL) index to assess the analgesic effect of a fentanyl bolus would be superior to standard clinical parameters. DESIGN Ancillary study of the NOLGYN study, a randomized controlled trial comparing intraoperative NOL-guided administration of fentanyl (NOL group) versus standardized care (SC group). SETTING University hospital in Montréal, Canada between November 2018, and December 2019. PATIENTS Women undergoing gynecological laparoscopic surgery. INTERVENTION In our evaluation of intraoperative nociception, we analyzed the analgesic effect of fentanyl using three parameters: MAP, HR, and the Nociception Level (NOL) index. All fentanyl injection events were extracted from the database. MAIN OUTCOME MEASURE The primary endpoint was the difference between values before and after each injection. RESULTS The median of the NOL index before fentanyl injection was 30.5 (IQR 19.4 to 40.7) versus 18.9 (IQR 11.5 to 27.4) after (P < 0.001). The median of MAP was 106.4 mmHg (IQR 99.9 to 113.4) before injection versus 103.2 mmHg (IQR 97.5 to 110.7) after (P < 0.001). The median of HR before injection was 74.2 (IQR 64.2 to 83.8) versus 72.4 (IQR 63.4 to 81.3) after (P < 0.001). CONCLUSIONS The NOL index, HR, and MAP all statistically discriminated the analgesic effect of fentanyl but only the NOL index proved clinically relevant to identify the analgesic effect of one fentanyl injection. TRIAL REGISTRATION www. CLINICALTRIALS gov (NCT03776838) registered in October 2018.
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Affiliation(s)
- Marzieh Ghiyasinasab
- Department of Mathematical and Industrial Engineering, Polytechnique Montréal, Montréal, Québec, Canada
| | - Louis Morisson
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital Research Centre, CIUSSS de l'Est de l'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada.
| | - Pascal Laferrière-Langlois
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital Research Centre, CIUSSS de l'Est de l'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
| | - Marc-André Geraldo-Demers
- Department of Mathematical and Industrial Engineering, Polytechnique Montréal, Montréal, Québec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Mathieu Nadeau-Vallée
- Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital Research Centre, CIUSSS de l'Est de l'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
| | - Nadia Lahrichi
- Department of Mathematical and Industrial Engineering, Polytechnique Montréal, Montréal, Québec, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital Research Centre, CIUSSS de l'Est de l'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada
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Beaudry-Richard A, Nadeau-Vallée M, Prairie É, Maurice N, Heckel É, Nezhady M, Pundir S, Madaan A, Boudreault A, Hou X, Quiniou C, Sierra EM, Beaulac A, Lodygensky G, Robertson SA, Keelan J, Adams Waldorf KM, Olson DM, Rivera JC, Lubell WD, Joyal JS, Bouchard JF, Chemtob S. Author Correction: Antenatal IL-1-dependent inflammation persists postnatally and causes retinal and sub-retinal vasculopathy in progeny. Sci Rep 2020; 10:6634. [PMID: 32296110 PMCID: PMC7160106 DOI: 10.1038/s41598-020-63705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Alexandra Beaudry-Richard
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Mathieu Nadeau-Vallée
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology, Université de Montréal, Montréal, Canada
| | - Élizabeth Prairie
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Noémie Maurice
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Émilie Heckel
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Mohammad Nezhady
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Sheetal Pundir
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Ankush Madaan
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada
| | - Amarilys Boudreault
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Xin Hou
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Christiane Quiniou
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Estefania Marin Sierra
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada
| | - Alexandre Beaulac
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Gregory Lodygensky
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Sarah A Robertson
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Jeffrey Keelan
- Div Obstetrics & Gynaecology, University of Western Australia King Edward Memorial Hospital, Perth, Australia
| | | | - David M Olson
- Departments of Obstetrics and Gynaecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
| | - Jose-Carlos Rivera
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montréal, Canada
| | - William D Lubell
- Department of Chemistry, Université de Montréal, Montréal, Canada
| | - Jean-Sebastien Joyal
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology, Université de Montréal, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada
| | | | - Sylvain Chemtob
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada. .,Department of Pharmacology, Université de Montréal, Montréal, Canada. .,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada.
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Madaan A, Chaudhari P, Nadeau-Vallée M, Hamel D, Zhu T, Mitchell G, Samuels M, Pundir S, Dabouz R, Howe Cheng CW, Mohammad Nezhady MA, Joyal JS, Rivera JC, Chemtob S. Müller Cell-Localized G-Protein-Coupled Receptor 81 (Hydroxycarboxylic Acid Receptor 1) Regulates Inner Retinal Vasculature via Norrin/Wnt Pathways. Am J Pathol 2019; 189:1878-1896. [PMID: 31220454 DOI: 10.1016/j.ajpath.2019.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 12/23/2022]
Abstract
Ischemic retinopathies are characterized by a progressive microvascular degeneration followed by a postischemic aberrant neovascularization. To reinstate vascular supply and metabolic equilibrium to the ischemic tissue during ischemic retinopathies, a dysregulated production of growth factors and metabolic intermediates occurs, promoting retinal angiogenesis. Glycolysis-derived lactate, highly produced during ischemic conditions, has been associated with tumor angiogenesis and wound healing. Lactate exerts its biological effects via G-protein-coupled receptor 81 (GPR81) in several tissues; however, its physiological functions and mechanisms of action in the retina remain poorly understood. Herein, we show that GPR81, localized predominantly in Müller cells, governs deep vascular complex formation during development and in ischemic retinopathy. Lactate-stimulated GPR81 Müller cells produce numerous angiogenic factors, including Wnt ligands and particularly Norrin, which contributes significantly in triggering inner retinal blood vessel formation. Conversely, GPR81-null mice retina shows reduced inner vascular network formation associated with low levels of Norrin (and Wnt ligands). Lactate accumulation during ischemic retinopathy selectively activates GPR81-extracellular signal-regulated kinase 1/2-Norrin signaling to accelerate inner retinal vascularization in wild-type animals, but not in the retina of GPR81-null mice. Altogether, we reveal that lactate via GPR81-Norrin participates in inner vascular network development and in restoration of the vasculature in response to injury. These findings suggest a new potential therapeutic target to alleviate ischemic diseases.
