The pathophysiology is not completely understood and alternative pathophysiological mechanisms have been implicated, including alterations in cell signalling, vascular adaptation, inflammatory responses and repair mechanisms [4] [6].
There is considerable literature on adaptation of inflammatory and pulmonary responses to ozone; the association of ozone with daily deaths in the summer is also well established.
Despite the ample literature on adaptation of inflammatory and pulmonary responses to ozone, and the link, in cohort studies, between lung function and mortality risk there has been little done to date to examine the question of adaptation in the acute mortality risk associated with ambient ozone.
Some genes in this category were decreased, which may indicate an anti-inflammatory process or an adaptation to prolonged inflammation.
The cells are considered to be 'athero-susceptible' a pre-pathological state of partial activation of pro-inflammatory and ER-stress adaptation to the local hemodynamic environment.
Taken together these data suggest that Mutyh somehow contributes to the cellular adaptation towards chronic inflammatory stimuli.
This temporal pattern of effect would be anticipated for O3, which produces acute inflammatory responses in the lung; adaptation of this inflammatory response with several days of repeated exposure has been demonstrated (Folinsbee et al. 1994; Frank et al. 2001).
The increased inflammatory cytokines then stimulate tissue adaptation, repair, resorption or injury [ 78- 81], based on future events and superimposed processes in these tissues [ 41, 42, 53, 82- 84].
Although the pimB-mutant phenotype could not be linked to reduced association with the MMR, the presence of high amounts of PIMs, lipomannan and Man-LAM results in a less inflammatory immune response and indicates adaptation of the mycobacteria to their host (Torrelles et al., 2009; Torrelles & Schlesinger, 2010;) (Fig. 7).
To obtain further insight into the different components associated with offspring outcomes, studies are needed with more detailed measurements of maternal nutritional status, body composition, metabolic and inflammatory measures, pregnancy-related hemodynamic adaptations and fetal growth.
