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DeFreitas MJ, Seeherunvong W, Katsoufis CP, RamachandraRao S, Duara S, Yasin S, Zilleruelo G, Rodriguez MM, Abitbol CL. Longitudinal patterns of urine biomarkers in infants across gestational ages. Pediatr Nephrol 2016; 31:1179-88. [PMID: 26862052 DOI: 10.1007/s00467-016-3327-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Urinary biomarkers may be indicators of acute kidney injury (AKI), although little is known of their developmental characteristics in healthy neonates across a full range of gestational age (GA). The purpose of this study was to examine patterns of urinary biomarkers across GA groups from birth to 3 months of age. METHODS Fifty-two infants ranging from 24 to 41 weeks' GA had urine assayed from birth through 3 months of age for 7 biomarkers including albumin (ALB), beta-2-microglobulin (B2M), cystatin-C (CysC), epidermal growth factor (EGF), neutrophil-gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and uromodulin (UMOD). RESULTS Of the seven urinary biomarkers, EGF and UMOD increased while others decreased with advancing GA. By 3 months of age, EGF and UMOD had increased in preterm infants to levels similar to those of term infants. UMOD/ml and EGF/ml appeared to be predominantly developmental biomarkers distinguishing estimated glomerular filtration rate (GFR) <30 ml/min/1.73 m(2) with receiver operator characteristic area under the curve (ROC-AUC) of 0.82; p = 0.002. When factored by urine creatinine CysC/cr + ALB/cr were the most significant functional markers with AUC = 0.79; p = 0.004; sensitivity 96 %; specificity 58 %. CONCLUSIONS Among healthy neonates, urinary biomarkers vary with GA. These data support the use of urinary biomarkers in the assessment of normal kidney development in the absence of injury.
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Affiliation(s)
- Marissa J DeFreitas
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA.
| | - Wacharee Seeherunvong
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
| | - Chryso P Katsoufis
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
| | - Satish RamachandraRao
- O'Brien Center for AKI Research, UC San Diego School of Medicine, San Diego, CA, USA
| | - Shahnaz Duara
- Division of Neonatology, University of Miami/Holtz Children's Hospital, Miami, FL, USA
| | - Salih Yasin
- Division of Perinatology and Obstetrics, University of Miami/Holtz Children's Hospital, Miami, FL, USA
| | - Gaston Zilleruelo
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
| | - Maria M Rodriguez
- Division of Pediatric Pathology, University of Miami/Holtz Children's Hospital, Miami, FL, USA
| | - Carolyn L Abitbol
- Division of Pediatric Nephrology, University of Miami/ Holtz Children's Hospital, 1611 NW 12th Avenue (Annex 504), Miami, FL, 33136, USA
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DeFreitas MJ, Katsoufis CP, Abitbol CL. Cardio-renal consequences of low birth weight and preterm birth. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Hoffman SB, Massaro AN, Soler-García ÁA, Perazzo S, Ray PE. A novel urinary biomarker profile to identify acute kidney injury (AKI) in critically ill neonates: a pilot study. Pediatr Nephrol 2013; 28:2179-88. [PMID: 23783654 PMCID: PMC4117312 DOI: 10.1007/s00467-013-2524-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/07/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The goal of this study was to assess the value of a urinary biomarker profile comprised of neutrophil gelatinase-associated lipocalin (NGAL), fibroblast growth factor-2 (FGF-2), and epidermal growth factor (EGF), to detect acute kidney injury (AKI) in critically ill neonates. METHODS We conducted a prospective cohort pilot study of at-risk neonates treated in a level IIIC neonatal intensive care unit (NICU) with therapeutic hypothermia (HT) (n = 25) or extracorporeal membrane oxygenation (ECMO) (n = 10). Urine was collected at baseline, 48 h of illness, and > 24 h post-recovery of their corresponding treatments. Control samples were collected from 27 healthy newborns. The data were expressed as urinary concentrations and values normalized for urinary creatinine. AKI was defined as the presence of oliguria >24 h and/or elevated serum creatinine (SCr), or the failure to improve the estimated creatinine clearance (eCCL) by >50% post-recovery. Non-parametric statistical tests and ROC analyses were used to interpret the data. RESULTS Fifteen at-risk newborns had AKI. In the first 48 h of illness, the urinary levels of NGAL and FGF-2 had high sensitivity but poor specificity to identify neonates with AKI. At recovery, low urinary EGF levels identified neonates with AKI with a sensitivity of 74% and specificity of 84%. Overall, in the early stages of a critical illness, the urinary levels of NGAL and FGF-2 were sensitive, but not specific, to identify neonates at risk of AKI. Low EGF levels post-recovery identified critically ill neonates with AKI. CONCLUSIONS These findings require validation in larger prospective studies.
