Developmental origins of physiological stress reactivity

The model of developmental origins of health and disease proposes that organisms during fetal period utilize cues that enable their adaptation in the postnatal environment they are likely to live, having short-term advantages when trying to survive in environment but simultaneously in the long run have costs for health. A large body of epidemiological research has found that low birth weight, a marker of intrauterine conditions, is associated with cardiovascular (CV) disease. Since the reported associations of birth weight with normal variation in the resting blood pressure (BP), a major predictor of CV disease risk, have been modest, a key candidate mediating the link has been CV and hypothalamus-pituitary-adrenal axes (HPAA) reactivity to stress. In addition, not only weight at birth but also gestational age and early postnatal growth may have independent associations to stress reactivity. The aim of this thesis was to investigate whether pre- and postnatal growth and gestational age are associated with CV and HPAA activity before, during and after stress in childhood and in late adulthood. Altogether 287 men and women aged 60-70 and 299 boys and girls aged 7-9 underwent Trier Social Stress Test. Several indices of HPAA and CV were measured and birth size and gestational age were obtained from birth records. Results showed that low birth weight was associated with low HPAA activity during psychosocial stress, and rapid gain in BMI during years 7-11 was related to heightened stress reactivity to psychosocial stress. Size at birth in children and gestational age and early postnatal (0-2 years) gain in height in adults were associated with CV stress responses; however, in a sex-specific manner. Given that CV stress responses and HPAA activity are markers of CV disease vulnerability, our results may partly explain the associations between early environment and later CV disease.

Dopamine receptors in human foetal brains:Characterization, regulation and ontogeny of [3H]spiperone binding sites in striatum

Eighteen corpora striata from normal human foetal brains ranging in gestational age from 16 to 40 weeks and five from post natal brains ranging from 23 days to 42 years were analysed for the ontogeny of dopamine receptors using [3H]spiperone as the ligand and 10 mM dopamine hydrochloride was used in blanks. Spiperone binding sites were characterized in a 40-week-old foetal brain to be dopamine receptors by the following criteria: (1) It was localized in a crude mitochondrial pellet that included synaptosomes; (2) binding was saturable at 0.8 nM concentration; (3) dopaminergic antagonists spiperone, haloperidol, pimozide, trifluperazine and chlorpromazine competed for the binding with IC50 values in the range of 0.3–14 nM while agonists—apomorphine and dopamine gave IC50 values of 2.5 and 10 μM, respectively suggesting a D2 type receptor.Epinephrine and norepinephrine inhibited the binding much less efficiently while mianserin at 10 μM and serotonin at 1 mM concentration did not inhibit the binding. Bimolecular association and dissociation rate constants for the reversible binding were 5.7 × 108 M−1 min−1 and 5.0 × 10−2 min−1, respectively. Equilibrium dissociation constant was 87 pM and the KD obtained by saturation binding was 73 pM.During the foetal age 16 to 40 weeks, the receptor concentration remained in the range of 38–60 fmol/mg protein or 570–1080 fmol/g striatum but it increased two-fold postnatally reaching a maximum at 5 years Significantly, at lower foetal ages (16–24 weeks) the [3H]spiperone binding sites exhibited a heterogeneity with a high (KD, 13–85 pM) and a low (KD, 1.2–4.6 nM) affinity component, the former accounting for 13–24% of the total binding sites. This heterogeneity persisted even when sulpiride was used as a displacer. The number of high affinity sites increased from 16 weeks to 24 weeks and after 28 weeks of gestation, all the binding sites showed only a single high affinity.GTP decreased the agonist affinity as observed by dopamine competition of [3H]spiperone binding in 20-week-old foetal striata and at all subsequent ages. GTP increased IC50 values of dopamine 2 to 4.5 fold and Hill coefficients were also increased becoming closer to one suggesting that the dopamine receptor was susceptible to regulation from foetal life onwards.

