Auswahl der wissenschaftlichen Literatur zum Thema „Prematurity, oxidative stress, antioxidants, metabolomics“

Bronchopulmonary dysplasia (BPD) remains the most common respiratory complication of prematurity as younger and smaller infants are surviving beyond the immediate neonatal period. The recognition that oxidative stress (OS) plays a key role in BPD pathogenesis has been widely accepted since at least the 1980s. In this article, we examine the interplay between OS and genetic regulation and review ‘omics’ data related to OS in BPD. Data from animal models (largely models of hyperoxic lung injury) and from human studies are presented. Epigenetic and transcriptomic analyses have demonstrated several genes related to OS to be differentially expressed in murine models that mimic BPD as well as in premature infants at risk of BPD development and infants with established lung disease. Alterations in the genetic regulation of antioxidant enzymes is a common theme in these studies. Data from metabolomics and proteomics have also demonstrated the potential involvement of OS-related pathways in BPD. A limitation of many studies includes the difficulty of obtaining timely and appropriate samples from human patients. Additional ‘omics’ studies could further our understanding of the role of OS in BPD pathogenesis, which may prove beneficial for prevention and timely diagnosis, and aid in the development of targeted therapies.

We review oxidative stress-related newborn disease and the mechanism of oxidative damage. In addition, we outline diagnostic and therapeutic strategies and future directions. Many reports have defined oxidative stress as an imbalance between an enhanced reactive oxygen/nitrogen species and the lack of protective ability of antioxidants. From that point of view, free radical-induced damage caused by oxidative stress seems to be a probable contributing factor to the pathogenesis of many newborn diseases, such as respiratory distress syndrome, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, and retinopathy of prematurity. We share the hope that the new understanding of the concept of oxidative stress and its relation to newborn diseases that has been made possible by new diagnostic techniques will throw light on the treatment of those diseases.

Ischemic retinopathies (IRs), such as retinopathy of prematurity (ROP), diabetic retinopathy (DR), and (in many cases) age-related macular degeneration (AMD), are ocular disorders characterized by an initial phase of microvascular changes that results in ischemia, followed by a second phase of abnormal neovascularization that may culminate into retinal detachment and blindness. IRs are complex retinal conditions in which several factors play a key role during the development of the different pathological stages of the disease. Increasing evidence reveals that oxidative stress and inflammatory processes are important contributors to the pathogenesis of IRs. Despite the beneficial effects of the photocoagulation and anti-VEGF therapy during neovascularization phase, the need to identify novel targets to prevent initial phases of these ocular pathologies is still needed. In this review, we provide an update on the involvement of oxidative stress and inflammation in the progression of IRs and address some therapeutic interventions by using antioxidants and anti-inflammatory agents.

Oxidative stress contributes to the severity of several newborn conditions to the extent that Saugstad coined the phrase “oxygen radical diseases of neonatology.” In order to counteract free radicals damage many strategies to augment antioxidant status in ill-term and preterm infants have been proposed and several medications have been experimented with mixed results. Several studies have tested the efficacy of melatonin to counteract oxidative damage in diseases of newborns such as chronic lung disease, perinatal brain injury, necrotizing enterocolitis, and retinopathy of prematurity, giving promising results. The peculiar perinatal susceptibility to oxidative stress indicates that prophylactic use of antioxidants as melatonin could help to prevent or at least reduce oxidative stress related diseases in newborns. However, more studies are needed to confirm these beneficial effects.

The retina, owing to its cellular anatomy and physical location, is susceptible to generating reactive oxygen species (ROS), which are associated with several major retinal diseases. When ROS exceeds the body’s natural antioxidants, the retina is in a state of oxidative stress, which is recognized as the pathogenesis of retinal diseases. The early stage of the pathogenic process is an adaptive change in which oxidative stress and endogenous defense mechanisms occur. If no treatment is applied, the retinal diseases will progress to the pathological stage with neuronal and vascular dysfunction or damage and even blindness. This review summarizes the role of oxidative stress in several common retinal diseases, including retinitis pigmentosa, age-related macular degeneration, diabetic retinopathy, glaucoma, and retinopathy of prematurity. In addition, we discuss the early intervention strategies for these diseases. An outline is provided to identify potential intervention targets for further research. Early intervention for retinal diseases is necessary and urgent and may offer hope to improve patients’ quality of life through functional vision.

