This work was supported in part through the National Institutes of Health (DK097335 &#38; T32AI007260) and the University of Iowa Stead Family Department of Pediatrics.

All animal procedures were approved by the University of Iowa Institutional Animal Care and Use Committee (Protocol #8041401). All animals were housed in an Association for Assessment and Accreditation of Laboratory Animal Care (AALAC) approved vivarium at the University of Iowa. All mice were wild type strain C57Bl/6J.
1. Establishment of FEMI in pregnant mice
<ol>
	<li>LPS preparation
	<ol>
		<li>Use LPS derived from Escherichia coli O55:B5 (stock concentration 2 mg/mL).</li>
		<li>Dilute LPS stock concentration 1:100 with sterile saline for a working concentration of 20 &#181;g/mL.</li>
	</ol>
	</li>
	<li>Maternal LPS injection
	<ol>
		<li>Inject pregnant dams at gestation day e15. This timepoint is approximately 75% through the murine pregnancy, making this model developmentally similar to the early third trimester of human pregnancies, which is when the majority of preterm births due to chorioamnionitis occur.</li>
		<li>Weigh pregnant mice immediately prior to injection to determine appropriate LPS dosing.</li>
		<li>Calculate the dose of working concentration by using the following formula: 5 &#181;L x gram body weight (gbw), for a total dose of LPS of 100 &#181;g/kg. For control animals, use an equivalent volume of normal saline for injection.</li>
		<li>Vortex LPS solution three times for 15 seconds on high prior to each injection.</li>
		<li>Draw up LPS volume into a 1 mL syringe.</li>
		<li>Restrain pregnant mouse with scruffing technique. Hold in dorsal recumbency position and perform the injection.
		<ol>
			<li>Insert a 30 gauge 8 mm needle bevel up overlying the right lower quadrant of the abdomen (to avoid bladder and abdominal vessels) at a 30&#8210;40&#176; angle. Insert about &#188; to &#189; the length of the needle.</li>
			<li>Pull back on the syringe plunger to ensure negative pressure prior to injecting. Proceed with injection if negative pressure is present.</li>
			<li>Following injection, monitor mice for approximately 30 min and then return to cages for the remainder of the pregnancy.</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
2. Delivery and care of offspring, and intestinal harvesting
<ol>
	<li>Deliver pups normally via vaginal delivery at e20. 
	NOTE: This model does have an expected dose-dependent fetal loss rate that can be seen in Figure 1 and is discussed in the results below.</li>
	<li>Allow pups to remain with mothers and receive ad libitum feeds.</li>
	<li>On the day of harvest, typically postnatal day 14 (P14), euthanize pups via cervical dislocation in compliance with Institutional Animal Care and Use Committee protocols.</li>
	<li>Using scissors and forceps, make a vertical incision down the midline of the abdomen, through the skin and peritoneum, for the entire length of the abdomen. Excise the small intestine from the stomach to the cecum with scissors and remove the mesentery with forceps.&#160;</li>
	<li>Isolate and keep the distal 1/3 of the small intestine (section representative of human ileum), discarding the proximal small intestine, the cecum, and the colon.</li>
	<li>Divide the ileum portion in half using scissors.</li>
	<li>Place the proximal half in an RNA stabilization solution for later RNA quantification.</li>
	<li>Place the distal half in 10% neutral buffered formalin for slide preparation.</li>
</ol>
3. Intestinal injury scoring
<ol>
	<li>Section paraffin embedded tissue into 5 &#181;m thick slices and mount on glass slides. 
	 
