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Mokhtar WA, Sherief LM, Kamal NM, ElSheikh AO, Omran FH, Abdulsaboor A, Sakr MM, El Gebally S, Shehab MMM, Alfaifi J, Turkistani R, Aljuaid F, Oshi MA, Elbekoushi FB, Mokhtar GA. Late onset neonatal sepsis: Can plasma gelsolin be a promising diagnostic marker? Medicine (Baltimore) 2024; 103:e37356. [PMID: 38457556 PMCID: PMC10919505 DOI: 10.1097/md.0000000000037356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
Plasma gelsolin (pGSN) correlates with clinical improvement in septic patients. We aimed to investigate pGSN levels as a diagnostic and prognostic marker of neonatal late-onset-sepsis (LOS). A case-control study was done on 184 neonates (92 with LOS and 92 controls). All participants were subjected to detailed history taking, full clinical evaluation, sepsis workup, and pGSN enzyme-linked immunosorbent-assay measurement. We detected significantly lower pGSN level among cases compared to controls (90.63 ± 20.64 vs 451.83 ± 209.59). It was significantly related to the severity of sepsis and mortality, with significantly lower values among cases with septic shock and multiorgan failure and non-survivors. Follow-up pGSN significantly increased after sepsis improvement in survivors compared to admission values. pGSN might be a reliable diagnostic and prognostic marker for LOS.
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Affiliation(s)
- Wesam A. Mokhtar
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Laila M. Sherief
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Naglaa M. Kamal
- Pediatric Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Azza O. ElSheikh
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Farida H. Omran
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Abdulsaboor
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maha M.H. Sakr
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shreif El Gebally
- Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Jaber Alfaifi
- Department of Child Health, Faculty of Medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia
| | - Reem Turkistani
- Pediatric Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Futun Aljuaid
- Pediatric Department, Taif Children Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohammed A.M. Oshi
- Neurology Division, Pediatric Department, Gaafar Ibnauf Children’s Emergency Hospital, Khartoum, Sudan
| | | | - Ghada A. Mokhtar
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Cedzyński M, Świerzko AS. Collectins and ficolins in neonatal health and disease. Front Immunol 2023; 14:1328658. [PMID: 38193083 PMCID: PMC10773719 DOI: 10.3389/fimmu.2023.1328658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
The immune system starts to develop early in embryogenesis. However, at birth it is still immature and associated with high susceptibility to infection. Adaptation to extrauterine conditions requires a balance between colonization with normal flora and protection from pathogens. Infections, oxidative stress and invasive therapeutic procedures may lead to transient organ dysfunction or permanent damage and perhaps even death. Newborns are primarily protected by innate immune mechanisms. Collectins (mannose-binding lectin, collectin-10, collectin-11, collectin-12, surfactant protein A, surfactant protein D) and ficolins (ficolin-1, ficolin-2, ficolin-3) are oligomeric, collagen-related defence lectins, involved in innate immune response. In this review, we discuss the structure, specificity, genetics and role of collectins and ficolins in neonatal health and disease. Their clinical associations (protective or pathogenic influence) depend on a variety of variables, including genetic polymorphisms, gestational age, method of delivery, and maternal/environmental microflora.
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Affiliation(s)
- Maciej Cedzyński
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Łódź, Poland
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3
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Donda K, Torres BA, Maheshwari A. Non-coding RNAs in Neonatal Necrotizing Enterocolitis. NEWBORN 2022; 1:120-130. [PMID: 35754997 PMCID: PMC9219563 DOI: 10.5005/jp-journals-11002-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Keyur Donda
- Department of Pediatrics, University of South Florida Health Morsani College of Medicine, Tampa, Florida, United States of America
| | - Benjamin A Torres
- Department of Pediatrics, University of South Florida Health Morsani College of Medicine, Tampa, Florida, United States of America
| | - Akhil Maheshwari
- Global Newborn Society, Clarksville, Maryland, United States of America
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Donda KT, Torres BA, Khashu M, Maheshwari A. Single Nucleotide Polymorphisms in Neonatal Necrotizing Enterocolitis. Curr Pediatr Rev 2022; 18:197-209. [PMID: 35040407 DOI: 10.2174/1573396318666220117091621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022]
Abstract
The etiopathogenesis of necrotizing enterocolitis (NEC) remains unclear, but increasing information suggests that the risk and severity of NEC may be influenced by single nucleotide polymorphisms in many genes. In this article, we have reviewed gene variations that have either been specifically identified in NEC or have been noted in other inflammatory bowel disorders with similar histopathological abnormalities. We present evidence from our own peer-reviewed laboratory studies and data from an extensive literature search in the databases PubMed, EMBASE, and Scopus. To avoid bias in the identification of existing studies, search keywords were short-listed both from our own studies and from PubMed's Medical Subject Heading (MeSH) thesaurus.
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Affiliation(s)
- Keyur T Donda
- Department of Pediatrics, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Benjamin A Torres
- Department of Pediatrics, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Minesh Khashu
- Poole Hospital NHS Foundation Trust and Bournemouth University, Poole, United Kingdom
| | - Akhil Maheshwari
- Department of Pediatrics, Johns Hopkins University, Baltimore, ML, USA
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Donda K, Bose T, Dame C, Maheshwari A. The Impact of MicroRNAs in Neonatal Necrotizing Enterocolitis and other Inflammatory Conditions of Intestine: A Review. Curr Pediatr Rev 2022; 19:5-14. [PMID: 35040406 DOI: 10.2174/1573396318666220117102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/28/2021] [Accepted: 11/11/2021] [Indexed: 01/28/2023]
Abstract
The understanding of necrotizing enterocolitis (NEC) etiopathogenesis is incomplete, contributing to the lack of early biomarkers and therapeutic options. Micro RNAs (miRNAs) are a class of RNAs that can alter gene expression and modulate various physiological and pathological processes. Several studies have been performed to evaluate the role of miRNA in the pathogenesis of NEC. In this article, we review the information on miRNAs that have been specifically identified in NEC or have been noted in other inflammatory bowel disorders that share some of the histopathological abnormalities seen frequently in NEC. This review highlights miRNAs that could be useful as early biomarkers of NEC and suggests possible approaches for future translational studies focused on these analytes. It is a novel field with potential for immense translational and clinical relevance in preventing, detecting, or treating NEC in very premature infants. Impact • Current information categorizes necrotizing enterocolitis (NEC) as a multifactorial disease, but microRNAs (miRNAs) may influence the risk of occurrence of NEC. • MiRNAs may alter the severity of the intestinal injury and the clinical outcome of NEC. • The literature on intestinal diseases of adults suggests additional miRNAs that have not been studied in NEC yet but share some features and deserve further exploration in human NEC, especially if affecting gut dysbiosis, intestinal perfusion, and coagulation disorders.
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Affiliation(s)
- Keyur Donda
- Department of Pediatrics, University of South Florida Health Morsani College of Medicine, Tampa, Florida, FL, United States
| | - Tanima Bose
- Institute for Clinical Neuroimmunology, Ludwig-Maximilians- University of Munich, Munich, Germany
| | - Christof Dame
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Akhil Maheshwari
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, MD, USA
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Dogan P, Ozkan H, Koksal N, Oral HB, Celebi S, Bagci O, Guney Varal I. Mannose-Binding Lectin Levels in Late-Onset Sepsis in Preterm Infants: Results from a Prospective Study in a Tertiary Care Center. Fetal Pediatr Pathol 2020; 39:363-372. [PMID: 31411530 DOI: 10.1080/15513815.2019.1652374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: This study aimed to determine the association between serum mannose-binding lectin (MBL) levels, gene polymorphisms and late-onset sepsis (LOS) in preterm infants. Methods: Infants with <37 gestational weeks were categorized into two groups according to the presence of LOS during their hospitalization. An MBL level <700 ng/ml was defined as deficiency, <400 ng/ml as severe deficiency. Codon 54 and 57 polymorphisms of MBL2 gene were analyzed. Results: Overall, 153 preterm infants were included. MBL deficiency was found to be more common in the LOS group (p = 0.02). The rate of Gram-negative sepsis was higher in MBL2 variant-type (p = 0.01). In the logistic regression analysis, MBL levels <700 ng/ml were found to have a significant effect on LOS development (odds ratio: 2.692, 95% confidence interval 1.196-5.8, p = 0.02). Conclusions: MBL deficiency is an important risk factor for the development of LOS. Furthermore, there is an association between MBL2 gene polymorphism and Gram-negative sepsis.
