1 5439 153 RENAL CONSEQUENCES OF PRETERM BIRTH. BACKGROUND: THE DEVELOPMENTAL ORIGIN OF HEALTH AND DISEASE CONCEPT IDENTIFIES THE BRAIN, CARDIOVASCULAR, LIVER, AND KIDNEY SYSTEMS AS TARGETS OF FETAL ADVERSE PROGRAMMING WITH ADULT CONSEQUENCES. AS THE LIMITS OF VIABILITY IN PREMATURE INFANTS HAVE BEEN PUSHED TO LOWER GESTATIONAL AGES, THE LONG-TERM IMPACT OF PREMATURITY ON KIDNEYS STILL REMAINS A SIGNIFICANT BURDEN DURING HOSPITAL STAY AND BEYOND. OBJECTIVES: THE PURPOSE OF THIS STUDY IS TO SUMMARIZE AVAILABLE EVIDENCE, MECHANISMS, AND SHORT- AND LONG-TERM RENAL CONSEQUENCES OF PREMATURITY AND IDENTIFY NEPHROPROTECTIVE STRATEGIES AND AREAS OF UNCERTAINTY. RESULTS: KIDNEY SIZE AND NEPHRON NUMBER ARE KNOWN TO BE REDUCED IN SURVIVING PREMATURE INFANTS DUE TO DISRUPTION OF ORGANOGENESIS AT A CRUCIAL DEVELOPMENTAL TIME POINT. INFLAMMATION, HYPEROXIA, AND ANTIANGIOGENIC FACTORS PLAY A ROLE IN EPIGENETIC CONDITIONING WITH POTENTIAL LIFE-LONG CONSEQUENCES. ADDITIONAL KIDNEY INJURY FROM HYPOPERFUSION AND NEPHROTOXICITY RESULTS IN STRUCTURAL AND FUNCTIONAL CHANGES OVER TIME WHICH ARE OFTEN UNNOTICED. NEPHROPATHY OF PREMATURITY AND ACUTE KIDNEY INJURY CONFOUND GLOMERULAR AND TUBULAR MATURATION OF PRETERM KIDNEYS. KIDNEY PROTECTIVE STRATEGIES MAY AMELIORATE GROWTH FAILURE AND SUBOPTIMAL NEURODEVELOPMENTAL OUTCOMES IN THE SHORT TERM. IN LATER LIFE, SUBCLINICAL CHRONIC RENAL DISEASE MAY PROGRESS, EVEN IN ASYMPTOMATIC SURVIVORS. CONCLUSION: AWARENESS OF RENAL IMPLICATIONS OF THERAPEUTIC INTERVENTIONS AND RENAL CONSERVATION EFFORTS MAY LEAD TO A VARIETY OF SHORT AND LONG-TERM BENEFITS. ADEQUATE MONITORING AND SUPPLEMENTATION OF MICROELEMENT LOSSES, GATHERING IMPROVED DATA ON RENAL HANDLING, AND EXPLORATION OF NEW AVENUES SUCH AS RELIABLE MARKERS OF INJURY AND NEW THERAPEUTIC STRATEGIES IN CONTEMPORARY POPULATIONS, AS WELL AS LONG-TERM FOLLOW-UP OF RENAL FUNCTION, IS WARRANTED. 2017 2 4158 33 MECHANOTRANSDUCTION DETERMINES THE STRUCTURE AND FUNCTION OF LUNG AND BONE: A THEORETICAL MODEL FOR THE PATHOPHYSIOLOGY OF CHRONIC DISEASE. MULTICELLULAR ORGANISMS HAVE EVOLVED IN ADAPTATION TO THE EARTH'S GRAVITATIONAL AND OXYGEN ENVIRONMENT. THIS EPIGENETIC PROCESS IS DEPENDENT ON THE CAPACITY OF MESODERMAL CELLS TO ACT AS MECHANOSENSORS THAT CAN CONFORM, DEFORM, AND REFORM IN ADAPTATION TO THE ORGANISM'S PHYSICAL ENVIRONMENT. MECHANICAL FORCES, SUCH AS HYDROSTATIC PRESSURE AND GRAVITY, PLAY IMPORTANT ROLES IN THE EMBRYONIC DEVELOPMENT, HOMEOSTASIS, AND REPAIR OF LUNG AND BONE. WE DISCUSS THE ROLE OF PARATHYROID HORMONE-RELATED PROTEIN (PTHRP) AS A MECHANOTRANSDUCER FOR STRETCH IN THESE ORGANS DURING NORMAL DEVELOPMENT, PARTICULARLY AS IT LENDS ITSELF TO HOMEOSTASIS; WE FURTHER DEMONSTRATE THAT "UNCOUPLING" OF SUCH MECHANISMS MAY PLAY A CENTRAL ROLE IN INJURY REPAIR, PARTICULARLY AS IT RELATES TO CHRONIC DISEASES OF LUNG AND BONE. ENDOTHERMAL PTHRP SIGNALING THROUGH ITS G-PROTEIN COUPLED RECEPTOR PROMOTES NORMAL CELL-CELL SIGNALING THAT MAINTAINS THE HOMEOSTATIC PHENOTYPES OF LUNG AND BONE. MOLECULAR DISRUPTION OF THE PTHRP/PTHRP RECEPTOR PATHWAY FROM ENDODERM TO MESODERM, BECAUSE OF SUCH FACTORS AS VOLUTRAUMA, HYPEROXIA, INFLAMMATION, AND MICROGRAVITY, ALTERS INTRACELLULAR SIGNALING, CAUSING MALADAPTIVE CELLULAR CHANGES, RESULTING IN MYOFIBROBLAST PROLIFERATION AND GRANULATION. EXAMPLES OF SUCH PATHOLOGIC CHANGES SPECIFICALLY RELATED TO THIS CELLULAR/MOLECULAR MECHANISM OF MALADAPTATION ARE CHRONIC LUNG DISEASE AND OSTEOPOROSIS. WE SUGGEST A NEW PARADIGM THAT MAY HELP IN THE FUTURE CREATION OF DIAGNOSTIC AND THERAPEUTIC MODALITIES FOR A WIDE RANGE OF DEVELOPMENTAL AND CHRONIC DISEASES RANGING FROM BRONCHOPULMONARY DYSPLASIA IN NEWBORNS TO IDIOPATHIC PULMONARY FIBROSIS AND OSTEOPOROSIS AS A RESULT OF AGING OR MICROGRAVITY. 