	NOTE: We send the specimens to a histology core for paraffin embedding, sectioning, and mounting onto slides.</li>
	<li>Deparaffinize slides according to standard procedures.</li>
	<li>Stain sections with hematoxylin and eosin according to standard procedures.</li>
	<li>Score sections on a 3-point scale for intestinal injury as previously described42,43.
	<ol>
		<li>Using light microscopy, assess generalized intestinal injury by two separate blinded investigators on a 3-point scale evaluating villus integrity and separation from the basement membrane43 (Supplementary Figure 1). Intestinal injury is best assessed at 20x magnification and numerical aperture 0.50.</li>
		<li>Assign a score of 0 to describe normal mucosa.</li>
		<li>Assign a score of 1 describe mild injury which encompasses the development of subepithelial Gruenhagen&#8217;s space, vacuolization or subepithelial lifting limited to the lamina propria or tips of villi.</li>
		<li>Assign a score of 2 to describe severe injury, indicated by epithelial lifting and vacuolization greater than half of the villi, villi distortion, or mucosal ulceration and disintegration of the lamina propria.</li>
	</ol>
	</li>
</ol>
4. Quantification of Paneth and goblet cells
<ol>
	<li>Following deparaffinization, stain slides of tissue sections from Step 2.8 with Alcian Blue/Periodic Acid Schiff stain to denote both goblet and Paneth cells as previously described44,45 according to the following steps. 
	NOTE: While Alcian Blue/Periodic Acid Schiff stain is not specific to either Paneth or goblet cells, in our experience, blinded experienced investigators have equivalent cellular quantification using this stain compared to cellular targeted antibodies, with significantly less background staining46.</li>
	<li>Deparaffinize, stain, and dehydrate slides as follows.
	<ol>
		<li>Submerge slides in xylene for 10 min twice. 
		CAUTION: Xylene should be used in a fume hood.</li>
		<li>Rinse with 100% EtOH.</li>
		<li>Submerge slides in 100 % EtOH for 3 min, then in 90% EtOH for 3 min, followed by 70% EtOH for 3 min, and lastly submerge slides in 50% EtOH for 3 min.</li>
		<li>Wash under running tap water for 5 min. 
		CAUTION: Point the section away from the running water to prevent loss of tissue sample.</li>
		<li>Filter Alcian blue stain solution with a standard coffee filter.</li>
		<li>Stain slides in Alcian blue stain for 15 min and then wash under running tap water for 2 min.</li>
		<li>Dilute 1 mg of periodic acid in 200 mL of double distilled water. Submerge slides in this solution for 5 min. Then wash under running tap water for 1 min.</li>
		<li>Stain with Schiff&#8217;s reagent for 10 min. Wash under running tap water for 5 min.</li>
		<li>Stain the slides with hematoxylin for 1 min and then wash under running tap water for 2 min.</li>
		<li>Submerge them in acid alcohol (1 mL of hydrochloric acid mixed in 99 mL of 70% EtOH) for 1 min.</li>
		<li>Submerge in Scott&#8217;s tap water (0.1% concentration of NaHCO3 in tap water) for 1 min and then wash under running tap water for 1 min.</li>
		<li>Dehydrate the slides.
		<ol>
			<li>Dip each slide 10 times in 70% EtOH, then dip 10 times in 90% EtOH, and 10 times in 100% EtOH.</li>
			<li>Submerge slides in 100% EtOH for 10 min, followed by submerging twice in fresh xylene for 3 min each.</li>
		</ol>
		</li>
		<li>Place a drop of mounting media on the specimen and place a coverslip over it.</li>
	</ol>
	</li>
	<li>Goblet cell counting
	<ol>
		<li>Using light microscopy, count goblet cells (Supplementary Figure 2). For each piece of intestinal tissue, count the number of goblet cells and 500 epithelial cells and express goblet cell ratio as a ratio per 100 epithelial cells. Goblet cells are best counted at 20x magnification and numerical aperture 0.5.</li>
	</ol>
	</li>
	<li>Paneth cell counting
	<ol>
		<li>Using light microscopy, count Paneth cells (Supplementary Figure 2). For each piece of intestinal tissue, express as a ratio of Paneth cells per intestinal crypt. Count 100 intestinal crypts per each piece of intestinal tissue. Paneth cells are best counted at 20x-60x magnification and numerical aperture 0.50-1.30.</li>
	</ol>
	</li>
</ol>

The authors have nothing to disclose.

Chorioamnionitis impacts 2&#8210;4% of term and 25&#8210;30% of preterm deliveries8,9. However, the impact of chorioamnionitis can extend long past birth as it has been shown to have significant effects on the fetus and neonate10,11,12,13,14,15,16. Importantly, chorioamnionitis has been shown to be associated with subsequent development of NEC15,16. While it is still incompletely understood, the pathogenesis of NEC likely involves a combination of intestinal immaturity, dysregulation of the immature immune system, intestinal inflammation, and bacterial translocation, culminating in a final common pathway of intestinal necrosis19. However, a mechanistic link between chorioamnionitis and subsequent development of NEC remains unclear20, and previous animal models of chorioamnionitis have been insufficient to examine this relationship. To address this gap in knowledge, we modified the commonly used LPS-induced murine model of chorioamnionitis and preterm birth34,37,38,39,40 to allow for neonatal birth and survival. In doing so, we have created a model that approximates the inflammatory condition seen in chorioamnionitis42 to study the impact of fetal exposure to maternal inflammation (FEMI) on subsequent intestinal development.
With this protocol, we have demonstrated that this murine model of chorioamnionitis, using LPS-induced FEMI, results in both short and long-term intestinal injury as well as interruption of normal intestinal development, most notably downregulation of both goblet and Paneth cells, both of which provide a first line of innate immunity against intestinal inflammation. The intestinal injury and histologic cellular changes that are seen with this model indicates that it is an effective model to mimic the injury seen in NEC. This is primarily because the downregulation of Paneth cells and goblet cells both have been implicated in the pathogenesis of NEC, and the patterns of histologic injury are similar to what are seen in human cases of NEC41,42,49. Therefore, this LPS-induced FEMI model of chorioamnionitis is an ideal model for investigating the mechanistic link between chorioamnionitis and later intestinal injury, specifically the development of NEC, as well as potential effects of chorioamnionitis on the developing microbiome, which would not be possible with existing models that utilize live bacteria.
In vivo, chorioamnionitis often involves an ascending bacterial infection that often results in preterm rupture of membranes and the clinical phenotype of chorioamnionitis, and animal models of chorioamnionitis exist which more accurately reflect this pathophysiology25,28,30,32. However, because our laboratory studies intestinal development, including the developing microbiome, the presence of live bacteria in a model of chorioamnionitis would confound the microbiome analysis. Therefore, existing models of chorioamnionitis utilizing live bacteria are impractical for investigating the mechanistic link between chorioamnionitis and later development of NEC. In addition, LPS-induced models of chorioamnionitis have already been effective in modeling postnatal white and gray matter brain injury36, demonstrating that this method is an effective way to model morbidities of prematurity that are associated with exposure to chorioamnionitis at the time of birth.
It is also important to note that this model is highly dependent on the dose of LPS used to induce FEMI. The primary critical step in this protocol is induction of FEMI in the pregnant dams with intraperitoneal injection of LPS; therefore, not surprisingly, we have found that the dose of LPS used to induce FEMI is extremely important in the outcomes of these experiments. With initial experiments, a dose of 100 &#181;g/kg of LPS was used, as this LPS dose was not associated with maternal mortality and resulted in approximately 50% neonatal survival as well as significant intestinal injury in offspring41,42.
LPS binds to the Toll-like receptor 4 (TLR4) complex, resulting in aggregation of intracellular signaling proteins, cytokine production, and the initiation of pro-inflammatory signaling50. Toll-like receptors (TLRs) including TLR2, TLR3, TLR4, TLR7, TLR8, and TLR9 are important in the induction of the inflammatory response that is seen with a variety of pathogens and microorganisms such as viruses, bacteria, and fungi51. Interestingly, upregulation of TLR3 has also been shown to correlate with increased histologic intestinal damage and viral shedding in a neonatal murine rotavirus model; furthermore, knockout of TLR3 ameliorated these effects52. Thus, while the model makes use of TLR4 pathways, it is reasonable to assume that stimulation of other TLRs may confer similar findings.
Using this methodology, we have been able to show that LPS injection in pregnant dams causes increases in maternal, placental, and fetal inflammatory markers while sparing the amniotic fluid, as well as inducing direct damage to the placenta42. Interestingly, this methodology showed no alteration of resistance in the uterine arteries. The FEMI model also has a significant impact on the offspring as we have shown that exposed pups have significant intestinal injury42 through an IL-6 dependent pathway41 and can impact important defense mechanisms of the intestine such as goblet cells and Paneth cells41. This injury makes the neonatal offspring increasingly susceptible to subsequent LPS-induced intestinal injury and inflammation41 which may explain why infants exposed to chorioamnionitis have an increased susceptibility to develop NEC.