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Affiliation(s)
- Pelin Dogan
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Hilal Ozkan
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Nilgun Koksal
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Haluk Barbaros Oral
- Uludag University, Faculty of Medicine, Department of Immunology, Bursa, Turkey
| | - Solmaz Celebi
- Uludag University, Faculty of Medicine, Department of Pediatrics, Division of Infectious Diseases, Bursa, Turkey
| | - Onur Bagci
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
| | - Ipek Guney Varal
- Uludag Universitesi, Uludag University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bursa, Turkey
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Balayan S, Chauhan N, Chandra R, Kuchhal NK, Jain U. Recent advances in developing biosensing based platforms for neonatal sepsis. Biosens Bioelectron 2020; 169:112552. [PMID: 32931992 DOI: 10.1016/j.bios.2020.112552] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 12/12/2022]
Abstract
Neonatal sepsis is a bloodstream infection primarily caused by Escherichia coli (E. coli), Group B Streptococcus (GBS), Listeria monocytogenes, Haemophilus influenzae, S. aureus, Klebsiella spp. and non-typhoidal Salmonella bacteria. Neonatal Sepsis is referred as a critical response to the infection in the neonatal period that can lead to the failure of body organs and thereby causing damage to the tissues resulting in death of the neonates. Nearly 4 million deaths across the world are occurred due to neonatal sepsis infections. In order to prevent the bloodstream infections in the neonates, it is indispensable to diagnose the disease properly for appropriate treatment during the point of care. Numerous studies have been reported to identify major biomarkers associated with neonatal sepsis including Serum Amyloid A (SAA), C - reactive protein (CRP), Procalcitonin (PCT) and Lipopolysaccharide-binding protein (LBP). Distinct diagnostic platforms have also been developed detecting the presence of bloodstream infections including electrochemical, potentiometric, and impedimetric sensors. Recently, electrochemical biosensors with the integration of nanomaterials have emerged as a better platform for neonatal sepsis biomarkers detection. This review article summarizes the diverse screening platforms, evaluation parameters, and new advances based on implications of nanomaterials for the development of biosensors detecting neonatal sepsis infections. The review further elucidates the significance and future scope of distinctive platforms which are predominantly associated with detection of neonatal sepsis.
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Affiliation(s)
- Sapna Balayan
- Amity Institute of Nanotechnology, Amity University, Noida, 201313, Uttar Pradesh, India
| | - Nidhi Chauhan
- Amity Institute of Nanotechnology, Amity University, Noida, 201313, Uttar Pradesh, India
| | - Ramesh Chandra
- Department of Chemistry, University of Delhi, Delhi, 110007, India
| | | | - Utkarsh Jain
- Amity Institute of Nanotechnology, Amity University, Noida, 201313, Uttar Pradesh, India.
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El-Madbouly AA, El Sehemawy AA, Eldesoky NA, Abd Elgalil HM, Ahmed AM. Utility of presepsin, soluble triggering receptor expressed on myeloid cells-1, and neutrophil CD64 for early detection of neonatal sepsis. Infect Drug Resist 2019; 12:311-319. [PMID: 30774398 PMCID: PMC6357881 DOI: 10.2147/idr.s191533] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Neonatal sepsis (NS) is an important cause of morbidity and mortality among newborns. Its diagnosis depends mainly on blood culture that takes at least 48 hours to give results. Therefore, searching for biomarkers for early diagnosis is of value. We aimed to assess presepsin, soluble triggering receptor expressed on myeloid cells (sTREM-1), and neutrophil CD64 (nCD64) as early diagnostic biomarkers in NS, and to compare them individually and in combination. Methods This hospital-based case–control study has been conducted on 60 full-term neonates recruited from the neonatal intensive care unit, Al-Zahraa Hospital, Al-Azhar University, Cairo, Egypt. Thirty infants with sepsis were compared to 30 postnatal age- and sex-matched healthy controls. Studied neonates were evaluated using clinical and laboratory indicators for sepsis. nCD64 was measured by flow cytometry and, serum presepsin and sTREM-1 were measured by ELISA. Results Presepsin, sTREM-1, and nCD64 levels were significantly elevated in septic neonates vs control group (P<0.05). The sensitivities of presepsin, sTREM, and nCD64 were 100%, 96.7%, and 86.7%, respectively. Presepsin had the best diagnostic performance in early diagnosis of NS followed by sTREM-1 and nCD64. Conclusion Presepsin and sTREM-1 are promising biomarkers in screening for NS in comparison with nCD64. However, nCD64 is better used in combination with other biomarkers as CRP.
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Affiliation(s)
- Asmaa A El-Madbouly
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Asmaa A El Sehemawy
- Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Noha A Eldesoky
- Biochemistry Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Heba Mohammed Abd Elgalil
- Community and Occupational Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,
| | - Amal M Ahmed
- Community and Occupational Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,
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Badawy M, Mosallam DS, Saber D, Madani H. Use of Mannose-Binding Lectin Gene Polymorphisms and the Serum MBL Level for the Early Detection of Neonatal Sepsis. J Pediatr Genet 2018; 7:150-157. [PMID: 30464858 DOI: 10.1055/s-0038-1675801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Background Mannose-binding lectin (MBL) is a component of innate immunity and is particularly important in neonates, in whom adaptive immunity has not yet completely developed. MBL deficiency and MBL2 gene polymorphisms are associated with an opsonization defect and have been associated with neonatal sepsis. Aim The aim of our study was to assess serum MBL levels and genotype MBL2 genes to determine whether they can serve as markers for predicting neonatal sepsis in neonatal intensive care units. Patients and Methods A case-control study was conducted with 114 neonates classified into two groups: the septic group included 64 neonates (41 preterm and 23 full-term infants), and the non-septic control group included 50 neonates (29 preterm and 21 full-term infants). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to genotype MBL2 gene exon 1 (rs1800450) and (rs1800451) SNPs. Enzyme-linked immunosorbent assay (ELISA) was used to measure MBL serum concentrations. Results The polymorphic genotypes BB and AC at codons 54 and 57, respectively, showed higher frequencies than the wild-type genotype (AA) (14.1% versus 12.9% and 28.1% versus 19.4% respectively) in both groups, and this difference was greater in the septic group than in the non-septic group; however, the differences did not reach statistical significance. The B and C allele frequencies were also higher in the septic group than in the non-septic group, but the differences did not reach statistical significance ( p = 0.282 and 0.394, respectively). The serum levels of MBL were significantly lower in the septic group than in the non-septic group ( p = 0.028). Conclusion This study found no association between MBL levels or MBL2 exon 1 genotypes or alleles and neonatal sepsis risk. Further studies with larger sample sizes are needed to determine the role of the MBL2 gene as a risk factor and early predictor of neonatal sepsis.
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Affiliation(s)
- Magda Badawy
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia S Mosallam
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Saber
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan Madani
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mannose-binding lectin and mannose-binding protein-associated serine protease 2 levels and infection in very-low-birth-weight infants. Pediatr Res 2018; 84:134-138. [PMID: 29807983 DOI: 10.1038/s41390-018-0017-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/11/2018] [Accepted: 04/01/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to explore the role of the lectin pathway in neonatal sepsis through the study of MBL and MASP2 levels and their relationship with infection in a cohort of very-low-birth-weight infants (VLBWI). METHODS MBL and MASP2 were measured in plasma samples of n = 89 VLBWI using ELISA and correlated with clinical parameters. MBL plasma levels were aligned with genotyping data of mbl2 exon 1 polymorphisms, rs1800450, rs1800451, and rs5030737. RESULTS MBL levels were clearly determined by MBL genotype, i.e., AA individuals had tenfold higher MBL levels than AO individuals. MBL and MASP2 levels did not correlate with gestational age, apart from MASP2 levels on day 7. During the first 21 days of life, we noted a gradual increase in both MBL and MASP2 levels. On day 7 of life, MASP2 levels in infants developing late-onset sepsis measured before the onset of symptoms were found to be lower, as compared to non-LOS infants. CONCLUSIONS In our cohort of VLBWI, MBL levels were genetically determined, but not associated with gestational age or sepsis in the first 21 days of life. Lower MASP2 levels on day 7 may indicate increased risk for late-onset infection.
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Scheid A, Li N, Jeffers C, Borriello F, Joshi S, Ozonoff A, Pettengill M, Levy O. Antimicrobial peptide LL-37 and recombinant human mannose-binding lectin express distinct age- and pathogen-specific antimicrobial activity in human newborn cord blood in vitro. F1000Res 2018; 7:616. [PMID: 30271580 PMCID: PMC6143923 DOI: 10.12688/f1000research.14736.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 01/07/2023] Open
Abstract
Background: There is a need to prevent and treat infection in newborns. One approach is administration of antimicrobial proteins and peptides (APPs) such as LL-37, a membrane-active cathelicidin antimicrobial peptide, and mannose-binding lectin (MBL), a pattern-recognition protein that binds to microbial surface polysaccharides resulting in opsonization and complement activation. Low plasma/serum levels of LL-37 and of MBL have been correlated with infection and exogenous administration of these agents may enhance host defense. Methods: The antimicrobial activity of LL-37 (15 µg/ml) or rMBL (0.5, 2 and 10 µg/ml) was tested in hirudin-anticoagulated preterm and term human cord blood (N = 12-14) against Staphylococcus aureus (SA) USA 300 (2x10 4 CFU/ml), Staphylococcus epidermis (SE) 1457 (2x10 4 CFU/ml) and Candida albicans (CA) SC5314 (1x10 4 CFU/ml). After incubation (1, 45, or 180 min), CFUs were enumerated by plating blood onto agar plates. Supernatants were collected for measurement of MBL via ELISA. Results: Preterm cord blood demonstrated impaired endogenous killing capacity against SA and SE compared to term blood. Addition of LL-37 strongly enhanced antimicrobial/antifungal activity vs SA, SE and CA in term blood and SE and CA in preterm blood. By contrast, rMBL showed modest fungistatic activity vs CA in a sub-analysis of term newborns with high basal MBL levels. Baseline MBL levels varied within preterm and term cohorts with no correlation to gestational age. In summary, exogenous LL-37 demonstrated significant antimicrobial activity against SA, SE and CA in term and SE and CA in preterm human blood tested in vitro. rMBL demonstrated modest antifungal activity in term cord blood of individuals with high baseline MBL levels. Conclusions: To the extent that our in vitro results predict the effects of APPs in vivo, development of APPs for prevention and treatment of infection should take into account host age as well as the target pathogen.