2003 3 1392 34 DIAGNOSTIC APPROACH TO PULMONARY HYPERTENSION IN PREMATURE NEONATES. BRONCHOPULMONARY DYSPLASIA (BPD) IS A FORM OF CHRONIC LUNG DISEASE IN PREMATURE INFANTS FOLLOWING RESPIRATORY DISTRESS AT BIRTH. WITH INCREASING SURVIVAL OF EXTREMELY LOW BIRTH WEIGHT INFANTS, ALVEOLAR SIMPLIFICATION IS THE DEFINING LUNG CHARACTERISTIC OF INFANTS WITH BPD, AND ALONG WITH PULMONARY HYPERTENSION, INCREASINGLY CONTRIBUTES TO BOTH RESPIRATORY MORBIDITY AND MORTALITY IN THESE INFANTS. GROWTH RESTRICTED INFANTS, INFANTS BORN TO MOTHERS WITH OLIGOHYDRAMNIOS OR FOLLOWING PROLONGED PRETERM RUPTURE OF MEMBRANES ARE AT PARTICULAR RISK FOR EARLY ONSET PULMONARY HYPERTENSION. ALTERED VASCULAR AND ALVEOLAR GROWTH PARTICULARLY IN CANALICULAR AND EARLY SACCULAR STAGES OF LUNG DEVELOPMENT FOLLOWING MECHANICAL VENTILATION AND OXYGEN THERAPY, RESULTS IN DEVELOPMENTAL LUNG ARREST LEADING TO BPD WITH PULMONARY HYPERTENSION (PH). EARLY RECOGNITION OF PH IN INFANTS WITH RISK FACTORS IS IMPORTANT FOR OPTIMAL MANAGEMENT OF THESE INFANTS. SCREENING TOOLS FOR EARLY DIAGNOSIS OF PH ARE EVOLVING; HOWEVER, ECHOCARDIOGRAPHY IS THE MAINSTAY FOR NON-INVASIVE DIAGNOSIS OF PH IN INFANTS. CARDIAC COMPUTED TOMOGRAPHY (CT) AND MAGNETIC RESONANCE ARE BEING USED AS IMAGING MODALITIES, HOWEVER THEIR ROLE IN IMPROVING OUTCOMES IN THESE PATIENTS IS UNCERTAIN. FOLLOW-UP OF INFANTS AT RISK FOR PH WILL HELP NOT ONLY IN EARLY DIAGNOSIS, BUT ALSO IN APPROPRIATE MANAGEMENT OF THESE INFANTS. AGGRESSIVE MANAGEMENT OF LUNG DISEASE, AVOIDANCE OF HYPOXEMIC EPISODES, AND OPTIMAL NUTRITION DETERMINE THE PROGRESSION OF PH, AS EPIGENETIC FACTORS MAY HAVE SIGNIFICANT EFFECTS, PARTICULARLY IN GROWTH-RESTRICTED INFANTS. INFANTS WITH DIAGNOSIS OF PH ARE MANAGED WITH PULMONARY VASODILATORS AND THOSE RESISTANT TO THERAPY NEED TO BE WORKED UP FOR THE PRESENCE OF CARDIO-VASCULAR ANOMALIES. THE MANAGEMENT OF INFANTS AND TODDLERS WITH PH, ESPECIALLY FOLLOWING PREMATURE BIRTH IS AN EMERGING FIELD. NONETHELESS, COMBINATION THERAPIES IN A MULTI-DISCIPLINARY SETTING IMPROVES OUTCOMES FOR THESE INFANTS. 2017 4 5216 49 PRETERM BIRTH: LONG TERM CARDIOVASCULAR AND RENAL CONSEQUENCES. BACKGROUND: CARDIOVASCULAR AND CHRONIC KIDNEY DISEASES ARE A PART OF NONCOMMUNICABLE CHRONIC DISEASES, THE LEADING CAUSES OF PREMATURE DEATH WORLDWIDE. THEY ARE RECOGNIZED AS HAVING EARLY ORIGINS THROUGH ALTERED DEVELOPMENTAL PROGRAMMING, DUE TO ADVERSE ENVIRONMENTAL CONDITIONS DURING DEVELOPMENT. PRETERM BIRTH IS SUCH AN ADVERSE FACTOR. RATES OF PRETERM BIRTH INCREASED IN THE LAST DECADES, HOWEVER, WITH THE IMPROVEMENT IN PERINATAL AND NEONATAL CARE, A GROWING NUMBER OF PRETERM BORN SUBJECTS HAS NOW ENTERED ADULTHOOD. CLINICAL AND EXPERIMENTAL EVIDENCE SUGGESTS THAT PRETERM BIRTH IS ASSOCIATED WITH IMPAIRED OR ARRESTED STRUCTURAL OR FUNCTIONAL DEVELOPMENT OF KEY ORGANS/SYSTEMS MAKING PRETERM INFANTS VULNERABLE TO CARDIOVASCULAR AND CHRONIC RENAL DISEASES AT ADULTHOOD. THIS REVIEW ANALYZES THE EVIDENCE OF SUCH CARDIOVASCULAR AND RENAL CHANGES, THE ROLE OF PERINATAL AND NEONATAL FACTORS SUCH AS ANTENATAL STEROIDS AND POTENTIAL PATHOGENIC MECHANISMS, INCLUDING DEVELOPMENTAL PROGRAMMING AND EPIGENETIC ALTERATIONS. CONCLUSION: PRETERM BORN SUBJECTS ARE EXPOSED TO A SIGNIFICANTLY INCREASED RISK FOR ALTERED CARDIOVASCULAR AND RENAL FUNCTIONS AT YOUNG ADULTHOOD. ADEQUATE, SPECIFIC FOLLOW-UP MEASURES REMAIN TO BE DETERMINED. WHILE ANTENATAL STEROIDS HAVE CONSIDERABLY IMPROVED PRETERM BIRTH OUTCOMES, REPEATED THERAPY SHOULD BE CONSIDERED WITH CAUTION, AS ANTENATAL STEROIDS INDUCE LONG-TERM CARDIOVASCULAR AND METABOLIC ALTERATIONS IN ANIMALS' MODELS AND THEIR INVOLVEMENT IN THE ACCELERATED CELLULAR SENESCENCE OBSERVED IN HUMAN STUDIES CANNOT BE EXCLUDED. 2018 5 4752 42 NOVEL ROLE OF GESTATIONAL HYDRALAZINE IN LIMITING MATERNAL AND DIETARY OBESITY-RELATED CHRONIC KIDNEY DISEASE. BACKGROUND: MATERNAL OBESITY IS A RISK FACTOR FOR CHRONIC KIDNEY DISEASE (CKD) IN OFFSPRING, UNDERPINNING THE THEORY OF THE DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE. DNA METHYLATION HAS BEEN IMPLICATED IN THE PROGRAMMING OF ADULT CHRONIC DISEASE BY MATERNAL OBESITY, THEREFORE, DNA DEMETHYLATING AGENTS MAY MITIGATE OFFSPRING RISK OF DISEASE. IN RODENT MODELS, LOW-DOSE HYDRALAZINE HAS PREVIOUSLY BEEN SHOWN TO REDUCE RENAL FIBROSIS VIA DNA DEMETHYLATION. WE USED MOUSE MODELS OF MATERNAL OBESITY AND OFFSPRING OBESITY TO DETERMINE WHETHER ADMINISTRATION OF LOW-DOSE HYDRALAZINE DURING GESTATION CAN PREVENT FETAL PROGRAMMING OF CKD IN OFFSPRING. METHODS: FEMALE C57BL/6 MICE RECEIVED HIGH FAT DIET (HFD) OR CHOW PRIOR TO MATING, DURING GESTATION AND