Are deficits of arachidonic and docosahexaenoic acids responsible for the neural and vascular complications of preterm babies?

We review evidence suggesting that pre- or postnatal deficits of arachidonic acid (AA) and docosahexaenoic acid (DHA) together with underdeveloped antioxidant protection contribute to neurovisual developmental disorders and other complications of premature birth. These two synergistic deficits occur at a time when 70% of energy is focused on brain development and when the brain and blood vessels are growing at high speed. The types of essential fatty acids fed to preterm babies bear no relation to what the infant would have received had it remained a fetus. This failure to meet essential fatty acid requirements exacerbates the AA and DHA deficits seen at birth; furthermore, the immature superoxide defenses remain depressed until the expected date of delivery. Deficits of these systems, which are required for cell membranes, the endothelium, and neural tissue, could provide the biochemical prerequisite for the membrane disorders to which these babies are at high risk: intraventricular hemorrhage, periventricular leucomalacia, retinopathy of prematurity, and bronchopulmonary dysplasia. Although poor vascular development during fetal and neonatal life may be repaired, the structural and antioxidant deficits identified in preterm babies may impair blood vessel development with long-term consequences. The conclusion drawn from this review is that present parenteral and enteral lipid nutrition for preterm babies is flawed and could be pathogenic. Full-term milk composition is the basis for the design of preterm infant foods, but full-term milk is different from the placental product that is rich in AA and DHA. Preterm lipid nutrition should be revised to be more in line with placental lipid transfer to the fetus.

Increased prostaglandin synthetase activity in inflamed tissues of the rabbit eye.

Tissues from normal and inflamed rabbit eyes were examined for prostaglandin synthetase activity using homogenates and microsomal preparation. Ocular inflammation was induced with 10 microgram Shigella endotoxin injected into the vitreous body. Homogenates of iris-ciliary processes of normal and inflamed eyes synthesized 2.3 and 5.6 microgram respectively of prostaglandins per g wet weight of tissues from endogenous substrate. Intact tissues from normal and inflamed eyes produced similar amounts of prostaglandins (2.2 and 5.3 microgram/g wet wt. respectively). Microsomes obtained from inflamed tissues produced 565 ng of prostaglandins per mg of protein per 30 min compared with 190 ng synthetized by normal microsomes. The apparent Km for the substrate of prostaglandin synthetase from inflamed tissues compared with that from normal was found to be lower. It is suggested that prostaglandin synthetase activity in the ocular tissues is modified during Shigella endotoxin-induced inflammation.

Enzymatic activities in the iris-ciliary body of the rabbit eye during experimentally induced acute ocular inflammation.

Intravitreal injection of 5 micrograms of Shigella endotoxin, in the rabbit eye, induced an acute inflammatory response which was characterised by conjunctival hyperaemia, limbal and ciliary vascular injection, iritis, aqueous flare, miosis and reduction in intraocular pressure. Iris-ciliary body tissues, from normal and inflamed eyes, were fractionated into subcellular enriched fractions and the activities and distribution of selected enzymes were estimated. Alkaline phosphatase, a plasma membrane-bound enzyme, showed an increase in activity, whereas succinate dehydrogenase and Mn-Superoxide dismutase, both mitochondrial-bound enzymes, exhibited decreased activities. Lysosomal acid phosphatase displayed an increase in free activity and retention of latent activity inside the organelle. No alteration in free activity was shown by acid cathepsin. The cholinesterases did not exhibit any changes in activities nor did the cytosolic enzymes Cu/Zn-superoxide dismutase and lactate dehydrogenase. The decrease activity of the respiratory mitochondrial enzyme succinate dehydrogenase may contribute to the reduction in intraocular pressure, and the ability of the lysosomal organelles to retain their hydrolytic enzymes, ensures recovery of the cell from acute inflammatory attack.

Essential fatty acids alter the activity of manganese-superoxide dismutase in rat heart.

The effects of oil-derived dietary essential fatty acids on the activities of mitchondrial Mn-SOD (manganese-superoxide dismutase) and cytosolic cupric zinc-superoxide dismutase (Cu/Zn-SOD) were investigated in rat heart. A control group of rats was fed a stock diet for 29 d, and a second group was fed on a fat-free diet. Three other groups were fed fat-free diets that were supplemented with (i) borage oil, which is rich in linoleic (18:2n-6) and gamma-linolenic (18:3n-6) acids, (ii) fungal oil, which is rich in gamma-linolenic, but low in linoleic acid, or (iii) evening primrose oil, which is rich in linoleic acid and low in gamma-linolenic acid. An increase in the percentage composition of arachidonic acid (20:4n-6) in both the choline and ethanolamine phospholipids, together with a decrease in linoleic acid in ethanolamine phospholipids, were found in heart membranes after feeding the rats with diets containing borage oil or fungal oil as compared to those fed the stock diet. The respective activities of Mn-SOD in rats fed the borage or fungal oil diets were also significantly higher than in rats fed the stock diet alone. No change in cytosolic Cn/Zn-SOD activity was observed. Dietary supply of linoleic acid-rich evening primrose oil resulted in an increased proportion of choline phospholipid linoleic acid without any changes in arachidonic acid content or in the activity of Mn-SOD. By contrast, a reduction in the activity of Mn-SOD was detected in rats fed a fat-free diet.(ABSTRACT TRUNCATED AT 250 WORDS)

The potential role for arachidonic and docosahexaenoic acids in protection against some central nervous system injuries in preterm infants.