An investigation into the feasibility of fetal lung maturity prediction using statistical textural features

Fetal lung and liver tissues were examined by ultrasound in 240 subjects during 24 to 38 weeks of gestational age in order to investigate the feasibility of predicting the maturity of the lung from the textural features of sonograms. A region of interest of 64 X 64 pixels is used for extracting textural features. Since the histological properties of the liver are claimed to remain constant with respect to gestational age, features obtained from the lung region are compared with those from liver. Though the mean values of some of the features show a specific trend with respect to gestation age, the variance is too high to guarantee definite prediction of the gestational age. Thus, we restricted our purview to an investigation into the feasibility of fetal lung maturity prediction using statistical textural features. Out of 64 features extracted, those features that are correlated with gestation age and less computationally intensive are selected. The results of our study show that the sonographic features hold some promise in determining whether the fetal lung is mature or immature.

Expression of Sonic Hedgehog During Cell Proliferation in the Human Cerebellum

The regulation of cell proliferation in the external granular layer (EGL) of the developing cerebellum is important for its normal patterning. An important signal that regulates EGL cell proliferation is Sonic hedgehog (Shh). Shh is secreted by the Purkinje cells (PC) and has a mitogenic effect on the granule cell precursors of the EGL. Deregulation of Shh signaling has been associated with abnormal development, and been implicated in medulloblastomas, which are tumors that arise from the cerebellum. Given the importance of the Shh pathway in cerebellum development and disease, there has been no systematic study of its expression pattern during human cerebellum development. In this study, we describe the expression pattern of Shh, its receptor patched, smoothened, and its effectors that belong to the Gli family of transcription factors, during normal human cerebellum development from 10 weeks of gestational age, and in medulloblastomas that represents a case of abnormal cell proliferation in the cerebellum. This expression pattern is compared to equivalent stages in the normal development of cerebellum in mouse, as well as in tumors. Important differences between human and mouse that reflect differences in the normal developmental program between the 2 species are observed. First, in humans there appears to be a stage of Shh signaling within the EGL, when the PC are not yet the source of Shh. Second, unlike in the postnatal mouse cerebellum, expression of Shh in the PC in the postnatal human cerebellum is downregulated. Finally, medulloblastomas in the human but not in patched heterozygote mouse express Shh. These results highlight cross-species differences in the regulation of the Shh signaling pathway.

The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort.

INTRODUCTION: Recent studies in other European countries suggest that the prevalence of congenital cryptorchidism continues to increase. This study aimed to explore the prevalence and natural history of congenital cryptorchidism in a UK centre. METHODS: Between October 2001 and July 2008, 784 male infants were born in the prospective Cambridge Baby Growth Study. 742 infants were examined by trained research nurses at birth; testicular position was assessed using standard techniques. Follow-up assessments were completed at ages 3, 12, 18 and 24 months in 615, 462, 393 and 326 infants, respectively. RESULTS: The prevalence of cryptorchidism at birth was 5.9% (95% CI 4.4% to 7.9%). Congenital cryptorchidism was associated with earlier gestational age (p<0.001), lower birth weight (p<0.001), birth length (p<0.001) and shorter penile length at birth (p<0.0001) compared with other infants, but normal size after age 3 months. The prevalence of cryptorchidism declined to 2.4% at 3 months, but unexpectedly rose again to 6.7% at 12 months as a result of new cases. The cumulative incidence of "acquired cryptorchidism" by age 24 months was 7.0% and these cases had shorter penile length during infancy than other infants (p = 0.003). CONCLUSIONS: The prevalence of congenital cryptorchidism was higher than earlier estimates in UK populations. Furthermore, this study for the first time describes acquired cryptorchidism or "ascending testis" as a common entity in male infants, which is possibly associated with reduced early postnatal androgen activity.

The role of androgens in fetal growth: observational study in two genetic models of disordered androgen signalling.