LACTATION. DURING GESTATION, DAMS RECEIVED SUBCUTANEOUS HYDRALAZINE (5 MG/KG) OR SALINE THRICE-WEEKLY. MALE OFFSPRING WEANED TO HFD OR CHOW, WHICH CONTINUED UNTIL ENDPOINT AT 32 WEEKS. BIOMETRIC AND METABOLIC PARAMETERS, RENAL GLOBAL DNA METHYLATION, RENAL FUNCTIONAL AND STRUCTURAL CHANGES, AND RENAL MARKERS OF FIBROSIS, INFLAMMATION AND OXIDATIVE STRESS WERE ASSESSED AT ENDPOINT. RESULTS: OFFSPRING EXPOSED TO MATERNAL OBESITY OR DIET-INDUCED OBESITY HAD SIGNIFICANTLY INCREASED RENAL GLOBAL DNA METHYLATION, TOGETHER WITH OTHER ADVERSE RENAL EFFECTS INCLUDING ALBUMINURIA, GLOMERULOSCLEROSIS, RENAL FIBROSIS, AND OXIDATIVE STRESS. OFFSPRING EXPOSED TO GESTATIONAL HYDRALAZINE HAD SIGNIFICANTLY REDUCED RENAL GLOBAL DNA METHYLATION. IN OBESE OFFSPRING OF OBESE MOTHERS, GESTATIONAL HYDRALAZINE SIGNIFICANTLY DECREASED ALBUMINURIA, GLOMERULOSCLEROSIS, AND SERUM CREATININE. OBESE OFFSPRING OF HYDRALAZINE-TREATED LEAN MOTHERS DISPLAYED REDUCED MARKERS OF RENAL FIBROSIS AND OXIDATIVE STRESS. CONCLUSION: GESTATIONAL HYDRALAZINE DECREASED RENAL GLOBAL DNA METHYLATION AND EXERTED RENOPROTECTIVE EFFECTS IN OFFSPRING. THIS SUPPORTS A POTENTIAL THERAPEUTIC EFFECT OF HYDRALAZINE IN PREVENTING MATERNAL OBESITY OR DIETARY OBESITY-RELATED CKD, THROUGH AN EPIGENETIC MECHANISM. 2021 6 621 38 BIOENERGETIC EVOLUTION EXPLAINS PREVALENCE OF LOW NEPHRON NUMBER AT BIRTH: RISK FACTOR FOR CKD. THERE IS GREATER THAN TENFOLD VARIATION IN NEPHRON NUMBER OF THE HUMAN KIDNEY AT BIRTH. ALTHOUGH LOW NEPHRON NUMBER IS A RECOGNIZED RISK FACTOR FOR CKD, ITS DETERMINANTS ARE POORLY UNDERSTOOD. EVOLUTIONARY MEDICINE REPRESENTS A NEW DISCIPLINE THAT SEEKS EVOLUTIONARY EXPLANATIONS FOR DISEASE, BROADENING PERSPECTIVES ON RESEARCH AND PUBLIC HEALTH INITIATIVES. EVOLUTION OF THE KIDNEY, AN ORGAN RICH IN MITOCHONDRIA, HAS BEEN DRIVEN BY NATURAL SELECTION FOR REPRODUCTIVE FITNESS CONSTRAINED BY ENERGY AVAILABILITY. OVER THE PAST 2 MILLION YEARS, RAPID GROWTH OF AN ENERGY-DEMANDING BRAIN IN HOMO SAPIENS ENABLED HOMINID ADAPTATION TO ENVIRONMENTAL EXTREMES THROUGH SELECTION FOR MUTATIONS IN MITOCHONDRIAL AND NUCLEAR DNA EPIGENETICALLY REGULATED BY ALLOCATION OF ENERGY TO DEVELOPING ORGANS. MATERNAL UNDERNUTRITION OR HYPOXIA RESULTS IN INTRAUTERINE GROWTH RESTRICTION OR PRETERM BIRTH, RESULTING IN LOW BIRTH WEIGHT AND LOW NEPHRON NUMBER. REGULATED THROUGH PLACENTAL TRANSFER, ENVIRONMENTAL OXYGEN AND NUTRIENTS SIGNAL NEPHRON PROGENITOR CELLS TO REPROGRAM METABOLISM FROM GLYCOLYSIS TO OXIDATIVE PHOSPHORYLATION. THESE PROCESSES ARE MODULATED BY COUNTERBALANCING ANABOLIC AND CATABOLIC METABOLIC PATHWAYS THAT EVOLVED FROM PROKARYOTE HOMOLOGS AND BY HYPOXIA-DRIVEN AND AUTOPHAGY PATHWAYS THAT EVOLVED IN EUKARYOTES. REGULATION OF NEPHRON DIFFERENTIATION BY HISTONE MODIFICATIONS AND DNA METHYLTRANSFERASES PROVIDE EPIGENETIC CONTROL OF NEPHRON NUMBER IN RESPONSE TO ENERGY AVAILABLE TO THE FETUS. DEVELOPMENTAL PLASTICITY OF NEPHROGENESIS REPRESENTS AN EVOLVED LIFE HISTORY STRATEGY THAT PRIORITIZES ENERGY TO EARLY BRAIN GROWTH WITH ADEQUATE KIDNEY FUNCTION THROUGH REPRODUCTIVE YEARS, THE TRADE-OFF BEING INCREASING PREVALENCE OF CKD DELAYED UNTIL LATER ADULTHOOD. THE RESEARCH IMPLICATIONS OF THIS EVOLUTIONARY ANALYSIS ARE TO IDENTIFY REGULATORY PATHWAYS OF ENERGY ALLOCATION DIRECTING NEPHROGENESIS WHILE ACCOUNTING FOR THE DIFFERENT LIFE HISTORY STRATEGIES OF ANIMAL MODELS SUCH AS THE MOUSE. THE CLINICAL IMPLICATIONS ARE TO OPTIMIZE NUTRITION AND MINIMIZE HYPOXIC/TOXIC STRESSORS IN CHILDBEARING WOMEN AND CHILDREN IN EARLY POSTNATAL DEVELOPMENT. 2020 7 1895 42 ENDOTHELIAL DYSFUNCTION IN INDIVIDUALS BORN AFTER FETAL GROWTH RESTRICTION: CARDIOVASCULAR AND RENAL CONSEQUENCES AND PREVENTIVE APPROACHES. INDIVIDUALS BORN AFTER INTRAUTERINE GROWTH RESTRICTION (IUGR) HAVE AN INCREASED RISK OF PERINATAL MORBIDITY/MORTALITY, AND THOSE WHO SURVIVE FACE LONG-TERM CONSEQUENCES SUCH AS CARDIOVASCULAR-RELATED DISEASES, INCLUDING SYSTEMIC HYPERTENSION, ATHEROSCLEROSIS, CORONARY HEART DISEASE AND CHRONIC KIDNEY DISEASE. IN ADDITION TO THE DEMONSTRATED LONG-TERM EFFECTS OF DECREASED NEPHRON ENDOWMENT AND HYPERACTIVITY OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS, INDIVIDUALS BORN AFTER IUGR ALSO