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Affiliation(s)
- Ankush Madaan
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada; Department of Pharmacology and Therapeutics, McGill University, Montréal, Quebec, Canada
| | - Prabhas Chaudhari
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada; Department of Experimental Medicine, McGill University, Montréal, Quebec, Canada
| | - Mathieu Nadeau-Vallée
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada; Department of Pharmacology, Université de Montréal, Montréal, Quebec, Canada
| | - David Hamel
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Tang Zhu
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Grant Mitchell
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Mark Samuels
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Sheetal Pundir
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Rabah Dabouz
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Colin Wayne Howe Cheng
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Quebec, Canada
| | - Mohammad A Mohammad Nezhady
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada
| | - Jean-Sébastien Joyal
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada; Department of Pharmacology and Therapeutics, McGill University, Montréal, Quebec, Canada; Department of Pharmacology, Université de Montréal, Montréal, Quebec, Canada
| | - José Carlos Rivera
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada; Research Center, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada.
| | - Sylvain Chemtob
- Departments of Pediatrics, Ophthalmology and Pharmacology, Centre Hospitalier Universitaire Sainte-Justine Research Center, Montréal, Quebec, Canada; Department of Pharmacology and Therapeutics, McGill University, Montréal, Quebec, Canada; Department of Pharmacology, Université de Montréal, Montréal, Quebec, Canada; Research Center, Maisonneuve-Rosemont Hospital, Montréal, Quebec, Canada.
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Beaudry-Richard A, Nadeau-Vallée M, Prairie É, Maurice N, Heckel É, Nezhady M, Pundir S, Madaan A, Boudreault A, Hou X, Quiniou C, Sierra EM, Beaulac A, Lodygensky G, Robertson SA, Keelan J, Adams Waldorf KM, Olson DM, Rivera JC, Lubell WD, Joyal JS, Bouchard JF, Chemtob S. Antenatal IL-1-dependent inflammation persists postnatally and causes retinal and sub-retinal vasculopathy in progeny. Sci Rep 2018; 8:11875. [PMID: 30089839 PMCID: PMC6082873 DOI: 10.1038/s41598-018-30087-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 07/23/2018] [Indexed: 12/13/2022] Open
Abstract
Antenatal inflammation as seen with chorioamnionitis is harmful to foetal/neonatal organ development including to eyes. Although the major pro-inflammatory cytokine IL-1β participates in retinopathy induced by hyperoxia (a predisposing factor to retinopathy of prematurity), the specific role of antenatal IL-1β associated with preterm birth (PTB) in retinal vasculopathy (independent of hyperoxia) is unknown. Using a murine model of PTB induced with IL-1β injection in utero, we studied consequent retinal and choroidal vascular development; in this process we evaluated the efficacy of IL-1R antagonists. Eyes of foetuses exposed only to IL-1β displayed high levels of pro-inflammatory genes, and a persistent postnatal infiltration of inflammatory cells. This prolonged inflammatory response was associated with: (1) a marked delay in retinal vessel growth; (2) long-lasting thinning of the choroid; and (3) long-term morphological and functional alterations of the retina. Antenatal administration of IL-1R antagonists - 101.10 (a modulator of IL-1R) more so than Kineret (competitive IL-1R antagonist) - prevented all deleterious effects of inflammation. This study unveils a key role for IL-1β, a major mediator of chorioamnionitis, in causing sustained ocular inflammation and perinatal vascular eye injury, and highlights the efficacy of antenatal 101.10 to suppress deleterious inflammation.
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Affiliation(s)
- Alexandra Beaudry-Richard
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Mathieu Nadeau-Vallée
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology, Université de Montréal, Montréal, Canada
| | - Élizabeth Prairie
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Noémie Maurice
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Émilie Heckel
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Mohammad Nezhady
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Sheetal Pundir
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Ankush Madaan
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada
| | - Amarilys Boudreault
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Xin Hou
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Christiane Quiniou
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Estefania Marin Sierra
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada
| | - Alexandre Beaulac
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Gregory Lodygensky
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada
| | - Sarah A Robertson
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Jeffrey Keelan
- Div Obstetrics & Gynaecology, University of Western Australia King Edward Memorial Hospital, Perth, Australia
| | | | - David M Olson
- Departments of Obstetrics and Gynaecology, Pediatrics and Physiology, University of Alberta, Edmonton, AB, Canada
| | - Jose-Carlos Rivera
- Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Centre, Montréal, Canada
| | - William D Lubell
- Department of Chemistry, Université de Montréal, Montréal, Canada
| | - Jean-Sebastien Joyal
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada.,Department of Pharmacology, Université de Montréal, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada
| | | | - Sylvain Chemtob
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Centre, Montréal, Canada. .,Department of Pharmacology, Université de Montréal, Montréal, Canada. .,Department of Pharmacology and Therapeutics, McGill University, Montréal, Canada.