OBJECTIVE: To examine the role of androgens on birth weight in genetic models of altered androgen signalling. SETTING: Cambridge Disorders of Sex Development (DSD) database and the Swedish national screening programme for congenital adrenal hyperplasia (CAH). PATIENTS: (1) 29 girls with XY karyotype and mutation positive complete androgen insensitivity syndrome (CAIS); (2) 43 girls and 30 boys with genotype confirmed CAH. MAIN OUTCOME MEASURES: Birth weight, birth weight-for-gestational-age (birth weight standard deviation score (SDS)) calculated by comparison with national references. RESULTS: Mean birth weight SDS in CAIS XY infants was higher than the reference for girls (mean, 95% CI: 0.4, 0.1 to 0.7; p=0.02) and was similar to the national reference for boys (0.1, -0.2 to 0.4). Birth weight SDS in CAH girls was similar to the national reference for girls (0.0, -0.2 to 0.2) and did not vary by severity of gene mutation. Birth weight SDS in CAH boys was also similar to the national reference for boys (0.2, -0.2 to 0.6). CONCLUSION: CAIS XY infants have a birth weight distribution similar to normal male infants and birth weight is not increased in infants with CAH. Alterations in androgen signalling have little impact on birth weight. Sex dimorphism in birth size is unrelated to prenatal androgen exposure.

Social, economic, and health impact of the respiratory syncytial virus: a systematic search

Background: Bronchiolitis caused by the respiratory syncytial virus (RSV) and its related complications are common in infants born prematurely, with severe congenital heart disease, or bronchopulmonary dysplasia, as well as in immunosuppressed infants. There is a rich literature on the different aspects of RSV infection with a focus, for the most part, on specific risk populations. However, there is a need for a systematic global analysis of the impact of RSV infection in terms of use of resources and health impact on both children and adults. With this aim, we performed a systematic search of scientific evidence on the social, economic, and health impact of RSV infection. Methods: A systematic search of the following databases was performed: MEDLINE, EMBASE, Spanish Medical Index, MEDES-MEDicina in Spanish, Cochrane Plus Library, and Google without time limits. We selected 421 abstracts based on the 6,598 articles identified. From these abstracts, 4 RSV experts selected the most relevant articles. They selected 65 articles. After reading the full articles, 23 of their references were also selected. Finally, one more article found through a literature information alert system was included. Results: The information collected was summarized and organized into the following topics: 1. Impact on health (infections and respiratory complications, mid-to long-term lung function decline, recurrent wheezing, asthma, other complications such as otitis and rhino-conjunctivitis, and mortality; 2. Impact on resources (visits to primary care and specialists offices, emergency room visits, hospital admissions, ICU admissions, diagnostic tests, and treatments); 3. Impact on costs (direct and indirect costs); 4. Impact on quality of life; and 5. Strategies to reduce the impact (interventions on social and hygienic factors and prophylactic treatments). Conclusions: We concluded that 1. The health impact of RSV infection is relevant and goes beyond the acute episode phase; 2. The health impact of RSV infection on children is much better documented than the impact on adults; 3. Further research is needed on mid-and long-term impact of RSV infection on the adult population, especially those at high-risk; 4. There is a need for interventions aimed at reducing the impact of RSV infection by targeting health education, information, and prophylaxis in high-risk populations.

Avaliação do consumo alimentar no período reprodutivo e variação de peso no pós-parto

