IUGR in the absence of postnatal 'catch-up' growth leads to improved whole body insulin sensitivity in rat offspring

A suboptimal in utero environment leads to fetal adaptations to ensure short-term survival but in the long-term may lead to disease when the postnatal growth does not reflect that in utero. This study examined the effect of IUGR on whole body insulin sensitivity and metabolic activity in adult rats. Female Wistar-Kyoto rats were fed either a normal protein diet (NPD 20% casein) or a low protein diet (LPD; 8.7% casein) during pregnancy and 2 wk of lactation. In offspring at 32 wk of age, indirect calorimetry and dual energy x-ray absorptiometry (DEXA) were performed to assess metabolic activity and body composition. Insulin sensitivity was assessed using a euglycemic-hyperinsulinemic clamp. At 3 d of age, male and female LPD offspring were 23 and 27% smaller than controls, respectively. They remained significantly smaller throughout the experimental period (~10% smaller at 32 wk). Importantly, there was increased insulin sensitivity in LPD offspring (47% increase in males and 38% increase in females); pancreatic insulin content was normal. Body composition, O2 consumption, respiratory exchange ratio (RER), and locomotor activity were not different to controls. These findings suggest that in the absence of “catch-up” growth IUGR programs for improved insulin sensitivity.

The lipid transporters ABCA1 and ABCG1 are differentially expressed in syncytiotrophoblasts of preeclamptic and IUGR placentas

A91

PP141. The lipid transporters ABCA1 and ABCG1 are differentially expressed in preeclamptic and IUGR placentas

INTRODUCTION The ATP-binding cassette (ABC) transporter A1 (ABCA1) and ABCG1 are highly expressed in the placenta in various compartments, including the villous syncytiotrophoblast (V-STB) and foetal endothelial cells. Among other not yet characterized functions, they play a role in the foeto-maternal transport of cholesterol and other lipophilic molecules. In humans, preliminary data suggest expressional changes of ABCA1 and ABCG1 in pathologic gestation, particularly under hypoxic conditions, but a systematic expression analysis in common human pregnancy diseases has never been performed. OBJECTIVES The aim of the present study was to characterize ABCA1 and ABCG1 expression in a large series of pathologic placentas, in particular from preeclampsia (PE) and intrauterine growth restriction (IUGR) which are associated with placental hypoxia. METHODS Placentas from 152 pathological pregnancies, including PE and/or HELLP (n=24) and IUGR (n=21), and 20 normal control placentas were assessed for their ABCA1 and ABCG1 mRNA and protein expression with quantitative RT-PCR and semi-quantitative immunohistochemical analysis, respectively. RESULTS ABCA1 protein expression in the V-STB was significantly less extensive in PE compared with normal controls (<10% of V-STB stained for ABCA1 in 58% PE placentas vs. 25% controls; p=0.035). Conversely, it was significantly more wide-spread in IUGR (>75% of V-STB stained in 57% IUGR placentas vs. 15% controls; p=0.009). Moreover, there was an insignificant trend for increased ABCA1 expression in fetal endothelial cells of stem villi in PE (p=0.0588). ABCA1 staining levels in V-STB were significantly associated with placental histopathological features related with hypoxia: they were decreased in placentas exhibiting syncytial knotting (p=0.033) and decidual vasculopathy (p=0.0437) and increased in low weight placentas (p=0.015). The significant and specific alterations in ABCA1 protein expression found at a specific cellular level were not paralleled by changes in ABCA1 mRNA abundance of total placental tissue. ABCG1 staining was universally extensive in the V-STB of normal placentas, always affecting more than 90% of V-STB surface. In comparison, ABCG1 staining of the V-STB was generally often reduced in pregnancy diseases. In particular, less than 90% of V-STB exhibited ABCG1 staining in 26% of PE placentas (p=0.022) and 35% of IUGR placentas (p=0.003). Similarly to ABCA1, ABCG1 mRNA expression in total placental tissue was not significantly different between controls and PE or IUGR. CONCLUSION ABCA1 and ABCG1 proteins are differentially expressed, with either down- or up-regulation, in the V-STB of placentas exhibiting features of chronic hypoxia, such as in PE and IUGR. This suggests that other factors in addition to hypoxia regulate the expression of placental lipid transporters. The specific changes on a cellular level were masked when only total tissue mRNA was analysed underlining the importance of cell specific expression analysis. The potential effects of decreased placental ABCA1 and ABCG1 expression on foetal nutrition and development remain to be elucidated.