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Affiliation(s)
- Annette Scheid
- Department of Pediatric Newborn Medicine, Brigham and Women's University Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ning Li
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Carleen Jeffers
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Francesco Borriello
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
- WAO Center of Excellence, Naples, Italy
| | - Sweta Joshi
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Al Ozonoff
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew Pettengill
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of MIT & Harvard, Cambridge, Massachusetts, USA
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Age-related variations in the in vitro bactericidal activity of human sera against Pseudomonas aeruginosa. Cent Eur J Immunol 2018; 43:18-25. [PMID: 29731689 PMCID: PMC5927169 DOI: 10.5114/ceji.2018.74869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/18/2017] [Indexed: 01/03/2023] Open
Abstract
The human serum is a vital component of the innate immunity of the host that acts as the first line of defence against invading pathogens. A key player in serum-mediated innate immune defence is a system of more than 35 proteins, collectively named as the complement system. After exposure of the pathogen, these proteins are activated in a cascade manner, ultimately forming a membrane attack complex (MAC) on the surface of the pathogen that directly lyses the bacterial cell. Formation of the MAC can be demonstrated in vitro by using serum bactericidal assay (SBA) that works in the absence of cellular components of blood after incubating the serum along with bacteria. Here, we describe the age-related differences in the bactericidal activity of human serum against Pseudomonas aeruginosa, an opportunistic human pathogen causing an array of hospital and community-acquired infections. We demonstrate that adult sera were highly effective in the in vitro killing of Pseudomonas aeruginosa as compared to children and the elderly (p < 0.0001). Sera from children were seriously compromised in the killing P. aeruginosa, whereas elderly sera showed a reduced level of killing. Data revealed a positive correlation between age and serum-killing with higher coefficient of determination values of 0.34, 0.27, and 0.58 and p values of < 0.0001, < 0.001, and < 0.0001, respectively, after 60, 90, and 120 minutes of incubation. Hence, our study highlights the age-related difference in the bactericidal activity of human sera. We conclude that sera of children are totally compromised, whereas elderly sera are only partially compromised, in the killing of P. aeruginosa.
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Abstract
OBJECTIVES Low mannose-binding lectin levels and haplotypes associated with low mannose-binding lectin production have been associated with infection and severe sepsis. We tested the hypothesis that mannose-binding lectin levels would be associated with severe infection in a large cohort of critically ill children. DESIGN Prospective cohort study. SETTING Medical and Surgical PICUs, Boston Children's Hospital. PATIENTS Children less than 21 years old admitted to the ICUs from November 2009 to November 2010. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We measured mannose-binding lectin levels in 479 of 520 consecutively admitted children (92%) with severe or life-threatening illness. We genotyped 213 Caucasian children for mannose-binding lectin haplotype tagging variants and assigned haplotypes. In the univariate analyses of mannose-binding lectin levels with preadmission characteristics, levels were higher in patients with preexisting renal disease. Patients who received greater than 100 mL/kg of fluids in the first 24 hours after admission had markedly lower mannose-binding lectin, as did patients who underwent spinal fusion surgery. Mannose-binding lectin levels had no association with infection status at admission, or with progression from systemic inflammatory response syndrome to sepsis or septic shock. Although mannose-binding lectin haplotypes strongly influenced mannose-binding lectin levels in the predicted relationship, low mannose-binding lectin-producing haplotypes were not associated with increased risk of infection. CONCLUSIONS Mannose-binding lectin levels are largely genetically determined. This relationship was preserved in children during critical illness, despite the effect of large-volume fluid administration on mannose-binding lectin levels. Previous literature evaluating an association between mannose-binding lectin levels and severe infection is inconsistent; we found no relationship in our PICU cohort. We found that mannose-binding lectin levels were lower after aggressive fluid resuscitation and suggest that studies of mannose-binding lectin in critically ill patients should assess mannose-binding lectin haplotypes to reflect preillness levels.
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Mannose-Binding Lectin: Biologic Characteristics and Role in the Susceptibility to Infections and Ischemia-Reperfusion Related Injury in Critically Ill Neonates. J Immunol Res 2017; 2017:7045630. [PMID: 28246614 PMCID: PMC5299167 DOI: 10.1155/2017/7045630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/08/2016] [Accepted: 12/28/2016] [Indexed: 01/14/2023] Open
Abstract
The mannose-binding lectin (MBL) is a member of the collectin family, belonging to the innate immunity system. Genetic, biologic, and clinical properties of MBL have been widely investigated throughout the last decades, although some interesting aspects of its potential clinical relevance are still poorly understood. Low circulating concentrations of MBL have been associated with increased risk of infection and poor neurologic outcome in neonates. On the other hand, an excessive and uncontrolled inflammatory response by the neonatal intestine after the exposure to luminal bacteria, leading to an increased production of MBL, may be involved in the onset of necrotizing enterocolitis. The purpose of the present review is to summarize the current knowledge about genetic and biologic characteristics of MBL and its role in the susceptibility to infections and to ischemia-reperfusion related tissue injuries to better explore its clinical relevance during the perinatal period and the possible future therapeutic applications.
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Świerzko AS, Szala-Poździej A, Kilpatrick DC, Sobociński M, Chojnacka K, Sokołowska A, Michalski M, Mazerant K, Jensenius JC, Matsushita M, Krajewski WR, Szczapa J, Bąk-Romaniszyn L, Zeman K, Cedzyński M. Components of the lectin pathway of complement activation in paediatric patients of intensive care units. Immunobiology 2016; 221:657-69. [PMID: 26850322 DOI: 10.1016/j.imbio.2016.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/18/2015] [Accepted: 01/12/2016] [Indexed: 11/18/2022]
Abstract
Infections are a major cause of childhood mortality. We investigated components of the lectin pathway of complement activation in the context of sepsis at both genetic and protein levels in neonates, infants and older children. Major components of the lectin pathway and two genes for Toll-like receptors were studied in 87 neonates with confirmed sepsis and compared with 40 babies with infections who did not develop sepsis (disease controls) and 273 infection-free neonatal controls. A second cohort comprised 47 older children with sepsis and 87 controls. Low MBL-conferring genotypes (LXA/O+O/O) were more frequent in sepsis patients than in healthy controls but no significant differences in the frequency of SNPs of other lectin pathway genes (FCN1, FCN2, FCN3, MASP1/3, MASP2) or TLR receptor genes (TLR2, TLR4) were found. One case of primary MASP-2 deficiency was found among healthy pre-terms and one neonate suffering from SIRS was heterozygous for the rare FCN1 gene mutation, +6658 G>A. Generally, sepsis was associated with low serum MBL and low ficolin-2 concentrations on admission. Among neonates, ficolin-1 and MASP-2 levels were elevated in sepsis relative to healthy, but not disease, controls. Unlike neonates, ficolin-3 and MASP-2 levels were lower in older patients than in healthy controls while no difference was found for ficolin-1. With the possible exception of MBL, inherited lectin pathway insufficiencies do not seem to predispose to sepsis, rather changes in protein concentrations reflect alterations in disease course.
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Affiliation(s)
- Anna S Świerzko
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Lodz, Poland
| | - Agnieszka Szala-Poździej
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Lodz, Poland
| | - David C Kilpatrick
- Scottish National Blood Transfusion Service, National Science Laboratory, Ellen's Glen Road, Edinburgh, EH17 7QT Scotland, UK
| | - Michał Sobociński
- Department of Anesthesiology and Intensive Therapy, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Karolina Chojnacka
- Department of Newborns Infectious Diseases, Poznan University of Medical Sciences, Polna 33, 60-533 Poznan, Poland
| | - Anna Sokołowska
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Lodz, Poland
| | - Mateusz Michalski
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Lodz, Poland; Institute of Microbiology, Biotechnology and Immunology, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | - Karolina Mazerant
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Lodz, Poland
| | - Jens C Jensenius
- Department of Biomedicine, Aarhus University, Vennellyst Boulevard 4, Aarhus DK-8000, Denmark
| | - Misao Matsushita
- Department of Applied Biochemistry, Tokai University, 4-1-1 Kitakaname, Hiratsuka-shi, Kanagawa 259-1292, Japan
| | - Wojciech R Krajewski
- Department of Anesthesiology and Intensive Therapy, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Jerzy Szczapa
- Department of Newborns Infectious Diseases, Poznan University of Medical Sciences, Polna 33, 60-533 Poznan, Poland
| | - Leokadia Bąk-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Krzysztof Zeman
- Department of Paediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
| | - Maciej Cedzyński
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Lodz, Poland.
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Wang LK, Huang MC, Liu CC, Chen CP. Second-trimester plasma mannose-binding lectin levels and risk of preterm birth. J Matern Fetal Neonatal Med 2016; 30:678-683. [PMID: 27124763 DOI: 10.1080/14767058.2016.1182978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate whether mannose-binding lectin (MBL) gene polymorphisms and low levels of second-trimester plasma MBL were significant risk factors for preterm birth in Taiwanese women. METHODS We conducted a prospective longitudinal study to explore the associations of MBL2 gene single nucleotide polymorphisms and plasma MBL levels between preterm birth and term controls. Blood samples were collected at 16-23 weeks of gestation, and were divided into 51 mothers with preterm births and 255 term controls after delivery. Blood samples were further collected at delivery from 11 mothers with term delivery and 9 with preterm births. DNA was isolated, and polymorphisms in exon 1, the promoter untranslated regions of MBL2 were determined by polymerase chain reaction. The plasma concentrations of MBL were measured by enzyme-linked immunosorbent assay. RESULTS There is a positive correlation between SNP genotypes and second-trimester plasma MBL levels. Among mothers with preterm births, a higher frequency of specific genotypes with low MBL levels was not observed. The second-trimester plasma MBL levels were not significantly different between mothers with preterm births (N = 51) and term deliveries (N = 255). However, among mothers (N = 11) with term pregnancies, the MBL plasma level significantly increased from the second trimester to delivery, whereas in mothers (N = 9) who developed preterm delivery, the MBL level did not significantly change. CONCLUSION Genotypes associated with low levels of plasma MBL during pregnancy did not increase the risk of preterm births. A low second-trimester plasma MBL level is therefore not a predictor for the development of preterm birth.
