Navigate Up
UPMC/University of Pittsburgh Schools of the Health Sciences
For Journalists
Senior Manager
Telephone: 412-578-9193 or 412-624-3212
Other Inquiries


Amniotic Fluid Could be Elixir that Prevents Deadly Gut Inflammation in Preemies

PITTSBURGH, June 25 – Lack of exposure to amniotic fluid could be the reason that preterm infants are more susceptible to the gastrointestinal inflammatory disease known as necrotizing enterocolitis (NEC), according to researchers at Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine. In an early online report in the Proceedings of the National Academy of Sciences, they show that feeding amniotic fluid to young mice reduced the risk of NEC in an experimental model, suggesting new therapeutic avenues for warding off the deadly condition.

Senior author David Hackam, M.D., Ph.D., Watson Family Professor of Surgery, Department of Surgery, Pitt School of Medicine, and co-director of the Fetal Diagnosis and Treatment Center at Children’s Hospital, noted that NEC is the leading cause of death from gastrointestinal disease in babies, and most commonly affects those who are born six to eight weeks too early. Twelve to 15 percent of all premature babies develop NEC.
 
“The disease occurs when these tiny babies are about two to three weeks of age,” he said. “At first, they are a little sick, but seem OK. Then, often without warning, they stop tolerating their feeds, their bellies become swollen and, in many cases, they become critically ill within hours. When I operate on them, I see patches of dead intestinal tissue that needs to be removed. It is devastating for families.”
 
The causes of NEC are not well understood, he added. In previous research, his team determined that a molecular switch called Toll-lie receptor 4 (TLR4) was turned on in intestinal tissue affected by NEC. Healthy infants born at term have relatively low levels of TLR4 in the gut. The protein is important in fending off infection because it is involved in the recognition of bacteria, leading the researchers to posit that unlike in healthy newborns, something goes wrong with the TLR4 response when preemies get colonized with normal gut flora.
 
“One big difference between a 34-week-old baby developing in its mother’s uterus and one in the neonatal intensive care unit is that the first one is floating in and swallowing amniotic fluid,” Dr. Hackam said. “Early delivery means that exposure to the fluid is gone, so we speculated that components of the fluid could help prevent NEC by keeping TLR4 in check.”

In the study, the researchers showed that injecting small amounts of amniotic fluid into the intestine of premature mice, or feeding the fluid to them, stopped NEC from developing. That’s because the fluid is rich in epidermal growth factor (EGF), a wound healing protein; when the researchers removed it from the fluid or blocked or removed the EGF receptor on intestinal cells, amniotic fluid no longer had a protective effect.

“It appears that EGF in amniotic fluid is able to shut off TLR4 activity and prevent NEC,” Dr. Hackam said. “Perhaps if we one day banked amniotic fluid after premature delivery, we could give it to newborns at risk for the problem. We also could identify a drug that inhibits TLR4 activity to try to save these babies.”
 
The research team includes lead author Misty Good, M.D., assistant professor of pediatrics, University of Pittsburgh School of Medicine; and others from Children’s Hospital and University of Pittsburgh School of Medicine.
 
The study was funded by National Institutes of Health grants R01GM078238 and RO1DK08752, and by the Children’s Hospital of Pittsburgh Foundation and the Hartwell Foundation.

©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com