The long non-coding RNA NEAT1 is increased in IUGR placentas, leading to potential new hypotheses of IUGR origin/development.

INTRODUCTION Intrauterine Growth Restriction (IUGR) is a multifactorial disease defined by an inability of the fetus to reach its growth potential. IUGR not only increases the risk of neonatal mortality/morbidity, but also the risk of metabolic syndrome during adulthood. Certain placental proteins have been shown to be implicated in IUGR development, such as proteins from the GH/IGF axis and angiogenesis/apoptosis processes. METHODS Twelve patients with term IUGR pregnancy (birth weight < 10th percentile) and 12 CTRLs were included. mRNA was extracted from the fetal part of the placenta and submitted to a subtraction method (Clontech PCR-Select cDNA Subtraction). RESULTS One candidate gene identified was the long non-coding RNA NEAT1 (nuclear paraspeckle assembly transcript 1). NEAT1 is the core component of a subnuclear structure called paraspeckle. This structure is responsible for the retention of hyperedited mRNAs in the nucleus. Overall, NEAT1 mRNA expression was 4.14 (±1.16)-fold increased in IUGR vs. CTRL placentas (P = 0.009). NEAT1 was exclusively localized in the nuclei of the villous trophoblasts and was expressed in more nuclei and with greater intensity in IUGR placentas than in CTRLs. PSPC1, one of the three main proteins of the paraspeckle, co-localized with NEAT1 in the villous trophoblasts. The expression of NEAT1_2 mRNA, the long isoform of NEAT1, was only modestly increased in IUGR vs. CTRL placentas. DISCUSSION/CONCLUSION The increase in NEAT1 and its co-localization with PSPC1 suggests an increase in paraspeckles in IUGR villous trophoblasts. This could lead to an increased retention of important mRNAs in villous trophoblasts nuclei. Given that the villous trophoblasts are crucial for the barrier function of the placenta, this could in part explain placental dysfunction in idiopathic IUGR fetuses.

Pre-eclampsia : The role of soluble VEGF receptor-1 and related anti-angiogenic factors beyond