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Affiliation(s)
- Liang-Kai Wang
- a Division of High Risk Pregnancy , MacKay Memorial Hospital , Taipei , Taiwan
| | - Ming-Chao Huang
- b Division of General Obstetrics and Gynecology , MacKay Memorial Hospital , Taipei , Taiwan , and
| | - Chang-Ching Liu
- c Department of Medical Research , MacKay Memorial Hospital , Taipei , Taiwan
| | - Chie-Pein Chen
- a Division of High Risk Pregnancy , MacKay Memorial Hospital , Taipei , Taiwan.,c Department of Medical Research , MacKay Memorial Hospital , Taipei , Taiwan
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Kumar SKM, Bhat BV. Distinct mechanisms of the newborn innate immunity. Immunol Lett 2016; 173:42-54. [PMID: 26994839 DOI: 10.1016/j.imlet.2016.03.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 12/23/2022]
Abstract
The ontogeny of immunity during early life is of high importance as it shapes the immune system for the entire course of life. The microbiome and the environment contribute to the development of immunity in newborns. As immune responses in newborns are predominantly less experienced they are increasingly susceptible to infections. Though the immune cells in newborns are in 'naïve' state, they have been shown to mount adult-like responses in several circumstances. The innate immunity plays a vital role in providing protection during the neonatal period. Various stimulants have been shown to enhance the potential and functioning of the innate immune cells in newborns. They are biased against the production of pro-inflammatory cytokines and this makes them susceptible to wide variety of intracellular pathogens. The adaptive immunity requires prior antigenic experience which is very limited in newborns. This review discusses in detail the characteristics of innate immunity in newborns and the underlying developmental and functional mechanisms involved in the immune response. A better understanding of the immunological milieu in newborns could help the medical fraternity to find novel methods for prevention and treatment of infection in newborns.
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Affiliation(s)
- S Kingsley Manoj Kumar
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - B Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
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Abstract
Sepsis is a major cause of neonatal morbidity and mortality, especially in vulnerable preterm populations. Immature immune defenses, and environmental and maternal factors contribute to this risk, with as many as a third of very preterm infants experiencing sepsis during their stay in the neonatal intensive care unit (NICU). Epidemiologic and twin studies have suggested that there is a genetic contribution to sepsis predilection. Several investigators have conducted candidate gene association studies on variants of specific interest and potential functional significance in neonatal sepsis. In this review, we describe details of studies that have evaluated genetic susceptibility in neonatal sepsis, and summarize findings from a review of candidate gene association studies.
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Affiliation(s)
- Lakshmi Srinivasan
- Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA.
| | - Haresh Kirpalani
- Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA
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Gao DN, Zhang Y, Ren YB, Kang J, Jiang L, Feng Z, Qu YN, Qi QH, Meng X. Relationship of serum mannose-binding lectin levels with the development of sepsis: a meta-analysis. Inflammation 2015; 38:338-47. [PMID: 25323207 DOI: 10.1007/s10753-014-0037-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many studies have evaluated the association between serum levels of mannose-binding lectin (MBL) and sepsis; however, the findings are inconclusive and conflicting. For a better understanding of MBL in sepsis, we conducted a comprehensive meta-analysis. Potential relevant studies were identified covering Science Citation Index, the Cochrane Library, PubMed, Embase, CINAHL, and Current Contents Index databases. Two reviewers extracted data and assessed studies independently. Statistical analyses were conducted with the version 12.0 STATA statistical software. Ten papers were collected for meta-analysis. Results identified that sepsis patients had considerably lower MBL level than those in the controls (standardized mean difference (SMD) = 1.59, 95 % confidence interval (95%CI) = 0.86∼2.31, P < 0.001). Ethnicity-subgroup analysis showed that sepsis patients were associated with decreased serum MBL level in contrast to the healthy controls in Asians (SMD = 3.07, 95%CI = 1.27∼4.88, P = 0.001) and Caucasians (SMD = 1.00, 95%CI = 0.35∼1.65, P = 0.003). In the group-stratified subgroup analysis, subjects with lower serum MBL level did underpin susceptibility to sepsis in the infants subgroup (SMD = 2.57, 95%CI = 1.59∼3.55, P < 0.001); however, this was not the case in the adults subgroup (SMD = 0.13, 95%CI = -1.30∼1.55, P = 0.862). Our study suggests an important involvement of serum MBL level in sepsis patients considering their lower level compared to controls, especially among infants.
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Affiliation(s)
- Dong-Na Gao
- Graduate School of Dalian Medical University, Dalian, 11600, People's Republic of China
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20
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Chen Q, Xue H, Chen M, Gao F, Xu J, Liu Q, Yang X, Zheng L, Chen H. High serum trypsin levels and the -409 T/T genotype of PRSS1 gene are susceptible to neonatal sepsis. Inflammation 2015; 37:1751-6. [PMID: 24777884 DOI: 10.1007/s10753-014-9904-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neonatal sepsis remains an important and common cause of morbidity and mortality among newborn infants, especially in developing countries. The aim of the present study was to determine whether serum trypsin levels and genotypes of cationic trypsinogen (PRSS1) gene could be served as markers for predicting neonatal sepsis. The serum trypsin levels and genotypes of PRSS1 were examined in both 50 infants with infection during neonatal period and 56 healthy neonates as controls. The infected infants were further subdivided into infants with sepsis group (n=18) and infected infants without sepsis (n=32). The genotype of PRSS1 was analyzed by direct sequencing, and the serum trypsin level was measured by immunoassay. It showed that the median value of serum trypsin was significantly higher in infected infants (31.90 ng/mL) than in controls (12.85 ng/mL; P=0.030). More importantly, sepsis subgroup (50.95 ng/mL) had significantly higher median serum trypsin than infected infants without sepsis subgroup (19.10 ng/mL) and controls (12.85 ng/mL) (P=0.015 and P=0.002, respectively). Additionally, the median serum trypsin levels were found significantly higher in infants who had T/T (37.90 ng/mL) genotype of PRSS1 compared with those who had C/T genotype (12.80 ng/mL; P=0.005). This study suggested that serum trypsin and rs10273639 C/T of PRSS1 were revealed to be novel markers for predicting neonatal sepsis.
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Affiliation(s)
- Qingquan Chen
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, 350004, Fuzhou, People's Republic of China
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21
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MBL2 genotypes and their associations with MBL levels and NICU morbidity in a cohort of Greek neonates. J Immunol Res 2015; 2015:478412. [PMID: 25879044 PMCID: PMC4387979 DOI: 10.1155/2015/478412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/23/2015] [Accepted: 02/28/2015] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to assess the frequency of MBL2 genotypes and their associations with MBL levels and various morbidities of a neonatal intensive care unit (NICU). One hundred and thirty-four (134) NICU (83 term and 51 preterm) and 150 healthy neonates were enrolled in the study. MBL2 genotype and MBL serum levels at birth were determined prospectively by PCR-RFLP-sequencing and enzyme-linked immunosorbent assay, respectively. NICU neonates displayed significantly lower MBL serum levels compared to healthy ones. MBL deficiency, defined as the low MBL2 expression group (XA/O and O/O), was significantly associated with an increased risk of respiratory morbidity, especially transient tachypnea of the newborn and respiratory distress syndrome (RDS). Moreover, an increase of 100 ng/mL of serum MBL levels decreases by 5% the risk of total respiratory morbidity and by 7% the risk of RDS, after correction for prematurity and sex and regardless of the presence of infections. Our study further supports the notion that neonates with MBL deficiency and low MBL serum levels at birth may be at higher risk of developing severe respiratory complications.
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Use of early biomarkers in neonatal brain damage and sepsis: state of the art and future perspectives. BIOMED RESEARCH INTERNATIONAL 2015; 2015:253520. [PMID: 25685774 PMCID: PMC4313065 DOI: 10.1155/2015/253520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/11/2014] [Indexed: 12/19/2022]
Abstract
The identification of early noninvasive biochemical markers of disease is a crucial issue of the current scientific research, particularly during the first period of life, since it could provide useful and precocious diagnostic information when clinical and radiological signs are still silent. The ideal biomarker should be practical and sensitive in the precocious identification of at risk patients. An earlier diagnosis may lead to a larger therapeutic window and improve neonatal outcome. Brain damage and sepsis are common causes of severe morbidity with poor outcome and mortality during the perinatal period. A large number of potential biomarkers, including neuroproteins, calcium binding proteins, enzymes, oxidative stress markers, vasoactive agents, and inflammatory mediators, have been so far investigated. The aim of the present review was to provide a brief overview of some of the more commonly investigated biomarkers used in case of neonatal brain damage and sepsis.
