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      Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review

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          Abstract

          Inflammation is increasingly recognized as a cause or consequence of common problems of humanity including obesity, stress, depression, pollution and disease states such as autoimmunity, asthma, and infection. Maternal immune activation (MIA), triggered by both acute and systemic chronic inflammation, is hypothesized to be one of the mechanisms implicated in the pathogenesis of neurodevelopmental disorders (NDD). Although there is substantial preclinical evidence to support the MIA hypothesis, the human evidence is disparate. We performed a systematic review on human studies examining associations between maternal inflammatory states and offspring NDDs (autism spectrum disorder- ASD, attention deficit hyperactivity disorder-ADHD, Tourette syndrome-TS). 32 meta-analyses and 26 additional individual studies were identified. Maternal states associated with ASD include obesity, gestational diabetes mellitus, pre-eclampsia, pollution, stress, depression, autoimmune diseases, and infection. Maternal states associated with ADHD include obesity, pre-eclampsia, smoking, low socioeconomic status (SES), stress, autoimmune disease, and asthma. Maternal states associated with TS include low SES, depression, and autoimmune diseases. Diverse maternal inflammatory states in pregnancy are associated with common offspring NDDs. Given the increased prevalence of NDDs, there is urgent need to explore relative and cumulative maternal risk factors and disease mechanisms. Defining preventable risk factors in high-risk pregnancies could mitigate the expression and severity of NDDs.

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          Chronic inflammation in the etiology of disease across the life span

          Although intermittent increases in inflammation are critical for survival during physical injury and infection, recent research has revealed that certain social, environmental and lifestyle factors can promote systemic chronic inflammation (SCI) that can, in turn, lead to several diseases that collectively represent the leading causes of disability and mortality worldwide, such as cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and autoimmune and neurodegenerative disorders. In the present Perspective we describe the multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress. Furthermore, we suggest potential strategies for advancing the early diagnosis, prevention and treatment of SCI.
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            Synaptic, transcriptional, and chromatin genes disrupted in autism

            Summary The genetic architecture of autism spectrum disorder involves the interplay of common and rare variation and their impact on hundreds of genes. Using exome sequencing, analysis of rare coding variation in 3,871 autism cases and 9,937 ancestry-matched or parental controls implicates 22 autosomal genes at a false discovery rate (FDR) < 0.05, and a set of 107 autosomal genes strongly enriched for those likely to affect risk (FDR < 0.30). These 107 genes, which show unusual evolutionary constraint against mutations, incur de novo loss-of-function mutations in over 5% of autistic subjects. Many of the genes implicated encode proteins for synaptic, transcriptional, and chromatin remodeling pathways. These include voltage-gated ion channels regulating propagation of action potentials, pacemaking, and excitability-transcription coupling, as well as histone-modifying enzymes and chromatin remodelers, prominently histone post-translational modifications involving lysine methylation/demethylation.
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              Maternal immune activation: Implications for neuropsychiatric disorders.

              Epidemiological evidence implicates maternal infection as a risk factor for autism spectrum disorder and schizophrenia. Animal models corroborate this link and demonstrate that maternal immune activation (MIA) alone is sufficient to impart lifelong neuropathology and altered behaviors in offspring. This Review describes common principles revealed by these models, highlighting recent findings that strengthen their relevance for schizophrenia and autism and are starting to reveal the molecular mechanisms underlying the effects of MIA on offspring. The role of MIA as a primer for a much wider range of psychiatric and neurologic disorders is also discussed. Finally, the need for more research in this nascent field and the implications for identifying and developing new treatments for individuals at heightened risk for neuroimmune disorders are considered.
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                Author and article information

                Contributors
                russell.dale@sydney.edu.au
                Journal
                Transl Psychiatry
                Transl Psychiatry
                Translational Psychiatry
                Nature Publishing Group UK (London )
                2158-3188
                21 January 2021
                21 January 2021
                2021
                : 11
                : 71
                Affiliations
                [1 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, , University of Sydney, ; Sydney, NSW Australia
                [2 ]GRID grid.410759.e, ISNI 0000 0004 0451 6143, Khoo Teck Puat-National University Children’s Medical Institute, , National University Health System, ; Singapore, Singapore
                [3 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, , University of Sydney, ; Sydney, NSW Australia
                [4 ]GRID grid.414054.0, ISNI 0000 0000 9567 6206, Department of Neuroservices, Starship Children’s Hospital, ; Auckland, New Zealand
                [5 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Child Population and Translational Health Research, Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, , The University of Sydney, ; Sydney, NSW Australia
                [6 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, The Brain and Mind Centre, , The University of Sydney, ; Sydney, NSW Australia
                [7 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, School of Life and Environmental Sciences and Charles Perkins Centre, , The University of Sydney, ; Sydney, NSW Australia
                [8 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, The University of Sydney, School of Medical Sciences and Discipline of Child and Adolescent Health, Faculty of Medicine and Health, ; Sydney, NSW Australia
                [9 ]GRID grid.413973.b, ISNI 0000 0000 9690 854X, Molecular Neurobiology Research Laboratory, Kids Research, Children’s Hospital at Westmead, and The Children’s Medical Research Institute, ; Westmead, NSW Australia
                [10 ]GRID grid.413973.b, ISNI 0000 0000 9690 854X, Kids Neuroscience Centre, Kids Research, Children’s Hospital at Westmead, ; Westmead, NSW Australia
                [11 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, School of Medical Sciences, Discipline of Applied Medical Science, Faculty of Medicine and Health, , The University of Sydney, ; Sydney, NSW Australia
                Author information
                http://orcid.org/0000-0003-4633-4316
                http://orcid.org/0000-0003-4928-692X
                http://orcid.org/0000-0002-8801-572X
                http://orcid.org/0000-0003-1219-4781
                http://orcid.org/0000-0001-5111-3978
                http://orcid.org/0000-0002-7025-2276
                http://orcid.org/0000-0002-2495-1826
                Article
                1198
                10.1038/s41398-021-01198-w
                7820474
                33479207
                0642aba7-f0f9-4455-aab7-85613b4a6a1a
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 29 September 2020
                : 12 November 2020
                : 25 November 2020
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                Article
                Custom metadata
                © The Author(s) 2021

                Clinical Psychology & Psychiatry
                autism spectrum disorders,adhd
                Clinical Psychology & Psychiatry
                autism spectrum disorders, adhd

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