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Mai-Vo TA, Nadeau-Vallée M, Beaudry-Richard A. Preterm Birth: An Inflammatory Syndrome, Not Just A Myometrial Disorder. UOJM 2017. [DOI: 10.18192/uojm.v7i2.2193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Preterm birth (PTB) is the leading cause of neonatal mortality and morbidity. Although the severity of neonatal outcomes is inversely correlated with gestational age, all PTBs can lead to potentially life-threatening neonatal outcomes and major lifelong health complications. Because advances in neonatal care have substantially decreased neonatal mortality, the incidence of PTB and its complications is unabatedly rising. PTB currently affects more than 10% of births worldwide, with similar numbers in developed countries. Correspondingly, improving neonatal outcome is a key objective of the World Health Organization. The recently approved (in Europe) tocolytics drug, Atosiban, used to prolong preterm gestation, has not been shown to improve neonatal outcome, nor have other tocolytic agents used in clinic. Thus, PTB remains an unmet medical need. Recent evidence shows that most, if not all, PTBs are associated with (overt or occult) inflammatory processes in gestational tissues, independent of infection. Pro- inflammatory cytokines are produced from maternal and fetal cells in response to sterile or infectious stressors. These seem to orchestrate a multi-tissue response including myometrial contractility, cervical ripening, and weakening/rupture of fetal membranes, leading to the onset of preterm labor. This integrated system might have been conserved through mammalian evolution due to increased maternal and/or fetal survival when gestation is terminated in specific settings, such as infection. Hence, inflammation may be a common pathway to the numerous aetiologies of PTB. Most importantly, recent evidence suggests that inflammation is transmitted to the fetus, thereby inducing organ injuries that may underlie the development of major neonatal diseases. Targeting inflammation prenatally instead of myometrial contraction could be a more successful and safe approach for the management of PTB, as suggested by recent animal studies. RésuméLa naissance prématurée est la principale cause de mortalité et de morbidité néonatale. Bien que la sévérité des issus néonataux soit inversement corrélée avec l’âge gestationnel à la naissance, toutes les naissances prématurées peuvent mener à des issus néonataux potentiellement mortels et à des complications avec répercussions s’échelonnant sur toute la vie. Étant donné que la mortalité néonatale a considérablement diminuée avec les récentes avancées en néonatalogie, l’incidence de la naissance prématurée et de ses complications sont en hausse. La naissance prématurée affecte présentement plus de 10% des naissances à travers le monde, avec des taux similaires dans les pays développés. Conséquemment, d’améliorer l’issu néonatal est un objectif clé de l’Organisation Mondiale de la Santé. Le tocolytique Atosiban récemment approuvé (en Europe) pour prolonger les gestations pré- maturées n’a pas démontré d’efficacité pour améliorer les issus néonataux, tout comme les autres tocolytiques utilisés en clinique, et la naissance prématurée demeure un besoin médical non-atteint. Des données récentes démontrent que la plupart, sinon toutes les naissances prématurées sont associées avec des processus inflammatoires (francs ou silencieux) dans les tissus gestationnels, indépendamment de l’infection. Les cytokines pro-inflammatoires sont produites dans les cellules maternelles et fœtales en réponse à des stresseurs stériles ou infectieux, et semblent orchestrer une réponse multi-tissulaire incluant la contractilité myométriale, la préparation cervicale, et l’affaiblissement/rupture des membranes fœtales, menant au commencement du travail préterme. Ce système intégré pourrait avoir été conservé durant l’évolution mammifère à cause d’une survie accrue de la mère et/ou du fœtus lorsque la gestation est terminée dans un contexte spécifique, comme l’infection. Donc, l’inflammation pourrait constituer une voie commune finale pour les nombreuses causes de la naissance prématurée. De façon importante, des données récentes sug- gèrent que cette inflammation est transmise au fœtus et en retour induit des dommages aux organes qui pourraient sous-tendre le développement de maladies néonatales majeures. De cibler l’inflammation en prénatal plutôt que les contractions myométriales pourrait constituer une approche sécuritaire et plus efficace, comme suggéré par de récentes études animales.