Pre-eclampsia is a pregnancy complication that affects about 5% of all pregnancies. It is known to be associated with alterations in angiogenesis -related factors, such as vascular endothelial growth factor (VEGF). An excess of antiangiogenic substances, especially the soluble receptor-1 of VEGF (sVEGFR-1), has been observed in maternal circulation after the onset of the disease, probably reflecting their increased placental production. Smoking reduces circulating concentrations of sVEGFR-1 in non-pregnant women, and in pregnant women it reduces the risk of pre-eclampsia. Soluble VEGFR-1 acts as a natural antagonist of VEGF and placental growth factor (PlGF) in human circulation, holding a promise for potential therapeutic use. In fact, it has been used as a model to generate a fusion protein, VEGF Trap , which has been found effective in anti-angiogenic treatment of certain tumors and ocular diseases. In the present study, we evaluated the potential use of maternal serum sVEGFR-1, Angiopoietin-2 (Ang-2) and endostatin, three central anti-angiogenic markers, in early prediction of subsequent pre-eclampsia. We also studied whether smoking affects circulating sVEGFR-1 concentrations in pregnant women or their first trimester placental secretion and expression in vitro. Last, in order to allow future discussion on the potential therapy based on sVEGFR-1, we determined the biological half-life of endogenous sVEGFR-1 in human circulation, and measured the concomitant changes in free VEGF concentrations. Blood or placental samples were collected from a total of 268 pregnant women between the years 2001 2007 in Helsinki University Central Hospital for the purposes above. The biomarkers were measured using commercially available enzyme-linked immunosorbent assays (ELISA). For the analyses of sVEGFR-1, Ang-2 and endostatin, a total of 3 240 pregnant women in the Helsinki area were admitted to blood sample collection during two routine ultrasoundscreening visits at 13.7 ± 0.5 (mean ± SD) and 19.2 ± 0.6 weeks of gestation. Of them, 49 women later developing pre-eclampsia were included in the study. Their disease was further classified as mild in 29 and severe in 20 patients. Isolated early-onset intrauterine growth retardation (IUGR) was diagnosed in 16 women with otherwise normal medical histories and uncomplicated pregnancies. Fifty-nine women remaining normotensive, non-proteinuric and finally giving birth to normal-weight infants were picked to serve as the control population of the study. Maternal serum concentrations of Ang-2, endostatin and sVEGFR-1, were increased already at 16 20 weeks of pregnancy, about 13 weeks before the clinical manifestation of preeclampsia. In addition, these biomarkers could be used to identify women at risk with a moderate precision. However, larger patient series are needed to determine whether these markers could be applied for clinical use to predict preeclampsia. Intrauterine growth retardation (IUGR), especially if noted at early stages of pregnancy and not secondary to any other pregnancy complication, has been suggested to be a form of preeclampsia compromising only the placental sufficiency and the fetus, but not affecting the maternal endothelium. In fact, IUGR and preeclampsia have been proposed to share a common vascular etiology in which factors regulating early placental angiogenesis are likely to play a central role. Thus, these factors have been suggested to be involved in the pathogenesis of IUGR. However, circulating sVEGFR-1, Ang-2 and endostatin concentrations were unaffected by subsequent IUGR at early second trimester. Furthermore, smoking was not associated with alterations in maternal circulating sVEGFR-1 or its placental production. The elimination of endogenous sVEGFR-1 after pregnancy was calculated from serial samples of eight pregnant women undergoing elective Caesarean section. As typical for proteins in human compartments, the elimination of sVEGFR-1 was biphasic, containing a rapid halflife of 3.4 h and a slow one of 29 h. The decline in sVEGFR-1 concentrations after mid-trimester legal termination of pregnancy was accompanied with a simultaneous increase in the serum levels of free VEGF so that within a few days after pregnancy VEGF dominated in the maternal circulation. Our study provides novel information on the kinetics of endogenous sVEGFR-1, which serves as a potential tool in the development of new strategies against diseases associated with angiogenic imbalance and alterations in VEGF signaling.

Intra-uterine growth restriction and increased risk of hypertension in adult life: A follow-up study of 50-year-olds

OBJECTIVE:

To compare blood pressure between 50-year-old adults who were born at term (37-42 weeks of gestation) with intra-uterine growth restriction (IUGR; birth weight <10th centile) and a control group of similar age born at term without IUGR (birth weight =10th centile).

STUDY DESIGN:

Controlled comparative study.

METHODS:

Participants included 232 men and women who were born at the Royal Maternity Hospital, Belfast, a large regional maternity hospital in Northern Ireland, between 1954 and 1956. One hundred and eight subjects who were born with IUGR were compared with 124 controls with normal birth weight for gestation. The main outcome measures were systolic and diastolic blood pressure at approximately 50 years of age, measured according to European recommendations.

RESULTS:

The IUGR group had higher systolic and diastolic blood pressure than the control group: 131.5 [95% confidence interval (CI) 127.9-135.1] vs 127.1 (95% CI 124.3-129.2) mmHg and 82.3 (95% CI 79.6-85.0) vs 79.0 (95% CI 77.0-81.0) mmHg, respectively. After adjustment for gender, the differences between the groups were statistically significant: systolic blood pressure 4.5 (95% CI 0.3-8.7) mmHg and diastolic blood pressure 3.4 (95% CI 0.2-6.5) mmHg (both P < 0.05). More participants in the IUGR group were receiving treatment for high blood pressure compared with the control group [16 (15%) vs 11 (9%)], although this was not statistically significant. The proportion of subjects with blood pressure >140/90 mmHg or currently receiving antihypertensive treatment was 45% (n = 49) for the IUGR group, and 31% (n = 38) for the control group (odds ratio 1.9, 95% CI 1.1-3.3). Adjustment for potential confounders made little difference.

CONCLUSIONS:

IUGR is associated with higher blood pressure at 50 years of age. Individuals born with IUGR should have regular blood pressure screening and early treatment as required. Hypertension remains underdiagnosed and undertreated in adult life.

