The authors are grateful to Dan Firl, Chris Corbett and Jesse Denson, PhD. Funding was provided by NIH NINDS R01 NS060765 to SR, the P30 CoBRE Pilot Program to LJ and the Child Health Signature Program to LJ at the University of New Mexico.

Institutional Care and Use Committees at both Boston Children&#8217;s Hospital and the University of New Mexico Health Sciences Center approved all experimental procedures.
NOTE: Prior to commencing the procedure, seal, sterilize and autoclave all surgical instruments and surgical drapes. Additionally, prepare post-operative medications in sterile vials including 0.125% bipivucaine and 0.1 mg/kg buprenorphine. Also prepare the lipopolysaccharide (LPS) solution sterilely: 0.04 mg/ml LPS (0111:B...

<ol>
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W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Inflammatory+responses+in+the+placenta+and+umbilical+cord.">Inflammatory responses in the placenta and umbilical cord.</a> Semin Fetal Neonatal Med. 11, 296-301 (2006).</li><li>Lee, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+chorioamnionitis+is+the+most+common+placental+lesion+in+late+preterm+birth.">Chronic chorioamnionitis is the most common placental lesion in late preterm birth.</a> Placenta. 34, 681-689 (2013).</li><li>Lee, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+histologic+chorioamnionitis+is+a+risk+factor+for+adverse+neonatal+outcome+in+late+preterm+birth+after+preterm+premature+rupture+of+membranes.">Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes.</a> PloS one. 8, e79941 (2013).</li><li>Pappas, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chorioamnionitis+and+early+childhood+outcomes+among+extremely+low+gestational+age+neonates.">Chorioamnionitis and early childhood outcomes among extremely low gestational age neonates.</a> JAMA Peds. 168, 137-147 (2014).</li><li>Gaillard, R., Arends, L. R., Steegers, E. A., Hofman, A., Jaddoe, V. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Second+and+third+trimester+placental+hemodynamics+and+the+risks+of+pregnancy+complications+the+Generation+R+Study.">Second and third trimester placental hemodynamics and the risks of pregnancy complications the Generation R Study.</a> Am J Epidemiol. 177, 743-754 (2013).</li><li>Trivedi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fetal+placental+inflammation+but+not+adrenal+activation+is+associated+with+extreme+preterm+delivery.">Fetal placental inflammation but not adrenal activation is associated with extreme preterm delivery.</a> Am J Obstet Gynecol. 206, 236 (2012).</li><li>Yanowitz, T. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemodynamic+disturbances+in+premature+infants+born+after+chorioamnionitis+association+with+cord+blood+cytokine+concentrations.">Hemodynamic disturbances in premature infants born after chorioamnionitis association with cord blood cytokine concentrations.</a> Pediatr Res. 51, 310-316 (2002).</li><li>Jantzie, L. L., Corbett, C. J., Firl, D. J., Robinson, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postnatal+Erythropoietin+Mitigates+Impaired+Cerebral+Cortical+Development+Following+Subplate+Loss+from+Prenatal+Hypoxia+Ischemia.">Postnatal Erythropoietin Mitigates Impaired Cerebral Cortical Development Following Subplate Loss from Prenatal Hypoxia Ischemia.</a> Cereb Cortex. , (2014).</li><li>Jantzie, L. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Erythropoietin+attenuates+loss+of+potassium+chloride+co+transporters+following+prenatal+brain+injury.">Erythropoietin attenuates loss of potassium chloride co transporters following prenatal brain injury.</a> Mol Cell Neurosci. 61, 152-162 (2014).</li><li>Jantzie, L. L., Miller, R. H., Robinson, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Erythropoietin+signaling+promotes+oligodendrocyte+development+following+prenatal+systemic+hypoxic+ischemic+brain+injury.">Erythropoietin signaling promotes oligodendrocyte development following prenatal systemic hypoxic ischemic brain injury.</a> Pediatric Res. 74, 658-667 (2013).</li><li>Mazur, M., Miller, R. H., Robinson, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postnatal+erythropoietin+treatment+mitigates+neural+cell+loss+after+systemic+prenatal+hypoxic+ischemic+injury.">Postnatal erythropoietin treatment mitigates neural cell loss after systemic prenatal hypoxic ischemic injury.</a> J Neurosurg Peds. 6, 206-221 (2010).</li><li>Robinson, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Developmental+changes+induced+by+graded+prenatal+systemic+hypoxic+ischemic+insults+in+rats.">Developmental changes induced by graded prenatal systemic hypoxic ischemic insults in rats.</a> Neurobiol Dis. 18, 568-581 (2005).</li><li>Delcour, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuroanatomical+sensorimotor+and+cognitive+deficits+in+adult+rats+with+white+matter+injury+following+prenatal+ischemia.">Neuroanatomical sensorimotor and cognitive deficits in adult rats with white matter injury following prenatal ischemia.</a> Brain Pathol. 22, 1-16 (2012).</li><li>Delcour, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+prenatal+ischemia+on+behavior+cognitive+abilities+and+neuroanatomy+in+adult+rats+with+white+matter+damage.">Impact of prenatal ischemia on behavior cognitive abilities and neuroanatomy in adult rats with white matter damage.</a> Behav Brain Res. 232, 233-244 (2012).