The chorionic membranes play an integral role in mammalian pregnancy. They include the chorion and amnion, which serve multiple functions. They surround and protect the fetus, facilitate paracrine signaling between the maternal and fetal compartments1, and create local feedback loops within the chorionic membranes, which may be involved in initiating parturition1. Current understanding of the membranes indicates that the amnion provides structural barrier function, and the chorion provides an immunological buffer primarily to protect the developing fetus from the maternal immune system2. Inflammation of these membranes is known as chorioamnionitis. Historically, the diagnosis of clinical chorioamnionitis was made following the presence of maternal fever plus one or more fetal or maternal clinical findings3,4. However, while this definition is clinically useful, its lack of precision has made chorioamnionitis research challenging. In 2015, in an attempt to clarify the diagnosis, an expert panel workshop by the Eunice Kennedy Shriver National Institute for Child Health and Human Development defined chorioamnionitis as intrauterine inflammation, or infection, or both (triple I)3. This clarification is important because while microbial induced infection is an important cause of uterine/amniotic inflammation, it occurs less commonly than sterile uterine/amniotic inflammation5,6,7. Overall, chorioamnionitis remains a significant public health problem, as it is seen in 2&#8210;4% of term deliveries and 25&#8210;30% of preterm deliveries8,9.
Chorioamnionitis can have significant effects on the fetus and neonate. It has been well documented in the literature that chorioamnionitis is associated with increased risk of many of the morbidities of prematurity, including bronchopulmonary dysplasia10, cerebral white matter injury11, intraventricular hemorrhage12, retinopathy of prematurity13, and both suspected and confirmed early onset neonatal sepsis14,15. As we are interested in injury and repair mechanisms of the immature intestinal tract, it is important to note that chorioamnionitis is also associated with later development of necrotizing enterocolitis (NEC)15,16. NEC is a devastating gastrointestinal disease of preterm infants that results in a dysregulated host response to inflammation and subsequent intestinal necrosis17. Each year, NEC affects over 4000 infants in the United States, and up to one third of these infants die from the disease18. The pathogenesis of NEC likely involves a combination of intestinal immaturity, dysregulation of the immature immune system, intestinal inflammation, and bacterial translocation19, culminating in a final common pathway of intestinal necrosis. Importantly, the onset of NEC often occurs weeks after birth and potential exposure to chorioamnionitis, making the mechanistic link between chorioamnionitis and subsequent development of NEC unclear20. One potential mechanism by which chorioamnionitis may contribute to the pathophysiology of NEC is through upregulation of the maternal immune system, subsequently producing a strong fetal inflammatory response which may disrupt normal fetal developmental patterns21,22,23.
Multiple mammalian models of chorioamnionitis exist in rodents and sheep24,25,26,27,28,29,30,31,32. However, few data exist concerning the development of the intestinal tract beyond the initial newborn period following chorioamnionitis-induced fetal exposure to maternal inflammation (FEMI). In order to explore the relationship between FEMI and subsequent development of injury of the immature intestinal tract, we have adapted the lipopolysaccharide (LPS)-induced FEMI model. Lipopolysaccharides are a major component of the extracellular surface on gram negative bacteria and are a potent stimulant of the innate immune system of multiple eukaryotic species, including humans33. Maternal LPS injection results in a sterile inflammatory cascade without the confounding effects of live bacteria, and it is a well-established model for induction of preterm birth34, as well as a model of acute chorioamnionitis and the fetal inflammatory response syndrome (FIRS), which is the most severe form of chorioamnionitis24,35. It has also been shown to induce both cerebral white and gray matter injury in a sheep model36 and a murine model37,38,39,40. However, to our knowledge, we are the first to use this model of chorioamnionitis and FEMI to investigate its effects on the development of the gastrointestinal tract past birth, as well as to investigate a possible mechanistic link between chorioamnionitis and later development of NEC41,42.