Early childhood neurodevelopment after intrauterine growth restriction: a systematic review

BACKGROUND AND OBJECTIVE: Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR.

METHODS: PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines.

RESULTS: Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR.

CONCLUSIONS: Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.

Metabonomics of human amniotic fluid for prenatal diagnostics

O trabalho apresentado nesta tese teve como principais objectivos contribuir para o conhecimento da composição do líquido amniótico humano (LA), colhido no 2º trimestre de gravidez, assim como investigar possíveis alterações na sua composição devido à ocorrência de patologias pré-natais, recorrendo à metabonómica e procurando, assim, definir novos biomarcadores de doenças da grávida e do feto. Após uma introdução descrevendo o estado da arte relacionado com este trabalho (Capítulo 1) e os princípios das metodologias analíticas usadas (Capítulo 2), seguida de uma descrição dos aspectos experimentais associados a esta tese (Capítulo 3), apresentam-se os resultados da caracterização da composição química do LA (gravidez saudável) por espectroscopia de ressonância magnética nuclear (RMN), assim como da monitorização da sua estabilidade durante o armazenamento e após ciclos de congelamento-descongelamento (Capítulo 4). Amostras de LA armazenadas a -20°C registaram alterações significativas, tornando-se estas menos pronunciadas (mas ainda mensuráveis) a -70°C, temperatura recomendada para o armazenamento de LA. Foram também observadas alterações de composição após 1-2 ciclos de congelamento-descongelamento (a ter em conta aquando da reutilização de amostras), assim como à temperatura ambiente (indicando um período máximo de 4h para a manipulação e análise de LA). A aquisição de espectros de RMN de 1H de alta resolução e RMN acoplado (LC-NMR/MS) permitiu a detecção de 75 compostos no LA do 2º trimestre, 6 dos quais detectados pela primeira vez no LA. Experiências de difusão (DOSY) permitiram ainda a caracterização das velocidades de difusão e massas moleculares médias das proteínas mais abundantes. O Capítulo 5 descreve o estudo dos efeitos de malformações fetais (FM) e de cromossomopatias (CD) na composição do LA do 2º trimestre de gravidez. A extensão deste trabalho ao estudo dos efeitos de patologias no LA que ocorrem no 3º trimestre de gravidez é descrita no Capítulo 6, nomeadamente no que se refere ao parto pré-termo (PTD), pré-eclampsia (PE), restrição do crescimento intra-uterino (IUGR), ruptura prematura de membranas (PROM) e diabetes mellitus gestacional (GDM). Como complemento a estes estudos, realizou-se uma análise preliminar da urina materna do 2º trimestre para o estudo de FM e GDM, descrita no Capítulo 7. Para interpretação dos dados analíticos, obtidos por espectroscopia RMN de 1H, cromatografia líquida de ultra eficiência acoplada a espectrometria de massa (UPLC-MS) e espectroscopia do infravermelho médio (MIR), recorreu-se à análise discriminante pelos métodos dos mínimos quadrados parciais e o método dos mínimos quadrados parciais ortogonal (PLS-DA e OPLS-DA) e à correlação espectral. Após análise por validação cruzada de Monte-Carlo (MCCV), os modelos PLS-DA de LA permitiram distinguir as FM dos controlos (sensibilidades 69-85%, especificidades 80-95%, taxas de classificação 80-90%), revelando variações metabólicas ao nível do metabolismo energético, dos metabolismos dos aminoácidos e glícidos assim como possíveis alterações ao nível do funcionamento renal. Observou-se também um grande impacto das FM no perfil metabólico da urina materna (medido por UPLC-MS), tendo no entanto sido registados modelos PLS-DA com menor sensibilidade (40-60%), provavelmente devido ao baixo número de amostras e maior variabilidade da composição da urina (relativamente ao LA). Foram sugeridos possíveis marcadores relacionados com a ocorrência de FM, incluindo lactato, glucose, leucina, valina, glutamina, glutamato, glicoproteínas e conjugados de ácido glucurónico e/ou sulfato e compostos endógenos e/ou exógenos (<1 M) (os últimos visíveis apenas na urina). No LA foram também observadas variações metabólicas devido à ocorrência de vários tipos de cromossomopatias (CD), mas de menor magnitude. Os perfis metabólicos de LA associado a pré- PTD produziram modelos que, apesar do baixo poder de previsão, sugeriram alterações precoces no funcionamento da unidade fetoplacentária, hiperglicémia e stress oxidativo. Os modelos obtidos para os grupos pré- IUGR pré- PE, pré- PROM e pré-diagnóstico GDM (LA e urina materna) registaram baixo poder de previsão, indicando o pouco impacto destas condições na composição do LA e/ou urina do 2º trimestre. Os resultados obtidos demonstram as potencialidades da análise dos perfis metabólicos do LA (e, embora com base em menos estudos, da urina materna) do 2º trimestre para o desenvolvimento de novos e complementares métodos de diagnóstico, nomeadamente para FM e PTD.