O presente estudo tem como tema central o ganho de peso e o consumo alimentar no período reprodutivo. A tese está dividida em três partes: i) revisão da literatura científica sobre os fatores de risco para o ganho de peso excessivo na gestação e para a sua retenção no pós-parto; ii) análise quantitativa e qualitativa do consumo alimentar (energia, nutrientes e alimentos) do período gestacional para o pós-parto; e iii) avaliação prospectiva da associação entre a dieta hiperproteica (≥ 1.2 g/kg) e a variação de peso pós-gestacional. A revisão da literatura apontou como principais determinantes da variação de peso no pós-parto os seguintes fatores: ganho de peso gestacional, peso pré-gestacional, dieta, atividade física, lactação, idade, escolaridade, renda, paridade e raça. As partes ii e iii correspondem a dois artigos, sendo que a população do estudo empregada nas duas análises foi baseada em uma coorte de mulheres no pós-parto atendidas no Centro Municipal de Saúde (CMS) Marcolino Candau, localizado no Município do Rio de Janeiro. Dentre as 709 mulheres convidadas para participar da pesquisa, 479 ingressaram na coorte. As mulheres foram recrutadas através dos serviços de pré-natal e na rotina pediátrica de imunização do BCG, oferecidos pelo CMS, e imediatamente após o parto, na maternidade central de referência. A coleta de dados ocorreu entre maio de 1999 e abril de 2001, sendo 15 meses de recrutamento e 9 meses de seguimento. As mulheres foram entrevistadas aos 15 dias, 2, 6 e 9 meses do pós-parto. Foram consideradas elegíveis para as duas analises as mulheres com idade entre 18 e 45 anos de idade, entrevistadas até 30 dias do pós-parto, sem doenças crônicas pré-existentes, com gravidez de 35 ou mais semanas gestacionais e sem gestação gemelar. O estudo sobre a composição da dieta do período gestacional para o pós-parto contou com 276 mulheres que responderam aos dois questionários de freqüência de consumo alimentar (QFCA) aplicados aos 15 dias e aos 6 meses do seguimento. Os resultados mostraram que as mulheres consumiram dietas mais energéticas na gravidez e aquelas que mais restringiram o consumo de energia no pós-parto, apresentaram um incremento na densidade de proteínas da dieta. As análises das medidas repetidos do peso foram realizadas para avaliar o efeito da dieta hiperproteica (≥ 1.2 g/kg) sobre a variação de peso no pós-parto, para as quais haviam dados de uma amostra de 430 mulheres. Os resultados mostraram que as mulheres com dieta hiperproteica perderam mais peso do que as mulheres com dieta normo ou hipoproteica (< 1.2 g/kg) (226 g/mês versus 123 g/mês). As duas analises indicam que um pequeno incremento no consumo de proteínas promove maior perda de peso. Estudos longitudinais futuros devem incluir avaliação relativa a segurança das dietas hiperproteicas no pós-parto.

Fatores de risco para ocorrência de restrição do crescimento extra-uterino em prematuros de muito baixo peso ao nascer

A desnutrição em recém-nascidos prematuros de muito baixo peso ao nascer (MBPN) é um fenômeno universal e vem aumentando nas últimas décadas. A restrição do crescimento extra-uterino (RCEU) é um importante indicador do estado nutricional nestes pacientes. O objetivo deste estudo foi identificar os fatores de risco para RCEU durante a internação hospitalar. Foi realizado estudo de coorte retrospectiva que incluiu 188 recém-nascidos MBPN adequados para idade gestacional (AIG), no período de 2002 a 2004. A análise constituiu-se em um modelo de regressão linear longitudinal de efeitos mistos, sendo observada a diferença na taxa de variação do peso para crianças com e sem RCEU na alta hospitalar. Oitenta e sete (46%) dos recém-nascidos incluídos no estudo apresentaram RCEU na alta hospitalar. Influenciaram a taxa de variação do peso ao longo da internação hospitalar: o menor peso ao nascer, sexo masculino, menor Apgar de 5o minuto, o maior escore CRIB; persistência do canal arterial, doença metabólica óssea, hemorragia intracraniana, displasia broncopulmonar e sepse. O maior tempo em oxigenioterapia, as transfusões sanguíneas, o uso de diurético, o maior tempo para atingir dieta plena e de uso de nutrição parenteral também foram preditores do crescimento. A desnutrição de recém-nascidos prematuros MBPN nas Unidades Neonatais é um problema frequente e influenciado tanto pelo cuidado neonatal quanto pelas características individuais de cada criança.