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Nadeau-Vallée M, Chin PY, Belarbi L, Brien MÈ, Pundir S, Berryer MH, Beaudry-Richard A, Madaan A, Sharkey DJ, Lupien-Meilleur A, Hou X, Quiniou C, Beaulac A, Boufaied I, Boudreault A, Carbonaro A, Doan ND, Joyal JS, Lubell WD, Olson DM, Robertson SA, Girard S, Chemtob S. Antenatal Suppression of IL-1 Protects against Inflammation-Induced Fetal Injury and Improves Neonatal and Developmental Outcomes in Mice. J Immunol 2017; 198:2047-2062. [PMID: 28148737 DOI: 10.4049/jimmunol.1601600] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/30/2016] [Indexed: 01/08/2023]
Abstract
Preterm birth (PTB) is commonly accompanied by in utero fetal inflammation, and existing tocolytic drugs do not target fetal inflammatory injury. Of the candidate proinflammatory mediators, IL-1 appears central and is sufficient to trigger fetal loss. Therefore, we elucidated the effects of antenatal IL-1 exposure on postnatal development and investigated two IL-1 receptor antagonists, the competitive inhibitor anakinra (Kineret) and a potent noncompetitive inhibitor 101.10, for efficacy in blocking IL-1 actions. Antenatal exposure to IL-1β induced Tnfa, Il6, Ccl2, Pghs2, and Mpges1 expression in placenta and fetal membranes, and it elevated amniotic fluid IL-1β, IL-6, IL-8, and PGF2α, resulting in PTB and marked neonatal mortality. Surviving neonates had increased Il1b, Il6, Il8, Il10, Pghs2, Tnfa, and Crp expression in WBCs, elevated plasma levels of IL-1β, IL-6, and IL-8, increased IL-1β, IL-6, and IL-8 in fetal lung, intestine, and brain, and morphological abnormalities: e.g., disrupted lung alveolarization, atrophy of intestinal villus and colon-resident lymphoid follicle, and degeneration and atrophy of brain microvasculature with visual evoked potential anomalies. Late gestation treatment with 101.10 abolished these adverse outcomes, whereas Kineret exerted only modest effects and no benefit for gestation length, neonatal mortality, or placental inflammation. In a LPS-induced model of infection-associated PTB, 101.10 prevented PTB, neonatal mortality, and fetal brain inflammation. There was no substantive deviation in postnatal growth trajectory or adult body morphometry after antenatal 101.10 treatment. The results implicate IL-1 as an important driver of neonatal morbidity in PTB and identify 101.10 as a safe and effective candidate therapeutic.
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Affiliation(s)
- Mathieu Nadeau-Vallée
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, University of Montreal, Montreal, Quebec H3T 1J4, Canada
| | - Peck-Yin Chin
- Department of Obstetrics and Gynecology, Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Lydia Belarbi
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Marie-Ève Brien
- Department of Obstetrics and Gynecology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada.,Department of Microbiology, Infectiology, and Immunology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada
| | - Sheetal Pundir
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3G 1Y6, Canada
| | - Martin H Berryer
- Department of Neurosciences, CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec H3T 1J4, Canada
| | - Alexandra Beaudry-Richard
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Ankush Madaan
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3G 1Y6, Canada
| | - David J Sharkey
- Department of Obstetrics and Gynecology, Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Alexis Lupien-Meilleur
- Department of Neurosciences, CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec H3T 1J4, Canada
| | - Xin Hou
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Christiane Quiniou
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Alexandre Beaulac
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Ines Boufaied
- Department of Obstetrics and Gynecology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada.,Department of Microbiology, Infectiology, and Immunology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada
| | - Amarilys Boudreault
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Adriana Carbonaro
- Department of Obstetrics and Gynecology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada.,Department of Microbiology, Infectiology, and Immunology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada
| | - Ngoc-Duc Doan
- Department of Chemistry, University of Montreal, Montreal, Quebec H3T 1J4, Canada
| | - Jean-Sebastien Joyal
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, University of Montreal, Montreal, Quebec H3T 1J4, Canada
| | - William D Lubell
- Department of Chemistry, University of Montreal, Montreal, Quebec H3T 1J4, Canada
| | - David M Olson
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta T6G 2R3, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 2R3, Canada; and.,Department of Physiology, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Sarah A Robertson
- Department of Obstetrics and Gynecology, Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia 5005, Australia;
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada; .,Department of Microbiology, Infectiology, and Immunology, University of Montreal, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1J4, Canada
| | - Sylvain Chemtob
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; .,Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, University of Montreal, Montreal, Quebec H3T 1J4, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3G 1Y6, Canada
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Madaan A, Nadeau-Vallée M, Rivera JC, Obari D, Hou X, Sierra EM, Girard S, Olson DM, Chemtob S. Lactate produced during labor modulates uterine inflammation via GPR81 (HCA 1). Am J Obstet Gynecol 2017; 216:60.e1-60.e17. [PMID: 27615440 DOI: 10.1016/j.ajog.2016.09.072] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/18/2016] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Uterine inflammatory processes trigger prolabor pathways and orchestrate on-time labor onset. Although essential for successful labor, inflammation needs to be regulated to avoid uncontrolled amplification and resolve postpartum. During labor, myometrial smooth muscle cells generate ATP mainly via anaerobic glycolysis, resulting in accumulation of lactate. Aside from its metabolic function, lactate has been shown to activate a G protein-coupled receptor, GPR81, reported to regulate inflammation. We therefore hypothesize that lactate produced during labor may act via GPR81 in the uterus to exert in a feedback manner antiinflammatory effects, to resolve or mitigate inflammation. OBJECTIVE We sought to investigate the role of lactate produced during labor and its receptor, GPR81, in regulating inflammation in the uterus. STUDY DESIGN We investigated the expression of GPR81 in the uterus and the pharmacological role of lactate acting via GPR81 during labor, using shRNA-GPR81 and GPR81-/- mice. RESULTS (1) Uterine lactate levels increased substantially from 2 to 9 mmol/L during labor. (2) Immunohistological analysis revealed expression of GPR81 in the uterus with high expression in myometrium. (3) GPR81 expression increased during gestation, and peaked near labor. (4) In primary myometrial smooth muscle cell and ex vivo uteri from wild-type mice, lactate decreased interleukin-1β-induced transcription of key proinflammatory Il1b, Il6, Ccl2, and Pghs2; suppressive effects of lactate were not observed in cells and tissues from GPR81-/- mice. (5) Conversely, proinflammatory gene expression was augmented in the uterus at term in GPR81-/- mice and wild-type mice treated intrauterine with lentiviral-encoded shRNA-GPR81; GPR81 silencing also induced proinflammatory gene transcription in the uterus when labor was induced by endotoxin (lipopolysaccharide). (6) Importantly, administration to pregnant mice of a metabolically stable specific GPR81 agonist, 3,5-dihydroxybenzoic acid, decreased endotoxin-induced uterine inflammation, preterm birth, and associated neonatal mortality. CONCLUSION Collectively, our data uncover a novel link between the anaerobic glycolysis and the control of uterine inflammation wherein the high levels of lactate produced during labor act on uterine GPR81 to down-regulate key proinflammatory genes. This discovery may represent a novel feedback mechanism to regulate inflammation during labor, and conveys a potential rationale for the use of GPR81 agonists to attenuate inflammation and resulting preterm birth.
