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• W4225326978 abstract "As we near the end of the first quarter of the 21st century, it is notable that many influential health and research governance bodies are highlighting the importance of directing strategies towards the understanding of lifecourse health and disease trajectories. These include the WHO's promotion of public health policies to incorporate lifecourse approaches in alliance with the United Nations Sustainable Development Goals (SDG) – especially the Health and Population SDG with the stated objective to ‘ensure healthy lives and promoting well-being for all at all ages’ (Kuruvilla et al., 2017; Mikkelsen et al., 2019; United Nations 2030 Agenda for Sustainable Development, 2015; World Health Organisation, 2022); Public Health England's (2019) guidance for a lifecourse approach to preventing ill-health; the UK government's review of early life in England and recognition of the importance for future health of the first 1001 days post-birth (The Best Start for Life, 2021); the Physiological Society's review of healthy ageing research (Growing Older, Better, 2019); and recent UKRI funding streams directed towards the establishment of interdisciplinary research networks in ageing across the lifecourse. There are many reasons underlying this. First, a recognition that population-level improvements in lifespan may have peaked (Marmot et al., 2020; Raleigh, 2021) with attention being directed towards facilitating a healthy lifecourse rather than increasing longevity per se. Second, the realization that meaningful improvement in the diagnosis of, and provision of therapeutic options for, the increasing number of people presenting in later life with multiple conditions of ill health will require a greater awareness of the origins of disease (Academy of Medical Sciences, 2018; Head et al., 2020; Mikkelsen et al., 2019; Public Health England, 2019; Whitty & Watt, 2020). Third, and related, the now strong body of information that indicates trajectories of good health, or ill-health, may be influenced by circumstances encountered early in life (Aagaard-Hansen et al., 2019; Crump & Howell, 2021; Hanson et al., 2016; Tribe et al., 2018). The requirement to interrogate the mechanisms determining lifecourse health, and their regulation and integration over time, speaks loudly to the interests of physiologists and the role of physiology: our curiosity to unravel the molecular mechanisms enabling our cells, tissues and organs to adapt to everyday stimuli; and the wish to gain insight into what has gone awry, and what to do about it, when the physiological reservoirs for remodelling are overwhelmed and tipped into the pathophysiological. This was the impetus for the Physiology 2021 symposium entitled ‘Physiological Resilience Across the Lifecourse: In Utero and Beyond’, where four renowned researchers addressed this topic across a range of organ systems and time frames and participated in an engaging and wide-ranging discussion forum with conference attendees. The short review articles herein summarize the thoughts of the speakers on these matters. Rosalind John describes research investigating the cross-talk between feto-placental and maternal environments during pregnancy and discusses the relevance for longer-term maternal and neonatal health and behaviour (John, 2022). It is well-established that the placenta plays a crucial role in pregnancy success by modulating the maternal environment (e.g., via structural and functional alterations of the uterine vasculature to facilitate maternal blood flow to the inter-villous space) and facilitating nutrient exchange between the maternal and placental circulations to support gestationally appropriate fetal growth. It has also been supposed that maternally derived adverse circumstances can impact negatively upon fetal/neonatal well-being. Herein a new role for the placenta is evoked: that of an endocrine regulator of both maternal and fetal physiology and behaviour. This advance is arrived at with the use of intricate murine models of pregnancy whereby genetic alterations of maternally or paternally imprinted genes, each of which influences placenta-derived hormonal production, are expressed in embryos transferred to pseudo-pregnant females. In essence, embryonic/fetal conditions that imposed placental endocrine insufficiency (e.g., reduced lactogen production) were associated with low birthweight of progeny (as anticipated), but the mothers also exhibited reduced care of themselves and their offspring. Moreover, transcriptomic analysis of brain from animals surviving to adulthood revealed differences in regions sensitive to in utero development from transgenic animals versus controls. This has opened up a new avenue of exploration whereby one has to consider that alterations in placental hormone production may impact directly upon maternal and fetal brain physiology and organism behaviour – of particular relevance to elucidating the mechanisms underlying the influence of prenatal adversity on brain health of mothers and babies. Christopher Stewart and colleagues discuss the wonders of the human gut microbiome and its role in regulating physiology throughout the lifecourse (Ahearn-Ford et al., 2022). The post-natal period up to 3 years of age is especially important in setting the parameters of homeostasis and maturation as microbes colonize the human body. This is evinced too by the impact of perturbations in neonatal gut microbiota being associated with development of later onset diseases including irritable bowel syndrome, cardiovascular disease and neurological disorders. Perhaps unsurprisingly, therefore, infants born preterm (and therefore having underdeveloped immune and gastrointestinal tract systems as well as being exposed to extra-uterine sterile environments) have a high incidence of necrotizing enterocolitis and this is associated with microbiome instability. This microbial dysregulation could contribute to the long-term health risks associated with preterm birth (PTB) that overlap considerably with microbial