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Fan X, Li X, Yu T, Jiao R, Song W, Su A, Li M, Guo Q. Evaluation of alanine aminotransferase/aspartate aminotransferase ratio and high-density lipoprotein for predicting neonatal adverse outcomes associated with intrahepatic cholestasis of pregnancy. PeerJ 2024; 12:e17613. [PMID: 38938614 PMCID: PMC11210484 DOI: 10.7717/peerj.17613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Abstract
Background To determine the association between lipid metabolism and intrahepatic cholestasis of pregnancy (ICP), and explore the value of maternal alanine aminotransferase/aspartate aminotransferase (ALT/AST) and high-density lipoprotein (HDL) in predicting adverse neonatal outcomes in women with ICP. Methods A total of 147 pregnant women with ICP admitted to The Fourth Hospital of Shijiazhuang and 120 normal pregnant women in the same period were selected in this study. The Mann-Whitney U test and Chi-square tests were used to compare the differences in clinical data. Multivariate logistic regression was used to analyze the relationship between ALT/AST and the occurrence of adverse pregnancy outcomes in patients with ICP. The combined predictive value of ALT/AST and HDL was determined by receiver operating characteristic (ROC) curve analysis. Results Among 147 women with ICP, 122 women had total bile acid (TBA) levels of 10-39.9 µmol/L, and 25 had TBA ≥ 40 µmol/L. There was significantly lower gestational age in patients with severe ICP than in those with mild and control groups (all p < 0.05), and the weight of newborns in the maternal ICP group was significantly lower than in the control group (p < 0.05). Increasing TBA levels was associated with higher AST, ALT, ALT/AST, and lower HDL level (all p < 0.05). Meanwhile, higher levels of ALT/AST was positively associated with neonatal hyperbilirubinemia [adjusted odds ratio (AOR) = 4.019, 95% CI [1.757-9.194, p = 0.001] and cardiac injury [AOR = 3.500, 95% CI [1.535-7.987], p = 0.003]. HDL was a significant protective factor for neonatal hyperbilirubinemia and cardiac injury [AOR = 0.315, 95% CI [0.126-0.788], p = 0.014; AOR = 0.134 (0.039-0.461), p = 0.001]. The area under the ROC curve (AUC) for prediction of neonatal hyperbilirubinemia by ALT/AST combined with HDL was 0.668 [95% CI [56.3-77.3%], p = 0.002], and the sensitivity and specificity were 47.1% and 84.0%, respectively. To predict neonatal cardiac injury, the AUC value was 0.668 [95% CI [56.4-77.1%], p = 0.002], with sensitivity and specificity were 41.2% and 87.1%, respectively. Conclusions The levels of higher ALT/AST and lower HDL were significantly associated with the risk of ICP-related adverse neonatal outcomes. Moreover, ALT/AST combined with HDL has moderate clinical value in predicting the adverse outcomes of neonatal hyperbilirubinemia and cardiac injury.
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Affiliation(s)
- Xizhenzi Fan
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xia Li
- Department of Scientific Research and Education, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Tianxiao Yu
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Ruifen Jiao
- Department of Obstetrics, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Wenhui Song
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Achou Su
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Mingwei Li
- Research Center for Clinical Medical Sciences, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Qing Guo
- Department of Obstetrics, Hebei Key Laboratory of Maternal and Fetal Medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Shijiazhuang, China
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Elmazzahy EA, El Din ZE, Nessem MA, El Tatawy S. Neurodevelopmental outcome at 6 months of age of full-term neonates with hyperbilirubinemia necessitating exchange transfusion. Early Hum Dev 2024; 190:105969. [PMID: 38341995 DOI: 10.1016/j.earlhumdev.2024.105969] [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: 11/08/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Bilirubin neurotoxicity involves a spectrum of varying severity that could result in adverse long-term sequelae. AIMS To compare the neurodevelopmental outcome of full-term neonates who underwent exchange transfusion with those who did not. STUDY DESIGN A retrospective cohort study. SUBJECTS This study included a retrospective review of records of sixty neonates who were matched in admission ages and serum bilirubin levels and the comparison groups were those who received an exchange transfusion (n = 30) versus those where exchange transfusion was planned, but the bilirubin levels dropped sufficiently during the period where the exchange blood was being prepared (n = 30). History, clinical examination, and laboratory investigations were documented. OUTCOME MEASURES Neurodevelopmental outcome, at 6 months of age, using Bayley scales of infant development was assessed. RESULTS The exchange group had statistically significant lower cognitive scores (p-value 0.005). The higher the rate of bilirubin decline, the better the language and motor scores in the phototherapy group (p-values 0.020 and 0.024 respectively). Infants with longer duration to exchange transfusion had lower cognitive, language, and motor scores (p-values 0.01, 0.001, and 0.003 respectively). CONCLUSIONS Slower rates of bilirubin decline and longer duration before intervention increase the chances of adverse neurodevelopmental outcomes.
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Affiliation(s)
| | - Zahraa Ezz El Din
- Department of Pediatrics, Cairo University Children's Hospital, Cairo, Egypt
| | - Marina Atef Nessem
- Department of Pediatrics, Cairo University Children's Hospital, Cairo, Egypt
| | - Sarah El Tatawy
- Department of Pediatrics, Cairo University Children's Hospital, Cairo, Egypt
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Fan X, Rong H, Wang Y, Li M, Song W, Su A, Yu T. The correlation between serum total bile acid and alanine aminotransferase of pregnant women and the disorders of neonatal hyperbilirubinemia-related amino acid metabolism. BMC Pregnancy Childbirth 2024; 24:26. [PMID: 38172739 PMCID: PMC10763467 DOI: 10.1186/s12884-023-06226-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To explore the association between liver metabolism-related indicators in maternal serum and neonatal hyperbilirubinemia (NHB), and further investigate the predictive value of these indicators in NHB-related amino acid metabolism disorders. METHODS 51 NHB and 182 No-NHB newborns and their mothers who treated in the Fourth Hospital of Shijiazhuang from 2018 to 2022 were participated in the study. The differences in clinical data were compared by the Mann-Whitney U test and Chi-square test. Multivariate logistic regression was used to analyze the relationship between maternal serum indicators and the occurrence of NHB. The correlation analysis and risk factor assessment of maternal serum indicators with NHB-related amino acid metabolic disorders were performed using Spearman correlation analysis and multivariate logistic regression. RESULTS Compared to the non NHB group, the NHB group had higher maternal serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), ALT/AST, and total bile acid (TBA), while lower levels of serum albumin (ALB), total cholesterol (TC) and high-density lipoprotein (HDL). The levels of alanine (ALA), valine (VAL), ornithine (ORN), and proline (PRO) in the newborns were reduced in NHB group, while arginine (ARG) showed a tendency to be elevated. Multiple logistic regression analysis showed that maternal ALT, AST, ALT/AST, and TBA levels were all at higher risk with the development of NHB, whereas ALB, TC, and HDL levels were negatively associated with NHB development. Increasing maternal TBA level was associated with lower ALA (r=-0.167, p = 0.011), VAL (r=-0.214, p = 0.001), ORN (r=-0.196, p = 0.003), and PRO in the newborns (r=-0.131, p = 0.045). Maternal ALT level was negatively associated with ALA (r=-0.135, p = 0.039), VAL (r=-0.177, p = 0.007), ORN (r=-0.257, p < 0.001), while ALT/AST was positively correlated with ARG (r = 0.133, p = 0.013). After adjustment for confounding factors, maternal serum TBA and ALT were the independent risk factor for neonatal ORN metabolic disorders [(adjusted odds ratio (AOR) = 0.379, 95%CI = 0.188-0.762, p = 0.006), (AOR = 0.441, 95%CI = 0.211-0.922, p = 0.030)]. Maternal ALT level was an independent risk factor for neonatal VAL metabolic disorders (AOR = 0.454, 95%CI = 0.218-0.949, p = 0.036). CONCLUSIONS The levels of high TBA, ALT, AST, and low HDL, TC of maternal were associated with the risk of NHB. Maternal TBA and ALT levels were independent risk factors for NHB-related amino acid disturbances which have value as predictive makers.
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Affiliation(s)
- Xizhenzi Fan
- Research center for clinical medical sciences, Hebei key laboratory of maternal and fetal medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Huijuan Rong
- Department of Nursing, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Yingying Wang
- Department of Functional Region of Diagnosis, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Mingwei Li
- Research center for clinical medical sciences, Hebei key laboratory of maternal and fetal medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Wenhui Song
- Research center for clinical medical sciences, Hebei key laboratory of maternal and fetal medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Achou Su
- Research center for clinical medical sciences, Hebei key laboratory of maternal and fetal medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Tianxiao Yu
- Research center for clinical medical sciences, Hebei key laboratory of maternal and fetal medicine, The Fourth Hospital of Shijiazhuang, Shijiazhuang, 050000, China.