Pregnancy and newborns disorders followed by urine metabolomics

Chapter 1 introduces the scope of the work by identifying the clinically relevant prenatal disorders and presently available diagnostic methods. The methodology followed in this work is presented, along with a brief account of the principles of the analytical and statistical tools employed. A thorough description of the state of the art of metabolomics in prenatal research concludes the chapter, highlighting the merit of this novel strategy to identify robust disease biomarkers. The scarce use of maternal and newborn urine in previous reports enlightens the relevance of this work. Chapter 2 presents a description of all the experimental details involved in the work performed, comprising sampling, sample collection and preparation issues, data acquisition protocols and data analysis procedures. The proton Nuclear Magnetic Resonance (NMR) characterization of maternal urine composition in healthy pregnancies is presented in Chapter 3. The urinary metabolic profile characteristic of each pregnancy trimester was defined and a 21-metabolite signature found descriptive of the metabolic adaptations occurring throughout pregnancy. 8 metabolites were found, for the first time to our knowledge, to vary in connection to pregnancy, while known metabolic effects were confirmed. This chapter includes a study of the effects of non-fasting (used in this work) as a possible confounder. Chapter 4 describes the metabolomic study of 2nd trimester maternal urine for the diagnosis of fetal disorders and prediction of later-developing complications. This was achieved by applying a novel variable selection method developed in the context of this work. It was found that fetal malformations (FM) (and, specifically those of the central nervous system, CNS) and chromosomal disorders (CD) (and, specifically, trisomy 21, T21) are accompanied by changes in energy, amino acids, lipids and nucleotides metabolic pathways, with CD causing a further deregulation in sugars metabolism, urea cycle and/or creatinine biosynthesis. Multivariate analysis models´ validation revealed classification rates (CR) of 84% for FM (87%, CNS) and 85% for CD (94%, T21). For later-diagnosed preterm delivery (PTD), preeclampsia (PE) and intrauterine growth restriction (IUGR), it is found that urinary NMR profiles have early predictive value, with CRs ranging from 84% for PTD (11-20 gestational weeks, g.w., prior to diagnosis), 94% for PE (18-24 g.w. pre-diagnosis) and 94% for IUGR (2-22 g.w. pre-diagnosis). This chapter includes results obtained for an ultraperformance liquid chromatography-mass spectrometry (UPLC-MS) study of pre-PTD samples and correlation with NMR data. One possible marker was detected, although its identification was not possible. Chapter 5 relates to the NMR metabolomic study of gestational diabetes mellitus (GDM), establishing a potentially predictive urinary metabolic profile for GDM, 2-21 g.w. prior to diagnosis (CR 83%). Furthermore, the NMR spectrum was shown to carry information on individual phenotypes, able to predict future insulin treatment requirement (CR 94%). Chapter 6 describes results that demonstrate the impact of delivery mode (CR 88%) and gender (CR 76%) on newborn urinary profile. It was also found that newborn prematurity, respiratory depression, large for gestational age growth and malformations induce relevant metabolic perturbations (CR 82-92%), as well as maternal conditions, namely GDM (CR 82%) and maternal psychiatric disorders (CR 91%). Finally, the main conclusions of this thesis are presented in Chapter 7, highlighting the value of maternal or newborn urine metabolomics for pregnancy monitoring and disease prediction, towards the development of new early and non-invasive diagnostic methods.