This review will examine the role of oxidative stress (OS) in the pathogenesis of necrotizing enterocolitis (NEC) and explore potential preventive and therapeutic antioxidant strategies. Preterm infants are particularly exposed to OS as a result of several perinatal stimuli and constitutive defective antioxidant defenses. For this reason, OS damage represents a contributing factor to several complications of prematurity, including necrotizing enterocolitis (NEC). Being NEC a multifactorial disease, OS may act as downstream component of the pathogenetic cascade. To counteract OS in preterm infants with NEC, several antioxidant strategies have been proposed and different antioxidant compounds have been experimented. It is well known that human milk (HM) is an important source of antioxidants. At the same time, the role of an exclusive HM diet is well recognized in the prevention of NEC. However, donor HM (DHM) processing may impair antioxidant properties. As DHM is becoming a common nutritional intervention for high risk PI, the antioxidant status of preterm and DHM and potential ways to preserve its antioxidant capacity may merit further investigation.

We have previously demonstrated placentas from laboring deliveries at high altitude have lower binding of hypoxia-inducible transcription factor (HIF) to DNA than those from low altitude. It has recently been reported that labor causes oxidative stress in placentas, likely due to ischemic hypoxic insult. We hypothesized that placentas of high-altitude residents acquired resistance, in the course of their development, to oxidative stress during labor. Full-thickness placental tissue biopsies were collected from laboring vaginal and nonlaboring cesarean-section term (37–41 wk) deliveries from healthy pregnancies at sea level and at 3,100 m. After freezing in liquid nitrogen within 5 min of delivery, we quantified hydrophilic and lipid metabolites using 31P and 1H NMR metabolomics. Metabolic markers of oxidative stress, increased glycolysis, and free amino acids were present in placentas following labor at sea level, but not at 3,100 m. In contrast, at 3,100 m, the placentas were characterized by the presence of concentrations of stored energy potential (phosphocreatine), antioxidants, and low free amino acid concentrations. Placentas from pregnancies at sea level subjected to labor display evidence of oxidative stress. However, laboring placentas at 3,100 m have little or no oxidative stress at the time of delivery, suggesting greater resistance to ischemia-reperfusion. We postulate that hypoxic preconditioning might occur in placentas that develop at high altitude.

Nutmeg is a traditional spice and medicinal plant with a variety of pharmacological activities. However, nutmeg abuse due to its hallucinogenic characteristics and poisoning cases are frequently reported. Our previous metabolomics study proved the hepatotoxicity of nutmeg and demonstrated that high-dose nutmeg can affect the synthesis and secretion of bile acids and cause oxidative stress. In order to further investigate the hepatotoxicity of nutmeg, normal saline, 1 g/kg, 4 g/kg nutmeg were administrated to male Kunming mice by intragastrical gavage for 7 days. Histopathological investigation of liver tissue, proteomics and biochemical analysis were employed to explore the mechanism of liver damage caused by nutmeg. The results showed that a high-dose (4 g/kg) of nutmeg can cause significant increased level of CYP450s and depletion of antioxidants, resulting in obvious oxidative stress damage and lipid metabolism disorders; but this change was not observed in low-dose group (1 g/kg). In addition, the increased level of malondialdehyde and decreased level of glutathione peroxidase were found after nutmeg exposure. Therefore, the present study reasonably speculates that nutmeg exposure may lead to liver injury through oxidative stress and the degree of this damage is related to the exposure dose.

Antioxidants are currently utilized to prevent the occurrence of liver cancer in non-alcoholic fatty liver disease (NAFLD) patients. Clinacanthus nutans possesses anti-oxidative and anti-inflammatory properties that could be an ideal therapy for liver problems. The objective of this study is to determine the potential antioxidative compounds from the C. nutans leaves (CNL) and stems (CNS). Chemical- and cell-based antioxidative assays were utilized to evaluate the bioactivities of CNS and CNL. The NMR metabolomics approach assisted in the identification of contributing phytocompounds. Based on DPPH and ABTS radical scavenging activities, CNL demonstrated stronger radical scavenging potential as compared to CNS. The leaf extract also recorded slightly higher reducing power properties. A HepG2 cell model system was used to investigate the ROS reduction potential of these extracts. It was shown that cells treated with CNL and CNS reduced innate ROS levels as compared to untreated controls. Interestingly, cells pre-treated with both extracts were also able to decrease ROS levels in cells induced with oxidative stress. CNL was again the better antioxidant. According to multivariate data analysis of the 1H NMR results, the main metabolites postulated to contribute to the antioxidant and hepatoprotective abilities of leaves were clinacoside B, clinacoside C and isoschaftoside, which warrants further investigation.