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Li Z, Ru S, Li J, Yang Y, Wang W. Continuous exposure to bisphenol S increases the accumulation of endogenous metabolic toxicants by obstructing the glucuronic acid pathway. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 336:122433. [PMID: 37659633 DOI: 10.1016/j.envpol.2023.122433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023]
Abstract
Uridine diphosphate glucuronic acid (UDPGA) is an essential substrate in the glucuronidation of exogenous and endogenous lipophilic compounds via the liver glucuronic acid pathway, and its synthesis depends on glucose and energy in the body. Bisphenol S (BPS), as a lipophilic environmental pollutant, has been widely utilized in the manufacturing of daily necessities. The biological effect of BPS in interference with liver energy metabolism might affect UDPGA synthesis and the excretion of lipophilic compounds, but this was not clearly revealed. Here, female zebrafish that were exposed to BPS for 35 days exhibited a significant decrease in UDPGA in the liver with significant accumulation of exogenous BPS and endogenous bilirubin in the body. One vital reason may be that the exposure to BPS for 35 days promoted the lipid formation through PPARg signaling and reduced energy levels in the liver, resulting in the decreased raw materials for UDPGA production in glucuronic acid pathway. Meanwhile, transcriptome analysis showed that BPS inhibited the mRNA expression levels of genes related to the glucuronic acid pathway. The accumulation of endogenous and exogenous lipophilic compounds can trigger a variety of toxicological effect. Thus, weakened liver detoxification might be the primary cause of the toxicological effects of lipophilic pollutants.
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Affiliation(s)
- Ze Li
- College of Marine Life Sciences, Ocean University of China, Qingdao, 266003, China
| | - Shaoguo Ru
- College of Marine Life Sciences, Ocean University of China, Qingdao, 266003, China
| | - Jiali Li
- College of Marine Life Sciences, Ocean University of China, Qingdao, 266003, China
| | - Yunjia Yang
- Beijing Key Laboratory of Diagnostic and Traceability Technologies for Food Poisoning, Beijing Center for Disease Prevention and Control, Beijing, 100013, China
| | - Weiwei Wang
- College of Marine Life Sciences, Ocean University of China, Qingdao, 266003, China.
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Sun S, Yu S, Yu H, Yao G, Guo X, Zhao F, Li J, Wang P. The pyroptosis mechanism of ototoxicity caused by unconjugated bilirubin in neonatal hyperbilirubinemia. Biomed Pharmacother 2023; 165:115162. [PMID: 37467648 DOI: 10.1016/j.biopha.2023.115162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
When activated by unconjugated bilirubin (UCB), inflammatory mediators such as IL - 18 and TNF contribute to the neurotoxicity and ototoxicity observed in severe neonatal hyperbilirubinemia. However, in cell and molecular level, the regulation and mechanism of UCB-induced ototoxicity are remained unclear. In this study, 7-day-old mammary rats were exposed to various concentrations of UCB to imitate the infant auditory damage. The auditory brainstem response result (ABR) indicated severe hearing loss, which occurred with increasing concentration. Morphological analysis of organotypic cochlear cultures treated with different concentrations of UCB indicated that auditory nerve fibers (ANF) were demyelinated and the density of spiral ganglion neurons (SGN) were decreased. In addition, HEI-OC1 cells treated with different concentrations of UCB showed severe necrosis by Flow Cytometry. The morphologic feature of pyroptosis has been observed by scanning electronic microscope. Cleaved Caspase-1, GSDMD and NLRP3 expression were significantly increased in cochlear explants with UCB-induced. To further clarify the molecular mechanism of UCB-induced inner ear cell pyroptosis, specific inhibitors of pyroptosis were applied, the protein associated with pyrotosis such as Cleaved Caspase-1, GSDMD, ASC, IL-18 and NLRP3 were significantly lower than the group with UCB alone. All the data above indicated that ERK /NLRP3/GSDMD signaling pathway involved in UCB-induced ototoxicity.
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Affiliation(s)
- Shihan Sun
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China; Bethune First Clinical Medical College, Jilin University, Changchun, Jilin, China
| | - Shuyuan Yu
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China
| | - Hong Yu
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China
| | - Gang Yao
- Department of Neurology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xinyi Guo
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China
| | - Fengyang Zhao
- Bethune First Clinical Medical College, Jilin University, Changchun, Jilin, China
| | - Jiannan Li
- Bethune First Clinical Medical College, Jilin University, Changchun, Jilin, China
| | - Ping Wang
- Department of Otolaryngology-Head and Neck Surgery, First Hospital of Jilin University, Changchun 130021, China.
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Wei F, Qi F, Li Y, Dou W, Zeng T, Wang J, Yao Z, Zhang L, Tang Z. Amino-rich nanofiber membrane with favorable hemocompatibility for highly efficient removal of bilirubin from plasma. Sep Purif Technol 2023. [DOI: 10.1016/j.seppur.2023.123648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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Woo S, Nah S, Kim M, Kim S, Lee D, Lee J, Moon J, Han S. Factors Associated with Neuroimaging Abnormalities in Children with Afebrile Seizure: A Retrospective Multicenter Study. West J Emerg Med 2023; 24:279-286. [PMID: 36976593 PMCID: PMC10047732 DOI: 10.5811/westjem.2022.12.57505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/15/2022] [Indexed: 03/22/2023] Open
Abstract
Introduction: Neuroimaging is recommended for patients with seizures to identify intracranial pathology. However, emergency physicians should consider the risks and benefits of neuroimaging in pediatric patients because of their need for sedation and greater sensitivity to radiation than adults. The purpose of this study was to identify associated factors of neuroimaging abnormalities in pediatric patients experiencing their first afebrile seizure.
Methods: This was a retrospective, multicenter study that included children who presented to the emergency departments (ED) of three hospitals due to afebrile seizures between January 2018– December 2020. We excluded children with a history of seizure or acute trauma and those with incomplete medical records. A single protocol was followed in the three EDs for all pediatric patients experiencing their first afebrile seizure. We performed multivariable logistic regression analysis to identify factors associated with neuroimaging abnormalities.
Results: In total, 323 pediatric patients fulfilled the study criteria, and neuroimaging abnormalities were observed in 95 patients (29.4%). Multivariable logistic regression analysis showed that Todd’s paralysis (odds ratio [OR] 3.72, 95% confidence interval [CI] 1.03-13.36; P=0.04), absence of poor oral intake (POI) (OR 0.21, 95% CI 0.05-0.98; P=0.05), lactic acidosis (OR 1.16, 95% CI 1.04- 1.30; P=0.01), and higher level of bilirubin (OR 3.33, 95% CI 1.11-9.95; P=0.03) were significantly associated with neuroimaging abnormalities. Based on these results, we constructed a nomogram to predict the probability of brain imaging abnormalities.
Conclusion: Todd’s paralysis, absence of POI, and higher levels of lactic acid and bilirubin were associated factors of neuroimaging abnormalities in pediatric patients with afebrile seizure.
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Affiliation(s)
- Seungho Woo
- Soonchunhyang University Bucheon Hospital, Department of Emergency Medicine, Bucheon, Republic of Korea
| | - Sangun Nah
- Soonchunhyang University Bucheon Hospital, Department of Emergency Medicine, Bucheon, Republic of Korea
| | - Minsol Kim
- Soonchunhyang University Bucheon Hospital, Department of Pediatrics, Bucheon, Republic of Korea
| | - Sangil Kim
- Soonchunhyang University Seoul Hospital, Department of Emergency Medicine, Seoul, Republic of Korea
| | - Dongwook Lee
- Soonchunhyang University Cheonan Hospital, Department of Emergency Medicine, Cheonan, Republic of Korea
| | - Jaewook Lee
- Soonchunhyang University Bucheon Hospital, Department of Radiology, Bucheon, Republic of Korea
| | - Jieun Moon
- Soonchunhyang University Bucheon Hospital, Clinical Trial Center, Department of Biostatistics, Bucheon, Republic of Korea
| | - Sangsoo Han
- Soonchunhyang University Bucheon Hospital, Department of Emergency Medicine, Bucheon, Republic of Korea
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Anusuyadevi K, Velmathi S. Expeditious fluorimetric detection of bilirubin by simple imidazole derived luminophore and it's pragmatic applicability in spiked biological fluids. Anal Chim Acta 2023; 1239:340678. [PMID: 36628705 DOI: 10.1016/j.aca.2022.340678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/19/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Bilirubin is an indispensable biomarker for liver diseases. Utilizing organic molecules as sensor platform for effective detection of bilirubin are little. In addition, the reported fluorophores required longer incubation time for detection. Hence, herein we have attempted to design an imidazole derivative 4-(3H-imidazo[4,5-b]pyridin-2-yl)-N,N-diphenylaniline (IMI) from triphenylamine and pyridine units which could detect bilirubin swiftly without any incubation period. IMI manifested an instant quenching of emission in presence of bilirubin with limit of detection (LOD) 11.74 × 10-6 mol L-1. The mechanistic aspect of detection involves coexistence of both static and dynamic quenching which was suitably justified. Finally, the pragmatic application of IMI was performed in bio-fluids.