Interações iniciais mãe-bebê: uma comparação entre díades de bebês prematuros e nascidos a termo

O estudo das interações iniciais entre mãe e bebê é fundamental para a compreensão da ontogênese humana (Seidl-de-Moura, et al., 2008) e para ajudar a promover a saúde relacional da díade. Nos estudos sobre as interações inicias entre mãe e bebê prematuro, ainda há um questionamento sobre se o nascimento prematuro e a internação em uma UTI-Neonatal fortalecem ou enfraquecem as trocas entre os membros da díade. Assim, neste estudo observou-se e analisou-se as interações iniciais entre mãe e bebê prematuro na UTI-Neonatal, observou o desenvolvimento das interações ao longo de dois meses, e comparou com interações de um grupo de mães-bebês nascidos a termo, de acordo com categorias predefinidas para a análise de vídeos. Também analisou, através de entrevistas, as características que as mães de cada tipo de díade relataram sobre seus filhos, bem como as metas de desenvolvimento apontadas e as emoções que expressaram em relação ao bebê. Participaram da pesquisa 20 díades mãe-bebê de nascidos a termo, e 20 díades de mãebebê de prematuros, nascidos entre 28 e 36 semanas de idade gestacional. Entre outras evidências, enquanto os bebês estavam na UTI-Neonatal, foram encontradas associações significativas entre as características maternas e as do bebê. Após a alta hospitalar, houve associações significativas entre a sincronia da díade e os comportamentos dos bebês. Não houve diferenças significativas entre as características de interações quando a díade estava na UTI-Neonatal e após dois meses. Não foram observadas diferenças significativas entre as díades de mães-bebês prematuros e mães-bebês a termo em relação à sincronia da díade, nem tampouco entre os comportamentos maternos nos dois momentos de observação, mas uma diferença significativa foi encontrada entre os comportamentos autorregulatórios dos bebês nascidos a termo e os dos prematuros. Verificou-se que para os dois grupos de mães, as emoções mais frequentemente relatadas foram as de amor e apego. As metas de desenvolvimento mais apontadas enquanto as mães estavam com seu bebê na UTI-Neonatal foram voltadas para o desenvolvimento físico do bebê, e quando os bebês estavam com dois meses, as metas eram mais voltadas para o desenvolvimento emocional, da mesma forma como ocorreu com as mães de bebês a termo. As características mais apontadas pelas mães ao pensarem em seus bebês enquanto eles estavam na UTI-Neonatal foram as físicas, enquanto após a alta, foram as pessoais e emocionais, assim como ocorreu com as mães de bebês nascidos a termo. Os resultados se contrapõem a afirmações de que em episódios de interação as mães de prematuros são menos sensitivas, mais intrusivas, e seus bebês, menos atentos e responsivos. Apontaram, ao contrário, para uma certa continuidade entre o que se observou na UTI-Neonatal e aos dois meses. Também não foram identificadas diferenças significativas na maioria das características de interações entre mães e bebês prematuros e mães e bebês nascidos a termo. Assim, tais resultados suavizam possíveis estigmatizações sobre estas mães e apontam a importância de se fortalecer essa relação na UTI-Neonatal através de estratégias de promoção de saúde.

Long-Term Burden and Respiratory Effects of Respiratory Syncytial Virus Hospitalization in Preterm Infants — The SPRING Study

The health status of premature infants born 32(1)-35(0) weeks' gestational age (wGA) hospitalized for RSV infection in the first year of life (cases; n = 125) was compared to that of premature infants not hospitalized for RSV (controls; n = 362) through 6 years. The primary endpoints were the percentage of children with wheezing between 2-6 years and lung function at 6 years of age. Secondary endpoints included quality of life, healthcare resource use, and allergic sensitization. A significantly higher proportion of cases than controls experienced recurrent wheezing through 6 years of age (46.7% vs. 27.4%; p = 0.001). The vast majority of lung function tests appeared normal at 6 years of age in both cohorts. In children with pulmonary function in the lower limit of normality (FEV1 Z-score [-2; -1]), wheezing was increased, particularly for cases vs. controls (72.7% vs. 18.9%, p = 0.002). Multivariate analysis revealed the most important factor for wheezing was RSV hospitalization. Quality of life on the respiratory subscale of the TAPQOL was significantly lower (p = 0.001) and healthcare resource utilization was significantly higher (p<0.001) in cases than controls. This study confirms RSV disease is associated with wheezing in 32-35 wGA infants through 6 years of age.

