Technical noteHistological changes in the umbilical artery following severe chorioamnionitis and funisitis may be indicative of early atherosclerosis
Introduction
Atherosclerosis is a chronic inflammatory process characterised by immune cell recruitment, lipid accumulation, smooth muscle proliferation and arterial wall thickening [1]. Although the clinical manifestations of atherosclerosis are apparent in adulthood, histological changes indicative of early atherosclerosis, including fatty streaks [2] and intimal thickening [3] may occur in the aorta prior to birth. These features are associated with perinatal cardiovascular risk factors in the mother, including hypercholesterolaemia, diabetes and smoking [4]. Increased umbilical artery intima-media thickness is reported following pregnancies complicated by diabetes [5]. Inflammation is a common mechanism mediating pathogenesis of these maternal risk factors, but there are no data linking perinatal inflammation with early histological changes of atherosclerosis in the umbilical artery. We therefore investigated whether the umbilical arteries from pregnancies complicated by severe chorioamnionitis with funisitis showed histopathologic evidence similar to that seen in early atherosclerosis.
Section snippets
Methods
Paraffin-embedded umbilical cord tissue from pregnancies complicated by severe histological chorioamnionitis with funisitis (n = 21) and controls matched for gestational age (completed weeks), sex and birth weight (±500 g) (n = 21) were identified from recent births at the Royal Women's Hospital (Melbourne, Australia). Severe chorioamnionitis with funisitis was defined by histological evidence of both maternal and fetal inflammatory response ≥ stage 2 by widely used semi-quantitative criteria
Results
Mean birth weight (SD) in cases (3012.91 (675.77) g) was similar to controls (3045.91 (704.19) g; P = 0.88), gestational age (mean 37.24 (3.21) weeks) and sex (43% males) were identical between groups. H&E stained sections from inflamed umbilical arteries showed increased numbers of acute inflammatory cells, with smaller numbers of non-foamy histiocytes and occasional eosinophils, associated with apoptotic debris, and oedema (Fig. 1). Where visible in the plane of section, inflamed umbilical
Discussion
Severe chorioamnionitis with funisitis is associated with significantly increased numbers of non-foamy CD68 and CD45 positive macrophages in the intima and media of the umbilical artery, indicating accumulation of monocyte-derived macrophages in atherosclerosis-prone regions of the arterial wall. These findings are consistent with a vasculitis, however, they are also analogous with the initial cellular changes observed in early (type I) atherosclerotic lesions that precede the development of
Funding sources
This work was supported by the National Health and Medical Research Council (APP1064629), and National Heart Foundation of Australia (100026).
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank Ali Moghimi and Meg Kaegi for their expertise and technical support during the study.
References (14)
- et al.
Fetal aorta wall inflammation in ultrasound-detected aortic intima/media thickness and growth retardation
J. Reprod. Immunol.
(2011) - et al.
Perinatal and infant early atherosclerotic coronary lesions
Can. J. Cardiol.
(2008) - et al.
Peculiarities of cell composition and cell proliferation in different type atherosclerotic lesions in carotid and coronary arteries
Atherosclerosis
(2010) - et al.
Progress and challenges in translating the biology of atherosclerosis
Nature
(2011) - et al.
Fatty streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia. Intimal accumulation of low density lipoprotein and its oxidation precede monocyte recruitment into early atherosclerotic lesions
J. Clin. Invest.
(1997) Effect of maternal cardiovascular conditions and risk factors on offspring cardiovascular disease
Circulation
(2014)- et al.
Umbilical artery intima-media and wall thickness in infants of diabetic mothers
Neonatology
(2012)
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