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Affiliation(s)
- Kathiresan Anusuyadevi
- Organic and Polymer Synthesis Laboratory, Department of Chemistry, National Institute of Technology, Tiruchirappalli, 620 015, India
| | - Sivan Velmathi
- Organic and Polymer Synthesis Laboratory, Department of Chemistry, National Institute of Technology, Tiruchirappalli, 620 015, India.
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Chen LW, Zhang Y, Xu DD, Wang Y, Gao H. Causal relationships of neonatal jaundice, direct bilirubin and indirect bilirubin with autism spectrum disorder: A two-sample Mendelian randomization analysis. Front Public Health 2023; 11:1137383. [PMID: 37124814 PMCID: PMC10133461 DOI: 10.3389/fpubh.2023.1137383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background Multiple systematic reviews and meta-analyses have examined the association between neonatal jaundice and autism spectrum disorder (ASD) risk, but their results have been inconsistent. This may be because the included observational studies could not adjust for all potential confounders. Mendelian randomization study can overcome this drawback and explore the causal relationship between the both. Methods We used the data of neonatal jaundice, direct bilirubin (DBIL), indirect bilirubin (IBIL), and ASD collected by genome-wide association study (GWAS) to evaluate the effects of neonatal jaundice, DBIL and IBIL on ASD by using a two-sample Mendelian randomized (MR). The inverse variance-weighted method (IVW) was the main method of MR analysis in this study. Weighted median method, MR-Egger regression and mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analysis. Results There was no evidence of an effect of neonatal jaundice (OR, 1.002, 95% CI, 0.977-1.027), DBIL (OR, 0.970, 95% CI, 0.884-1.064) and IBIL (OR, 1.074, 95% CI, 0.882-1.308) on ASD risk by IVW test. In the weighted median method, MR-Egger regression and leave-one-out analysis, the results were robust and no heterogeneity or pleiotropy was observed. Conclusions We found that neonatal jaundice, DBIL and IBIL were not associated with ASD in this study. However, this paper did not explore the effect of severity and duration of jaundice on ASD in different ethnic populations, which may require further research.
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Affiliation(s)
- Li-wen Chen
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yi Zhang
- Key Laboratory of Population Health Across Life Cycle, Ministry of Education of the People's Republic of China, Anhui Medical University, Hefei, Anhui, China
| | - Dou-dou Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yang Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- *Correspondence: Yang Wang
| | - Hui Gao
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Ministry of Education Key Laboratory for Full Life Cycle Population Health, Anhui Medical University, Hefei, Anhui, China
- Hui Gao
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Anzar N, Suleman S, Kumar R, Rawal R, Pundir CS, Pilloton R, Narang J. Electrochemical Sensor for Bilirubin Detection Using Paper-Based Screen-Printed Electrodes Functionalized with Silver Nanoparticles. MICROMACHINES 2022; 13:mi13111845. [PMID: 36363867 PMCID: PMC9693322 DOI: 10.3390/mi13111845] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/02/2023]
Abstract
A notable diagnostic for the detection of hemolytic diseases is bilirubin, a by-product of haemoglobin breakdown. The concentration of bilirubin ranges from 0.3 to 1.9 mg in 100 mL of blood. Low blood bilirubin levels are associated with a greater risk of coronary heart disease and anaemia. Hyperbilirubinemia results from a serum bilirubin level of more than 2.5 mg/100 mL. Therefore, it is very crucial to check the serum bilirubin level. Analytical equipment for point-of-care testing must be portable, small, and affordable. A unique method is used to detect bilirubin selectively using paper-based screen-printed carbon electrodes that were covalently linked with nanoparticles, that serves as a key biomarker for jaundice. In order to create an electrochemical biosensor, bilirubin oxidase was immobilised on electrodes modified with AgNPs. The morphology of Ag nanoparticles in terms of size and shape was determined using both UV- Vis Spectroscopy and transmission electron microscopy (TEM). The biosensor's analytical response was assessed using potentiostat (Cyclic voltammetry (CV) and linear sweep voltammetry (LSV)). The developed paper-based sensor provided optimum feedback and a broad linear range of 1 to 9 µg/mL for bilirubin, with a lower LOD of 1 µg/mL. Through tests of bilirubin in artificial blood serum, the viability is confirmed. The method that is being used makes it possible to create and use an inexpensive, miniature electrochemical sensor.
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Affiliation(s)
- Nigar Anzar
- Department of Biotechnology, Jamia Hamdard University, New Delhi 110062, India
| | - Shariq Suleman
- Department of Biotechnology, Jamia Hamdard University, New Delhi 110062, India
| | - Rocky Kumar
- Department of Biotechnology, Jamia Hamdard University, New Delhi 110062, India
| | - Rachna Rawal
- Department of Physics and Astrophysics, University of Delhi, Delhi 110007, India
| | | | - Roberto Pilloton
- Institute of Crystallography of National Research council (IC-CNR), Monterotondo, I-00015 Rome, Italy
| | - Jagriti Narang
- Department of Biotechnology, Jamia Hamdard University, New Delhi 110062, India
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Models of bilirubin neurological damage: lessons learned and new challenges. Pediatr Res 2022:10.1038/s41390-022-02351-x. [PMID: 36302856 DOI: 10.1038/s41390-022-02351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Jaundice (icterus) is the visible manifestation of the accumulation of bilirubin in the tissue and is indicative of potential toxicity to the brain. Since its very first description more than 2000 years ago, many efforts have been undertaken to understand the molecular determinants of bilirubin toxicity to neuronal cells to reduce the risk of neurological sequelae through the use of available chemicals and in vitro, ex vivo, in vivo, and clinical models. Although several studies have been performed, important questions remain unanswered, such as the reasons for regional sensitivity and the interplay with brain development. The number of new molecular effects identified has increased further, which has added even more complexity to the understanding of the condition. As new research challenges emerged, so does the need to establish solid models of prematurity. METHODS This review critically summarizes the key mechanisms of severe neonatal hyperbilirubinemia and the use of the available models and technologies for translational research. IMPACT We critically review the conceptual dogmas and models used for studying bilirubin-induced neurotoxicity. We point out the pitfalls and translational gaps, and suggest new clinical research challenges. We hope to inform researchers on the pro and cons of the models used, and to help direct their experimental focus in a most translational research.
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12
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Ultrasensitive electrochemical sensor based on molecular imprinted polymer and ferromagnetic nanocomposite for bilirubin analysis in the saliva and serum of newborns. Microchem J 2022. [DOI: 10.1016/j.microc.2022.107474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gao C, Zhang Q, Yang Y, Li Y, Lin W. Recent trends in therapeutic application of engineered blood purification materials for kidney disease. Biomater Res 2022; 26:5. [PMID: 35120554 PMCID: PMC8815201 DOI: 10.1186/s40824-022-00250-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022] Open
Abstract
Blood purification is a commonly used method to remove excess metabolic waste in the blood in renal replacement therapy. The sufficient removal of these toxins from blood can reduce complications and improve survival lifetime in dialysis patients. However, the current biological blood purification materials in clinical practice are not ideal, where there is an unmet need for producing novel materials that have better biocompatibility, reduced toxicity, and, in particular, more efficient toxin clearance rates and a lower cost of production. Given this, this review has carefully summarized newly developed engineered different structural biomedical materials for blood purification in terms of types and structure characteristics of blood purification materials, the production process, as well as interfacial chemical adsorption properties or mechanisms. This study may provide a valuable reference for fabricating a user-friendly purification device that is more suitable for clinical blood purification applications in dialysis patients.