Nutrição hiperproteica em recém-nascidos com muito baixo peso e evolução de índices antropométricos até a alta hospitalar: ensaio clínico randomizado

Apesar de diversos estudos sobre nutrição de prematuros terem sido realizados, ainda não existe consenso sobre a melhor estratégia nutricional a ser adotada. Atualmente a taxa de crescimento dessa população não é semelhante àquela encontrada no ambiente intrauterino. O presente estudo tem por objetivo avaliar se o maior aporte proteico enteral durante a internação hospitalar promove melhora dos índices antropométricos na alta hospitalar. Realizou-se um ensaio clínico randomizado com 117 prematuros nascidos entre janeiro de 2009 e julho de 2013 com peso ≤ 1500 gramas e idade gestacional≤32 semanas em uma unidade terciária de saúde, excluídos os nascidos com malformações graves, aferindo-se os índices antropométricos ao nascimento e na alta hospitalar. Randomizou-se os prematuros por meio de sorteio em dois grupos. O grupo 1 (n=53), foi submetido a um aporte protéico enteral diário de 4,5 gramas/kg/dia, enquanto o grupo 2 (n=64), recebeu 3,5 gramas/kg/dia. Avaliou-se se a nutrição enteral com aporte protéico maior que o comumente utilizado em unidades de terapia intensiva neonatais e também descrito na literatura, promove diferenças antropométricas na alta hospitalar. Na análise dos resultados, verificou-se diferença estatisticamente significativa para retorno ao peso de nascimento (p=0,02), crescimento de escore-Z em relação ao peso de nascimento (p=0,03) e crescimento escore-Z em relação ao comprimento de nascimento (p=0,02) quando comparados o grupo 1 ao 2. Não houve diferenças estatisticamente significativas nas incidências de enterocolite necrotizante (p=0,70, RR 0,88), déficit ponderal na alta (p=0,27, RR 0,70), restrição de crescimento na alta (p= 0,39, RR 0,82) e déficit de perímetro cefálico na alta (p=0,45, RR 0,67). Concluiu-se, apesar das limitações metodológicas do estudo, que os participantes do grupo 1 apresentaram menor decréscimo de escores-Z em relação ao peso de nascimento e ao comprimento de nascimento quando comparados ao grupo 2, além de necessidade de menor tempo para recuperação do peso de nascimento. Não houve diferença entre os grupos para tempo de internação hospitalar, assim como para intercorrências de interesse (enterocolite necrotizante, déficit ponderal na alta, restrição de crescimento na alta e déficit de perímetro cefálico na alta).

Application of neural networks to the ranking of perinatal variables influencing birthweight.

In this paper we compare Multi-Layer Perceptrons (a neural network type) with Multivariate Linear Regression in predicting birthweight from nine perinatal variables which are thought to be related. Results show, that seven of the nine variables, i.e., gestational age, mother's body-mass index (BMI), sex of the baby, mother's height, smoking, parity and gravidity, are related to birthweight. We found no significant relationship between birthweight and each of the two variables, i.e., maternal age and social class.

A clinical system for three-dimensional extended-field-of-view ultrasound.

OBJECTIVE: This work is concerned with the creation of three-dimensional (3D) extended-field-of-view ultrasound from a set of volumes acquired using a mechanically swept 3D probe. 3D volumes of ultrasound data can be registered by attaching a position sensor to the probe; this can be an inconvenience in a clinical setting. A position sensor can also cause some misalignment due to patient movement and respiratory motion. We propose a combination of three-degrees-of-freedom image registration and an unobtrusively integrated inertial sensor for measuring orientation. The aim of this research is to produce a reliable and portable ultrasound system that is able to register 3D volumes quickly, making it suitable for clinical use. METHOD: As part of a feasibility study we recruited 28 pregnant females attending for routine obstetric scans to undergo 3D extended-field-of-view ultrasound. A total of 49 data sets were recorded. Each registered data set was assessed for correct alignment of each volume by two independent observers. RESULTS: In 77-83% of the data sets more than four consecutive volumes registered. The successful registration relies on good overlap between volumes and is adversely affected by advancing gestational age and foetal movement. CONCLUSION: The development of reliable 3D extended-field-of-view ultrasound may help ultrasound practitioners to demonstrate the anatomical relation of pathology and provide a convenient way to store data.