EXHIBIT EARLY ALTERATIONS IN VASCULAR STRUCTURE AND FUNCTION, WHICH HAVE BEEN IDENTIFIED AS KEY FACTORS OF THE DEVELOPMENT OF CARDIOVASCULAR-RELATED DISEASES. THE ENDOTHELIUM PLAYS A MAJOR ROLE IN MAINTAINING VASCULAR FUNCTION AND HOMEOSTASIS. THEREFORE, IT IS NOT SURPRISING THAT IMPAIRED ENDOTHELIAL FUNCTION CAN LEAD TO THE LONG-TERM DEVELOPMENT OF VASCULAR-RELATED DISEASES. ENDOTHELIAL DYSFUNCTION, PARTICULARLY IMPAIRED ENDOTHELIUM-DEPENDENT VASODILATION AND VASCULAR REMODELING, INVOLVES DECREASED NITRIC OXIDE (NO) BIOAVAILABILITY, IMPAIRED ENDOTHELIAL NO SYNTHASE FUNCTIONALITY, INCREASED OXIDATIVE STRESS, ENDOTHELIAL PROGENITOR CELLS DYSFUNCTION AND ACCELERATED VASCULAR SENESCENCE. PREVENTIVE APPROACHES SUCH AS BREASTFEEDING, SUPPLEMENTATION WITH FOLATE, VITAMINS, ANTIOXIDANTS, L-CITRULLINE, L-ARGININE AND TREATMENT WITH NO MODULATORS REPRESENT PROMISING STRATEGIES FOR IMPROVING ENDOTHELIAL FUNCTION, MITIGATING LONG-TERM OUTCOMES AND POSSIBLY PREVENTING IUGR OF VASCULAR ORIGIN. MOREOVER, THE IDENTIFICATION OF EARLY BIOMARKERS OF ENDOTHELIAL DYSFUNCTION, ESPECIALLY EPIGENETIC BIOMARKERS, COULD ALLOW EARLY SCREENING AND FOLLOW-UP OF INDIVIDUALS AT RISK OF DEVELOPING CARDIOVASCULAR AND RENAL DISEASES, THUS CONTRIBUTING TO THE DEVELOPMENT OF PREVENTIVE AND THERAPEUTIC STRATEGIES TO AVERT THE LONG-TERM EFFECTS OF ENDOTHELIAL DYSFUNCTION IN INFANTS BORN AFTER IUGR. 2017 8 4197 40 METABOLIC PROFILES IN OVINE CAROTID ARTERIES WITH DEVELOPMENTAL MATURATION AND LONG-TERM HYPOXIA. BACKGROUND: LONG-TERM HYPOXIA (LTH) IS AN IMPORTANT STRESSOR RELATED TO HEALTH AND DISEASE DURING DEVELOPMENT. AT DIFFERENT TIME POINTS FROM FETUS TO ADULT, WE ARE EXPOSED TO HYPOXIC STRESS BECAUSE OF PLACENTAL INSUFFICIENCY, HIGH-ALTITUDE RESIDENCE, SMOKING, CHRONIC ANEMIA, PULMONARY, AND HEART DISORDERS, AS WELL AS CANCERS. INTRAUTERINE HYPOXIA CAN LEAD TO FETAL GROWTH RESTRICTION AND LONG-TERM SEQUELAE SUCH AS COGNITIVE IMPAIRMENTS, HYPERTENSION, CARDIOVASCULAR DISORDERS, DIABETES, AND SCHIZOPHRENIA. SIMILARLY, PROLONGED HYPOXIC EXPOSURE DURING ADULT LIFE CAN LEAD TO ACUTE MOUNTAIN SICKNESS, CHRONIC FATIGUE, CHRONIC HEADACHE, COGNITIVE IMPAIRMENT, ACUTE CEREBRAL AND/OR PULMONARY EDEMA, AND DEATH. AIM: LTH ALSO CAN LEAD TO ALTERATION IN METABOLITES SUCH AS FUMARATE, 2-OXOGLUTARATE, MALATE, AND LACTATE, WHICH ARE LINKED TO EPIGENETIC REGULATION OF GENE EXPRESSION. IMPORTANTLY, DURING THE INTRAUTERINE LIFE, A FETUS IS UNDER A RELATIVE HYPOXIC ENVIRONMENT, AS COMPARED TO NEWBORN OR ADULT. THUS, THE CHANGES IN GENE EXPRESSION WITH DEVELOPMENT FROM FETUS TO NEWBORN TO ADULT MAY BE AS A CONSEQUENCE OF UNDERLYING CHANGES IN THE METABOLIC PROFILE BECAUSE OF THE HYPOXIC ENVIRONMENT ALONG WITH DEVELOPMENTAL MATURATION. TO EXAMINE THIS POSSIBILITY, WE EXAMINED THE METABOLIC PROFILE IN CAROTID ARTERIES FROM NEAR-TERM FETUS, NEWBORN, AND ADULT SHEEP IN BOTH NORMOXIC AND LONG-TERM HYPOXIC ACCLIMATIZED GROUPS. RESULTS: OUR RESULTS DEMONSTRATE THAT LTH DIFFERENTIALLY REGULATED GLUCOSE METABOLISM, MITOCHONDRIAL METABOLISM, NICOTINAMIDE COFACTOR METABOLISM, OXIDATIVE STRESS AND ANTIOXIDANTS, MEMBRANE LIPID HYDROLYSIS, AND FREE FATTY ACID METABOLISM, EACH OF WHICH MAY PLAY A ROLE IN GENETIC-EPIGENETIC REGULATION. 2015 9 3428 30 HUMANS AT HIGH ALTITUDE: HYPOXIA AND FETAL GROWTH. HIGH-ALTITUDE STUDIES OFFER INSIGHT INTO THE EVOLUTIONARY PROCESSES AND PHYSIOLOGICAL MECHANISMS AFFECTING THE EARLY PHASES OF THE HUMAN LIFESPAN. CHRONIC HYPOXIA SLOWS FETAL GROWTH AND REDUCES THE PREGNANCY-ASSOCIATED RISE IN UTERINE ARTERY (UA) BLOOD FLOW. MULTIGENERATIONAL VS. SHORTER-TERM HIGH-ALTITUDE RESIDENTS ARE PROTECTED FROM THE ALTITUDE-ASSOCIATED REDUCTIONS IN UA FLOW AND FETAL GROWTH. PRESENTLY UNKNOWN IS WHETHER THIS FETAL-GROWTH PROTECTION IS DUE TO THE GREATER DELIVERY OR METABOLISM OF OXYGEN, GLUCOSE OR OTHER SUBSTRATES OR TO OTHER CONSIDERATIONS SUCH AS MECHANICAL FACTORS PROTECTING FRAGILE FETAL VILLI, THE CREATION OF A RESERVE PROTECTING AGAINST ISCHEMIA/REPERFUSION INJURY, OR IMPROVED PLACENTAL O(2) TRANSFER AS THE RESULT OF NARROWING THE A-V O(2) DIFFERENCE AND RAISING UTERINE P(V)O(2). PLACENTAL GROWTH AND DEVELOPMENT APPEAR TO BE NORMAL OR MODIFIED AT HIGH ALTITUDE IN WAYS LIKELY TO BENEFIT DIFFUSION. MUCH REMAINS TO BE LEARNED CONCERNING THE EFFECTS OF CHRONIC HYPOXIA ON EMBRYONIC DEVELOPMENT. FURTHER RESEARCH IS REQUIRED FOR IDENTIFYING THE FETOPLACENTAL AND MATERNAL MECHANISMS RESPONSIBLE FOR TRANSFORMING THE MATERNAL VASCULATURE AND REGULATING UA BLOOD FLOW AND FETAL GROWTH. GENOMIC AS WELL AS EPIGENETIC STUDIES ARE OPENING NEW AVENUES OF INVESTIGATION THAT CAN YIELD INSIGHTS INTO THE BASIC PATHWAYS AND EVOLUTIONARY PROCESSES INVOLVED. 