<table><tbody><tr><td>10% neutral buffered formalin</td><td>Sigma</td><td>HT501128</td><td></td></tr><tr><td>Alcian blue stain</td><td>Newcomer supply</td><td>1003A</td><td></td></tr><tr><td>C57Bl6/J mice</td><td>Jackson Laboratories</td><td>664</td><td></td></tr><tr><td>Ethanol</td><td>Decon labs</td><td>2701</td><td></td></tr><tr><td>HCl</td><td>Sigma</td><td>H1758</td><td></td></tr><tr><td>Hematoxylin stain</td><td>Leica</td><td>381562</td><td></td></tr><tr><td>LPS</td><td>Sigma</td><td>L2880</td><td></td></tr><tr><td>NaHCO3</td><td>Sigma</td><td>S6014</td><td></td></tr><tr><td>Nikon Eclipse Ni-U Microscope</td><td>Nikon</td><td>2CE-MQVJ-1</td><td></td></tr><tr><td>Periodic Acid</td><td>ACROS</td><td>H5106</td><td>CAS# 10450-59-9</td></tr><tr><td>RNAlater</td><td>Thermofisher</td><td>Am7021</td><td></td></tr><tr><td>Schiff&#039;s reagent</td><td>Sigma</td><td>S5133</td><td></td></tr><tr><td>Secor Imager 2400</td><td>Meso Scale Discovery (MSD)</td><td></td><td></td></tr><tr><td>V-Plex Assay</td><td>Meso Scale Discovery (MSD)</td><td></td><td></td></tr><tr><td>Xylene</td><td>Sigma</td><td>534056</td><td></td></tr></tbody></table>

a murine model of fetal exposure to maternal inflammation to study the effects of acute chorioamnionitis on newborn intestinal development

Chorioamnionitis is a common precipitant of preterm birth and is associated with many of the morbidities of prematurity, including necrotizing enterocolitis (NEC). However, a mechanistic link between these two conditions remains yet to be discovered. We have adopted a murine model of chorioamnionitis involving lipopolysaccharide (LPS)-induced fetal exposure to maternal inflammation (FEMI). This model of FEMI induces a sterile maternal, placental, and fetal inflammatory cascade, which is also present in many cases of clinical chorioamnionitis. Although models exist that utilize live bacteria and more accurately mimic the pathophysiology of an ascending infection resulting in chorioamnionitis, these methods may cause indirect effects on development of the immature intestinal tract and the associated developing microbiome. Using this protocol, we have demonstrated that LPS-induced FEMI results in a dose-dependent increase in pregnancy loss and preterm birth, as well as disruption of normal intestinal development in offspring. Further, we have demonstrated that FEMI significantly increases intestinal injury and serum cytokines in offspring, while simultaneously decreasing goblet and Paneth cells, both of which provide a first line of innate immunity against intestinal inflammation. Although a similar model of LPS-induced FEMI has been used to model the association between chorioamnionitis and subsequent abnormalities of the central nervous system, to our knowledge, this protocol is the first to attempt to elucidate a mechanistic link between chorioamnionitis and later perturbations in intestinal development as a potential link between chorioamnionitis and NEC.