The role of the dopaminergic neurotrophin growth/differentiation factor-5 in the developing rat ventral midbrain

Growth differentiation factor-5 (GDF-5) is a member of the transforming growth factor-β superfamily, a family of proteins that play diverse roles in many aspects of cell growth, proliferation and differentiation. GDF-5 has also been shown to be a trophic factor for embryonic midbrain dopaminergic neurons in vitro (Krieglstein et al. 1995) and after transplantation to adult rats in vivo (Sullivan et al. 1998). GDF-5 has also been shown to have neuroprotective and neurorestorative effects on adult dopaminergic neurons in the substantia nigra in animal models of Parkinson’s disease (Sullivan et al. 1997, 1999; Hurley et al. 2004). This experimental evidence has lead to GDF-5 being proposed as a neurotrophic factor with potential for use in the treatment of Parkinson’s disease. However, it is not know if GDF-5 is expressed in the brain and whether it plays a role in dopaminergic neuron development. The experiments presented here aim to address these questions. To that end this thesis is divided into five separate studies each addressing a particular question associated with GDF-5 and its expression patterns and roles during the development of the rat midbrain. Expression of the GDF-5 in the developing rat ventral mesencephalon (VM) was found to begin at E12 and peak on E14, the day that dopaminergic neurons undergo terminal differentiation. In the adult rat, GDF-5 was found to be restricted to heart and brain, being expressed in many areas of the brain, including striatum and midbrain. This indicated a role for GDF-5 in the development and maintenance of dopaminergic neurons. The appropriate receptors for GDF-5 (BMPR-II and BMPR-Ib) were found to be expressed at high levels in the rat VM at E14 and BMPR-II expression was demonstrated on dopaminergic neurons in the E13 mouse VM. GDF-5 resulted in a three-fold increase in the numbers of dopaminergic neurons in cultures of E14 rat VM, without affecting the numbers of neurones or total cells. GDF-5 was found to increase the proportion of neurons that were dopaminergic. The numbers of Nurr1-positive cells were not affected by GDF-5 treatment, but GDF-5 did increase the numbers of Nurr1- positive cells that expressed tyrosine hydroxylase (TH). Taken together this data indicated that GDF-5 increases the conversion of Nurr1-positive, TH-negative cells to Nurr1-positive, TH-positive cells. In GDF-5 treated cultures, total neurite length, neurite arborisation and somal area of dopaminergic were all significantly increased compared to control cultures. Thus this study showed that GDF-5 increased the numbers and morphological differentiation of VM dopaminergic neurones in vitro. In order to examine if GDF-5 could induce a dopaminergic phenotype in neural progenitor cells, neurosphere cultures prepared from embryonic rat VM were established. The effect of the gestational age of the donor VM on the proportion of cell types generated from neurospheres from E12, E13 and E14 VM was examined. Dopaminergic neurons could only be generated from neurospheres which were prepared from E12 VM. Thus in subsequent studies the effect of GDF-5 on dopaminergic induction was examined in progentior cell cultures prepared from the E12 rat VM. In primary cultures of E12 rat VM, GDF-5 increased the numbers of TH-positive cells without affecting the proliferation or survival of these cells. In cultures of expanded neural progenitor cells from the E12 rat VM, GDF-5 increased the expression of Nurr1 and TH, an action that was dependent on signalling through the BMPR-Ib receptor. Taken together, these experiments provide evidence that GDF-5 is expressed in the developing rat VM, is involved in both the induction of a dopaminergic phenotype in cells of the VM and in the subsequent morphological development of these dopaminergic neurons