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Affiliation(s)
- Cui Gao
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Qian Zhang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Yi Yang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
- Department of Nephology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
- International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
| | - Yangyang Li
- Key Laboratory of Women's Reproductive Health Research of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
- Cancer Center, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Weiqiang Lin
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
- International Institutes of Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
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14
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Yang FC, Vivian JL, Traxler C, Shapiro SM, Stanford JA. MGE-Like Neural Progenitor Cell Survival and Expression of Parvalbumin and Proenkephalin in a Jaundiced Rat Model of Kernicterus. Cell Transplant 2022; 31:9636897221101116. [PMID: 35596532 PMCID: PMC9125107 DOI: 10.1177/09636897221101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 02/27/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022] Open
Abstract
Kernicterus is a permanent condition caused by brain damage from bilirubin toxicity. Dystonia is one of the most debilitating symptoms of kernicterus and results from damage to the globus pallidus (GP). One potential therapeutic strategy to treat dystonia in kernicterus is to replace lost GP neurons and restore basal ganglia circuits through stem cell transplantation. Toward this end, we differentiated human embryonic stem cells (hESCs) into medial ganglion eminence (MGE; the embryological origin of most of the GP neurons)-like neural precursor cells (NPCs). We determined neurochemical phenotype in cell culture and after transplanting into the GP of jaundiced Gunn rats. We also determined grafted cell survival as well as migration, distribution, and morphology after transplantation. As in the GP, most cultured MGE-like NPCs expressed γ-aminobutyric acid (GABA), with some co-expressing markers for parvalbumin (PV) and others expressing markers for pro-enkephalin (PENK). MGE-like NPCs survived in brains at least 7 weeks after transplantation, with most aggregating near the injection site. Grafted cells expressed GABA and PV or PENK as in the normal GP. Although survival was low and the maturity of grafted cells varied, many cells produced neurite outgrowth. While promising, our results suggest the need to further optimize the differentiation protocol for MGE-like NPC for potential use in treating dystonia in kernicterus.
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Affiliation(s)
- Fu-Chen Yang
- Department of Molecular and Integrative Physiology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Jay L. Vivian
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Catherine Traxler
- Department of Molecular and Integrative Physiology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Steven M. Shapiro
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - John A. Stanford
- Department of Molecular and Integrative Physiology, The University of Kansas Medical Center, Kansas City, KS, USA
- Kansas Intellectual and Developmental Disabilities Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
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15
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Lahmann JM, Faase RA, Leu HY, Jacques SL, Scottoline B, Schilke KF, Baio JE, Higgins AZ. Microfluidic photoreactor to treat neonatal jaundice. BIOMICROFLUIDICS 2021; 15:064104. [PMID: 34853627 PMCID: PMC8616629 DOI: 10.1063/5.0066073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
While in most cases, jaundice can be effectively treated using phototherapy, severe cases require exchange transfusion, a relatively risky procedure in which the neonate's bilirubin-rich blood is replaced with donor blood. Here, we examine extracorporeal blood treatment in a microfluidic photoreactor as an alternative to exchange transfusion. This new treatment approach relies on the same principle as phototherapy but leverages microfluidics to speed up bilirubin removal. Our results demonstrate that high-intensity light at 470 nm can be used to rapidly reduce bilirubin levels without causing appreciable damage to DNA in blood cells. Light at 470 nm was more effective than light at 505 nm. Studies in Gunn rats show that photoreactor treatment for 4 h significantly reduces bilirubin levels, similar to the bilirubin reduction observed for exchange transfusion and on a similar time scale. Predictions for human neonates demonstrate that this new treatment approach is expected to exceed the performance of exchange transfusion using a low blood flow rate and priming volume, which will facilitate vascular access and improve safety.
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Affiliation(s)
- John M. Lahmann
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Ryan A. Faase
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Hsuan Yu Leu
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Steven L. Jacques
- Department of Bioengineering, University of Washington, Seattle, Washington 98105, USA
| | - Brian Scottoline
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Kate F. Schilke
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Joe E. Baio
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Adam Z. Higgins
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
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16
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Kujabi ML, Petersen JP, Pedersen MV, Parner ET, Henriksen TB. Neonatal jaundice and autism spectrum disorder: a systematic review and meta-analysis. Pediatr Res 2021; 90:934-949. [PMID: 33526883 DOI: 10.1038/s41390-020-01272-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Two meta-analyses concluded that jaundice was associated with an increased risk of autism. We hypothesize that these findings were due to methodological limitations of the studies included. Neonatal jaundice affects many infants and risks of later morbidity may prompt physicians towards more aggressive treatment. METHODS To conduct a systematic literature review and a meta-analysis of the association between neonatal jaundice and autism with particular attention given to low risk of bias studies. Pubmed, Scopus, Embase, Cochrane, and Google Scholar were searched for publications until February 2019. Data was extracted by use of pre-piloted structured sheets. Low risk of bias studies were identified through predefined criteria. RESULTS A total of 32 studies met the inclusion criteria. The meta-analysis of six low risk of bias studies showed no association between neonatal jaundice and autism; cohort studies risk ratio 1.09, 95% CI, 0.99-1.20, case-control studies odds ratio 1.29 95% CI 0.95, 1.76. Funnel plot of all studies suggested a high risk of publication bias. CONCLUSIONS We found a high risk of publication bias, selection bias, and potential confounding in all studies. Based on the low risk of bias studies there was no convincing evidence to support an association between neonatal jaundice and autism. IMPACT Meta-analysis of data from six low risk of bias studies indicated no association between neonatal jaundice and autism spectrum disorder. Previous studies show inconsistent results, which may be explained by unadjusted confounding and selection bias. Funnel plot suggested high risk of publication bias when including all studies. There is no evidence to suggest jaundice should be treated more aggressively to prevent autism.
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Affiliation(s)
- Monica L Kujabi
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Jesper P Petersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Mette V Pedersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Erik T Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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17
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Fluorescent sensing of free bilirubin at nanomolar level using a Langmuir-Blodgett film of glucuronic acid-functionalized gold nanoclusters. Anal Bioanal Chem 2021; 413:7009-7019. [PMID: 34535815 DOI: 10.1007/s00216-021-03660-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/21/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Serum bilirubin is an important indicator to assess liver function and diagnose various types of liver diseases. The level of serum bilirubin is also negatively correlated with the risk of cardiovascular disease and cancer. We had fabricated a fluorescent film sensor aiming at free bilirubin detection at the nanomolar level. Gold nanoclusters capped by human serum albumin (HSA-AuNCs) were utilized as a fluorescent platform for bilirubin biorecognition. HSA-AuNCs were functionalized with glucuronic acid to increase the binding sites for bilirubin. An ultrathin film of glucuronic acid-functionalized gold nanoclusters was obtained by the Langmuir-Blodgett (LB) technique. When exposed to bilirubin, the interaction between free bilirubin and the functionalized AuNCs resulted in fluorescent quenching of the film. Good linearity could be achieved for the quenching efficiency versus the logarithm of free bilirubin concentration over a concentration range of 1.00 nM~5.00 μM. The limit of detection (LOD) was calculated to be (2.70 ± 0.14) × 10-1 nM (S/N = 3). The film sensor presents a good anti-interference capability towards common substances coexisting with bilirubin in serum. Satisfactory results achieved in the tests of real serum samples indicate that the LB film sensor can be used for bilirubin determination in nanomolar concentration.