Recent advances in vitamin D research indicate that this vitamin, a secosteroid hormone, has beneficial effects on several body systems other than the musculoskeletal system. Both 25 dihydroxy vitamin D [25(OH)2D] and its active hormonal form, 1,25-dihydroxyvitamin D [1,25(OH)2D] are essential for human physiological functions, including damping down inflammation and the excessive intracellular oxidative stresses. Vitamin D is one of the key controllers of systemic inflammation, oxidative stress and mitochondrial respiratory function, and thus, the aging process in humans. In turn, molecular and cellular actions form 1,25(OH)2D slow down oxidative stress, cell and tissue damage, and the aging process. On the other hand, hypovitaminosis D impairs mitochondrial functions, and enhances oxidative stress and systemic inflammation. The interaction of 1,25(OH)2D with its intracellular receptors modulates vitamin D–dependent gene transcription and activation of vitamin D-responsive elements, which triggers multiple second messenger systems. Thus, it is not surprising that hypovitaminosis D increases the incidence and severity of several age-related common diseases, such as metabolic disorders that are linked to oxidative stress. These include obesity, insulin resistance, type 2 diabetes, hypertension, pregnancy complications, memory disorders, osteoporosis, autoimmune diseases, certain cancers, and systemic inflammatory diseases. Vitamin D adequacy leads to less oxidative stress and improves mitochondrial and endocrine functions, reducing the risks of disorders, such as autoimmunity, infections, metabolic derangements, and impairment of DNA repair; all of this aids a healthy, graceful aging process. Vitamin D is also a potent anti-oxidant that facilitates balanced mitochondrial activities, preventing oxidative stress-related protein oxidation, lipid peroxidation, and DNA damage. New understandings of vitamin D-related advances in metabolomics, transcriptomics, epigenetics, in relation to its ability to control oxidative stress in conjunction with micronutrients, vitamins, and antioxidants, following normalization of serum 25(OH)D and tissue 1,25(OH)2D concentrations, likely to promise cost-effective better clinical outcomes in humans.

The improvement of peri-neonatal care has allowed a progressive drastic increase in the survival of high-risk preterm infants, i.e., very preterm or very low birth weight (VLBW) and extremely preterm or extremely low birth weight (ELBW) infants. However, the increased survival correlates with an almost stable incidence of disability as a result of the same prematurity, in particular for the lower gestational age (GA) groups. Furthermore, even infants born moderate and late preterm (32-36 weeks GA), although at a lower risk, are not exempt from clinical problems which also result in significant economic and social costs, considering the large number of these patients. In order to improve the short and long-term outcomes of these infants at risk, increasing attention in neonatology is focused on understanding the pathophysiological mechanisms underlying the prematurity-related diseases, and -at the same time- on the study of the individual diversification of these mechanisms. The concepts of fetal programming and developmental reprogramming represent the biological substrates that explain the importance of the mother-placenta-fetus/newborn triad in the realization of the long-term global health status and justify the interest in the development of a “precision neonatology”, that is, of personalized care solutions according to a tailored approach. The identification of the newborn at risk and its potential problems therefore represents a fundamental step for the implementation of follow-up programs for these newborns, and vice versa an adequate follow-up path allows, over time, the critical analysis of the pathophysiological mechanisms and the perinatal data feedback: both of them represent essential steps in the benchmarking process, which in turn contributes to the definition of individualized strategies for improving clinical and care performance. Throughout the diagnostic-care process that includes the identification of the newborn at risk, the individual risk stratification, the early diagnosis of pathology and the effects of any therapeutic intervention, biomarkers represent essential tools, such as those of oxidative stress (OS, that is critical for fetal programming and common denominator of many prematurity-related pathologies, called in fact “free radical related diseases of prematurity”) and the potential biomarkers identifiable through the modern approaches of metabolomics, “the new clinical chemistry” [Antonucci R. 2010]. With these objectives, the Ph.D. research project has therefore been articulated on various preliminary work fronts, which can open the way to research aimed at developing a precision neonatology in a continuous evolution. The present thesis aims to summarize and unify the evidence-based scientific knowledge extrapolated from the literature and that obtained through the personal studies carried out, especially in the more recent field of metabolomics. The following topics are therefore addressed and illustrated: a brief introduction on the evolution in neonatology and the role and importance of biomarkers between research and clinical practice (Chapter 1); the conditions that define neonatal risk, even those less known and in which the long-term risk is less striking but significantly impacts on social and health costs (Chapter 2); the critical review of the literature regarding biomarkers of oxidative stress, potential clinical biomarkers of diagnostic-prognostic utility in the preterm infant (Chapter 3); the possible preventive and antioxidant defense strategies in the newborn and the potential role of melatonin in preterm infants (Chapter 4); the application of metabolomics in neonatology between physiology and pathophysiology in the long-term follow-up of both full-term and preterm newborns (Chapter 5); finally, the conclusions and future perspectives of the research theme are briefly discussed, for a possible extension of the preliminary works presented through the project of the Ph.D. (Chapter 6).