Exposure to FEMI on embryonic day 15 leads to a dose-dependent loss of pregnancy and a dose dependent rate of preterm labor (Figure 1)42. For the experiments, we chose to use an LPS dose of 100 &#181;g/kg to minimize pregnancy loss and prematurity (50% loss between both prematurity and intrauterine fetal demise) while exposing the fetuses to a significant inflammatory insult.
Using this approach, we next examined the effects of FEMI on subsequent injury of the offspring. Using a 3-point histologic scale to measure generalized intestinal injury, we found significant injury at birth (P0) and at adulthood (P56 or 8 weeks of life) (Figure 2). It is important to note that this injury occurred in the absence of any additional stimuli to the animals other than FEMI, suggesting that FEMI alone disrupts the normal homeostasis of the newborn murine intestinal tract. As the mouse is born with a relatively immature intestine that continues to develop during the first 4 weeks of life47,48, this is relevant to preterm infants who also have immature intestinal tracts.
To further understand the effect of FEMI on both the normal development of the intestinal epithelium and on the defense mechanisms of the immature intestinal tract, we quantified the number of mucin-producing goblet cells and antimicrobial peptide-producing Paneth cells in the distal third of the small intestinal tract which is similar to the human ileum. We found that FEMI disrupted the normal composition of the intestinal epithelium by inducing loss of both goblet cells and Paneth cells compared to animals without FEMI (Figure 3).
To investigate the effects of FEMI on the neonatal inflammatory response, using ELISA with electrochemiluminescence, we quantified a variety of serum inflammatory markers, which included IL-1&#946;, IL-10, KC-GRO (the murine equivalent of IL-8), and IL-6, from serum of pups with and without FEMI (Figure 4). We found that FEMI significantly increased the inflammatory cascade for all cytokines at P0. The inflammatory cascade at later ages (P7&#8210;P56) differed based on timepoint and cytokine. Most interestingly, for IL-6, there were similar levels at P7&#8210;P28 in the FEMI and sham groups, but despite no secondary intervention, there were significantly higher levels in the FEMI group at P56. This is especially important as we have demonstrated that IL-6 is a critical cytokine for the development of postnatal intestinal injury in the FEMI model.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/61464/61464fig01.jpg" /> 
Figure 1: Effect of FEMI dose on pregnancy outcomes.&#160;Survival of pregnancy litters is dose dependent with higher doses causing higher rates of pregnancy loss (A) and higher rates of premature birth (B). Figure is adapted with permission from Fricke et al42. FEMI using an LPS dose of 100 &#181;g/kg creates a 50% survival for pups by one week of life. Each data point is representative of an n &#62; 8 pregnancies and at least three individual experiments. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61464/61464fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/61464/61464fig02.jpg" /> 
Figure 2: Effect of FEMI on distal small intestinal injury patterns over time.&#160;Intestinal samples were harvested at birth, 1 week of life, 2 weeks of life, and 8 weeks of life from mice exposed to FEMI (100 &#181;g/kg of LPS) or sham control. Samples were scored using a 3-point injury scale by blinded investigators42,43. FEMI alone with no further insult induced significant amount of injury at birth, 1 week of life, and at 8 weeks of life. Figure has been adapted with permission from Fricke et al.42. Each data point is representative of an n &#62; 10 pups and at least three individual experiments from at least 3 pregnant dams. Mann-Whitney non-parametric T-testing was used to compare intestinal injury scores at each timepoint. The asterisk indicates p &#60; 0.05. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61464/61464fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/61464/61464fig03.jpg" /> 
Figure 3: FEMI induces alterations of normal goblet and Paneth cell quantities in the small intestine during development.&#160;Intestinal samples were harvested at birth, 1, 2, 4, and 8 weeks of life from mice exposed to FEMI (100 &#181;g/kg LPS) or sham control. Samples were stained with Alcian blue/Periodic Acid Schiff stain to detect both goblet and Paneth cells and these were quantified by a blinded investigator. Both goblet cells and Paneth cells from animals with FEMI showed either a trend or a significant decrease compared to sham controls at all ages. Figure adapted with permission from Elgin et al.41. Each data point is representative of an n &#62; 10 pups and at least three individual experiments. Error bars represent standard error of the mean. Student T-testing was used to compare quantities of goblet and Paneth cells at each time point. The asterisk indicates p &#60; 0.05. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61464/61464fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/61464/61464fig04.jpg" /> 
Figure 4: FEMI induces a global neonatal inflammatory surge for all cytokines immediately after birth at P0, with a late surge of IL-6 at P56.&#160;Serum cytokines were quantified at P0, P7, P14, and P28 using ELISA with electrochemiluminescence according to the manufacturer&#8217;s instructions, and plates were read at 620 nm. Cytokine values are represented here in a radar plot, and all cytokines are plotted as percent of maximal value. There were significant increases in all cytokines (IL-1&#946;, IL-10, KC-GRO and IL-6) at P0 in the FEMI group compared to the control group (all p &#60; 0.05). There was also a resurgent increase in IL-6 levels at P56 in the pups with FEMI compared to no FEMI (p &#60; 0.05 by non-parametric Kruskal-Wallis testing), which was the only cytokine that was significantly elevated in the FEMI group compared to control at this late timepoint. Figure adapted with permission from Elgin et al.41. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61464/61464fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Supplementary Figure 1: Intestinal injury scoring of H&#38;E stained ileal tissue. Injury scores are determined by a three-point intestinal injury scoring scale (0=normal, 1=mild injury, 2=severe injury) based on degree of villi vacuolization, mucosal ulceration, lamina propria damage, and presence of hemorrhage within villi as previously described43. Figure adapted with permission from Elgin et al.41. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61464/61464supfig01.jpg" target="_blank">Please click here to download this figure.</a>
Supplementary Figure 2: Representative appearance of Alcian Blue/PAS staining of goblet and Paneth cells. Alcian Blue/PAS staining of intestinal tissues allows clear visualization of goblet cells, present in intestinal villi (top panel marked with white arrows, image taken at 20x magnification), and Paneth cells, present in crypts of Lieberkuhn, located below the intestinal villi in the lamina propria (bottom panel marked with yellow arrows, image taken at 60x magnification). <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61464/61464supfig02.jpg" target="_blank">Please click here to download this figure.</a>

Watch this Scientific Journal Video about A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development at JoVE.com

A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development

We developed a model of chorioamnionitis to simulate fetal exposure to maternal inflammation (FEMI) without complications of live organisms to examine the effects of FEMI on development of the offspring&#8217;s intestinal tract. This allows for study of mechanistic causes for development of intestinal injury following chorioamnionitis.

Chorioamnionitis is a common precipitant of preterm birth and is associated with many of the morbidities of prematurity, including necrotizing ...