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18
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Zheng H, Lin J, Lin Q, Zheng W. Magnetic Resonance Image of Neonatal Acute Bilirubin Encephalopathy: A Diffusion Kurtosis Imaging Study. Front Neurol 2021; 12:645534. [PMID: 34512498 PMCID: PMC8425508 DOI: 10.3389/fneur.2021.645534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/16/2021] [Indexed: 01/31/2023] Open
Abstract
Background and Objective: The abnormal T1-weighted imaging of MRI can be used to characterize neonatal acute bilirubin encephalopathy (ABE) in newborns, but has limited use in evaluating the severity and prognosis of ABE. This study aims to assess the value of diffusion kurtosis imaging (DKI) in detecting ABE and understanding its pathogenesis. Method: Seventy-six newborns with hyperbilirubinemia were grouped into three groups (mild group, moderate group, and severe group) based on serum bilirubin levels. All the patients underwent conventional MRI and DKI serial, as well as 40 healthy full-term infants (control group). The regions of interest (ROIs) were the bilateral globus pallidus, dorsal thalamus, frontal lobe, auditory radiation, superior temporal gyrus, substantia nigra, hippocampus, putamen, and inferior olivary nucleus. The values of mean diffusivity (MD), axial kurtosis (AK), radial kurtosis (RK), and mean kurtosis (MK), and fractional anisotropy (FA), radial diffusivity (RD), and axis diffusivity (AD) of the ROIs were evaluated. All newborns were followed up and evaluated using the Denver Development Screening Test (DDST). According to the follow-up results, the patients were divided into the normal group, the suspicious abnormal group, and the abnormal group. Result: Compared with the control group, significant differences were observed with the increased MK of dorsal thalamus, AD of globus pallidus in the moderate group, and increased RD, MK, AK, and RK value of globus pallidus, dorsal thalamus, auditory radiation, superior temporal gyrus, and hippocampus in the severe group. The peak value of total serum bilirubin was moderately correlated with the MK of globus pallidus, dorsal thalamus, and auditory radiation and was positively correlated with the other kurtosis value. Out of 76 patients, 40 finished the DDST, and only 9 patients showed an abnormality. Compared with the normal group, the AK value of inferior olivary nucleus showed significant differences (p < 0.05) in the suspicious abnormal group, and the MK of globus pallidus, temporal gyrus, and auditory radiation; RK of globus pallidus, dorsal thalamus, and auditory radiation; and MD of globus pallidus showed significant differences (p < 0.05) in the abnormal group. Conclusion: DKI can reflect the subtle structural changes of neonatal ABE, and MK is a sensitive indicator to indicate the severity of brain damage.
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Affiliation(s)
- Hongyi Zheng
- Department of Radiology, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Jiefen Lin
- Department of Radiology, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Qihuan Lin
- Department of Radiology, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Wenbin Zheng
- Department of Radiology, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
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19
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Culhaoglu B, Erbek SS, İnce DA, Ecevit AN, Erbek S. Medial olivary complex reflex in term newborns with hyperbilirubinemia. Int J Pediatr Otorhinolaryngol 2021; 147:110777. [PMID: 34116320 DOI: 10.1016/j.ijporl.2021.110777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/21/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to compare the integrity of the efferent auditory pathways of newborns that had high hyperbilirubinemia levels and required treatment due to these and healthy newborns. METHODS Term-born (37 weeks or later) infants that were brought to the Newborn Polyclinic of the Başkent University Hospital were included in the study. The study included a total of 84 infants including healthy newborns (n = 42) and those that had jaundice and were receiving phototherapy (n = 42). After conducting a general otorhinolaryngology examination on all newborns included in the study, Transient Otoacoustic Emission (TEOAE) test was carried out in the absence and presence of contralateral noise. The obtained contralateral suppression values were compared between the two groups. RESULTS In the TEOAE test, the responses obtained at 1 kHz in the newborns receiving phototherapy were found to be lower. The difference between the groups was significant (p = 0.038). The rates of suppression presence at 2 kHz, 2.8 kHz and total OAE were found significantly higher (p < 0.05) in the group not receiving phototherapy. Among the phototherapy-receiving infants, the hyperbilirubinemia levels of the infants in whom suppression was obtained in the contralateral suppression test did not show a statistically significant difference in comparison to those in whom suppression was not obtained (p > 0.05). CONCLUSION Based on the obtained data, hyperbilirubinemia may have a disruptive effect on the efferent auditory system in newborns. Consequently, we are of the opinion that, in addition to hearing screening in risky newborn infants, a MOC suppression test would be useful.
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Affiliation(s)
- Belde Culhaoglu
- Dept. of Otolaryngology, Faculty of Medicine, Baskent University, Ankara, Turkey.
| | - Selim S Erbek
- Dept. of Otolaryngology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Deniz Anuk İnce
- Dept. of Pediatric Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ayşe Nur Ecevit
- Dept. of Pediatric Neonatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Seyra Erbek
- Dept. of Otolaryngology, Faculty of Medicine, Baskent University, Ankara, Turkey
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20
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Kumar V, Kumar P, Sundaram V, Munjal SK, Malhi P, Panda NK. Childhood neurodevelopmental outcomes of survivors of acute bilirubin encephalopathy: A retrospective cohort study. Early Hum Dev 2021; 158:105380. [PMID: 33990043 DOI: 10.1016/j.earlhumdev.2021.105380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reports on childhood neurodevelopmental and neurosensory outcomes following acute bilirubin encephalopathy from low- and middle-income countries are scarce. AIM This study aimed to analyze the neurodevelopmental and neurosensory outcomes of survivors of acute bilirubin encephalopathy. STUDY DESIGN Retrospective cohort. SUBJECTS Neonates with admission diagnosis of acute bilirubin encephalopathy were followed up and assessed for neuromotor, neurodevelopmental and neurosensory functions between 18 m and 12.5 years of age. RESULTS In 67 neonates with acute bilirubin encephalopathy, a composite outcome of cerebral palsy or death was observed in 33 (49%) subjects. Choreo-athetoid cerebral palsy [19 (73%)] was the most common type observed. Sensori-neural hearing loss was observed in 46 (79%) subjects. Subjects with cerebral palsy had significantly low Developmental profile-3 scores in all assessed domains. Neonates with an early-stage acute bilirubin encephalopathy (aOR (95% C.I): 0.12 (0.05-0.71); p = 0.02) and those with a normal neurological examination at discharge (aOR (95% C.I): 0.11 (0.06-0.7); p = 0.049) had significantly lower odds of the primary outcome. CONCLUSIONS Majority of survivors of acute bilirubin encephalopathy had adverse outcomes during childhood in the form of cerebral palsy and sensory-neural hearing loss. Cognitive functions were better preserved than the language and general development in the affected children.
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Affiliation(s)
- Vinod Kumar
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Praveen Kumar
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Venkataseshan Sundaram
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sanjay Kumar Munjal
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Prahbhjot Malhi
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Naresh Kumar Panda
- Department of Otorhinolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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21
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Indirect neonatal hyperbilirubinemia and associated risk factors for long phototheraphy duration in a baby-friendly hospital in Konya, Turkey. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.910028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Early Motor Repertoire in Infants With Biliary Atresia: A Nationwide Prospective Cohort Study. J Pediatr Gastroenterol Nutr 2021; 72:592-596. [PMID: 33346571 DOI: 10.1097/mpg.0000000000003021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to assess the neurological status in infants with biliary atresia (BA) at time of diagnosis, using Prechtl's validated General Movement Assessment. METHODS Infants diagnosed with BA were prospectively included in a nationwide cohort study. From birth to approximately 46 weeks of postmenstrual age (PMA), general movements (GMs) are defined as "writhing movements." At 46 to 49 weeks PMA, "'fidgety movements" emerge. The infant's early motor repertoire was recorded on video before Kasai portoenterostomy. We scored GM optimality scores (min-max 5-42) or motor optimality scores (MOS, min-max 5-28) as appropriate. We defined GM optimality scores <36 and MOS <26 as atypical, and compared the results with 2 reference groups of healthy peers. RESULTS We assessed GMs in 35 infants with BA (11/35 boys, gestational age 40 weeks [36-42], birth weight 3370 g [2015-4285]). At time of diagnosis (PMA 47 weeks [42-60]), 16 infants (46%) showed atypical GMs. The proportion of infants with atypical GMs was significantly higher in BA (46%) than in 2 reference groups of healthy infants (vs 10%, P < 0.001; vs 18%, P < 0.001). Total and direct bilirubin levels were 165 μmol/L (87-364) and 134 μmol/L (72-334), respectively, height z score was 0.05 (-2.90, 1.75), weight z score -0.52 ([-2.50, -0.20) and mean upper arm circumference z score -1.80 (-2.50, -0.20). We found no statistically significant relation between atypical GMs and clinical variables. CONCLUSIONS Almost half of the infants with BA showed atypical GMs at time of diagnosis, suggesting neurological impairment. Close monitoring of these infants is warranted to determine their individual neurodevelopmental trajectories.