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Brien ME, Duval C, Palacios J, Boufaied I, Hudon-Thibeault AA, Nadeau-Vallée M, Vaillancourt C, Sibley CP, Abrahams VM, Jones RL, Girard S. Uric Acid Crystals Induce Placental Inflammation and Alter Trophoblast Function via an IL-1-Dependent Pathway: Implications for Fetal Growth Restriction. J Immunol 2016; 198:443-451. [PMID: 27903743 DOI: 10.4049/jimmunol.1601179] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/24/2016] [Indexed: 12/21/2022]
Abstract
Excessive placental inflammation is associated with several pathological conditions, including stillbirth and fetal growth restriction. Although infection is a known cause of inflammation, a significant proportion of pregnancies have evidence of inflammation without any detectable infection. Inflammation can also be triggered by endogenous mediators, called damage associated molecular patterns or alarmins. One of these damage-associated molecular patterns, uric acid, is increased in the maternal circulation in pathological pregnancies and is a known agonist of the Nlrp3 inflammasome and inducer of inflammation. However, its effects within the placenta and on pregnancy outcomes remain largely unknown. We found that uric acid (monosodium urate [MSU]) crystals induce a proinflammatory profile in isolated human term cytotrophoblast cells, with a predominant secretion of IL-1β and IL-6, a result confirmed in human term placental explants. The proinflammatory effects of MSU crystals were shown to be IL-1-dependent using a caspase-1 inhibitor (inhibits IL-1 maturation) and IL-1Ra (inhibits IL-1 signaling). The proinflammatory effect of MSU crystals was accompanied by trophoblast apoptosis and decreased syncytialization. Correspondingly, administration of MSU crystals to rats during late gestation induced placental inflammation and was associated with fetal growth restriction. These results make a strong case for an active proinflammatory role of MSU crystals at the maternal-fetal interface in pathological pregnancies, and highlight a key mediating role of IL-1. Furthermore, our study describes a novel in vivo animal model of noninfectious inflammation during pregnancy, which is triggered by MSU crystals and leads to reduced fetal growth.
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Affiliation(s)
- Marie-Eve Brien
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Microbiology, Virology and Immunology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | - Cyntia Duval
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | - Julia Palacios
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | - Ines Boufaied
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada
| | | | - Mathieu Nadeau-Vallée
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, University de Montreal, Montreal H3T 1C5, Canada
| | - Cathy Vaillancourt
- Institut de la Recherche Scientifique, Centre Institut Armand-Frappier, Laval, Quebec H7V 1B7, Canada
| | - Colin P Sibley
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, M13 9WL, United Kingdom.,St. Mary's Hospital, Central Manchester University Hospital National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom; and
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, CT 06510
| | - Rebecca L Jones
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, M13 9WL, United Kingdom.,St. Mary's Hospital, Central Manchester University Hospital National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, United Kingdom; and
| | - Sylvie Girard
- Ste-Justine Hospital Research Centre, Feto-Maternal and Neonatal Pathologies Research Axis, University of Montreal, Montreal, Quebec H3T 1C5, Canada; .,Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Microbiology, Virology and Immunology, University of Montreal, Montreal, Quebec H3T 1C5, Canada.,Department of Pharmacology, University de Montreal, Montreal H3T 1C5, Canada
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Nadeau-Vallée M, Obari D, Palacios J, Brien MÈ, Duval C, Chemtob S, Girard S. Sterile inflammation and pregnancy complications: a review. Reproduction 2016; 152:R277-R292. [PMID: 27679863 DOI: 10.1530/rep-16-0453] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/27/2016] [Indexed: 02/06/2023]
Abstract
Inflammation is essential for successful embryo implantation, pregnancy maintenance and delivery. In the last decade, important advances have been made in regard to endogenous, and therefore non-infectious, initiators of inflammation, which can act through the same receptors as pathogens. These molecules are referred to as damage-associated molecular patterns (DAMPs), and their involvement in reproduction has only recently been unraveled. Even though inflammation is necessary for successful reproduction, untimely activation of inflammatory processes can have devastating effect on pregnancy outcomes. Many DAMPs, such as uric acid, high-mobility group box 1 (HMGB1), interleukin (IL)-1 and cell-free fetal DNA, have been associated with pregnancy complications, such as miscarriages, preeclampsia and preterm birth in preclinical models and in humans. However, the specific contribution of alarmins to these conditions is still under debate, as currently there is lack of information on their mechanism of action. In this review, we discuss the role of sterile inflammation in reproduction, including early implantation and pregnancy complications. Particularly, we focus on major alarmins vastly implicated in numerous sterile inflammatory processes, such as uric acid, HMGB1, IL-1α and cell-free DNA (especially that of fetal origin) while giving an overview of the potential role of other candidate alarmins.