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Luo J, Xu F, Lu GJ, Lin HC, Feng ZC. Low mannose-binding lectin (MBL) levels and MBL genetic polymorphisms associated with the risk of neonatal sepsis: An updated meta-analysis. Early Hum Dev 2014; 90:557-64. [PMID: 25105751 DOI: 10.1016/j.earlhumdev.2014.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/09/2014] [Accepted: 07/14/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Relatively low serum mannose-binding lectin (MBL) levels and MBL genetic polymorphisms have been implicated as high risk factors for neonatal sepsis. However, different studies have reported conflicting findings and have generally been underpowered to exclude modest effect sizes. METHODS Standard methodology of systematic reviews and meta-analyses was followed. PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched from January 1996 to December 2013. The eligible studies were collected and analyzed using Review Manager 5.2. Meta-Disc version 1.4 was used to describe and calculate sensitivity, specificity, summary receiver operator characteristic (SROC) curves and area under the curve. SROC curve analysis was used to summarize the overall performance. Funnel plots, Egger's test and Begg's test were used to investigate publication bias. RESULTS Seven studies addressing low MBL levels and MBL genetic polymorphisms (structure variant A/O, A/B of Exon1) were analyzed for susceptibility to neonatal sepsis, respectively. All of these control studies were of reasonable methodological quality. The pooled unadjusted odds ratio showed that low MBL levels were significantly associated with neonatal sepsis (P=0.0002; odds ratio=4.94, 95% confidence interval=2.16-11.29) and MBL genetic polymorphisms were also significantly associated with neonatal sepsis (P=0.03; odds ratio=1.41, 95% confidence interval=1.03-1.94). In subgroup analysis based on gestational age, increased risk was found in the preterm infants in the dominant model (RR 2.33, 95%CI 1.06-5.13, P=0.03). However, no association was observed for term infants in subgroup analysis. Additionally, the SROC curve of low MBL levels in the prediction of neonatal sepsis indicated a poor predictive ability. The area under curve was 0.80 (95% confidence interval=0.74-0.86). CONCLUSION Currently available evidence shows that neonates with low serum MBL levels are more than four times more likely to have neonatal sepsis compared to those with higher serum MBL levels. Neonates with MBL genetic polymorphisms are also susceptible to developing neonatal sepsis. However, a low serum MBL level was only of moderate value in detecting neonatal sepsis.
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Affiliation(s)
- Jun Luo
- Department of Neonatology, BaYi Children's Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital of Southern Medical University, Beijing, China; Department of Neonatology, Bao'an Maternity and Child Health Hospital of Shenzhen, Guangdong, China
| | - Fen Xu
- Department of Neonatology, Bao'an Maternity and Child Health Hospital of Shenzhen, Guangdong, China
| | - Guang-Jin Lu
- Department of Neonatology, Bao'an Maternity and Child Health Hospital of Shenzhen, Guangdong, China
| | - Hung-Chih Lin
- Department of Pediatrics and School of Chinese Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Zhi-Chun Feng
- Department of Neonatology, BaYi Children's Hospital Affiliated to Clinical Medical College in Beijing Military General Hospital of Southern Medical University, Beijing, China.
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Pettengill MA, van Haren SD, Levy O. Soluble mediators regulating immunity in early life. Front Immunol 2014; 5:457. [PMID: 25309541 PMCID: PMC4173950 DOI: 10.3389/fimmu.2014.00457] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/08/2014] [Indexed: 12/15/2022] Open
Abstract
Soluble factors in blood plasma have a substantial impact on both the innate and adaptive immune responses. The complement system, antibodies, and anti-microbial proteins and peptides can directly interact with potential pathogens, protecting against systemic infection. Levels of these innate effector proteins are generally lower in neonatal circulation at term delivery than in adults, and lower still at preterm delivery. The extracellular environment also has a critical influence on immune cell maturation, activation, and effector functions, and many of the factors in plasma, including hormones, vitamins, and purines, have been shown to influence these processes for leukocytes of both the innate and adaptive immune systems. The ontogeny of plasma factors can be viewed in the context of a lower effectiveness of immune responses to infection and immunization in early life, which may be influenced by the striking neonatal deficiency of complement system proteins or enhanced neonatal production of the anti-inflammatory cytokine IL-10, among other ontogenic differences. Accordingly, we survey here a number of soluble mediators in plasma for which age-dependent differences in abundance may influence the ontogeny of immune function, particularly direct innate interaction and skewing of adaptive lymphocyte activity in response to infectious microorganisms and adjuvanted vaccines.
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Affiliation(s)
- Matthew Aaron Pettengill
- Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA , USA ; Harvard Medical School , Boston, MA , USA
| | - Simon Daniël van Haren
- Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA , USA ; Harvard Medical School , Boston, MA , USA
| | - Ofer Levy
- Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital , Boston, MA , USA ; Harvard Medical School , Boston, MA , USA
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Ingels C, Vanhorebeek I, Steffensen R, Derese I, Jensen L, Wouters PJ, Hermans G, Thiel S, Van den Berghe G. Lectin pathway of complement activation and relation with clinical complications in critically ill children. Pediatr Res 2014; 75:99-108. [PMID: 24129551 DOI: 10.1038/pr.2013.180] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/12/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Critically ill children are susceptible to nosocomial infections, which contribute to adverse outcomes. Deficiencies in the innate immunity lectin pathway of complement activation are implicated in a child's vulnerability to infections in conditions such as cancer, but the role during critical illness remains unclear. We hypothesized that low on-admission levels of the pathway proteins are, in part, genetically determined and associated with susceptibility to infectious complications and adverse outcomes. METHODS We studied protein levels of mannose-binding lectin (MBL), H-ficolin and M-ficolin, three MBL-associated-serine proteases (MASPs) and MBL-associated protein (MAp44), and relation with functional genetic polymorphisms, in 130 healthy children and upon intensive care unit (ICU) admission in 700 critically ill children of a randomized study on glycemic control. RESULTS Levels of MASP-1, MASP-2, MASP-3, and MAp-44 were lower and the levels of M-ficolin were higher in ICU patients on admission than those in matched healthy controls. Only a low on-admission MASP-3 level was independently associated with risk of new ICU infections and prolonged ICU stay, after correcting for other risk factors. On-admission MASP-3 varied with age, illness severity, and genetic variation. CONCLUSION Low on-admission MASP-3 levels in critically ill children were independently associated with subsequent acquisition of infection and prolonged ICU stay. The biological explanation needs further investigation.
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Affiliation(s)
- Catherine Ingels
- Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Ilse Vanhorebeek
- Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Rudi Steffensen
- Regional Centre for Blood Transfusion and Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Inge Derese
- Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Lisbeth Jensen
- Department of Biomedicine, Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark
| | - Pieter J Wouters
- Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Greet Hermans
- Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Steffen Thiel
- Department of Biomedicine, Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark
| | - Greet Van den Berghe
- Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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Cakmak BC, Calkavur S, Ozkinay F, Koroglu OA, Onay H, Itirli G, Karaca E, Yalaz M, Akisu M, Kultursay N. Association between bronchopulmonary dysplasia and MBL2 and IL1-RN polymorphisms. Pediatr Int 2012; 54:863-8. [PMID: 22882323 DOI: 10.1111/j.1442-200x.2012.03714.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 05/12/2012] [Accepted: 07/17/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The imbalance between pro-inflammatory and anti-inflammatory cytokines may play a role in the development of bronchopulmonary dysplasia (BPD) in preterm infants. Mannose binding lectin (MBL) codon 54 and interleukin 1 receptor antagonist gene (IL1-RN) polymorphisms cause genetic predisposition to increased risk of infection and inflammation, therefore may increase the risk of BPD. The aim of this study was to investigate the relationship between MBL, IL1-RN gene polymorphisms and BPD development in preterm infants. METHODS MBL codon 54 and IL1-RN polymorphisms were studied in 71 infants who were born at <32 weeks of gestation, with the diagnosis of BPD (group 1) and in a control group of preterm infants without BPD (group 2). RESULTS IL1-RN and MBL2 variant genes were closely associated with increased risk of BPD (both P < 0.001) together with significantly lower birthweight (P < 0.001 and P = 0.001, respectively), lower 5 min Apgar scores (P = 0.009 for both genes) and increased neonatal infection rate (P < 0.001 and P < 0.009, respectively). The IL1 RN 1/1 genotype was protective (odds ratio [OR], 0.075; 95% confidence interval [CI]: 0.019-0.76) while the IL1-RN 2/2 genotype increased the risk for BPD (OR, 11.7; 95%CI: 1.3-103.6). The MBL-AA genotype was protective against BPD (OR, 0.066; 95%CI: 0.02-0.2) whereas the MBL-BB genotype increased the susceptibility for the development of BPD (OR, 23.8; 95%CI: 2.8-200.6). CONCLUSION MBL and IL 1 RN polymorphisms are closely related to low birthweight and increase the risk of neonatal sepsis and BPD development in preterm infants.