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JoVE Journal

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3.7K Views.  University of Iowa. We ontwikkelden een model van chorioamnionitis om foetale blootstelling aan maternale ontsteking (FEMI) te simuleren zonder complicaties van levende organismen om de effecten van FEMI op de ontwikkeling van het darmkanaal van het nageslacht te onderzoeken. Dit maakt het mogelijk om mechanistische oorzaken voor de ontwikkeling van darmletsel na chorioamnionitis te bestuderen.

Video: A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development

Non-Invasive Model of Neuropathogenic Escherichia coli Infection in the Neonatal Rat

Investigation of the interactions between animal host and bacterial pathogen is only meaningful if the infection model employed replicates the principal features of the natural infection. This protocol describes procedures for the establishment and evaluation of systemic infection due to neuropathogenic Escherichia coli K1 in the neonatal rat. Colonization of the gastrointestinal tract leads to dissemination of the pathogen along the gut-lymph-blood-brain course of infection and the model displays strong age dependency. A strain of E. coli O18:K1 with enhanced virulence for the neonatal rat produces exceptionally high rates of colonization, translocation to the blood compartment and invasion of the meninges following transit through the choroid plexus. As in the human host, penetration of the central nervous system is accompanied by local inflammation and an invariably lethal outcome. The model is of proven utility for studies of the mechanism of pathogenesis, for evaluation of therapeutic interventions and for assessment of bacterial virulence.

Non-Invasive Model of Neuropathogenic Escherichia coli Infection in the Neonatal Rat

Here, a procedure is described for the establishment of systemic infection in the neonatal rat with cultures of Escherichia coli K1. This non-invasive procedure permits colonization of the gastrointestinal tract, translocation of the pathogen to the systemic circulation, and invasion of the central nervous system at the choroid plexus.

Investigation of the interactions between animal host and bacterial pathogen is only meaningful if the infection model employed replicates the principal ...

Immunology and Infection

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There are many different animal models available for studying the pathogenesis of human inflammatory bowel diseases (IBD), each with its own advantages and disadvantages. We describe here an experimental colitis model that is initiated by adoptive transfer of syngeneic splenic CD4+CD45RBhigh T cells into T and B cell deficient recipient mice. The CD4+CD45RBhigh T cell population that largely consists of na&#239;ve effector cells is capable of inducing chronic intestinal inflammation, closely resembling key aspects of human IBD. This method can be manipulated to study aspects of disease onset and progression. Additionally it can be used to study the function of innate, adaptive, and regulatory immune cell populations, and the role of environmental exposures, i.e., the microbiota, in intestinal inflammation. In this article we illustrate the methodology for inducing colitis with a step-by-step protocol. This includes a video demonstration of key technical aspects required to successfully develop this murine model of experimental colitis for research purposes.

Induction of Murine Intestinal Inflammation by Adoptive Transfer of Effector CD4+CD45RBhigh T Cells into Immunodeficient Mice

Here, we present a protocol to induce colonic inflammation in mice by adoptive transfer of syngeneic CD4+CD45RBhigh T cells into T and B cell deficient recipients. Clinical and histopathological features mimic human inflammatory bowel diseases. This method allows the study of the initiation of colonic inflammation and progression of disease.

There are many different animal models available for studying the pathogenesis of human inflammatory bowel diseases (IBD), each with its own advantages ...

Development of an Antigen-driven Colitis Model to Study Presentation of Antigens by Antigen Presenting Cells to T Cells

Inflammatory bowel disease (IBD) is a chronic inflammation which affects the gastrointestinal tract (GIT). One of the best ways to study the immunological mechanisms involved during the disease is the T cell transfer model of colitis. In this model, immunodeficient mice (RAG-/- recipients) are reconstituted with naive CD4+ T cells from healthy wild type hosts.
This model allows examination of the earliest immunological events leading to disease and chronic inflammation, when the gut inflammation perpetuates but does not depend on a defined antigen. To study the potential role of antigen presenting cells (APCs) in the disease process, it is helpful to have an antigen-driven disease model, in which a defined commensal-derived antigen leads to colitis. An antigen driven-colitis model has hence been developed. In this model OT-II CD4+ T cells, that can recognize only specific epitopes in the OVA protein, are transferred into RAG-/- hosts challenged with CFP-OVA-expressing E. coli. This model allows the examination of interactions between APCs and T cells in the lamina propria.

In this antigen-driven colitis model, OT-II CD4+ T cells expressing a red fluorescent protein were adoptively transferred into RAG-/- mice that express a green fluorescent protein in mononuclear phagocytes (MPs). The hosts were challenged with Escherichia coli (E.coli) expressing the ovalbumin protein (OVA) fused to a cyan fluorescent protein (CFP).

Inflammatory bowel disease (IBD) is a chronic inflammation which affects the gastrointestinal tract (GIT). One of the best ways to study the immunological ...

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.

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 ...