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Affiliation(s)
- Mathieu Nadeau-Vallée
- Departments of PediatricsOphthalmology and Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada.,Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada
| | - Dima Obari
- Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada
| | - Julia Palacios
- Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Marie-Ève Brien
- Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada.,Department of MicrobiologyVirology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Cyntia Duval
- Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Sylvain Chemtob
- Departments of PediatricsOphthalmology and Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada .,Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada
| | - Sylvie Girard
- Department of PharmacologyUniversité de Montréal, Montreal, Quebec, Canada .,Department of Obstetrics & GynecologyCHU Sainte-Justine Research Center, Montreal, Quebec, Canada.,Department of MicrobiologyVirology and Immunology, Université de Montréal, Montreal, Quebec, Canada
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Nadeau-Vallée M, Boudreault A, Leimert K, Hou X, Obari D, Madaan A, Rouget R, Zhu T, Belarbi L, Brien MÈ, Beaudry-Richard A, Olson DM, Girard S, Chemtob S. Uterotonic Neuromedin U Receptor 2 and Its Ligands Are Upregulated by Inflammation in Mice and Humans, and Elicit Preterm Birth. Biol Reprod 2016; 95:72. [PMID: 27512149 PMCID: PMC5394981 DOI: 10.1095/biolreprod.116.140905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
Abstract
Uterine labor requires the conversion of a quiescent (propregnancy) uterus into an activated (prolabor) uterus, with increased sensitivity to endogenous uterotonic molecules. This activation is induced by stressors, particularly inflammation in term and preterm labor. Neuromedin U (NmU) is a neuropeptide known for its uterocontractile effects in rodents. The objective of the study was to assess the expression and function of neuromedin U receptor 2 (NmU-R2) and its ligands NmU and the more potent neuromedin S (NmS) in gestational tissues, and the possible implication of inflammatory stressors in triggering this system. Our data show that NmU and NmS are uterotonic ex vivo in murine tissue, and they dose-dependently trigger labor by acting specifically via NmU-R2. Expression of NmU-R2, NmU, and NmS is detected in murine and human gestational tissues by immunoblot, and the expression of NmS in placenta and of NmU-R2 in uterus increases considerably with gestation age and labor, which is associated with amplified NmU-induced uterocontractile response in mice. NmU- and NmS-induced contraction is associated with increased NmU-R2-coupled Ca++ transients, and Akt and Erk activation in murine primary myometrial smooth muscle cells (mSMCs), which are potentiated with gestational age. NmU-R2 is upregulated in vitro in mSMCs and in vivo in uterus in response to proinflammatory interleukin 1beta (IL1beta), which is associated with increased NmU-induced uterocontractile response and Ca++ transients in murine and human mSMCs; additionally, placental NmS is markedly upregulated in vivo in response to IL1beta. In human placenta at term, immunohistological analysis revealed NmS expression primarily in cytotrophoblasts; furthermore, stimulation with lipopolysaccharide (LPS; Gram-negative endotoxin) markedly upregulates NmS expression in primary human cytotrophoblasts isolated from term placentas. Correspondingly, decidua of women with clinical signs of infection who delivered preterm display significantly higher expression of NmS compared with those without infection. Importantly, in vivo knockdown of NmU-R2 prevents LPS-triggered preterm birth in mice and the associated neonatal mortality. Altogether, our data suggest a critical role for NmU-R2 and its ligands NmU and NmS in preterm labor triggered by infection. We hereby identify NmU-R2 as a relevant target for preterm birth.
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Affiliation(s)
- Mathieu Nadeau-Vallée
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada
| | - Amarilys Boudreault
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Kelycia Leimert
- Departments of Obstetrics and Gynecology, Pediatrics, and Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Xin Hou
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Dima Obari
- Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada
| | - Ankush Madaan
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Raphaël Rouget
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Tang Zhu
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Lydia Belarbi
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - Marie-Ève Brien
- Departments of Obstetrics and Gynecology, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Alexandra Beaudry-Richard
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada
| | - David M Olson
- Departments of Obstetrics and Gynecology, Pediatrics, and Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Sylvie Girard
- Departments of Obstetrics and Gynecology, CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Sylvain Chemtob
- Departments of Pediatrics, Ophthalmology, and Pharmacology, CHU Sainte-Justine Research Centre, Montreal, Quebec, Canada Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada Department of Pharmacology & Therapeutics, McGill University, Montreal, Quebec, Canada
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Nadeau-Vallée M, Hou X. GPR120 local regulation might explain the contradictory pro/anti-inflammatory effects of ω-3 PUFA observed in gestational tissue. J Perinat Med 2016; 44:111. [PMID: 25915076 DOI: 10.1515/jpm-2014-0379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/12/2015] [Indexed: 11/15/2022]
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13
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Nadeau-Vallée M, Obari D, Quiniou C, Lubell WD, Olson DM, Girard S, Chemtob S. A critical role of interleukin-1 in preterm labor. Cytokine Growth Factor Rev 2015; 28:37-51. [PMID: 26684042 DOI: 10.1016/j.cytogfr.2015.11.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/24/2015] [Accepted: 11/03/2015] [Indexed: 12/16/2022]
Abstract
Preterm birth (PTB) is a leading cause of neonatal mortality and morbidity worldwide, and represents a heavy economic and social burden. Despite its broad etiology, PTB has been firmly linked to inflammatory processes. Pro-inflammatory cytokines are produced in gestational tissues in response to stressors and can prematurely induce uterine activation, which precedes the onset of preterm labor. Of all cytokines implicated, interleukin (IL)-1 has been largely studied, revealing a central role in preterm labor. However, currently approved IL-1-targeting therapies have failed to show expected efficacy in pre-clinical studies of preterm labor. Herein, we (a) summarize animal and human studies in which IL-1 or IL-1-targeting therapeutics are implicated with preterm labor, (b) focus on novel IL-1-targeting therapies and diagnostic tests, and (c) develop the case for commercialization and translation means to hasten their development.