</li><li>Delcour, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mild+musculoskeletal+and+locomotor+alterations+in+adult+rats+with+white+matter+injury+following+prenatal+ischemia.">Mild musculoskeletal and locomotor alterations in adult rats with white matter injury following prenatal ischemia.</a> Intl J Devel Neurosci. 29, 593-607 (2011).</li><li>Jantzie, L. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complex+pattern+of+interaction+between+in+utero+hypoxia+ischemia+and+intra+amniotic+inflammation+disrupts+brain+development+and+motor+function.">Complex pattern of interaction between in utero hypoxia ischemia and intra amniotic inflammation disrupts brain development and motor function.</a> J Neuroinflam. 11, 131 (2014).</li><li>Back, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selective+vulnerability+of+late+oligodendrocyte+progenitors+to+hypoxia+ischemia.">Selective vulnerability of late oligodendrocyte progenitors to hypoxia ischemia.</a> J Neurosci. 22, 455-463 (2002).</li><li>Jantzie, L. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Developmental+Expression+of+N+Methyl+d+Aspartate+(NMDA)+Receptor+Subunits+in+Human+White+and+Gray+Matter+Potential+Mechanism+of+Increased+Vulnerability+in+the+Immature+Brain.">Developmental Expression of N Methyl d Aspartate (NMDA) Receptor Subunits in Human White and Gray Matter Potential Mechanism of Increased Vulnerability in the Immature Brain.</a> Cereb Cortex. 25, 482-495 (2015).</li><li>Jantzie, L. L., Robinson, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preclinical+Models+of+Encephalopathy+of+Prematurity.">Preclinical Models of Encephalopathy of Prematurity.</a> Devel Neurosci. , (2015).</li><li>Workman, A. D., Charvet, C. J., Clancy, B., Darlington, R. B., Finlay, B. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modeling+transformations+of+neurodevelopmental+sequences+across+mammalian+species.">Modeling transformations of neurodevelopmental sequences across mammalian species.</a> J Neurosci. 33, 7368-7383 (2013).</li><li>Herlenius, E., Lagercrantz, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+neurotransmitter+systems+during+critical+periods.">Development of neurotransmitter systems during critical periods.</a> Exper Neurol. 190, S8-S21 (2004).</li><li>Kelsom, C., Lu, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+and+specification+of+GABAergic+cortical+interneurons.">Development and specification of GABAergic cortical interneurons.</a> Cell Biosci. 3, 19 (2013).</li><li>Kinney, H., Back, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+oligodendroglial+development+Relationship+to+periventricualr+leukomalacia.">Human oligodendroglial development Relationship to periventricualr leukomalacia.</a> Semin Pediatr Neuro. 5, 180-189 (1998).</li><li>Robinson, S., Li, Q., DeChant, A., Cohen, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neonatal+loss+of+gamma+amino+butyric+acid+pathway+expression+after+human+perinatal+brain+injury.">Neonatal loss of gamma amino butyric acid pathway expression after human perinatal brain injury.</a> J Neurosurg Peds. 104, 396-408 (2006).</li><li>Xu, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Late+development+of+the+GABAergic+system+in+the+human+cerebral+cortex+and+white+matter.">Late development of the GABAergic system in the human cerebral cortex and white matter.</a> J Neuropathol Exp Neurol. 70, 841-858 (2011).</li><li>Segovia, K. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arrested+oligodendrocyte+lineage+maturation+in+chronic+perinatal+white+matter+injury.">Arrested oligodendrocyte lineage maturation in chronic perinatal white matter injury.</a> Ann Neurol. 63, 520-530 (2008).</li><li>Robinson, S., Li, Q., Dechant, A., Cohen, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neonatal+loss+of+gamma+aminobutyric+acid+pathway+expression+after+human+perinatal+brain+injury.">Neonatal loss of gamma aminobutyric acid pathway expression after human perinatal brain injury.</a> J Neurosurg. 104, 396-408 (2006).</li><li>Boksa, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+prenatal+infection+on+brain+development+and+behavior+a+review+of+findings+from+animal+models.">Effects of prenatal infection on brain development and behavior a review of findings from animal models.</a> Brain Behav Immun. 24, 881-897 (2010).</li><li>Burd, I., Brown, A., Gonzalez, J. M., Chai, J., Elovitz, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+mouse+model+of+term+chorioamnionitis+unraveling+causes+of+adverse+neurological+outcomes.">A mouse model of term chorioamnionitis unraveling causes of adverse neurological outcomes.</a> Repro Sci. 18, 900-907 (2011).</li><li>Bergeron, J. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=White+matter+injury+and+autistic+like+behavior+predominantly+affecting+male+rat+offspring+exposed+to+group+B+streptococcal+maternal+inflammation.">White matter injury and autistic like behavior predominantly affecting male rat offspring exposed to group B streptococcal maternal inflammation.</a> Devel Neurosci. 35, 504-515 (2013).</li><li>Uchida, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Ureaplasma+parvum+lipoprotein+multiple+banded+antigen+on+pregnancy+outcome+in+mice.">Effects of Ureaplasma parvum lipoprotein multiple banded antigen on pregnancy outcome in mice.</a> J Reprod Immunol. 100, 118-127 .</li></ol>