Probiotic Studies in Neonatal Mice Using Gavage

Adult mouse models have been widely used to understand the mechanism behind disease progression in humans. The applicability of studies done in adult mouse models to neonatal diseases is limited. To better understand disease progression, host responses and long-term impact of interventions in neonates, a neonatal mouse model likely is a better fit. The sparse use of neonatal mouse models can in part be attributed to the technical difficulties of working with these small animals. A neonatal mouse model was developed to determine the effects of probiotic administration in early life and to specifically assess the ability to establish colonization in the newborn mouse intestinal tract. Specifically, to assess probiotic colonization in the neonatal mouse, Lactobacillus plantarum (LP) was delivered directly into the neonatal mouse gastrointestinal tract. To this end, LP was administered to mice by feeding through intra-esophageal (IE) gavage. A highly reproducible method was developed to standardize the process of IE gavage that allows an accurate administration of probiotic dosages while minimizing trauma, an aspect particularly important given the fragility of newborn mice. Limitations of this process include possibilities of esophageal irritation or damage and aspiration if gavaged incorrectly. This approach represents an improvement on current practices because IE gavage into the distal esophagus reduces the chances of aspiration. Following gavage, the colonization profile of the probiotic was traced using quantitative polymerase chain reaction (qPCR) of the extracted intestinal DNA with LP specific primers. Different litter settings and cage management techniques were used to assess the potential for colonization-spread. The protocol details the intricacies of IE neonatal mouse gavage and subsequent colonization quantification with LP.

This study details the process of gavaging precise amounts of probiotics to neonatal mice. The experimental set-up was optimized to include but is not limited to probiotic dosing, methods of administration, and quantification of bacteria in the intestines.

Adult mouse models have been widely used to understand the mechanism behind disease progression in humans. The applicability of studies done in adult ...

A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis

Neonates are at an increased risk of bacterial sepsis due to the unique immune profile they display in the first months of life. We have established a protocol for studying the pathogenesis of E. coli O1:K1:H7, a serotype responsible for high mortality rates in neonates. Our method utilizes intravital imaging of neonatal pups at different time points during the progression of infection. This imaging, paralleled by measurement of bacteria in the blood, inflammatory profiling, and tissue histopathology, signifies a rigorous approach to understanding infection dynamics during sepsis. In the current report, we model two infectious inoculums for comparison of bacterial burdens and severity of disease. We find that subscapular infection leads to disseminated infection by 10 h post-infection. By 24 h, infection of luminescent E. coli was abundant in the blood, lungs, and other peripheral tissues. Expression of inflammatory cytokines in the lungs is significant at 24 h, and this is followed by cellular infiltration and evidence of tissue damage that increases with infectious dose. Intravital imaging does have some limitations. This includes a luminescent signal threshold and some complications that can arise with neonates during anesthesia. Despite some limitations, we find that our infection model offers an insight for understanding longitudinal infection dynamics during neonatal murine sepsis, that has not been thoroughly examined to date. We expect this model can also be adapted to study other critical bacterial infections during early life.

Infection of neonatal mice with bioluminescent E. coli O1:K1:H7 results in a septic infection with significant pulmonary inflammation and lung pathology. Here, we describe procedures to model and further study neonatal sepsis using longitudinal intravital imaging in parallel with enumeration of systemic bacterial burdens, inflammatory profiling, and lung histopathology.

Neonates are at an increased risk of bacterial sepsis due to the unique immune profile they display in the first months of life. We have established a ...

C-section of Preclinical Animal Model of Chorioamnionitis Triggered by Group B Streptococcus (GBS)

Group B Streptococcus (GBS) is one of the most common bacteria isolated during human pregnancy. It is a leading cause of placental infection/inflammation, termed chorioamnionitis. Chorioamnionitis exposes the developing fetus to a high risk of organ injuries, perinatal morbidity, and mortality, as well as life-long neurobehavioral impairments and other non-neurological developmental issues. The two most frequent subtypes of GBS isolates from maternal and fetal tissues are serotypes Ia (13%-23%) and III (25%-53%). Our lab has developed and characterized a rat model of GBS-induced chorioamnionitis to study subsequent impacts on the central nervous system of the developing fetus and to understand underlying mechanistic aspects. This article presents the design as well as uses of the preclinical rat model, which closely reproduces the hallmark of GBS-induced chorioamnionitis in humans. This article aims to help scientists reproduce the experimental design as well as to provide support through examples of troubleshooting. The present model may also contribute to potential discoveries through uncovering causes, mechanisms, and novel therapeutic avenues, which remain unsettled in many developmental impairments arising from chorioamnionitis. Furthermore, the use of this model may be extended to the studies of perinatal non-neurological common and severe morbidities affecting, for instance, the retina, bowel, lung, and kidney. The main interest of this research is in the field of GBS-induced fetal neurodevelopmental impairments such as cerebral palsy (CP), attention deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). The rationale supporting this model is presented in this article, followed by procedures and results.

C-section of Preclinical Animal Model of Chorioamnionitis Triggered by Group B Streptococcus GBS

The goal of this protocol is to describe a preclinical animal model of Group B Streptococcus (GBS)-induced chorioamnionitis. The study is designed to investigate mechanistic processes, potential causal links with developmental impairments, and finally to develop translational anti-inflammatory placento- and neuro-protective treatments.

Group B Streptococcus (GBS) is one of the most common bacteria isolated during human pregnancy. It is a leading cause of placental infection/inflammation, ...

Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates

Newborns ingest maternal E. coli strains that colonize their intestinal tract around the time of delivery. E. coli strains with the ability to translocate across the gut invade the newborn's bloodstream, causing life-threatening bacteremia. The methodology presented here utilizes polarized intestinal epithelial cells grown on semipermeable inserts to assess the transcytosis of neonatal E. coli bacteremia isolates in vitro. This method uses the established T84 intestinal cell line that has the ability to grow to confluence and form tight junctions and desmosomes. After reaching confluence, mature T84 monolayers develop transepithelial resistance (TEER), which can be quantified using a voltmeter. The TEER values are inversely correlated with the paracellular permeability of extracellular components, including bacteria, across the intestinal monolayer. The transcellular passage of bacteria (transcytosis), on the other hand, does not necessarily alter the TEER measurements. In this model, bacterial passage across the intestinal monolayer is quantified for up to 6 h post-infection, and repeated measurements of TEER are made to monitor the paracellular permeability. In addition, this method facilitates the use of techniques such as immunostaining to study the structural changes in tight junctions and other cell-to-cell adhesion proteins during bacterial transcytosis across the polarized epithelium. The use of this model contributes to the characterization of the mechanisms by which neonatal E. coli transcytose across the intestinal epithelium to produce bacteremia.

Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates

Escherichia coli&#160;causes sepsis in neonates who ingest the bacteria around the time of birth. The process involved in&#160;E. coli&#8217;s&#160;ability to travel from the enteric tract to the bloodstream is poorly understood. This&#160;in vitro&#160;model assesses the ability of&#160;E. coli&#160;strains to travel through the intestinal epithelial cells.

Newborns ingest maternal E. coli strains that colonize their intestinal tract around the time of delivery. E. coli strains with the ability to translocate ...

A Neonatal BALB/c Mouse Model of Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is the most severe gastrointestinal (GI) disease that often occurs in premature infants, especially very low birth weight infants, with high mortality and unclear pathogenesis. The cause of NEC may be related to inflammatory immune regulatory system abnormalities. An NEC animal model is an indispensable tool for NEC disease immune research. NEC animal models usually use C57BL/6J neonatal mice; BALB/c neonatal mice are rarely used. Related studies have shown that when mice are infected, Th2 cell differentiation is predominant in BALB/c mice compared to C57BL/6J mice. Studies have suggested that the occurrence and development of NEC are associated with an increase in T helper type 2 (Th2) cells and are generally accompanied by infection. Therefore, this study used neonatal BALB/c mice to induce an NEC model with similar clinical characteristics and intestinal pathological changes as those observed in children with NEC. Further study is warranted to determine whether this animal model could be used to study Th2 cell responses in NEC.

Necrotizing enterocolitis (NEC) is the most severe gastrointestinal (GI) disease that often occurs in premature infants, especially very low birth weight infants, with high mortality and unclear pathogenesis. The cause of NEC may be related to inflammatory immune regulatory system abnormalities. An NEC animal model is an indispensable tool for NEC disease immune research. NEC animal models usually use C57BL/6J neonatal mice; BALB/c neonatal mice are rarely used. Related studies have shown that when mice are infected, Th2 cell differentiation is predominant in BALB/c mice compared to C57BL/6J mice. Studies have suggested that the occurrence and development of NEC are associated with an increase in T helper type 2 (Th2) cells and are generally accompanied by infection. Therefore, this study used neonatal BALB/c mice to induce an NEC model with similar clinical characteristics and intestinal pathological changes as those observed in children with NEC. Further study is warranted to determine whether this animal model could be used to study Th2 cell responses in NEC.

Necrotizing enterocolitis (NEC) is the most severe gastrointestinal (GI) disease that often occurs in premature infants, especially very low birth weight ...

Effect of Hyaluronic Acid 35 kDa on an In Vitro Model of Preterm Small Intestinal Injury and Healing Using Enteroid-Derived Monolayers

In vitro scratch wound assays are commonly used to investigate the mechanisms and characteristics of epithelial healing in a variety of tissue types. Here, we describe a protocol to generate a two-dimensional (2D) monolayer from three-dimensional (3D) non-human primate enteroids derived from intestinal crypts of the terminal ileum. These enteroid-derived monolayers were then utilized in an in vitro scratch wound assay to test the ability of hyaluronan 35 kDa (HA35), a human milk HA mimic, to promote cell migration and proliferation along the epithelial wound edge. After the monolayers were grown to confluency, they were manually scratched and treated with HA35 (50 &#181;g/mL, 100 &#181;g/mL, 200 &#181;g/mL) or control (PBS). Cell migration and proliferation into the gap were imaged using a transmitted-light microscope equipped for live-cell imaging. Wound closure was quantified as percent wound healing using the Wound Healing Size Plugin in ImageJ.&#160;The scratch area and rate of cell migration and the percentage of wound closure were measured over 24 h. HA35 in vitro accelerates wound healing in small intestinal enteroid monolayers, likely through a combination of cell proliferation at the wound edge and migration to the wound area. These methods can potentially be used as a model to explore intestinal regeneration in the preterm human small intestine.

Effect of Hyaluronic Acid 35 kDa on an In Vitro Model of Preterm Small Intestinal Injury and Healing Using Enteroid-Derived Monolayers

This protocol describes a method to establish and perform a scratch wound assay on two-dimensional (2D) monolayers derived from three-dimensional (3D) enteroids isolated from non-human primate ileum.

In vitro scratch wound assays are commonly used to investigate the mechanisms and characteristics of epithelial healing in a variety of tissue types. ...

A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development

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