Modèles de dysfonction érectile chez le rat

Des modèles de dysfonction érectile (DE) ont été développés et étudiés chez le rat. Cependant, peu de choses sont connues dans certains modèles présentant des facteurs de risque de la DE, en l’occurrence le rat soumis à une diète riche en glucose, le rat avec une restriction de croissance intra-utérine (RCIU) et le rat avec l’infusion continue de l’angiotensine (Ang) II en ce qui concerne l’évaluation de la fonction érectile in vivo. C’est ainsi que nous nous sommes proposés cette étude. La fonction érectile a été mesurée par la stimulation électrique du nerf caverneux à des cohortes de rats mâles Sprague-Dawley de différents âges comme suit: 1) des rats jeunes de 12 semaines d’âge, adultes reproducteurs à la retraite d’environ 30 semaines d’âge et des rats de 27 et 29 semaines soumis à une diète riche en glucose par l’eau de breuvage (10%) à court (1 semaine), moyen (6 semaines) et long (12 ou 13 semaines) termes; 2) des rats jeunes âgés de 12 semaines recevant une infusion soit de l’Ang II (200ng/kg/min) soit de la saline par mini-pompes osmotiques sous-cutanées pendant 1 et 2 semaines; et 3) des rats adultes âgés de 36 semaines avec une RCIU. La fonction érectile a été représentée par des courbes de variations de pression intracaverneuse (PIC) et d’aire sous la courbe (ASC) normalisées avec la pression artérielle moyenne (PAM) en réponse à la stimulation nerveuse à différents volts. À la fin des expériences, les animaux ont été sacrifiés, le sang recueilli pour le dosage de la glycémie et de l’insulinémie; le pénis, l’aorte thoracique et le cœur prélevés à des fins d’analyses protéique et histologique. La diète riche en glucose à court terme a eu un effet néfaste sur la fonction érectile chez le jeune rat mais bénéfique chez le rat adulte reproducteur; de même que pour les études à long terme, la diète riche en glucose a amélioré ou renversé la DE associée au vieillissement. Les rats avec RCIU ont exhibé une baisse très significative de la fonction érectile. Ces détériorations ou améliorations de la fonction érectile avec le glucose ou dans la RCIU ont été principalement associées à des modifications de l’expression de l’Akt, en plus d’une augmentation de l’insuline sérique dans les groupes avec le glucose. L’Ang II a entraîné une baisse de la fonction érectile, statistiquement très significative après 1 semaine et maintenue après 2 semaines de traitement, sans causer des changements morphologiques au cœur et à l’aorte thoracique. En conclusion : l’atteinte du système érectile se fait précocement dans les complications cardiovasculaires liées à l’activation du SRA, l’implication de l’Akt dans la modulation de la fonction érectile dépend de type de vieillissement et de la diète, le RCIU est un facteur de risque pour la DE.

Étude des déterminants démographiques de l’hypotrophie fœtale au Québec

Cette recherche vise à décrire l’association entre certaines variables démographiques telles que l’âge de la mère, le sexe, le rang de naissance et le statut socio-économique – représenté par l’indice de Pampalon – et l’hypotrophie fœtale au Québec. L’échantillon est constitué de 127 216 naissances simples et non prématurées ayant eu lieu au Québec entre le 1er juillet 2000 et le 30 juin 2002. Des régressions logistiques portant sur le risque d’avoir souffert d’un retard de croissance intra-utérine ont été effectuées pour l’ensemble du Québec ainsi que pour la région socio-sanitaire (RSS) de Montréal. Les résultats révèlent que les enfants de premier rang et les enfants dont la mère était âgée de moins de 25 ans ou de 35 ans et plus lors de l’accouchement ont un risque plus élevé de souffrir d’hypotrophie fœtale et ce dans l’ensemble du Québec et dans la RSS de Montréal. De plus, les résultats démontrent que le risque augmente plus la mère est défavorisée. Puisque l’indice de Pampalon est un proxy écologique calculé pour chaque aire de diffusion, les intervenants en santé publique peuvent désormais cibler géographiquement les femmes les plus à risque et adapter leurs programmes de prévention en conséquence. Ainsi, le nombre de cas d’hypotrophie fœtale, voire même la mortalité infantile, pourraient être réduits.