Encephalopathy of prematurity is difficult to model in animals because of the complex interaction of etiologies, neurodevelopmental time course, intricacy of human cerebral network formation, overlapping mechanisms of injury, and the diverse phenotypes of CNS insults manifest in human preterm infants. EoP is associated with specific cell-type vulnerabilities (i.e. immature oligodendrocytes)21, as well as diverse developmentally-regulated pathways (i.e. subplate, membrane transporters and rece...

With over 12% of infants born in the United States before 37 weeks estimated gestational age1, perinatal brain injury (PBI) from prematurity is a significant cause of permanent disability. PBI from prematurity, also termed encephalopathy of prematurity (EoP), affects the entire central nervous system (CNS). CNS injury often commences in utero, and is exacerbated by antenatal processes including chorioamnionitis and postnatal complications such as hypoxia and sepsis. PBI from systemic insults alters neurodevelopment and leads to cerebral palsy, epilepsy, cognitive delay and numerous neuropsychiatric disorders affecting emotional regulation, memory and executive function1,2. Although much progress has been made, a limited understanding remains of how the cellular and molecular consequences of CNS injury from preterm birth translate to the multitude of neurological sequelae in children who are born preterm. This lack of knowledge hinders real-time diagnosis of CNS injury severity and informed dosing of emerging interventions. Additionally, age-appropriate therapeutic strategies for this vulnerable patient population remain elusive.
Intrauterine inflammation is very common in extreme prematurity and involves a complex fetal-maternal-placental inflammatory cascade3. Intrauterine infection is often subclinical. Specific placental findings consistent with acute inflammation, or histologic chorioamnionitis, are major determinants of the fetal inflammatory response and are coincident with brain injury associated with preterm birth3-5. Indeed, the fetal inflammatory response has distinct clinical implications for long-term outcomes from preterm birth. Infants who are small for gestational age (SGA) or who experience infection are exceptionally vulnerable to neurological deficits3,4. Chorioamnionitis is a typical pathological diagnosis following preterm birth6,7, and histological examination reveals signs of inflammation in 70% of placentas from infants born very preterm4. Further, chorioamnionitis is associated with cognitive impairment at two years8. Evidence of maternal vascular underperfusion in the placenta of infants born extremely preterm is also associated with cerebral palsy in childhood9. The synergistic impact of chorioamnionitis and placental perfusion defects is well illustrated by the remarkably high risk of abnormal neurologic outcomes in this patient population at two years of age10,11.
To mimic human systemic placental perfusion defects and chorioamnionitis associated with pathogen-induced inflammation, we developed a model of prenatal transient systemic hypoxia-ischemia (TSHI) combined with intra-amniotic lipopolysaccharide (LPS) in rats. Our goal was to adapt our model of TSHI alone in rats12-16 to include intrauterine inflammation, to facilitate preclinical modeling of CNS injury associated with preterm birth. TSHI alone has revealed persistent loss of oligodendroglial lineage cells, cortical neurons, increased cell death, and elevated pro-inflammatory cytokine levels, with progressive ischemic intervals leading to a graded pattern of injury consistent with prenatal brain injury16. Modifications to the ischemic components of this model have also demonstrated deficits in memory encoding, short and long-term memory and mild musculoskeletal alterations in rats as they age17-19. Indeed, we have previously demonstrated that the combination of TSHI+LPS recapitulates the pathophysiological hallmarks of EoP, including oligodendrocyte and neuronal loss, axonal injury, cellular inflammation and functional abnormalities20.