2011 10 6066 48 THE DEVELOPMENTAL ORIGINS OF HEALTH AND CHRONIC KIDNEY DISEASE: CURRENT STATUS AND PRACTICES IN JAPAN. THE CONCEPT OF THE DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE (DOHAD) VIEWS UNFAVORABLE PERINATAL CIRCUMSTANCES AS CONTRIBUTING TO THE DEVELOPMENT OF DISEASES IN LATER LIFE. IT IS WELL KNOWN THAT SUCH UNFAVORABLE CIRCUMSTANCES PLAY AN IMPORTANT ROLE AS A RISK FACTOR FOR CHRONIC KIDNEY DISEASE (CKD) IN INFANTS BORN WITH PREMATURITY. LOW BIRTHWEIGHT (LBW) IS BELIEVED TO BE A POTENTIAL CONTRIBUTOR TO CKD IN ADULTHOOD. PRETERM AND/OR LBW INFANTS ARE BORN WITH INCOMPLETE NEPHROGENESIS. AS A RESULT, THE NUMBER OF NEPHRONS IS LOW. THE POOR INTRAUTERINE ENVIRONMENT ALSO CAUSES EPIGENETIC CHANGES THAT ADVERSELY AFFECT POSTNATAL RENAL FUNCTION. AFTER BIRTH, HYPERFILTRATION OF INDIVIDUAL NEPHRONS DUE TO LOW NEPHRON NUMBERS CAUSES PROTEINURIA AND SECONDARY GLOMERULOSCLEROSIS. FURTHERMORE, THE RISK OF CKD INCREASES AS RENAL DAMAGE TAKES A SECOND HIT FROM EXPOSURE TO NEPHROTOXIC SUBSTANCES AND ACQUIRED INSULTS SUCH AS ACUTE KIDNEY INJURY AFTER BIRTH AMONG INFANTS IN NEONATAL INTENSIVE CARE. MEANWHILE, UNFORTUNATELY, RECENT STUDIES HAVE SHOWN THAT THE NUMBER OF NEPHRONS IN HEALTHY JAPANESE INDIVIDUALS IS APPROXIMATELY TWO-THIRDS LOWER THAN THAT IN PREVIOUS REPORTS. THIS MEANS THAT JAPANESE PREMATURE INFANTS ARE CLEARLY AT A HIGH RISK OF DEVELOPING CKD IN LATER LIFE. RECENTLY, SEVERAL DOHAD-RELATED CKD STUDIES FROM JAPANESE RESEARCHERS HAVE BEEN REPORTED. HERE, WE SUMMARIZE THE RELEVANCE OF CKD IN CONJUNCTION WITH DOHAD AND REVIEW RECENT STUDIES THAT HAVE EXAMINED THE IMPACT OF THE UPWARD LBW TREND IN JAPAN ON RENAL HEALTH. 2022 11 3466 33 HYPOXIA AS A KEY PLAYER IN THE AKI-TO-CKD TRANSITION. RECENT CLINICAL AND ANIMAL STUDIES HAVE SHOWN THAT ACUTE KIDNEY INJURY (AKI), EVEN IF FOLLOWED BY COMPLETE RECOVERY OF RENAL FUNCTION, CAN EVENTUALLY RESULT IN CHRONIC KIDNEY DISEASE (CKD). RENAL HYPOXIA IS EMERGING AS A KEY PLAYER IN THE PATHOPHYSIOLOGY OF THE AKI-TO-CKD TRANSITION. CAPILLARY RAREFACTION AFTER AKI EPISODES INDUCES RENAL HYPOXIA, WHICH CAN IN TURN PROFOUNDLY AFFECT TUBULAR EPITHELIAL CELLS, (MYO)FIBROBLASTS, AND INFLAMMATORY CELLS, CULMINATING IN TUBULOINTERSTITIAL FIBROSIS, I.E., PROGRESSION TO CKD. DAMAGED TUBULAR EPITHELIAL CELLS THAT FAIL TO REDIFFERENTIATE MIGHT SUPPLY A DECREASED AMOUNT OF VASCULAR ENDOTHELIAL GROWTH FACTOR AND CONTRIBUTE TO CAPILLARY RAREFACTION, THUS AGGRAVATING HYPOXIA AND FORMING A VICIOUS CYCLE. MOUNTING EVIDENCE ALSO SHOWS THAT EPIGENETIC CHANGES ARE CLOSELY RELATED TO RENAL HYPOXIA IN THE PATHOPHYSIOLOGY OF CKD PROGRESSION. ANIMAL EXPERIMENTS SUGGEST THAT TARGETING HYPOXIA IS A PROMISING STRATEGY TO BLOCK THE TRANSITION FROM AKI TO CKD. HOWEVER, THE PRECISE MECHANISMS BY WHICH HYPOXIA INDUCES THE AKI-TO-CKD TRANSITION AND BY WHICH HYPOXIA-INDUCIBLE FACTOR ACTIVATION CAN EXERT A PROTECTIVE EFFECT IN THIS CONTEXT SHOULD BE CLARIFIED IN FURTHER STUDIES. 2014 12 5190 35 PRENATAL CAUSES OF KIDNEY DISEASE. IT HAS RECENTLY BEEN INCREASINGLY RECOGNISED THAT DISTURBED INTRA-UTERINE DEVELOPMENT MAY IMPACT ON RENAL AND CARDIOVASCULAR RISK IN ADULT LIFE, E.G. ALBUMINURIA AND CHRONIC KIDNEY DISEASE, HYPERTENSION, TYPE 2 DIABETES OR CARDIOVASCULAR EVENTS. ACCORDING TO BARKER'S HYPOTHESIS, WHEN RESOURCES IN UTERO ARE RESTRICTED, THEIR ALLOCATION TO THE DEVELOPMENT OF THE KIDNEY AND PANCREATIC ISLETS IS RESTRICTED TO GUARANTEE APPROPRIATE DEVELOPMENT OF THE BRAIN AND HEART. THE UNDERLYING EPIGENETIC MECHANISMS INVOLVE MODIFICATION OF GENE EXPRESSION BY ALTERED DNA METHYLATION AND HISTONE ACETYLATION AS WELL AS BY ALLOCATION OF STEM CELLS. THE RESULT OF THIS TRADE-OFF BETWEEN THE BRAIN AND KIDNEY DURING ORGANOGENESIS IS A DIMINISHED NUMBER OF NEPHRONS ('NEPHRON UNDERDOSING') WHICH PREDISPOSES TO ALBUMINURIA AND RISK OF CHRONIC KIDNEY DISEASE, AS WELL AS HYPERTENSION. IN PARALLEL, CHANGED APPETITE CENTRES, INSULIN RESISTANCE AND BETA-CELL DEVELOPMENT PREDISPOSE TO OBESITY, METABOLIC SYNDROME AND TYPE 2 DIABETES AND THE RESULTING RENAL SEQUELAE. NUMEROUS FACTORS MAY TRIGGER INTRA-UTERINE RESTRICTION OF FETAL GROWTH, SUCH AS UTERINE UNDERPERFUSION, MATERNAL MALNUTRITION, HYPERGLYCAEMIA AND HYPERINSULINAEMIA OF THE MOTHER, SMOKING OR MEDICATIONS. 