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Affiliation(s)
- Suma Bhat Hoffman
- Neonatology, Children's National Medical Center, Washington, DC, United States
| | - An N. Massaro
- Neonatology, Children's National Medical Center, Washington, DC, United States,Department of Pediatrics, The George Washington University School of Medicine and Health, Sciences, Washington, DC, United States
| | | | - Sofia Perazzo
- Children’s Research Institute, Washington, DC, United States
| | - Patricio E. Ray
- Children’s Research Institute, Washington, DC, United States,Department of Pediatrics, The George Washington University School of Medicine and Health, Sciences, Washington, DC, United States
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Rowland KJ, Choi PM, Warner BW. The role of growth factors in intestinal regeneration and repair in necrotizing enterocolitis. Semin Pediatr Surg 2013; 22:101-11. [PMID: 23611614 PMCID: PMC3635039 DOI: 10.1053/j.sempedsurg.2013.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Necrotizing enterocolitis (NEC) is a devastating intestinal disease resulting in major neonatal morbidity and mortality. The pathology is poorly understood, and the means of preventing and treating NEC are limited. Several endogenous growth factors have been identified as having important roles in intestinal growth as well as aiding intestinal repair from injury or inflammation. In this review, we will discuss several growth factors as mediators of intestinal regeneration and repair as well as potential therapeutic agents for NEC.
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Affiliation(s)
| | | | - Brad W. Warner
- Correspondence: Brad W. Warner, M.D. St. Louis Children's Hospital One Children's Place; Suite 5S40 St. Louis MO 63110 (314) 454-6022 - Phone (314) 454-2442 – Fax
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Nair RR, Warner BB, Warner BW. Role of epidermal growth factor and other growth factors in the prevention of necrotizing enterocolitis. Semin Perinatol 2008; 32:107-13. [PMID: 18346534 DOI: 10.1053/j.semperi.2008.01.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Necrotizing enterocolitis (NEC) presents as the most common gastrointestinal emergency during the neonatal period and results in ulceration and necrosis of the distal small intestine and proximal colon. The etiology of NEC remains unknown. Based on the complexity of gut development, multiple growth factors and cytokines may be needed to synergistically support the developing gut. Epidermal growth factor (EGF) has been shown to play an important role in intestinal cell restitution, proliferation, and maturation. EGF is found in abundant quantities in many fluids, including the gastrointestinal tract, amniotic fluid, breast milk, and saliva. Preliminary clinical trials using EGF in neonates diagnosed with NEC have been shown to promote repair of intestinal epithelium. Additionally, other growth factors are also emerging as potential treatment modalities, including erythropoietin, granulocyte colony stimulating factor, and heparin-binding EGF. The role of EGF and other growth factors in the pathogenesis and prevention of NEC will be reviewed.
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Affiliation(s)
- Rajalakshmi R Nair
- Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA
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Warner BB, Ryan AL, Seeger K, Leonard AC, Erwin CR, Warner BW. Ontogeny of salivary epidermal growth factor and necrotizing enterocolitis. J Pediatr 2007; 150:358-63. [PMID: 17382110 DOI: 10.1016/j.jpeds.2006.11.059] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 10/05/2006] [Accepted: 11/21/2006] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the ontogeny of salivary epidermal growth factor (sEGF) in premature infants and to determine the relation of sEGF to the development of necrotizing enterocolitis (NEC). STUDY DESIGN Salivary EGF was prospectively measured in 327 infants with gestational ages from 23 weeks to term. Infants of < or = 32 weeks' gestation (n = 261) were followed with weekly sEGF measurements through 3 weeks of life. Multivariable regression analyses were used to determine variables significantly related to sEGF levels and to identify predictors of NEC. RESULTS Over the first 3 weeks of life, sEGF increased across gestational age and postnatal age categories. In multivariable models, gestational age was a significant predictor of sEGF levels (P < .009). In a cohort of 27 infants who had NEC, gestational age, race, and changes in sEGF levels between weeks of life 1 and 2 were predictive of the development of NEC. These infants had lower sEGF at week 1 and greater increases from week 1 to week 2 compared with infants without NEC. CONCLUSIONS There is a positive relation between sEGF levels and gestational age. Patterns of sEGF levels over the first 2 weeks of life were significantly related to development of NEC in very low birth weight infants.