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			<td >Sigma</td>
			<td >S8776</td>
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			<td >LPS 011B4</td>
			<td>Sigma</td>
			<td>L2630</td>
			<td></td>
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			<td >Evan&#39;s Blue Dye</td>
			<td>Sigma</td>
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			<td>00023-0312</td>
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			<td>Roboz</td>
			<td>RS-8100</td>
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			<td>Roboz</td>
			<td>RS-6808</td>
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			<td >Surgical Scissors</td>
			<td>Roboz</td>
			<td>RS-5880</td>
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			<td >Surgical Scissors</td>
			<td>F.S.T.</td>
			<td>14002-16</td>
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			<td >Syringe</td>
			<td>BD</td>
			<td>309628</td>
			<td>1 ml</td>
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			<td>BD</td>
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			<td>Fisherbrand</td>
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			<td>Kent Scientific Corp.</td>
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			<td>Kent Scientific Corp.</td>
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			<td>30G Pressure</td>
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			<td >3-0 Perma Hand Silk Sutures</td>
			<td>Ethicon</td>
			<td>1684G</td>
			<td>Black braided, 3-0 (2 metric), 18&#34;, non-absorbable,&#160; PS-1 24mm needle, 3/8 circle</td>
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			<td >Insulin Syringes</td>
			<td>BD</td>
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			<td>Leica</td>
			<td>3801521</td>
			<td>Surgipath Gill II Hematoxylin</td>
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			<td >Eosin</td>
			<td>Leica</td>
			<td>3801601</td>
			<td>Surgipath Eosin</td>
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			<td>Fisherbrand</td>
			<td>X3S-4</td>
			<td>Histological Grade</td>
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			<td>Fisherbrand</td>
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modeling encephalopathy of prematurity using prenatal hypoxia-ischemia with intra-amniotic lipopolysaccharide in rats

Encephalopathy of prematurity (EoP) is a term that encompasses the central nervous system (CNS) abnormalities associated with preterm birth. To best advance translational objectives and uncover new therapeutic strategies for brain injury associated with preterm birth, preclinical models of EoP must include similar mechanisms of prenatal global injury observed in humans and involve multiple components of the maternal-placental-fetal system. Ideally, models should produce a similar spectrum of functional deficits in the mature animal and recapitulate multiple aspects of the pathophysiology. To mimic human systemic placental perfusion defects, placental underperfusion and/or chorioamnionitis associated with pathogen-induced inflammation in early preterm birth, we developed a model of prenatal transient systemic hypoxia-ischemia (TSHI) combined with intra-amniotic lipopolysaccharide (LPS). In pregnant Sprague Dawley rats, TSHI via uterine artery occlusion on embryonic day 18 (E18) induces a graded placental underperfusion defect associated with increasing CNS damage in the fetus. When combined with intra-amniotic LPS injections, placental inflammation is increased and CNS damage is compounded with associated white matter, gait and imaging abnormalities. Prenatal TSHI and TSHI+LPS prenatal insults meet several of the criteria of an EoP model including recapitulating the intrauterine insult, causing loss of neurons, oligodendrocytes and axons, loss of subplate, and functional deficits in adult animals that mimic those observed in children born extremely preterm. Moreover, this model allows for the dissection of inflammation induced by divergent injury types.

Following TSHI+LPS at E18, hematoxylin and eosin staining reveals significant histopathological abnormalities in both the placenta (Figure 1) and in the brain (Figure 2). Placentas examined on E19 and E21 are grossly edematous with micro-hemorrhage, and necrosis throughout the decidua and labyrinth. Significant inflammatory infiltrate and increased vascularity is also observed. Brains examined on P2 reveal ventriculomegaly, as well as white matter and subplate neuron loss compared to sha...

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Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats

Encephalopathy of prematurity encompasses the central nervous system abnormalities associated with injury from preterm birth. This report describes a clinically relevant rat model of in utero transient systemic hypoxia-ischemia and intra-amniotic lipopolysaccharide administration (LPS) that mimics chorioamnionitis, and the related impact of infectious stimuli and placental underperfusion on CNS development.

Encephalopathy of prematurity (EoP) is a term that encompasses the central nervous system (CNS) abnormalities associated with preterm birth. To best ...

modeling-encephalopathy-prematurity-using-prenatal-hypoxia-ischemia

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JoVE Journal

Medicine

11.2K visualizações.  University of New Mexico. Encephalopathy of prematurity encompasses the central nervous system abnormalities associated with injury from preterm birth. This report describes a clinically relevant rat model of in utero transient systemic hypoxia-ischemia and intra-amniotic lipopolysaccharide administration (LPS) that mimics chorioamnionitis, and the related impact of infectious stimuli and placental underperfusion on CNS development.