2009 13 4797 33 NUTRITIONAL INTERVENTIONS TO IMPROVE BRAIN OUTCOMES IN PRETERM INFANTS. THE LAST 20 YEARS HAVE SEEN DRAMATIC IMPROVEMENTS IN SURVIVAL FOR PRETERM INFANTS IN BOTH HIGH- AND LOW-INCOME SETTINGS. SURVIVAL RATES OF OVER 50% IN INFANTS BORN 16 WEEKS EARLY (24 WEEKS' GESTATION) ARE NOW COMMONPLACE IN WELL-RESOURCED NEONATAL INTENSIVE CARE UNITS. HOWEVER, ENSURING ADEQUATE NUTRIENT INTAKES ESPECIALLY IN THE FIRST FEW DAYS AND WEEKS IS CHALLENGING, AND MANY INFANTS SHOW POOR GROWTH AND NUTRITIONAL STATUS. GOOD NUTRITIONAL MANAGEMENT SHOULD BE SEEN AS THE CORNERSTONE OF GOOD NEONATAL CARE AND IS KEY TO IMPROVING A RANGE OF IMPORTANT OUTCOMES INCLUDING REDUCED RATES OF RETINOPATHY OF PREMATURITY, CHRONIC LUNG DISEASE, NECROTIZING ENTEROCOLITIS (NEC), AND SEPSIS. EQUALLY IMPORTANTLY, IS THAT GOOD NUTRITIONAL STATUS IS ESSENTIAL TO OPTIMIZE BRAIN GROWTH AND DIFFERENTIATION. THERE ARE MULTIPLE POTENTIAL MECHANISMS THAT LINK NUTRITION TO BRAIN OUTCOMES IN PRETERM INFANTS INCLUDING NEEDS FOR TISSUE ACCRETION, ENERGY SUPPLY, SIGNALING ROLES, FUNCTIONAL COMPONENTS IN HUMAN MILK, EPIGENETIC REGULATION, PREVENTION OF NEC AND DISEASE, AND IMPACTS ON THE GUT BRAIN AXES. THIS ARTICLE WILL REVIEW DATA IN SUPPORT OF DIFFERENT MECHANISTIC LINKS FOR THE IMPACT OF NUTRITION ON BRAIN OUTCOMES IN PRETERM INFANTS. 2021 14 5179 43 PREGNANCY: AN UNDERUTILIZED WINDOW OF OPPORTUNITY TO IMPROVE LONG-TERM MATERNAL AND INFANT HEALTH-AN APPEAL FOR CONTINUOUS FAMILY CARE AND INTERDISCIPLINARY COMMUNICATION. PHYSIOLOGIC ADAPTATIONS DURING PREGNANCY UNMASK A WOMAN'S PREDISPOSITION TO DISEASES. COMPLICATIONS ARE INCREASINGLY PREDICTED BY FIRST-TRIMESTER ALGORITHMS, AMPLIFY A PRE-EXISTING MATERNAL PHENOTYPE AND ACCELERATE RISKS FOR CHRONIC DISEASES IN THE OFFSPRING UP TO ADULTHOOD (BARKER HYPOTHESIS). RECENT EVIDENCE SUGGESTS THAT VICE VERSA, PREGNANCY DISEASES ALSO INDICATE MATERNAL AND EVEN GRANDPARENT'S RISKS FOR CHRONIC DISEASES (REVERSE BARKER HYPOTHESIS). PUB-MED AND EMBASE WERE REVIEWED FOR MESH TERMS "FETAL PROGRAMMING" AND "PREGNANCY COMPLICATIONS COMBINED WITH MATERNAL DISEASE" UNTIL JANUARY 2017. STUDIES LINKING PREGNANCY COMPLICATIONS TO FUTURE CARDIOVASCULAR, METABOLIC, AND THROMBOTIC RISKS FOR MOTHER AND OFFSPRING WERE REVIEWED. WOMEN WITH A HISTORY OF MISCARRIAGE, FETAL GROWTH RESTRICTION, PREECLAMPSIA, PRETERM DELIVERY, OBESITY, EXCESSIVE GESTATIONAL WEIGHT GAIN, GESTATIONAL DIABETES, SUBFERTILITY, AND THROMBOPHILIA MORE FREQUENTLY DEMONSTRATE WITH ECHOCARDIOGRAPHIC ABNORMALITIES, HIGHER FASTING INSULIN, DEVIATING LIPIDS OR CLOTTING FACTORS AND SHOW DEFECTIVE ENDOTHELIAL FUNCTION. THROMBOPHILIA HINTS TO THROMBOTIC RISKS IN LATER LIFE. PREGNANCY ABNORMALITIES CORRELATE WITH FUTURE CARDIOVASCULAR AND METABOLIC COMPLICATIONS AND EARLIER MORTALITY. CONVERSELY, WOMEN WITH A NORMAL PREGNANCY HAVE LOWER RATES OF SUBSEQUENT DISEASES THAN THE GENERAL FEMALE POPULATION CREATING THE TERM: "PREGNANCY AS A WINDOW FOR FUTURE HEALTH." ALTHOUGH THE PLACENTA WORKS AS A GATEKEEPER, MANY PREGNANCY COMPLICATIONS MAY LEAD TO SICKNESS AND EARLIER DEATH IN LATER LIFE WHEN THE CHILD BECOMES AN ADULT. THE EPIGENETIC MECHANISMS AND THE MISMATCH BETWEEN PRE- AND POSTNATAL LIFE HAVE CREATED THE TERM "FETAL ORIGIN OF ADULT DISEASE." UP TO NOW, THE IMPACT OF CARDIOVASCULAR, METABOLIC, OR THROMBOTIC RISK PROFILES HAS BEEN INVESTIGATED SEPARATELY FOR MOTHER AND CHILD. IN THIS MANUSCRIPT, WE STRIVE TO ILLUSTRATE THE CONSEQUENCES FOR BOTH, FETUS AND MOTHER WITHIN A COHESIVE PERSPECTIVE AND THUS TRY TO DEMONSTRATE THE COMPLEX INTERRELATIONSHIP OF GENETICS AND EPIGENETICS FOR LONG-TERM HEALTH OF SOCIETIES AND FUTURE GENERATIONS. MATERNAL-FETAL MEDICINE SPECIALISTS SHOULD HAVE A KEY ROLE IN THE PREVENTION OF NON-COMMUNICABLE DISEASES BY IMPLEMENTING A FRAMEWORK FOR PATIENT CONSULTATION AND INTERDISCIPLINARY NETWORKS. HEALTH-CARE PROVIDERS AND POLICY MAKERS SHOULD INCREASINGLY INVEST IN A STRATIFIED PRIMARY PREVENTION AND FOLLOW-UP TO REDUCE THE INCREASING NUMBER OF MANIFEST CARDIOVASCULAR AND METABOLIC DISEASES AND TO PREVENT WASTE OF HEALTH-CARE RESOURCES. 