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Affiliation(s)
- Bilin Cetinkaya Cakmak
- Division of Neonatology, Department of Pediatrics, Ege University Faculty of Medicine, Bornova/Izmir, Turkey
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Navratilova Z, Gallo J, Mrazek F, Lostak J, Petrek M. MBL2gene variation affecting serum MBL is associated with prosthetic joint infection in Czech patients after total joint arthroplasty. ACTA ACUST UNITED AC 2012; 80:444-51. [DOI: 10.1111/tan.12001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/25/2012] [Accepted: 08/21/2012] [Indexed: 02/01/2023]
Affiliation(s)
- Z. Navratilova
- Laboratory of Immunogenomics and Immunoproteomics, Faculty of Medicine and Dentistry; Palacky University; Olomouc; Czech Republic
| | - J. Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry and University Hospital Olomouc; Olomouc; Czech Republic
| | - F. Mrazek
- Laboratory of Immunogenomics and Immunoproteomics, Faculty of Medicine and Dentistry; Palacky University; Olomouc; Czech Republic
| | - J. Lostak
- Department of Orthopaedics, Faculty of Medicine and Dentistry and University Hospital Olomouc; Olomouc; Czech Republic
| | - M. Petrek
- Laboratory of Immunogenomics and Immunoproteomics, Faculty of Medicine and Dentistry; Palacky University; Olomouc; Czech Republic
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Sharma AA, Jen R, Butler A, Lavoie PM. The developing human preterm neonatal immune system: a case for more research in this area. Clin Immunol 2012; 145:61-8. [PMID: 22926079 DOI: 10.1016/j.clim.2012.08.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/07/2012] [Accepted: 08/08/2012] [Indexed: 12/23/2022]
Abstract
Neonates, particularly those born prematurely, are among the most vulnerable age group for morbidity and mortality due to infections. Immaturity of the innate immune system and a high need for invasive medical procedures in the context of a preterm birth make these infants highly susceptible to common neonatal pathogens. Preterm infants who survive may also suffer permanent disabilities due to organ damage resulting from either the infection itself or from the inflammatory response generated under an oxidative stress. Infections in preterm infants continue to pose important healthcare challenges. Yet, developmental maturation events in the innate immune system that underlie their excessively high vulnerability to infection remain largely understudied. In this review article, we identify pertinent knowledge gaps that must be filled in order to orient future translational research.
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Briana DD, Liosi S, Gourgiotis D, Boutsikou M, Baka S, Marmarinos A, Hassiakos D, Malamitsi-Puchner A. The potential role of the lectin pathway of complement in the host defence of full-term intrauterine growth restricted neonates at birth. J Matern Fetal Neonatal Med 2012; 25:531-4. [PMID: 22082351 DOI: 10.3109/14767058.2011.636108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To prospectively investigate the potential role of the lectin pathway of complement in intrauterine-growth-restriction (IUGR, associated with impaired immunocompetence and increased risk for neonatal infections), by determining cord blood concentrations of mannose-binding lectin (MBL), H-ficolin and L-ficolin (important mediators of neonatal innate immunity) in IUGR and appropriate for gestational age (AGA) pregnancies. Furthermore, we aimed to describe correlations among cord blood MBL, H- and L-ficolin concentrations and with several demographic parameters of the infants at birth. METHODS Serum MBL, H- and L-ficolin concentrations were determined by ELISA in 154 mixed arteriovenous cord blood samples from IUGR (n = 50) and AGA (n = 104) singleton full-term infants. RESULTS Cord blood MBL concentrations were significantly lower in IUGR cases than AGA controls (p = 0.029). No differences in cord blood H- and L-ficolin concentrations were observed between groups. In the IUGR group, cord blood MBL concentrations negatively correlated with respective L-ficolin ones (r = -0.442, p = 0.001). CONCLUSIONS The relatively decreased MBL expression in IUGR fetuses at term could possibly contribute to IUGR-associated neonatal immunodeficiency, predisposing to increased susceptibility to infections. The negative correlation between MBL and L-ficolin concentrations in the IUGR group might suggest an underlying immune variation and needs to be further investigated.
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Affiliation(s)
- Despina D Briana
- Neonatal Division, 2nd Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece
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Factors of the lectin pathway of complement activation and their clinical associations in neonates. J Biomed Biotechnol 2012; 2012:363246. [PMID: 22619494 PMCID: PMC3348535 DOI: 10.1155/2012/363246] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/12/2011] [Accepted: 12/30/2011] [Indexed: 11/18/2022] Open
Abstract
This paper summarizes the data concerning soluble defense lectins (mannan-binding lectin, M-ficolin, L-ficolin, and H-ficolin) with the unique ability to activate complement and their associated serine proteases (MASPs) in neonates. The clinical importance of deficiencies of these immune factors is presented in aspects of perinatal mortality, premature births, and low birthweight. Prenatal serum concentrations of L-ficolin, H-ficolin, and MASP-2 (and probably M-ficolin) correlate with gestational age and birthweight. The relationship of serum MBL to gestational age is controversial. The MBL2 genotypes XA/O and O/O (associated with low-serum MBL) are associated with perinatal infections, whereas the high serum MBL-conferring A/A genotypes may be associated with prematurity. Low-serum L-ficolin concentrations, but not low-serum H-ficolin concentrations, are also associated with perinatal infections. Much of the literature is inconsistent, and the relationships reported so far require independent confirmation at both gene and protein levels. Our preliminary conclusion is that these soluble defense lectins play a protective role in the neonate, and that insufficiency of such factors contributes to the adverse consequences of prematurity and low birthweight.
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Özkan H, Köksal N, Çetinkaya M, Kiliç Ş, Çelebi S, Oral B, Budak F. Serum mannose-binding lectin (MBL) gene polymorphism and low MBL levels are associated with neonatal sepsis and pneumonia. J Perinatol 2012; 32:210-7. [PMID: 21681178 DOI: 10.1038/jp.2011.79] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to determine the serum mannose-binding lectin (MBL) levels and the frequency of MBL gene polymorphisms in infants with neonatal sepsis. STUDY DESIGN Between January 2008 and January 2010, a total of 93 infants were included in this study and 53 of them had neonatal sepsis diagnosis as study group and 40 infants who had no sepsis according to clinical and laboratory findings as control group. RESULT Serum MBL levels were found to be low in 17 of 93 infants. Eleven of them were in the sepsis group and six of them were in the control group. Serum MBL levels were significantly lower in infants with sepsis compared with the control group. Frequencies of genotype AB and BB were also significantly higher in the study group compared with the control group. Most importantly, presence of B allele of MBL exon 1 gene was found to be associated with an increased risk for neonatal sepsis. Additionally, in the study group, the mean serum MBL levels were found to be significantly lower in the premature infants compared with the term infants. Pneumonia, bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH) were significantly higher in infants with MBL deficiency compared with infants with normal MBL levels. CONCLUSION Low MBL levels and presence of B allele of MBL exon 1 gene were found to be important risk factors for development of both neonatal sepsis and pneumonia, especially in premature infants. Low MBL levels and MBL gene polymorphisms might also be associated with inflammation-related neonatal morbidities such as BPD and IVH.
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Affiliation(s)
- H Özkan
- Division of Neonatology, Department of Pediatrics, Uludag University School of Medicine, Bursa, Turkey
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32
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Borghesi A, Tzialla C, Decembrino L, Manzoni P, Stronati M. New possibilities of prevention of infection in the newborn. J Matern Fetal Neonatal Med 2012; 24 Suppl 2:28-30. [PMID: 21749301 DOI: 10.3109/14767058.2011.604934] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Severe infections represent the main cause of neonatal mortality and morbidity. Strategies of proven effectiveness in reducing the incidence of infection in neonatal intensive care units (NICUs) include hand hygiene practices and prevention of central venous catheter-related bloodstream infections. In recent years, new strategies have been developed to prevent infections in NICU including prevention of neonatal sepsis with lactoferrin, the use of heparin for the prevention of CRBSIs, the judicious use of antibiotics and chemoprophylaxis, prevention of invasive fungal infections with fluconazole, the use of specific anti-staphylococcal immunoglobulins, and the early identification of infants at higher risk of infection with the use of specific markers (mannose-binding lectin). This review will focus on these new strategies and on their role in clinical practice in order to further reduce the incidence of infection in NICU.
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Affiliation(s)
- Alessandro Borghesi
- Neonatology, Neonatal Pathology and NICU, Foundation IRCCS Policlinico San Matteo, Pavia, Italy.
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McGreal EP, Hearne K, Spiller OB. Off to a slow start: under-development of the complement system in term newborns is more substantial following premature birth. Immunobiology 2011; 217:176-86. [PMID: 21868122 DOI: 10.1016/j.imbio.2011.07.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 07/24/2011] [Indexed: 01/19/2023]
Abstract
Complement represents a keystone to the innate immune system, with three activation pathways that utilise foreign microbial pattern recognition as well as activation by the host's specific antibodies. However, innate immunity is not synonymous with neonatal immunity. The complement system in healthy term (38-42 weeks gestation) newborns is under-developed and, with only a few exceptions (e.g. C7 and factor D), the circulating complement component concentrations are between 10 and 80% of adult levels. Complement activation is tightly regulated and the circulating regulator levels are also low relative to adults, sometimes at almost undetectable levels (e.g. C4b-binding protein). For premature newborns, these relative deficiencies are even more marked. Newborns are known to be more susceptible to infection, and the importance of complement, not only through its decreased ability to directly lyse bacteria with the common terminal pathway, but also its reduced ability to recruit (chemotaxis) innate and adaptive leukocytes to sites of microbial invasion and reduced ability to enhance phagocytosis (opsonisation) will be discussed. Complement also holds a key role in enhancing and directing refinement of the specific antibody response to pathogens (as an adjuvant) that likely plays a role in the well-known under-performance of the humoral immune response in newborns.