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Affiliation(s)
- Mathieu Nadeau-Vallée
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Center, Montréal H3T 1C5, Canada; Department of Pharmacology, Université de Montréal, Montréal H3C 3J7, Canada
| | - Dima Obari
- Department of Pharmacology, Université de Montréal, Montréal H3C 3J7, Canada
| | - Christiane Quiniou
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Center, Montréal H3T 1C5, Canada
| | - William D Lubell
- Department of Chemistry, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - David M Olson
- Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton AB TG6 2S2, Canada
| | - Sylvie Girard
- Departments of Obstetrics and Gynecology, CHU Sainte-Justine Research Centre, Montréal H3T 1C5, Canada.
| | - Sylvain Chemtob
- Departments of Pediatrics, Ophthalmology and Pharmacology, CHU Sainte-Justine Research Center, Montréal H3T 1C5, Canada.
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14
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Al Rabea A, Nadeau-Vallée M, Hou X. Implication of the complement system, specifically the active form and the anaphylatoxins, in human parturition. J Reprod Immunol 2015; 112:81. [PMID: 26344896 DOI: 10.1016/j.jri.2015.08.004] [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] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Areej Al Rabea
- McGill University, Department of Experimental Surgery, Canada
| | | | - Xin Hou
- CHU Sainte-Justine Research Center, Department of Pediatrics, Canada
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15
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Nadeau-Vallée M, Quiniou C, Palacios J, Hou X, Erfani A, Madaan A, Sanchez M, Leimert K, Boudreault A, Duhamel F, Rivera JC, Zhu T, Noueihed B, Robertson SA, Ni X, Olson DM, Lubell W, Girard S, Chemtob S. Novel Noncompetitive IL-1 Receptor-Biased Ligand Prevents Infection- and Inflammation-Induced Preterm Birth. J Immunol 2015; 195:3402-15. [PMID: 26304990 DOI: 10.4049/jimmunol.1500758] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/22/2015] [Indexed: 11/19/2022]
Abstract
Preterm birth (PTB) is firmly linked to inflammation regardless of the presence of infection. Proinflammatory cytokines, including IL-1β, are produced in gestational tissues and can locally upregulate uterine activation proteins. Premature activation of the uterus by inflammation may lead to PTB, and IL-1 has been identified as a key inducer of this condition. However, all currently available IL-1 inhibitors are large molecules that exhibit competitive antagonism properties by inhibiting all IL-1R signaling, including transcription factor NF-κB, which conveys important physiological roles. We hereby demonstrate the efficacy of a small noncompetitive (all-d peptide) IL-1R-biased ligand, termed rytvela (labeled 101.10) in delaying IL-1β-, TLR2-, and TLR4-induced PTB in mice. The 101.10 acts without significant inhibition of NF-κB, and instead selectively inhibits IL-1R downstream stress-associated protein kinases/transcription factor c-jun and Rho GTPase/Rho-associated coiled-coil-containing protein kinase signaling pathways. The 101.10 is effective at decreasing proinflammatory and/or prolabor genes in myometrium tissue and circulating leukocytes in all PTB models independently of NF-κB, undermining NF-κB role in preterm labor. In this work, biased signaling modulation of IL-1R by 101.10 uncovers a novel strategy to prevent PTB without inhibiting NF-κB.