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Affiliation(s)
- Barbara B Warner
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Warner BW, Warner BB. Role of epidermal growth factor in the pathogenesis of neonatal necrotizing enterocolitis. Semin Pediatr Surg 2005; 14:175-80. [PMID: 16084405 DOI: 10.1053/j.sempedsurg.2005.05.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Neonatal necrotizing enterocolitis (NEC) is an increasingly frequent condition encountered in premature infants for which the etiology is not well understood. Epidermal growth factor (EGF) is abundant in many fluids bathing the fetal and neonatal gastrointestinal tract, including amniotic fluid, saliva, and breast milk. EGF is acknowledged to be important for normal intestinal development as well as repair following injury to the gastrointestinal mucosa. There appears to be mounting evidence to support a possible link between deficient EGF production and the development of NEC. The relevant evidence for the role of EGF in intestinal development and mucosal repair, as well as its potential involvement in the genesis of NEC will be reviewed.
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Affiliation(s)
- Brad W Warner
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
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Shin CE, Falcone RA, Stuart L, Erwin CR, Warner BW. Diminished epidermal growth factor levels in infants with necrotizing enterocolitis. J Pediatr Surg 2000; 35:173-6; discussion 177. [PMID: 10693661 DOI: 10.1016/s0022-3468(00)90005-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/PURPOSE Because epidermal growth factor (EGF) is trophic to the intestinal mucosa, and neonatal necrotizing enterocolitis (NEC) is associated with a disrupted intestinal mucosal barrier, the authors sought to determine whether diminished levels of EGF were present in infants with NEC. METHODS Saliva, serum, and urine specimens were obtained from infants with NEC during a 3-year period (February 1995 to May 1998). Control patients without NEC were chosen based on similar postnatal age and birthweight. EGF levels were determined by enzyme-linked immunosorbent assay (ELISA). Differences between groups were compared using Mann-Whitney Rank sum test with P less than .05 considered significant. Results are presented as mean values +/-SEM. RESULTS Twenty-five infants with NEC were compared with 19 control patients. Birth weight (1,616+/-238 g control v. 1,271+/-124 g NEC) and postnatal age (23+/-6 days control v. 22+/-3 days NEC) were similar. Infants with NEC had significantly lower levels of EGF in both saliva (590+/-80 pg/mL control v. 239+/-41 pg/mL NEC; P<.001) and serum (35+/-8 pg/mL control v. 5.6+/-1.9 pg/mL NEC; P<.001). Urinary EGF was also lower in the NEC group, but was not statistically significant. CONCLUSIONS Premature infants with NEC have significantly diminished levels of salivary and serum EGF. Reduced levels of this growth factor may distinguish infants at risk for NEC and play a pivotal role in the pathogenesis of the perturbed intestinal mucosal barrier that is central to this condition.
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Affiliation(s)
- C E Shin
- Department of Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH 45229-3039, USA
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Abstract
Immaturity of the epidermal barrier in the preterm infant may have serious clinical consequences. However, regardless of the degree of prematurity, the barrier rapidly matures such that by 2 wk all infants display a competent barrier. To determine whether the change from an aqueous (intrauterine) to a xeric environment might be the stimulus for this accelerated maturation, we examined the effects of air exposure on cutaneous barrier formation in vitro. Skin explants from d 17 fetal rats were incubated either submerged or at the air-medium interface. As previously reported, a competent barrier formed under submerged conditions after 3-4 d, precisely mirroring the time course of maturation in utero. In contrast, barrier maturation was accelerated in air-exposed explants, with functional, histologic, and structural markers of barrier formation observed after only 2 d of incubation. A water-impermeable membrane blocked the acceleration of barrier formation, resulting in a developmental time course comparable to that for submerged explants. In contrast a water vapor-permeable membrane did not block the acceleration. Glucocorticoids and thyroid hormone, which accelerate barrier formation in utero or in vitro under submerged conditions, did not further accelerate barrier formation in the air-exposed model. These data indicate that: 1) air exposure accelerates barrier ontogenesis, suggesting that water flux may be an important signal for the accelerated barrier formation that occurs in premature infants; and 2) factors which accelerate barrier formation in utero may not further accelerate barrier formation in neonates.