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Affiliation(s)
- Eamon P McGreal
- Cardiff University, School of Medicine, Department of Child Health, University Hospital of Wales, Heath Park, Cardiff, UK
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34
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Wahab Mohamed WA, Saeed MA. Mannose-binding lectin serum levels in neonatal sepsis and septic shock. J Matern Fetal Neonatal Med 2011; 25:411-4. [DOI: 10.3109/14767058.2011.582903] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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35
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Sallenbach S, Thiel S, Aebi C, Otth M, Bigler S, Jensenius JC, Schlapbach LJ, Ammann RA. Serum concentrations of lectin-pathway components in healthy neonates, children and adults: mannan-binding lectin (MBL), M-, L-, and H-ficolin, and MBL-associated serine protease-2 (MASP-2). Pediatr Allergy Immunol 2011; 22:424-30. [PMID: 21226765 DOI: 10.1111/j.1399-3038.2010.01104.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to measure serum concentrations of five lectin-pathway components, mannan-binding lectin (MBL), M-ficolin, L-ficolin, H-ficolin, and MBL-associated serine protease-2 (MASP-2), in healthy neonates and children, to determine if they change with age and to compare them with serum concentrations in healthy adults. Concentrations were measured in 141 preterm and 30 term neonates, in 120 children including infants and adolescents, and in 350 adults (97 for L-ficolin) by inhouse time-resolved immunofluorometric assays or commercially available enzyme-linked immunosorbent assays. The adjacent categories method applying Wilcoxon-Mann-Whitney tests was used to determine age categories where concentrations differed significantly. Displaying serum concentration vs. age, an inverted-U shape (higher concentrations in children than in neonates and adults) was found for MBL and the ficolins, and an S-shape for MASP-2. Serum concentrations of all five lectin-pathway components were significantly lower in preterm neonates <32-wk gestational age compared to older neonates, infants, and children. Only M-ficolin in children >1 yr and H-ficolin in term neonates and in children were found to be comparable with adult values. MBL, M-, L-, and H-ficolin, and MASP-2 serum concentrations show important changes with age. The respective normal ranges for adults should not be used in the pediatric population. The age-specific pediatric ranges established here may be used instead.
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Aydemir C, Onay H, Oguz SS, Ozdemir TR, Erdeve O, Ozkinay F, Dilmen U. Mannose-binding lectin codon 54 gene polymorphism in relation to risk of nosocomial invasive fungal infection in preterm neonates in the neonatal intensive care unit. J Matern Fetal Neonatal Med 2010; 24:1124-7. [PMID: 21142772 DOI: 10.3109/14767058.2010.536865] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Preterm neonates are susceptible to infection due to a combination of sub-optimal immunity and increased exposure to invasive organisms. Invasive fungal infections are associated with significant morbidity and mortality among preterm infants cared for in the neonatal intensive care unit (NICU). Mannose-binding lectin (MBL) is a component of the innate immune system, which may be especially important in the neonatal setting. The objective of this study was to investigate the presence of any association between MBL gene polymorphism and nosocomial invasive fungal infection in preterm neonates. METHODS Codon 54 (B allele) polymorphism in exon 1 of the MBL gene was investigated in 31 patients diagnosed as nosocomial invasive fungal infection and 30 control preterm neonates. RESULTS AB genotype was determined in 26% and 30% of patient and control groups, respectively, and the difference was not statistically significant. AA genotype was determined in 74% of the patient group and in 67% of the control group, and the difference was not statistically significant. B allele frequency was not different significantly in the patient group (13%) compared to the control group (18%). CONCLUSIONS In our study, no relationship was found between MBL codon 54 gene polymorphism and the risk of nosocomial invasive fungal infection in preterm neonates in NICU.
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Affiliation(s)
- Cumhur Aydemir
- Department of Neonatology, Zekai Tahir Burak Maternity Hospital, Ankara, Turkey.
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37
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Auriti C, Prencipe G, Inglese R, Azzari C, Ronchetti MP, Tozzi A, Seganti G, Orzalesi M, De Benedetti F. Role of mannose-binding lectin in nosocomial sepsis in critically ill neonates. Hum Immunol 2010; 71:1084-8. [PMID: 20732365 DOI: 10.1016/j.humimm.2010.08.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/23/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
We investigated the association of mannose-binding lectin (MBL) serum levels with nosocomial sepsis (NS), their changes overtime during infection, their relation with pathogens, with the MBL2 genotype and their relationship with mortality. In a prospective observational study, we included 365 critically ill neonates: 261 had no infection and 104 had at least 1 septic event. The median MBL serum concentration was significantly lower in infected than in noninfected neonates (p < 0.001). Low MBL levels on admission increased the risk of infection, independently from gestational age and invasive procedures. The median peak MBL level during infection was higher than the median level on admission (p < 0.001) and was correlated with it (r(2) = 0.83, p < 0.001). Moreover, MBL levels on admission were not associated with death (OR = 0.80, 95% CI = 0.56-1.14, p = 0.21). Similarly, no association was found between MBL peak levels during infection and death among infected neonates (OR = 1.10, 95% CI = 0.78-1.57, p = 0.57). In 127 neonates (42 infected) genotyped for exon-1 and -221 promoter MBL2 variants, we did not find significant difference in the frequencies of MBL2 genotypes between infected and noninfected neonates. Moreover, no association was found between MBL2 genotypes and death.
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Affiliation(s)
- Cinzia Auriti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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38
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Osthoff M, Rovó A, Stern M, Danner D, Gratwohl A, Tichelli A, Trendelenburg M. Mannose-binding lectin levels and major infections in a cohort of very long-term survivors after allogeneic stem cell transplantation. Haematologica 2010; 95:1389-96. [PMID: 20418242 DOI: 10.3324/haematol.2009.017863] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Life-threatening infections are a major cause of death after allogeneic stem cell transplantation. Complement Mannose-binding lectin is a key component of innate immunity. Functional deficiency of mannose-binding lectin due to genetic polymorphism is frequent. Previous reports showed conflicting results with respect to the influence of functional mannose-binding lectin deficiency on infectious risk after allogeneic stem cell transplantation. The aim of this study was to clarify the impact of low mannose-binding lectin levels on infectious risk in a unique cohort of very long-term survivors after stem cell transplantation. DESIGN AND METHODS Incidence of major infections was evaluable in 43 out of 44 very long-term survivors (over ten years) and studied retrospectively in relation to mannose-binding lectin serum concentrations. RESULTS Recipients with mannose-binding lectin levels below 1,000 ng/mL were at increased risk to suffer from one or more major infections (P=0.002) during entire follow up. Infectious susceptibility was increased after neutrophil recovery, particularly until 24 months (Hazard Ratio 3.4) with sustained effects afterwards (Hazard Ratio 2.9). Mannose-binding lectin serum concentrations below 1,000 ng/mL were independently associated with major infections after neutrophil recovery (P=0.009). In subgroup analyses occurrence of severe herpes virus infections in particular was associated with significantly lower mannose-binding lectin levels (P=0.02). CONCLUSIONS Our findings indicate that low mannose-binding lectin levels may predict markedly increased susceptibility to severe infections with sustained effects even late after allogeneic stem cell transplantation. Determinations of mannose-binding lectin status should therefore be included into pre-transplantation risk assessment.
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Affiliation(s)
- Michael Osthoff
- Laboratory of Clinical Immunology, Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, CH-4031 Basel, Switzerland.
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Ozdemir O, Dinleyici EC, Tekin N, Colak O, Aksit MA. Low-mannose-binding lectin levels in susceptibility to neonatal sepsis in preterm neonates with fetal inflammatory response syndrome. J Matern Fetal Neonatal Med 2010; 23:1009-13. [DOI: 10.3109/14767050903551418] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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40
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Evaluation of lectin pathway activity and mannan-binding lectin levels in the course of pregnancy complicated by diabetes type 1, based on the genetic background. Arch Immunol Ther Exp (Warsz) 2009; 57:221-8. [DOI: 10.1007/s00005-009-0029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 11/10/2008] [Indexed: 01/04/2023]
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Swierzko AS, Atkinson APM, Cedzynski M, Macdonald SL, Szala A, Domzalska-Popadiuk I, Borkowska-Klos M, Jopek A, Szczapa J, Matsushita M, Szemraj J, Turner ML, Kilpatrick DC. Two factors of the lectin pathway of complement, l-ficolin and mannan-binding lectin, and their associations with prematurity, low birthweight and infections in a large cohort of Polish neonates. Mol Immunol 2009; 46:551-8. [PMID: 18950864 DOI: 10.1016/j.molimm.2008.07.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 07/21/2008] [Accepted: 07/23/2008] [Indexed: 11/30/2022]
Abstract
Ficolins and one collectin, mannan-binding lectin (MBL), are the only factors known to activate the lectin pathway (LP) of complement. There is considerable circumstantial evidence that MBL insufficiency can increase susceptibility to various infections and influence the course of several non-infectious diseases complicated by infections. Much less information is available concerning l-ficolin. We report the results of a prospective study to investigate any association between either MBL deficiency or l-ficolin deficiency with prematurity, low birthweight or perinatal infections in a large cohort of Polish neonates, representing an ethnically homogenous population (n=1832). Cord blood samples were analysed to determine mbl-2 gene variants, MBL concentrations and MBL-MASP-2 complex activities (MBL-dependent lectin pathway activity) as well as l-ficolin levels. Median concentrations of l-ficolin and MBL were 2500 and 1124 ng/ml, respectively, while median LP activity was 272 mU/ml. After genotyping, 60.6% of babies were mbl-2 A/A, 35.4% were A/O and 4% were O/O genotypes. We found relative l-ficolin deficiency to be associated with prematurity, low birthweight and infections. l-Ficolin concentration correlated with gestational age and with birthweight, independently of gestational age. Preterm deliveries (<38 weeks) occurred more frequently among neonates with low LP activity but not with those having low serum MBL levels. Similarly, no association of serum MBL deficiency with low birthweight was found, but there was a correlation between LP activity and birthweight. Genotypes conferring very low serum MBL concentrations were associated with perinatal infections, and high-MBL-conferring genotypes were associated with prematurity. Our findings suggest that l-ficolin participates in host defence during the perinatal period and constitute the first evidence that relative l-ficolin deficiency may contribute to the adverse consequences of prematurity. Some similar trends were found with facets of MBL deficiency, but the observed relationships were weaker and less consistent.