The risk of central nervous, visual, and auditory damage increases from 2/1000 live births in the normal birthweight to > 200/1000 as birthweight falls below 1500 g. Such babies are most likely to be born preterm. Advances in infant care have led to increasing numbers of very-low-birthweight, preterm infants surviving to school age with moderate to severe brain damage. Steroids are one of the current treatments, but they cause significant, long-term problems. The evidence reported here suggests an additional approach to protecting the very preterm infant by supporting neurovascular membrane integrity. The complications of preterm, very-low-birthweight babies include bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, periventricular leukomalacia, and necrotizing enterocolitis, all of which have a vascular component. Arachidonic acid (AA) and DHA are essential, structural, and functional constituents of cell membranes. They are especially required for the growth and function of the brain and vascular systems, which are the primary biofocus of human fetal growth. Molecular dynamics and experimental evidence suggest that DHA could be the ligand for the retinoid X receptor (RXR) in neural tissue. RXR activation is an obligatory step in signaling to the nucleus and in the regulation of gene expression. Very preterm babies are born with minimal fat stores and suboptimal circulating levels of these nutrients. Postnatally, they lose the biomagnification of the proportions of AA and DHA by the placenta for the fetus. No current nutritional management repairs these deficits. The placental biomagnification profile highlights AA rather than DHA. The resultant fetal FA profile closely resembles that of the vascular endothelium and not the brain. Without this nourishment, cell membrane abnormalities would be predicted. We present a scientific rationale for a common pathogenic process in the complications of prematurity.

Nutrition and neurodevelopmental disorders.

Since the 1960s the structural requirements for the growth, development and function of the brain have become better understood due to the recognition of the prodigious energy needs for brain development and its structural requirements for lipids. The most vulnerable period of neural development is during embryonic and fetal growth. There is now both retrospective and prospective evidence that maternal nutrition prior to conception is most important to pregnancy outcome. Our studies on maternal nutrition in pregnancy again illustrate the relationship of maternal nutrition to birthweight and head circumference. In a study of 513 pregnancies we found that nutrient intakes in mothers of low birthweight babies were well below those of mothers whose babies were in the 3.5-4.5 Kg range at which morbidity is at its lowest. Nutrient intakes tracked with birthweight, independent of smoking and alcohol up to, but not above 3,270 g. The closest correlations were obtained with the diet of the mother at or about the time of conception rather than later in the pregnancy. Our studies also reveal that premature and intrauterine growth retarded babies were born with deficits of the types of essential fatty acids (arachidonic AA, docosahexaenoic DHA acids) known to be required for brain development. Deficits of brain DHA have been found experimentally to impair visual and cognitive development and also to cause haemorrhage, not unlike peri-ventricular haemorrhage in low birthweight babies, the above evidence is suggestive of a route to test the prevention and treatment of these types of membrane related disorders.

The nutritional contribution to bovine spongiform encephalopathy.

Evidence that changes in feeding style alter the membrane fatty acid composition of ruminant tissue is presented here by comparing zoo giraffe with the same species from their natural habitat. The membrane changes seen are similar to those used experimentally to make animals susceptible to basic brain protein and encephalomalacia. Similar membrane responses have been noted in cattle. Use of animal protein and increased nitrogen in cattle feeds would lead to a relative deficiency of essential fatty acids in the cell membranes and hence reduced membrane stability. By analogy with crazy chick disease (nutritional encephalomalacia) and experimental encephalomyelitis in rats, the possibility that the changes in animals feeds would have depleted cattle tissue membranes and made them susceptible to BSE is discussed. The assumption being made is that the principle of a requirement of essential fatty acids for neural integrity and immune system function would apply to cattle as well as to other species.

Timolol inhibits adenylate cyclase activity in the iris-ciliary body and trabecular meshwork of the eye and blocks activation of the enzyme by salbutamol.

The enzymatic activity of adenylate cyclase in homogenates and membrane-rich fractions prepared from rabbit iris-ciliary bodies and bovine trabecular meshwork was found to be inhibited by timolol. Treatment of iris-ciliary body homogenates with Triton X-305 resulted in abolition of the inhibitory effect of the drug on the activity of the enzyme. The stimulatory effect of salbutamol on the enzyme was also susceptible to blockade by timolol. It is suggested that the hypotensive action of timolol on intraocular pressure results from structural and functional changes induced on the plasma membranes of the iris-ciliary body and trabecular meshwork by the thiadiazole group of the molecule, and, also, from the occupation of the adrenergic receptors of the iris-ciliary body by the tert-butylamino-2-hydroxypropoxy part of the compound.