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Abdul-Mumin A, Cotache-Condor C, Bimpong KA, Grimm A, Kpiniong MJ, Yakubu RC, Kwarteng PG, Fuseini YH, Smith ER. Decrease in Admissions and Change in the Diagnostic Landscape in a Newborn Care Unit in Northern Ghana During the COVID-19 Pandemic. Front Pediatr 2021; 9:642508. [PMID: 33842411 PMCID: PMC8027062 DOI: 10.3389/fped.2021.642508] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The coronavirus disease (COVID-19) has spread worldwide with an increasing number of patients, including pregnant women and neonates. This study aims to evaluate morbidity and mortality in the COVID-19 era compared to the preceding year in the Neonatal Intensive Care Unit (NICU) at Tamale Teaching Hospital, Ghana. Methods: This is a cross-sectional study carried out on neonates admitted to NICU between March 1st to August 31st, 2019 (pre-COVID-19 era) and March 1st to August 31st, 2020 (COVID-19 era). Multivariate logistic regression was performed to identify predictors of mortality for both periods. Results: From 2,901 neonates, 1,616 (56%) were admitted before, and 1,285 (44%) were admitted during the pandemic. Admissions decreased during the COVID-19 era, reaching their lowest point between June and August 2020. Compared to the previous year, during the COVID-19 era, admissions of patients born at TTH, delivered at home, and with infections decreased from 50 to 39%, 7 to 4%, and 22 to 13%, respectively. Referred status (OR = 3.3) and vaginal delivery (OR = 1.6) were associated with an increased likelihood of mortality. For low- birth weight neonates, admissions of patients born at TTH, with vaginal and home delivery decreased from 62 to 48%, 8 to 2%, and 59 to 52%, respectively. Neonatal infections and congenital anomalies decreased from 8 to 4%, 5 to 3%, respectively. The likelihood of mortality among referred patients increased by 50%. Conclusion: We observed a marked decrease in admissions and change in the diagnosis landscape and related mortality during the pandemic. Underlying challenges, including fear, financing, and health system capacity, might intensify delays and lack of access to newborn care in northern Ghana, leading to higher rates of lifelong disabilities and mortality. Immediate damage control measures, including an improved home-based continuum of care and equipping families to participate in the newborn care with complemented m-health approaches, are needed with urgency.
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Affiliation(s)
- Alhassan Abdul-Mumin
- Department of Pediatrics and Child Health, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Cesia Cotache-Condor
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States
| | | | - Andie Grimm
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States
| | - Mary Joan Kpiniong
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | - Rafiuk Cosmos Yakubu
- Department of Pediatrics and Child Health, Tamale Teaching Hospital, Tamale, Ghana
| | | | | | - Emily R. Smith
- Department of Public Health, Robbins College of Health and Human Services, Baylor University, Waco, TX, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
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Sharma D, Harish R, Bhatti A, Uppal R, Naseem J. Early Neurodevelopmental Outcome of Neonates with Gestation 35 Weeks or More with Serum Bilirubin in Exchange Range Without Encephalopathy: A Prospective Observational Study. Neonatal Netw 2021; 40:66-72. [PMID: 33731372 DOI: 10.1891/0730-0832/11-t-675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe early neurodevelopment outcomes of neonates with severe hyperbilirubinemia without acute bilirubin encephalopathy (ABE). METHODS Neonates born at gestation ≥35 weeks, admitted to NICU with total serum bilirubin (TSB) in exchange range with no features of ABE, were followed up until the age of 6 months. Infants were assessed for impaired hearing and neurodevelopment at 3 months and 6 months of age. RESULTS A total of 59 neonates were enrolled in the study. At 3 months of age, 7.6 percent of neonates were found to have hypotonia and motor delay, whereas 42.3 percent had abnormal brainstem evoked response audiometery. At 6 months, 6.4 percent of neonates were found to have persistent neurodevelopmental impairment. CONCLUSION Severe hyperbilirubinemia is associated with impaired neurodevelopment and hearing even in infants without ABE. Peak TSB level strongly correlates with abnormal outcomes.
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25
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Yi K, Li H, Zhang X, Zhang L. Designed Tb(III)-Functionalized MOF-808 as Visible Fluorescent Probes for Monitoring Bilirubin and Identifying Fingerprints. Inorg Chem 2021; 60:3172-3180. [PMID: 33599496 DOI: 10.1021/acs.inorgchem.0c03312] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abnormal bilirubin (BR) level is a sign of several fatal diseases, so it is of great significance and challenge to develop a facile and effective family routine strategy for BR sensing. Herein, novel water-stable Tb3+@MOF-808 has been synthesized using a coordinated postsynthetic modification strategy and designed as a convenient and efficient fluorescence probe. The fabricated fluorescent probe exhibits a remarkable fluorescence quenching effect with the successive addition of BR, which displays fascinating features, such as fast response time, high sensitivity, and excellent selectivity. The quenching mechanism between the fluorescent probe and BR was also illustrated in detail. Importantly, the devised fluorescent probe successfully achieved the determination of BR in serum and urine, which has also been successfully used in the design of portable BR test paper. The developed monitoring platform for BR levels in vivo provides promising application potential for the prevention and early diagnosis of fatal diseases. Additionally, a molecular logic gate device that performs intelligent fluorescent sensing of BR was constructed. More interestingly, Tb3+@MOF-808 is used for development of latent fingerprints on different guest surfaces. The lines of the fluorescent fingerprints are clear and coherent, the details are obvious, and even sweat pores can be observed by naked eyes, which provides new means for tracking the criminal clue and handling cases efficiently.
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Affiliation(s)
- Kuiyu Yi
- College of Chemistry, Liaoning University, 66 Chongshan Middle Road, Shenyang, Liaoning 110036, People's Republic of China
| | - Hui Li
- College of Chemistry, Liaoning University, 66 Chongshan Middle Road, Shenyang, Liaoning 110036, People's Republic of China
| | - Xiaoting Zhang
- College of Chemistry, Liaoning University, 66 Chongshan Middle Road, Shenyang, Liaoning 110036, People's Republic of China
| | - Lei Zhang
- College of Chemistry, Liaoning University, 66 Chongshan Middle Road, Shenyang, Liaoning 110036, People's Republic of China
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26
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Hansen TWR, Wong RJ, Stevenson DK. Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn. Physiol Rev 2020; 100:1291-1346. [PMID: 32401177 DOI: 10.1152/physrev.00004.2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.
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Affiliation(s)
- Thor W R Hansen
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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27
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Jacob SS, Bankapur A, Barkur S, Acharya M, Chidangil S, Rao P, Kamath A, Lakshmi RV, Baby PM, Rao RK. Micro-Raman Spectroscopy Analysis of Optically Trapped Erythrocytes in Jaundice. Front Physiol 2020; 11:821. [PMID: 32754052 PMCID: PMC7366392 DOI: 10.3389/fphys.2020.00821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/19/2020] [Indexed: 12/31/2022] Open
Abstract
Derangements in bilirubin metabolism and/or dysfunctions in the hepato-biliary system lead to the unhealthy buildup of bilirubin in blood, resulting in jaundice. During the course of this disorder, circulating red cells are invariably subjected to toxic effects of serum bilirubin and an array of inflammatory compounds. This study aimed to investigate the vibrational spectroscopy of live red cells in jaundice using micro-Raman spectroscopy combined with optical-trap. Red cells from blood samples of healthy volunteers and patients with jaundice were optically immobilized and micro-Raman probed using a 785 nm diode laser. Raman signatures from red cells in jaundice exhibited significant variations from the normal and the spectral-markers were obtained from multivariate analytical methods. This research gives insightful views on how different pathologies can act as "stress-milieus" for red cells in circulation, possibly impeding their normal functions and also exasperating anemia. Raman spectroscopy, an emerging bio-analytical technique, is sensitive in detecting molecular-conformations in situ, at cellular-levels and in real-time. This study could pave way in understanding fundamental red cell behavior in different diseases by analyzing Raman markers.