dysbiosis referred to previously. Intriguingly, developments in human intestinal organoid model systems, although in their infancy, appear to offer promise for investigating the physiological mechanisms of host–microbiome interactions and their alteration in disease circumstances. Vaelerie Luyckx, together with Robert Chevalier, addresses the issue of chronic kidney disease (CKD), which affects 1/10 of the adult population and rising, and the role that adverse gestational circumstances may contribute to this (Luyckx & Chevalier, 2022). Population-level studies give compelling voice to this notion. Fetal growth restriction, pre-eclampsia and preterm birth are each risk factors for development of hypertension, proteinuria and kidney disease in later life. Furthermore, female individuals exposed to such adverse in utero circumstances are more likely to experience similar pregnancy situations in adulthood. The in utero period is crucial for kidney development including the process of nephrogenesis. Studies of murine nutrient deficiency negatively impact on nephron number perhaps as nutrient utilization is diverted to the development of other organ systems (e.g., brain). It is therefore tempting to associate the extent of fetal kidney nephrogenesis with risk of later onset CKD and associated co-morbidities. Adam Lewandowski also considers the impact of PTB on physiological outcomes later in life (Lewandowski, 2022). PTB, as mentioned above, is a risk factor for later development of cardiovascular disease. In his review, investigations of the influence of being born prematurely on maturation of cardiac structure and function, and the incidence of cardiac-related disease are discussed. A combination of in vivo imaging approaches – echocardiography or magnetic resonance imaging – undertaken in the last decade, in alliance with information from large cohort patient registry studies from Scandinavia, are revealing important mechanistic associations between heart structure, function and disease, and the influence of PTB relative to age-matched individuals born at term. Notably, in early adulthood, the incidence of PTB was associated with lower left and right ventricular volumes, and increased masses, as well as reduced left ventricular ejection fraction upon exercise challenge. Left ventricular mass was positively correlated to systolic blood pressure in young adults with the association stronger for those born prematurely. An elevation of diffuse left ventricular fibrosis in adults born prematurely was also noted. These intricate studies provide valuable information as to the possible mechanisms contributing to the increased cardiac disease risk of being born prematurely. Of interest is a cross-over of potential benefits remarked upon in the reviews of Lewandowski (2022) and Ahearn-Ford et al. (2022) – for cardiac performance or gut microbiome homeostasis respectively – of continuous breast-feeding of preterm infants. The Physiology 2021 Symposium presentations, and these reviews, indicate clearly that there is a crucial role for physiological research in unravelling the mechanisms that serve to maintain homeostasis in the face of innumerable challenges over the lifecourse. There is a common thread woven through these reviews that alerts us to a fourth reason for research strategies to embed genuine consideration of lifecourse health and disease trajectories: that is, lifecourse takes on a very different perspective depending upon the starting point. Some other notable examples of this are cases of congenital conditions and/or genetic diseases diagnosed early in life. For example, congenital heart disease, Deuchenne's muscular dystrophy and cystic fibrosis (CF). These patients encounter, from very early days, many severe challenges to their physiological robustness. Yet, through a combination of decades-long fundamental and clinical physiology-related research, our understanding of the adaptations occurring, and the efficacy of new drugs (e.g., ion channel potentiators for CF, Sheppard et al., 2017) and non-medicinal interventions (e.g., aerobic exercise for CF patients; Williams & Stevens, 2013), are contributing to lifecourse improvements in terms of well-being and longevity for affected individuals. For example, in cystic fibrosis mortality has changed from early teenage years to the expectation that most patients born now will live well in to their fifth decade (Sheppard et al., 2017). In turn, these gains in integrated physiology knowledge garnered from studying situations of early-onset, and persistent, life challenges may prove to be of use in (i) elucidating the sequelae of mechanisms that lead to later adult-onset chronic diseases, and (ii) developing diagnostic and therapeutic tools to minimize the pathophysiology occurrence/impact. In summary, there remains a need to acquire rigorous, integrated experimental data for the identification and quantification of the reservoirs of physiological adaptations available for responding to different lifecourse challenges and to harness this information to improve resilience to disease. The spatiotemporal scales over which these occur are immense in complexity – from subcellular to whole organism, from milliseconds to decades and even across generations – and reflect the demanding nature of these tasks. It is why the funding and policy strategies mentioned at the outset of this article, and the research approaches described eloquently in these reviews, need to be supported and built upon if we are to increase our physiological knowledge base in a manner applicable to improving lifecourse health outcomes in the second quarter of this century. None. Both authors have read and approved the final version of this manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All persons designated as authors qualify for authorship, and all those who qualify for authorship are listed." @default.
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• W4225326978 title "Physiological resilience across the lifecourse: In utero and beyond" @default.
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