2017 15 3595 31 IMPLICATIONS OF MATERNAL CONDITIONS AND PREGNANCY COURSE ON OFFSPRING'S MEDICAL PROBLEMS IN ADULT LIFE. IN THE LAST DECADE, NUMEROUS EPIDEMIOLOGICAL, CLINICAL AND EXPERIMENTAL DATA SHOW THAT PERICONCEPTIONAL, PERINATAL AND POSTNATAL ENVIRONMENT DETERMINES THE OFFSPRING'S RISK FOR LATER-LIFE CHRONIC DISEASE. FOR THIS PHENOMENON, THE TERM "FETAL" OR "PERINATAL PROGRAMMING" IS USED. IN EXPOSED OFFSPRING ALREADY IN CHILDHOOD AND EARLY ADULTHOOD, METABOLIC AND CARDIOVASCULAR CHANGES CAN BE OBSERVED, LEADING TO OBESITY, DIABETES AND HYPERTENSION. NOWADAYS, THE MODE OF CONCEPTION (E.G., IN VITRO FERTILIZATION), MATERNAL METABOLIC CONDITIONS (E.G., UNDERNUTRITION, OVERNUTRITION, DIABETES) AND COMPLICATIONS DURING PREGNANCY (E.G., PREECLAMPSIA, INTRAUTERINE GROWTH RESTRICTION) ARE SUSPECTED TO BE NEGATIVE PREDICTORS FOR OFFSPRING'S LONG-TERM HEALTH. MECHANISMS RESPONSIBLE FOR THESE EFFECTS STILL REMAIN MAINLY UNCLEAR, BUT INCLUDE EPIGENETIC, TRANSCRIPTIONAL, ENDOPLASMIC RETICULUM STRESS, AND REACTIVE OXYGEN SPECIES. THIS REVIEW PRESENTS A PIECE OF THE PUZZLE WITH REGARDS TO PERICONCEPTIONAL AND EARLY PERINATAL CONDITIONS DETERMINING LATER-LIFE RISK FOR CHRONIC ADULT DISEASE. 2016 16 4381 40 MITOCHONDRIAL DYSFUNCTION AND THE AKI-TO-CKD TRANSITION. ACUTE KIDNEY INJURY (AKI) HAS BEEN WIDELY RECOGNIZED AS AN IMPORTANT RISK FACTOR FOR THE OCCURRENCE AND DEVELOPMENT OF CHRONIC KIDNEY DISEASE (CKD). EVEN MILDER AKI HAS ADVERSE CONSEQUENCES AND COULD PROGRESS TO RENAL FIBROSIS, WHICH IS THE ULTIMATE COMMON PATHWAY FOR VARIOUS TERMINAL KIDNEY DISEASES. THUS, IT IS URGENT TO DEVELOP A STRATEGY TO HINDER THE TRANSITION FROM AKI TO CKD. SOME MECHANISMS OF THE AKI-TO-CKD TRANSITION HAVE BEEN REVEALED, SUCH AS NEPHRON LOSS, CELL CYCLE ARREST, PERSISTENT INFLAMMATION, ENDOTHELIAL INJURY WITH VASCULAR RAREFACTION, AND EPIGENETIC CHANGES. PREVIOUS STUDIES HAVE ELUCIDATED THE PIVOTAL ROLE OF MITOCHONDRIA IN ACUTE INJURIES AND DEMONSTRATED THAT THE FITNESS OF THIS ORGANELLE IS A MAJOR DETERMINANT IN BOTH THE PATHOGENESIS AND RECOVERY OF ORGAN FUNCTION. RECENT RESEARCH HAS SUGGESTED THAT DAMAGE TO MITOCHONDRIAL FUNCTION IN EARLY AKI IS A CRUCIAL FACTOR LEADING TO TUBULAR INJURY AND PERSISTENT RENAL INSUFFICIENCY. DYSREGULATION OF MITOCHONDRIAL HOMEOSTASIS, ALTERATIONS IN BIOENERGETICS, AND ORGANELLE STRESS CROSS TALK CONTRIBUTE TO THE AKI-TO-CKD TRANSITION. IN THIS REVIEW, WE FOCUS ON THE PATHOPHYSIOLOGY OF MITOCHONDRIA IN RENAL RECOVERY AFTER AKI AND PROGRESSION TO CKD, CONFIRMING THAT TARGETING MITOCHONDRIA REPRESENTS A POTENTIALLY EFFECTIVE THERAPEUTIC STRATEGY FOR THE PROGRESSION OF AKI TO CKD. 2020 17 1373 27 DEVELOPMENTAL ORIGINS OF NONALCOHOLIC FATTY LIVER DISEASE. OBESE PREGNANT WOMEN MAY TRANSMIT THEIR METABOLIC PHENOTYPE TO OFFSPRING, LEADING TO A CYCLE OF OBESITY AND DIABETES OVER GENERATIONS. EARLY CHILDHOOD OBESITY PREDICTS NONALCOHOLIC FATTY LIVER DISEASE (NAFLD), THE MOST COMMON CHRONIC HUMAN LIVER DISEASE. THE FETUS MAY BE VULNERABLE TO STEATOSIS BECAUSE IMMATURE FETAL ADIPOSE DEPOTS ARE NOT AVAILABLE TO BUFFER THE EXCESS TRANSPLACENTAL LIPID DELIVERY IN MATERNAL OBESITY. IN ANIMAL MODELS, IN UTERO HIGH-FAT DIET EXPOSURE RESULTS IN AN INCREASE IN THE ACCUMULATION OF LIVER TRIGLYCERIDES IN OFFSPRING AND INCREASED HEPATIC OXIDATIVE STRESS AND APOPTOSIS, PERHAPS PRIMING THE LIVER FOR LATER DEVELOPMENT OF NAFLD. INNATE IMMUNE DYSFUNCTION AND NECROINFLAMMATORY CHANGES HAVE BEEN OBSERVED IN POSTNATAL OFFSPRING LIVER OF ANIMALS BORN TO HIGH-FAT-FED DAMS. POSTWEANING, LIVERS OF OFFSPRING EXPOSED TO MATERNAL HIGH-FAT FEEDING IN UTERO SHARE PATHOPHYSIOLOGIC FEATURES WITH HUMAN NAFLD, INCLUDING INCREASED DE NOVO LIPOGENESIS AND DECREASED FREE FATTY ACID OXIDATION. HUMAN STUDIES USING MAGNETIC RESONANCE IMAGING HAVE SHOWN THAT MATERNAL BMI PREDICTS INFANT INTRAHEPATOCELLULAR LIPID STORAGE, AS SEEN IN ANIMAL MODELS. THE GENERATIONAL TRANSFER OF NAFLD MAY OCCUR VIA EPIGENETIC CHANGES IN OFFSPRING LIVER. TRANSMISSION OF MICROBIOTA FROM MOTHER TO INFANT MAY IMPACT ENERGY RETENTION AND IMMUNE FUNCTION THAT CONTRIBUTE TO A PREDISPOSITION TO NAFLD. 