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Affiliation(s)
- Sanu Susan Jacob
- Department of Physiology, Kasturba Medical College-Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Aseefhali Bankapur
- Department of Atomic and Molecular Physics, Centre of Excellence for Biophotonics, Manipal Academy of Higher Education, Manipal, India
| | - Surekha Barkur
- Department of Atomic and Molecular Physics, Centre of Excellence for Biophotonics, Manipal Academy of Higher Education, Manipal, India
| | - Mahendra Acharya
- Department of Atomic and Molecular Physics, Centre of Excellence for Biophotonics, Manipal Academy of Higher Education, Manipal, India
| | - Santhosh Chidangil
- Department of Atomic and Molecular Physics, Centre of Excellence for Biophotonics, Manipal Academy of Higher Education, Manipal, India
| | - Pragna Rao
- Department of Biochemistry, Kasturba Medical College-Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - R. Vani Lakshmi
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Prathap M. Baby
- Department of Physiology, Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Raghavendra K. Rao
- Department of Physiology, Kasturba Medical College-Manipal, Manipal Academy of Higher Education, Manipal, India
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28
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Long-term neurodevelopmental outcomes of significant neonatal jaundice in Taiwan from 2000-2003: a nationwide, population-based cohort study. Sci Rep 2020; 10:11374. [PMID: 32647318 PMCID: PMC7347619 DOI: 10.1038/s41598-020-68186-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/05/2020] [Indexed: 12/01/2022] Open
Abstract
Newborns with significant neonatal jaundice (SNJ) would admit for evaluation and/or intervention due to an earlier or more rapid increase in bilirubin level. Bilirubin-induced neurological dysfunction in this population might be underestimated. We aimed to investigate the risk of long-term neurodevelopmental sequelae of SNJ in Taiwan. An SNJ 2000–2003 follow-up cohort consisting of 66,983 neonates was extracted from the nationwide, population-based health insurance database in Taiwan to survey the accumulative incidence of long-term (7-year) neurodevelopmental sequelae in comparison to a reference general-population neonate cohort of 12,579 individuals born in 2000. The SNJ follow-up cohort was furtherly categorized into subgroups according to interventions (phototherapy, intensive phototherapy, and exchange transfusion). The SNJ follow-up cohort exhibited significantly higher cumulative rates of long-term neurodevelopmental sequelae than did the reference cohort (P < 0.05). The risks of infantile cerebral palsy, hearing loss, and developmental delay in the SNJ follow-up cohort were between twice and three times of those in the reference cohort after adjusting for gender, comorbid perinatal disorders and urbanization levels. All intervention subgroups demonstrated higher risks for long-term neurodevelopmental sequelae than the reference cohort (P < 0.05) after adjustment. Patients with SNJ are at risk of developing neurodevelopmental disorders during their growth period. A scheduled follow-up protocol of physical and neurodevelopmental assessment during early childhood for these SNJ patients would potentially be helpful for the early detection of and intervention for neurodevelopmental disorders.
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29
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Chen Z, Vong CT, Gao C, Chen S, Wu X, Wang S, Wang Y. Bilirubin Nanomedicines for the Treatment of Reactive Oxygen Species (ROS)-Mediated Diseases. Mol Pharm 2020; 17:2260-2274. [PMID: 32433886 DOI: 10.1021/acs.molpharmaceut.0c00337] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Reactive oxygen species (ROS) are chemically reactive species that are produced in cellular aerobic metabolism. They mainly include superoxide anion, hydrogen peroxide, hydroxyl radicals, singlet oxygen, ozone, and nitric oxide and are implicated in many physiological and pathological processes. Bilirubin, a cardinal pigment in the bile, has been increasingly investigated to treat cancer, diabetes, ischemia-reperfusion injury, asthma, and inflammatory bowel diseases (IBD). Indeed, bilirubin has been shown to eliminate ROS production, so it is now considered as a promising therapeutic agent for ROS-mediated diseases and can be used for the development of antioxidative nanomedicines. This review summarizes the current knowledge of the physiological mechanisms of ROS production and its role in pathological changes and focuses on discussing the antioxidative effects of bilirubin and its application in the experimental studies of nanomedicines. Previous studies have shown that bilirubin was mainly used as a responsive molecule in the microenvironment of ROS overproduction in neoplastic tissues for the development of anticancer nanodrugs; however, it could also exert powerful ROS scavenging activity in chronic inflammation and ischemia-reperfusion injury. Therefore, bilirubin, as an inartificial ROS scavenger, is expected to be used for the development of nanomedicines against more diseases due to the universality of ROS involvement in human pathological conditions.
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Affiliation(s)
- Zhejie Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999087, China
| | - Chi Teng Vong
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999087, China
| | - Caifang Gao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999087, China
| | - Shiyun Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999087, China
| | - Xu Wu
- Laboratory of Molecular Pharmacology, Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Shengpeng Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999087, China
| | - Yitao Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao 999087, China
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Khadem Al-Hosseini M, Rahideh ST, Saadati A, Rahmati N, Azadeh F, Janani L, Shidfar F. The effect of vitamin C supplementation in the last month of pregnancy on neonatal bilirubin levels; A double-blind randomized clinical trial. Complement Ther Med 2020; 50:102359. [PMID: 32444041 DOI: 10.1016/j.ctim.2020.102359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Jaundice is a typical condition in the neonatal period, particularly in the Asian continent. Drowsiness and disruption of breastfeeding, behavioral and neurological disorders, hearing loss and mental retardation are the results of impairment in controlling it. The increase in oxidant substances can stimulate the heme oxygenase enzyme and increase the conversion of heme to bilirubin. In some studies, vitamin C levels in the blood of infants with hyperbilirubinemia were lower than in healthy infants. DESIGN In this double-blind clinical trial study, 144 healthy pregnant women aged 20-40 years who were in 34th weeks of gestation were randomly divided into intervention, and control groups and until the end of pregnancy, they took a 500 mg tablet of vitamin C or placebo (Preparation of starch) daily. Demographic information, dietary intake, and physical activity level of the participants were also evaluated. The total blood bilirubin level was measured on the fifth day after birth using a sample of the neonatal heel. Statistical analysis was performed using SPSS software version 22. In this study P-value < 0. 05 was considered significant. RESULTS Of the 144 participants, 128 of them completed the intervention. There was no significant difference between the two groups at the level of vitamin C intake through diet, and anthropometric indices, but the total bilirubin level in the neonates of the two groups was statistically different (P = 0.02). CONCLUSION Vitamin C supplementation in the last month of pregnancy had a significant effect on neonatal bilirubin level and decreased it significantly.
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Affiliation(s)
- M Khadem Al-Hosseini
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - S T Rahideh
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - A Saadati
- Pediatric Research Center, Qom University of Medical Sciences, Qom, Iran
| | - N Rahmati
- Department of Obstetrics and Gynecology, Qom University of Medical Sciences, Qom, Iran
| | - F Azadeh
- Health Deputy, Qom University of Medical Sciences, Qom, Iran
| | - L Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - F Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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Ma X, Shang X, Qin X, Lu J, Liu M, Wang X. Characterization of organic anion transporting polypeptide 1b2 knockout rats generated by CRISPR/Cas9: a novel model for drug transport and hyperbilirubinemia disease. Acta Pharm Sin B 2020; 10:850-860. [PMID: 32528832 PMCID: PMC7276679 DOI: 10.1016/j.apsb.2019.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023] Open
Abstract
Organic anion transporting polypeptide 1B1 and 1B3 (OATP1B1/3) as important uptake transporters play a fundamental role in the transportation of exogenous drugs and endogenous substances into cells. Rat OATP1B2, encoded by the Slco1b2 gene, is homologous to human OATP1B1/3. Although OATP1B1/3 is very important, few animal models can be used to study its properties. In this report, we successfully constructed the Slco1b2 knockout (KO) rat model via using the CRISPR/Cas9 technology for the first time. The novel rat model showed the absence of OATP1B2 protein expression, with no off-target effects as well as compensatory regulation of other transporters. Further pharmacokinetic study of pitavastatin, a typical substrate of OATP1B2, confirmed the OATP1B2 function was absent. Since bilirubin and bile acids are the substrates of OATP1B2, the contents of total bilirubin, direct bilirubin, indirect bilirubin, and total bile acids in serum are significantly higher in Slco1b2 KO rats than the data of wild-type rats. These results are consistent with the symptoms caused by the absence of OATP1B1/3 in Rotor syndrome. Therefore, this rat model is not only a powerful tool for the study of OATP1B2-mediated drug transportation, but also a good disease model to study hyperbilirubinemia-related diseases.