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Affiliation(s)
- Mathieu Nadeau-Vallée
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, University of Montreal, Montreal, Quebec H3C 3J7, Canada
| | - Christiane Quiniou
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Julia Palacios
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Xin Hou
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Atefeh Erfani
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Ankush Madaan
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3G 1Y6, Canada
| | - Mélanie Sanchez
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3G 1Y6, Canada
| | - Kelycia Leimert
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta TG6 2S2, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta TG6 2S2, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta TG6 2S2, Canada
| | - Amarilys Boudreault
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - François Duhamel
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, University of Montreal, Montreal, Quebec H3C 3J7, Canada
| | - José Carlos Rivera
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Maisonneuve-Rosemont Hospital, Research Center, Montreal, Quebec H1T 2M4, Canada
| | - Tang Zhu
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Baraa Noueihed
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada
| | - Sarah A Robertson
- Department of Obstetrics and Gynecology, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Xin Ni
- Department of Obstetrics and Gynecology, Second Military Medical University, Shanghai 200433, China
| | - David M Olson
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta TG6 2S2, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta TG6 2S2, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta TG6 2S2, Canada
| | - William Lubell
- Department of Chemistry, University of Montreal, Montreal, Quebec H3C 3J7, Canada
| | - Sylvie Girard
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Obstetrics and Gynecology, CHU Sainte-Justine Research Centre, Montreal, Quebec H3T 1C5, Canada; and Department of Physiology, CHU Sainte-Justine Research Centre, Montreal, Quebec H3T 1C5, Canada
| | - Sylvain Chemtob
- Department of Pediatrics, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Ophthalmology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, CHU Sainte-Justine Research Center, Montreal, Quebec H3T 1C5, Canada; Maisonneuve-Rosemont Hospital, Research Center, Montreal, Quebec H1T 2M4, Canada;
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Nadeau-Vallée M, Palacios J, Boudreault A, Chemtob S. [New insights to prevent preterm labor]. Med Sci (Paris) 2015; 31:374-6. [PMID: 25958754 DOI: 10.1051/medsci/20153104010] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mathieu Nadeau-Vallée
- Département de pédiatrie, pharmacologie et ophtalmologie, CHU Sainte-Justine, centre de recherche, 3175 chemin Côte-Sainte-Catherine, Montréal, H3T 1C5 Canada
| | - Julia Palacios
- Département de médecine, université de Montréal, 2900 boulevard Édouard-Montpetit, Montréal, H3C 3J7 Canada
| | - Amarilys Boudreault
- Département de médecine, université de Montréal, 2900 boulevard Édouard-Montpetit, Montréal, H3C 3J7 Canada
| | - Sylvain Chemtob
- Département de pédiatrie, pharmacologie et ophtalmologie, CHU Sainte-Justine, centre de recherche, 3175 chemin Côte-Sainte-Catherine, Montréal, H3T 1C5 Canada
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Nadeau-Vallée M, Hou X. Paradoxal Inflammatory Effects of Anti-Inflammatory Mediators in Fetal Origin Cells. Am J Reprod Immunol 2015; 74:99. [PMID: 25694119 DOI: 10.1111/aji.12370] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Xin Hou
- Department of Pediatrics, Research Centre - CHU Sainte-Justine, Montréal, QC, Canada
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Nadeau-Vallée M, Hou X. Slit2 withdrawal could contribute to the common inflammatory pathway leading to labor. J Reprod Immunol 2015; 110:130. [PMID: 25613543 DOI: 10.1016/j.jri.2014.12.004] [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] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | - Xin Hou
- Research Centre, CHU Sainte-Justine, Department of Pediatrics, Canada
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Hamel D, Sanchez M, Duhamel F, Roy O, Honoré JC, Noueihed B, Zhou T, Nadeau-Vallée M, Hou X, Lavoie JC, Mitchell G, Mamer OA, Chemtob S. G-protein-coupled receptor 91 and succinate are key contributors in neonatal postcerebral hypoxia-ischemia recovery. Arterioscler Thromb Vasc Biol 2013; 34:285-93. [PMID: 24285580 DOI: 10.1161/atvbaha.113.302131] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [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: 12/16/2022]
Abstract
OBJECTIVE Prompt post-hypoxia-ischemia (HI) revascularization has been suggested to improve outcome in adults and newborn subjects. Other than hypoxia-inducible factor, sensors of metabolic demand remain largely unknown. During HI, anaerobic respiration is arrested resulting in accumulation of carbohydrate metabolic intermediates. As such succinate readily increases, exerting its biological effects via a specific receptor, G-protein-coupled receptor (GPR) 91. We postulate that succinate/GPR91 enhances post-HI vascularization and reduces infarct size in a model of newborn HI brain injury. APPROACH AND RESULTS The Rice-Vannucci model of neonatal HI was used. Succinate was measured by mass spectrometry, and microvascular density was evaluated by quantification of lectin-stained cryosection. Gene expression was evaluated by real-time polymerase chain reaction. Succinate levels rapidly increased in the penumbral region of brain infarcts. GPR91 was foremost localized not only in neurons but also in astrocytes. Microvascular density increased at 96 hours after injury in wild-type animals; it was diminished in GPR91-null mice leading to an increased infarct size. Stimulation with succinate led to an increase in growth factors implicated in angiogenesis only in wild-type mice. To explain the mode of action of succinate/GPR91, we investigated the role of prostaglandin E2-prostaglandin E receptor 4, previously proposed in neural angiogenesis. Succinate-induced vascular endothelial growth factor expression was abrogated by a cyclooxygenase inhibitor and a selective prostaglandin E receptor 4 antagonist. This antagonist also abolished succinate-induced neovascularization. CONCLUSIONS We uncover a dominant metabolic sensor responsible for post-HI neurovascular adaptation, notably succinate/GPR91, acting via prostaglandin E2-prostaglandin E receptor 4 to govern expression of major angiogenic factors. We propose that pharmacological intervention targeting GPR91 could improve post-HI brain recovery.
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Affiliation(s)
- David Hamel
- From the Department of Pediatrics, Research Center-CHU Ste-Justine, Montréal, Quebec, Canada (D.H., O.R., J.C.H., T.Z., X.H., J.-C.L., G.A.M., S.C.); Departments of Pharmacology (D.H., F.D., S.C.) and Biomedical Sciences (O.R., M.N.-V.), Université de Montréal, Montréal, Quebec, Canada; and Department of Pharmacology and Therapeutics (M.S., B.N., S.C.), Goodman Cancer Research and Metabolomics Core Facility (O.A.M.), McGill University, Montréal, Quebec, Canada
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