2014 18 2805 43 FETAL MALNUTRITION AND LONG-TERM OUTCOMES. EPIDEMIOLOGICAL STUDIES HAVE SHOWN THAT LOWER BIRTHWEIGHT IS ASSOCIATED WITH A WIDE RANGE OF ADVERSE OUTCOMES IN LATER LIFE, INCLUDING POORER 'HUMAN CAPITAL' (SHORTER STATURE, LOWER COGNITIVE PERFORMANCE), INCREASED RISK FACTORS FOR LATER DISEASE (HIGHER BLOOD PRESSURE AND REDUCED GLUCOSE TOLERANCE, AND LUNG, KIDNEY AND IMMUNE FUNCTION), CLINICAL DISEASE (DIABETES, CORONARY HEART DISEASE, CHRONIC LUNG AND KIDNEY DISEASE), AND INCREASED ALL-CAUSE AND CARDIOVASCULAR MORTALITY. HIGHER BIRTHWEIGHT IS ASSOCIATED WITH AN INCREASED RISK OF CANCER AND (IF CAUSED BY GESTATIONAL DIABETES) OBESITY AND DIABETES. THE 'DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE' HYPOTHESIS PROPOSES THAT FETAL NUTRITION HAS PERMANENT EFFECTS ON GROWTH, STRUCTURE AND METABOLISM ('PROGRAMMING'). THIS IS SUPPORTED BY STUDIES IN ANIMALS SHOWING THAT MATERNAL UNDER- AND OVERNUTRITION DURING PREGNANCY CAN PRODUCE SIMILAR ABNORMALITIES IN THE ADULT OFFSPRING. COMMON CHRONIC DISEASES COULD POTENTIALLY BE PREVENTED BY ACHIEVING OPTIMAL FETAL NUTRITION, AND THIS COULD HAVE ADDITIONAL BENEFITS FOR SURVIVAL AND HUMAN CAPITAL. RECENT FOLLOW-UP OF CHILDREN BORN AFTER RANDOMIZED NUTRITIONAL INTERVENTIONS IN PREGNANCY PROVIDES WEAK EVIDENCE OF BENEFICIAL EFFECTS ON GROWTH, VASCULAR FUNCTION, LIPID CONCENTRATIONS, GLUCOSE TOLERANCE AND INSULIN RESISTANCE. ANIMAL STUDIES INDICATE THAT EPIGENETIC PHENOMENA MAY BE AN IMPORTANT MECHANISM UNDERLYING PROGRAMMING, AND THAT NUTRITIONAL INTERVENTIONS MAY NEED TO START PRECONCEPTIONALLY. 2013 19 1366 37 DEVELOPMENTAL ORIGINS OF CHRONIC KIDNEY DISEASE: SHOULD WE FOCUS ON EARLY LIFE? CHRONIC KIDNEY DISEASE (CKD) IS BECOMING A GLOBAL BURDEN, DESPITE RECENT ADVANCES IN MANAGEMENT. CKD CAN BEGIN IN EARLY LIFE BY SO-CALLED "DEVELOPMENTAL PROGRAMMING" OR "DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE" (DOHAD). EARLY-LIFE INSULTS CAUSE STRUCTURAL AND FUNCTIONAL CHANGES IN THE DEVELOPING KIDNEY, WHICH IS CALLED RENAL PROGRAMMING. EPIDEMIOLOGICAL AND EXPERIMENTAL EVIDENCE SUPPORTS THE PROPOSITION THAT EARLY-LIFE ADVERSE EVENTS LEAD TO RENAL PROGRAMMING AND MAKE SUBJECTS VULNERABLE TO DEVELOPING CKD AND ITS COMORBIDITIES IN LATER LIFE. IN ADDITION TO LOW NEPHRON ENDOWMENT, SEVERAL MECHANISMS HAVE BEEN PROPOSED FOR RENAL PROGRAMMING. THE DOHAD CONCEPT OPENS A NEW WINDOW TO OFFSET THE PROGRAMMING PROCESS IN EARLY LIFE TO PREVENT THE DEVELOPMENT OF ADULT KIDNEY DISEASE, NAMELY REPROGRAMMING. HERE, WE REVIEW THE KEY THEMES ON THE DEVELOPMENTAL ORIGINS OF CKD. WE HAVE PARTICULARLY FOCUSED ON THE FOLLOWING AREAS: EVIDENCE FROM HUMAN STUDIES SUPPORT FETAL PROGRAMMING OF KIDNEY DISEASE; INSIGHT FROM ANIMAL MODELS OF RENAL PROGRAMMING; HYPOTHETICAL MECHANISMS OF RENAL PROGRAMMING; ALTERATIONS OF RENAL TRANSCRIPTOME IN RESPONSE TO EARLY-LIFE INSULTS; AND THE APPLICATION OF REPROGRAMMING INTERVENTIONS TO PREVENT THE PROGRAMMING OF KIDNEY DISEASE. 2017 20 5255 23 PROGRESS IN UNDERSTANDING THE PATHOGENESIS OF BPD USING THE BABOON AND SHEEP MODELS. BRONCHOPULMONARY DYSPLASIA (BPD) IS AMONG THE MOST COMMON CHRONIC LUNG DISEASES IN INFANTS IN THE US. IMPROVED SURVIVAL OF PRETERM INFANTS WHO DEVELOPED BPD IS BECOMING INCREASINGLY IMPORTANT BECAUSE OF THE HIGH RISK FOR PERSISTENT PULMONARY MORBIDITIES SUCH AS POOR RESPIRATORY GAS EXCHANGE, PULMONARY HYPERTENSION, AND EXCESS AIRWAY EXPIRATORY RESISTANCE LATER IN LIFE. THIS REVIEW FOCUSES ON UNIQUE INSIGHTS PROVIDED BY THE TWO LARGE-ANIMAL, PHYSIOLOGICAL MODELS OF NEONATAL CHRONIC LUNG DISEASE: PRETERM BABOONS AND PRETERM LAMBS. THE MODELS' ARE VALUABLE BECAUSE THEY CONTRIBUTE TO BETTER UNDERSTANDING OF THE UNDERLYING MOLECULAR PATHOGENIC MECHANISMS. AN EPIGENETIC HYPOTHESIS IS PROPOSED AS A PATHOGENIC MECHANISM FOR BPD AND ITS PERSISTENT PULMONARY MORBIDITIES. 2013