La néoglucogenèse rénale : un nouvel aspect dans la restriction de croissance intra-utérine chez le rat

Bien que l’environnement intra-utérin défavorable soit associé à des conditions pathologiques à l’âge adulte, les mécanismes mis en place in utero ne sont pas encore élucidés. Nous avons établi un modèle de restriction de croissance intra-utérine (RCIU) en donnant une diète faible en sodium à la rate pendant la dernière semaine de gestation. Ce modèle se caractérise par une diminution de perfusion placentaire et une redistribution du flot sanguin, favorisant l’irrigation des organes nobles (cœur et cerveau) au détriment du rein fœtal. De plus, l’expression rénale du facteur de croissance endothéliale vasculaire (VEGF) est diminuée chez le fœtus. L’hypothèse de travail est que la néoglucogenèse hépatique et rénale augmente chez les fœtus RCIU afin de compenser la diminution de perfusion placentaire, et que l’expression rénale des récepteurs de VEGF (Flt-1 et Flk-1) est altérée à la suite de la redistribution du flot sanguin. Nos objectifs étaient de comparer l’expression protéique des enzymes de la néoglucogenèse et des récepteurs de VEGF entre les fœtus témoins et RCIU. L’aldolase B, la fructose-1,6-biphosphatase et la glucose-6-phosphatase augmentent dans les reins de fœtus RCIU par rapport aux témoins alors qu’aucun changement n’est observé dans le foie. De plus, l’expression de ces enzymes est différente selon le sexe du fœtus. Une diminution de Flt-1 est notée dans les reins de fœtus RCIU. Nos résultats démontrent que des adaptations surviennent chez le fœtus à la suite d’une insulte intra-utérine favorisant sa survie mais ayant des conséquences telles que la dysfonction rénale observée chez les adultes de ce modèle animal. À long terme, ces travaux pourront permettre d’entrevoir des avenues pour mieux identifier les approches de prévention lors de naissance à la suite d’une RCIU.

Métabolisme énergétique cardiaque fœtal dans un modèle de restriction de croissance intra-utérine chez le rat

Une diète faible en sodium donnée à des rates lors de la dernière semaine de gestation induit une diminution de l’expansion volumique, du diamètre des artères utérines et du poids des placentas comparativement à des rates témoins. Ces perturbations suggèrent une diminution de la perfusion placentaire affectant l’apport foetal en nutriments. Les ratons naissent avec une restriction de croissance intra-utérine (RCIU). Chez le foetus, le substrat énergétique cardiaque principal est le glucose via la glycolyse. À la naissance, la source principale d’énergie est l’utilisation des acides gras par la β-oxydation. Nous émettons l’hypothèse que dans ce modèle de RCIU, le coeur foetal répond à la diminution d’apport nutritionnel due à une atteinte maternelle en adaptant son métabolisme énergétique cardiaque à la baisse. Les rates gestantes (témoins et recevant la diète faible en sodium) sont sacrifiées au jour 22 de gestation (sur 23). Les coeurs foetaux sont prélevés afin de caractériser les protéines dites « limitantes » in vitro des voies de la glycolyse et de la β-oxydation. Les expressions protéiques de GLUT1, GLUT4, HK1, HK2, CPT2, CPT1β, cytochrome c, PFK1, PKM1/2, mesurées par immunobuvardage de type Western, sont similaires entre les coeurs des foetus RCIU et témoins, mâles et femelles. L’expression protéique de CPT1α est diminuée dans les coeurs des femelles RCIU seulement. Il n’existe aucune différence significative entre les différents groupes quant à l’activité enzymatique de PKM1/2. Nos résultats dressent un profil métabolique général suggérant que le sexe du foetus peut avoir un effet sur la réponse cardiaque foetale à une atteinte du volume sanguin maternel causée par la diète restreinte en sodium. Ce profil métabolique semble démontrer une atteinte du catabolisme des lipides. Afin de bien caractériser cette réponse du mécanisme énergétique, l’activité enzymatique des autres enzymes principales de la glycolyse (HK1, HK2, PFK1), le flux intra-mitochondrial d’acyl CoA à travers les CPTs ainsi que la quantité totale d’acétyl CoA devront être quantifiés.