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Affiliation(s)
- K Hanley
- Department of Dermatology, University of California, San Francisco 94143, USA
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Santer R, Borlinghaus P, Sievers E, Segura E, Lamerz R. Urinary excretion of epidermal growth factor and transforming growth factor-alpha in breast-fed and formula-fed infants. Acta Paediatr 1993; 82:1024-8. [PMID: 8155917 DOI: 10.1111/j.1651-2227.1993.tb12802.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Urinary epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) concentrations were determined by radioimmunoassay in a longitudinal study analyzing 348 24-h urine specimens of 32 infants (16 breast-fed, 16 formula-fed) during the first 16 weeks of life. EGF excretion showed a statistically significant increase from 6.0 +/- 2.5 to 14.1 +/- 4.9 micrograms/g creatinine (mean +/- 1 SD) during the investigation period. TGF-alpha levels were fairly constant throughout this period. Comparing breast-fed infants, with more than 100-fold higher ingestion of EGF and TGF-alpha, with formula-fed infants, no significant differences in urinary EGF and TGF-alpha excretion were observed. These results do not rule out a systemic effect of EGF and TGF-alpha after intestinal absorption in breast-fed infants. The results suggest, however, that urinary EGF and TGF-alpha originate mainly from sources other than intestinal absorption.
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Affiliation(s)
- R Santer
- Department of Pediatrics, Christian-Albrechts-University, Kiel, Germany
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Ruiz-Torres A. Basic results for assessment of human ageing. Arch Gerontol Geriatr 1991; 12:261-72. [PMID: 15374453 DOI: 10.1016/0167-4943(91)90033-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/1990] [Accepted: 12/13/1990] [Indexed: 10/27/2022]
Abstract
The study of collagen metabolism during the total life span of mammals has contributed greatly to the understanding of the human ageing process. Particularly relevant is the demonstration that these tissue dynamics of collagen in the whole organism is clearly age-dependent, but progresses non-synchronously in different organs. Thus, supply and degradation are tightly linked processes in all tissues, as in the case of other proteins, but the catabolic process regulates the turnover of already deposited collagen in adaptation to local needs. In the whole body there is a similar age-dependent interaction regarding the part of the organism whose activity is directly related with regulating functions mainly supporting the parenchyma, the other part of the organism to work as well as possible. It can be deduced that this regulation attains great importance in ageing because the capacity to survive is dependent on it. At the same time as we expose this dynamical conception of ageing we point out some ageing parameters from experimental gerontology capable of being applied in such a manner as to objectify human ageing manifestations. Furthermore, we propose a way to quantify total ageing on the basis of this interaction, as in a two-compartment system leading to one result which would mean vitality. We discuss related questions, mainly regarding the reference population as control and a good parameter selection which should represent total ageing manifestations in the human body.
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Affiliation(s)
- A Ruiz-Torres
- Instituto Universitario de Investigación Gerontológica y Metabólica, Universidad Autónoma de Madrid, Madrid, Spain
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Haigh R, D'Souza SW, Micklewright L, Gregory H, Butler SJ, Hollingsworth M, Donnai P, Boyd RD. Human amniotic fluid urogastrone (epidermal growth factor) and fetal lung phospholipids. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1989; 96:171-8. [PMID: 2784690 DOI: 10.1111/j.1471-0528.1989.tb01657.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Urogastrone was measured by radioimmunoassay in amniotic fluid obtained from 186 complicated pregnancies at 22 to 40 weeks gestation. Amniocentesis was performed for a variety of indications to obtain information about fetal lung maturity or bilirubin levels before induction of labour or caesarean section in various obstetric conditions. In 114 specimens lung phospholipids extracted from amniotic fluid were also assayed using two-dimensional thin layer chromatography. Urogastrone concentrations became measurable at approximately 30 weeks gestation and thereafter there was a 10-fold rise in concentrations between 30 and 40 weeks gestation. This increase in urogastrone concentration was positively correlated with a rise in phosphatidylcholine and phosphatidylglycerol concentrations and the phosphatidylcholine (lecithin)/sphingomyelin ratio (L/S). These results are compatible with a role for urogastrone in human fetal lung maturation.
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Affiliation(s)
- R Haigh
- Department of Child Health, University of Manchester
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