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Affiliation(s)
- Anna St Swierzko
- Laboratory of Immunobiology of Infections, Institute of Medical Biology, Polish Academy of Sciences, Lodowa 106, 93-232 Lodz, Poland.
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Pesonen E, Hallman M, Sarna S, Andsberg E, Haataja R, Meri S, Persson K, Puolakkainen M, Ohlin H, Truedsson L. Mannose-binding lectin as a risk factor for acute coronary syndromes. Ann Med 2009; 41:591-8. [PMID: 19711212 DOI: 10.1080/07853890903110994] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mannose-binding lectin (MBL) is a multifunctional protein involved in innate immunity. We tested whether MBL and elevated viral and bacterial antibodies were risk factors for acute coronary events. DESIGN Controlled cohort study. METHODS A total of 354 patients with unstable angina pectoris (UA) or acute myocardial infarction (AMI) were compared with 334 paired controls. RESULTS Enterovirus titres were associated with increased risk of UA (odds ratio 10.04, P<0.001) and AMI (odds ratio 3.18, P=0.003), but titres did not correlate with either MBL concentration or genotype. Chlamydia pneumoniae heat shock protein 60 IgG concentrations were also associated with increased risk of UA (odds ratio 1.63, P=0.049). Compared to asymptomatic controls, patients had lower complement C3 serum concentrations (P<0.001), higher MBL serum concentration, and more frequently had MBL genotypes that determined high MBL levels (P<0.001). High MBL genotypes had odds ratios of 1.16 (P=0.010) for UA and 1.12 (P=0.007) for AMI. The elevation of MBL concentrations in the acute phase correlated with MBL concentrations after recovery (r=0.85, P<0.001). CONCLUSIONS Elevated microbial titres, indicating an on-going inflammation, were associated with cardiovascular events. MBL might have a dual role both decreasing susceptibility to infections and increasing the risk of acute coronary syndromes.
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Affiliation(s)
- Erkki Pesonen
- Department of Pediatric Cardiology, University Hospital of Lund, Sweden.
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Schlapbach LJ, Aebi C, Fisch U, Ammann RA, Otth M, Bigler S, Nelle M, Berger S, Kessler U. Higher cord blood levels of mannose-binding lectin-associated serine protease-2 in infants with necrotising enterocolitis. Pediatr Res 2008; 64:562-6. [PMID: 18596574 DOI: 10.1203/pdr.0b013e3181841335] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Necrotising enterocolitis (NEC) causes significant morbidity and mortality in premature infants. The role of innate immunity in the pathogenesis of NEC remains unclear. Mannose-binding lectin (MBL) recognizes microorganisms and activates the complement system via MBL-associated serine protease-2 (MASP-2). The aim of this study was to investigate whether MBL and MASP-2 are associated with NEC. This observational case-control study included 32 infants with radiologically confirmed NEC and 64 controls. MBL and MASP-2 were measured in cord blood using ELISA. Multivariate logistic regression was performed. Of the 32 NEC cases (median gestational age, 30.5 wk), 13 (41%) were operated and 5 (16%) died. MASP-2 cord blood concentration ranged from undetectable (<10 ng/mL) to 277 ng/mL. Eighteen of 32 (56%) NEC cases had higher MASP-2 levels (> or =30 ng/mL) compared with 22 of 64 (34%) controls (univariate OR 2.46; 95% CI 1.03-5.85; p = 0.043). Higher cord blood MASP-2 levels were significantly associated with an increased risk of NEC in multivariate analysis (OR 3.00; 95% CI 1.17-7.93; p = 0.027). MBL levels were not associated with NEC (p = 0.64). In conclusion, infants later developing NEC had significantly higher MASP-2 cord blood levels compared with controls. Higher MASP-2 may favor complement-mediated inflammation and could thereby predispose to NEC.
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Dzwonek AB, Neth OW, Thiébaut R, Gulczynska E, Chilton M, Hellwig T, Bajaj-Elliott M, Hawdon J, Klein NJ. The role of mannose-binding lectin in susceptibility to infection in preterm neonates. Pediatr Res 2008; 63:680-5. [PMID: 18317236 DOI: 10.1203/pdr.0b013e31816fdbff] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Preterm neonates are susceptible to infection due to a combination of sub-optimal immunity and increased exposure to invasive organisms. Mannose-binding lectin (MBL) is a component of the innate immune system, which may be especially important in the neonatal setting. The objective of this study was to investigate the impact of MBL on susceptibility and severity of infection in preterm neonates during their first month of life. One hundred fifty eight preterm neonates were genotyped for MBL mutations by heteroduplex analyses. Consecutive serum MBL levels were measured by ELISA and clinical and laboratory data, including blood cultures, were collected for each baby. A third of the premature neonates had genetically determined MBL deficiency. In addition, MBL levels were also low in the first week of life and lower in neonates with a wild type genotype who were less than 28 wk gestation or a birth weight of less than 1000 g, thereby increasing the number of neonates with a low MBL level at birth. MBL deficiency was associated with an increased risk of sepsis (p < 0.01). This study indicates that MBL levels are low in neonates at birth and renders premature neonates to an increased risk of infection.
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Affiliation(s)
- Agnieszka B Dzwonek
- Department of Infectious Diseases and Microbiology, University College London, WC1N 3JN, United Kingdom
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Hilgendorff A, Heidinger K, Pfeiffer A, Bohnert A, König IR, Ziegler A, Merz C, Frey G, Chakraborty T, Gortner L, Bein G. Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants. Genes Immun 2007; 8:671-7. [PMID: 17898783 DOI: 10.1038/sj.gene.6364432] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deficiency in the collectin mannose-binding lectin (MBL) increases the risk for pulmonary and systemic infections and its complications in children and adults. The aim of this prospective cohort study was to determine the genetic association of sequence variations within the MBL gene with systemic infections and pulmonary short- and long-term complications in preterm infants below 32 weeks gestational age (GA). Three single-nucleotide polymorphisms (SNPs) in the coding region and one SNP in the promotor region of MBL2 were genotyped by direct sequencing and with sequence-specific probes in 284 newborn infants <32 weeks GA. Clinical variables were comprehensively monitored. An association was found between two SNPs and the development of bronchopulmonary dysplasia (BPD), defined as persistent oxygen requirement at 36 weeks postmenstrual age, adjusting for covariates GA, grade of respiratory distress syndrome and days on mechanical ventilation (rs1800450 (exon 1 at codon 54, B variant): odds ratio dominant model (OR)=3.59, 95% confidence interval (CI)=1.62-7.98; rs7096206 (-221, X variant): OR=2.40, 95% CI=1.16-4.96). Haplotype analyses confirmed the association to BPD, and a single haplotype (frequency 56%) including all SNPs in their wild-type form showed a negative association with the development of BPD. We detected no association between the MBL gene variations and the development of early-onset infections or further pulmonary complications. Frequent variants of the MBL gene, leading to low MBL concentrations, are associated with the diagnosis of BPD in preterm infants. This provides a basis for potential therapeutic options and further genetic and proteomic analysis of the function of MBL in the resistance against pulmonary long-term complications in preterm infants.
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Affiliation(s)
- A Hilgendorff
- Department of Paediatrics, University of Giessen and Marburg, Giessen, Germany.
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Frakking FNJ, Brouwer N, van Eijkelenburg NKA, Merkus MP, Kuijpers TW, Offringa M, Dolman KM. Low mannose-binding lectin (MBL) levels in neonates with pneumonia and sepsis. Clin Exp Immunol 2007; 150:255-62. [PMID: 17711490 PMCID: PMC2219357 DOI: 10.1111/j.1365-2249.2007.03479.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We investigated whether deficiency of mannose-binding lectin (MBL), a component of innate immunity, is associated with neonatal pneumonia and sepsis during the first 72 h, i.e. early onset, and during the first month after birth. In 88 neonatal intensive care patients (71 premature), MBL2 genotype and MBL plasma levels at birth were determined prospectively by Taqman analysis and enzyme-linked immunosorbent assay, respectively. Thirty-five neonates (40%) had low, i.e. </= 0.7 microg/ml, MBL plasma levels at birth. Median (interquartile range) MBL plasma levels in 32 no early-onset sepsis (EOS) cases, 44 possible EOS cases and 11 EOS cases were 1.57 (0.57-2.67) microg/ml, 1.05 (0.41-1.70) microg/ml and 0.20 (0.10-0.77) microg/ml, respectively (P < 0.01). During the first month, 28 neonates (32%) had no infection, 49 (55%) had suspected infection, five (6%) had pneumonia and six (7%) had culture-proven sepsis. Low MBL levels at birth were associated both with an increased risk of developing pneumonia (OR: 12.0; 95% CI: 1.1-126.1; P = 0.04) and culture-proven sepsis (OR: 15.0; 95% CI: 1.5-151.3; P = 0.02). These results were confirmed by genetic analysis of MBL deficiency. Low MBL levels at birth are associated with an increased risk of early-onset sepsis, culture-proven sepsis and pneumonia during the first month of life.
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Affiliation(s)
- F N J Frakking
- Departments of Clinical Immunology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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