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Key Words
- A/G, albumin/globulin ratio
- ADRs, adverse drug reactions
- ALB, albumin
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- AUC, the area under the time–plasma concentration curve
- BUN, blood urea nitrogen
- CL/F, clearance/bioavailability
- CR, reatinine
- CRISPR, clustered regularly interspaced short palindromic repeats
- CRISPR/Cas9
- Chr, chromosome
- Cmax, peak concentration
- DAB, 3,3′-diaminobenzidine
- DBL, direct bilirubin
- DDI, drug–drug interaction
- DMSO, dimethyl sulfoxide
- FDA, the U.S. Food and Drug Administration
- GAPDH, glyceraldehyde 3-phosphate dehydrogenase
- GLB, globulin
- GLU, glucose
- HCG, human chorionic gonadotropin
- HDL-C, high density lipoprotein cholesterol
- HE, haemotoxylin and eosin
- HMG, hydroxymethylglutaryl
- HRP, horseradish peroxidase
- HZ, heterozygous
- IBIL, indirect bilirubin
- IS, internal standard solution
- KO, knockout
- LDL-C, low density lipoprotein cholesterol
- MC, methylcellulose
- MRT, mean residence time
- NC, nitrocellulose
- OATP1B1/3
- OATP1B1/3, organic anion transporting polypeptide 1B1 and 1B3
- OATP1B2
- OATPs, organic anion transporting polypeptides
- PAM, protospacer adjacent motif
- PMSG, pregnant mare serum gonadotropin
- R-GT, γ-glutamyltranspeptidase
- Rat model
- SD, Sprague–Dawley
- SDS-PAGE, sodium dodecyl sulfate polyacrylamide gel electrophoresis
- SLC, solute carrier
- SNPs, single nucleotide polymorphisms
- T-CH, total cholesterol
- T7E I, T7 endonuclease I
- TALEN, transcription activator-like effector nuclease
- TBA, total bile acid
- TBL, total bilirubin
- TBST, Tris-buffered saline Tween 20
- TG, triglyceride
- TP, total protein
- Tmax, peak time
- Transporter
- UA, uric acid
- Ugt1a1, UDP glucuronosyltransferase family 1 member A1
- Vd/F, the apparent volume of distribution/bioavailability
- WT, wild type
- ZFN, zinc-finger nucleases
- crRNA, mature CRISPR RNA
- p.o., peroral
- sgRNA, single guide RNA
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Affiliation(s)
| | | | | | | | | | - Xin Wang
- Corresponding author. Tel.: +86 21 24206564; fax: +86 21 5434 4922.
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32
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Cordero C, Schieve LA, Croen LA, Engel SM, Maria Siega-Riz A, Herring AH, Vladutiu CJ, Seashore CJ, Daniels JL. Neonatal jaundice in association with autism spectrum disorder and developmental disorder. J Perinatol 2020; 40:219-225. [PMID: 31388117 PMCID: PMC7031756 DOI: 10.1038/s41372-019-0452-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the association between neonatal jaundice and autism spectrum disorder (ASD) and non-ASD developmental disorder (DD). STUDY DESIGN We analyzed data from the Study to Explore Early Development, a US multisite, case-control study conducted from 2007 to 2011. Developmental assessment classified children aged 2-5 years into: ASD (n = 636), DD (n = 777), or controls (POP; n = 926). Neonatal jaundice (n = 1054) was identified from medical records and maternal interviews. We examined associations between neonatal jaundice and ASD and DD using regression models to obtain adjusted odds ratios (aOR). RESULTS Our results showed interaction between gestational age and neonatal jaundice. Neonatal jaundice was associated with ASD at 35-37 weeks (aOR = 1.83, 95%CI 1.05, 3.19), but not ≥38 weeks gestation (aOR = 0.97, 95%CI 0.76, 1.24). Similar results were observed with DD. CONCLUSIONS Further exploration of timing and severity of neonatal jaundice and ASD/DD is warranted.
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Affiliation(s)
- Christina Cordero
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Anna Maria Siega-Riz
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Family, Community & Mental Health Systems, University of Virginia, Charlottesville, VA, USA
| | - Amy H Herring
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Statistical Science, Duke University, Durham, NC, USA
| | | | - Carl J Seashore
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Julie L Daniels
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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Nitti M, Furfaro AL, Mann GE. Heme Oxygenase Dependent Bilirubin Generation in Vascular Cells: A Role in Preventing Endothelial Dysfunction in Local Tissue Microenvironment? Front Physiol 2020; 11:23. [PMID: 32082188 PMCID: PMC7000760 DOI: 10.3389/fphys.2020.00023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 12/22/2022] Open
Abstract
Among antioxidants in the human body, bilirubin has been recognized over the past 20 years to afford protection against different chronic conditions, including inflammation and cardiovascular disease. Moderate increases in plasma concentration and cellular bilirubin generation from metabolism of heme via heme oxygenase (HMOX) in virtually all tissues can modulate endothelial and vascular function and exert antioxidant and anti-inflammatory roles. This review aims to provide an up-to-date and critical overview of the molecular mechanisms by which bilirubin derived from plasma or from HMOX1 activation in vascular cells affects endothelial function. Understanding the molecular actions of bilirubin may critically improve the management not only of key cardiovascular diseases, but also provide insights into a broad spectrum of pathologies driven by endothelial dysfunction. In this context, therapeutic interventions aimed at mildly increasing serum bilirubin as well as bilirubin generated endogenously by endothelial HMOX1 should be considered.
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Affiliation(s)
- Mariapaola Nitti
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Anna Lisa Furfaro
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Giovanni E Mann
- King's British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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34
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Experimental models assessing bilirubin neurotoxicity. Pediatr Res 2020; 87:17-25. [PMID: 31493769 DOI: 10.1038/s41390-019-0570-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/29/2019] [Accepted: 08/16/2019] [Indexed: 02/08/2023]
Abstract
The molecular and cellular events leading to bilirubin-induced neurotoxicity, the mechanisms regulating liver and intestine expression in neonates, and alternative pathways of bilirubin catabolism remain incompletely defined. To answer these questions, researchers have developed a number of model systems to closely recapitulate the main characteristics of the disease, ranging from tissue cultures to engineered mouse models. In the present review we describe in vitro, ex vivo, and in vivo models developed to study bilirubin metabolism and neurotoxicity, with a special focus on the use of engineered animal models. In addition, we discussed the most recent studies related to potential therapeutic approaches to treat neonatal hyperbilirubinemia, ranging from anti-inflammatory drugs, activation of nuclear receptor pathways, blockade of bilirubin catabolism, and stimulation of alternative bilirubin-disposal pathways.
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35
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Oyewusi AJ, Oridupa OA, Saba AB, Oyewusi IK, Mshelbwala MF. Effect of the methanol extract of the red cultivar Allium cepa L. on the serum biochemistry and electrolytes of rats following sub-chronic oral administration. J Basic Clin Physiol Pharmacol 2019; 31:/j/jbcpp.ahead-of-print/jbcpp-2018-0175/jbcpp-2018-0175.xml. [PMID: 31800393 DOI: 10.1515/jbcpp-2018-0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 09/06/2019] [Indexed: 11/15/2022]
Abstract
Background In traditional medicine, Allium cepa Linnaeus is used for the treatment of several disease conditions. Whilst reports abound on the effects of several cultivars of A. cepa L on biochemical parameters, similar information on the red cultivar is scarce. This study examines the effects of the methanol extract of the red cultivar A. cepa L on some serum biochemical parameters in experimental Wistar rats. Materials and methods Fifty-five Wistar rats were divided into three groups (A, B and C), which include 25, 25 and 5 rats, respectively. The rats in Groups A and B were sub-divided into 5 groups of 5 rats. Each rat was administered a certain dose of methanol extract of the red cultivar A. cepa L for 14 days (Group A) or 28 days (Group B). Group C rats served as the control and were administered with distilled water (10 mL/kg). Results A. cepa L administration resulted in dyslipidaemia, hyponatremia, hypokalaemia and hyperchloraemia; a significant (p < 0.05) decrease in hepatic enzymes and a significant (p < 0.05) increase in serum bicarbonate, bilirubin and its fractions. Conclusions These biochemical results indicate that the excessive and prolonged medicinal consumption of A. cepa L products beyond 7 days may induce moderate hepatic injury and mild renal dysfunction and may complicate disease conditions, such as hypertension and diabetes. Thus, in order to minimize its toxic effects, it is recommended that A. cepa L products should not be used for more than seven consecutive days or beyond a dosage of 90 mg/kg.
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Affiliation(s)
- Adeoye Joshua Oyewusi
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine, Federal University of Agriculture, Abeokuta, Ogun state, Nigeria, Phone no.:+234 8036676864
| | - Olayinka A Oridupa
- Department of Veterinary Pharmacology and Toxicology, University of Ibadan, Ibadan, Nigeria
| | - Adebowale B Saba
- Department of Veterinary Pharmacology and Toxicology, University of Ibadan, Ibadan, Nigeria
| | - Ibironke K Oyewusi
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, Federal University of Agriculture, Abeokuta, Ogun state, Nigeria
| | - Musa F Mshelbwala
- Department of Veterinary Pathology, College of Veterinary Medicine, Federal University of Agriculture, Abeokuta, Ogun state, Nigeria
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Ca 2+-dependent recruitment of voltage-gated sodium channels underlies bilirubin-induced overexcitation and neurotoxicity. Cell Death Dis 2019; 10:774. [PMID: 31601780 PMCID: PMC6787254 DOI: 10.1038/s41419-019-1979-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 02/08/2023]
Abstract
Neonatal jaundice is prevalent among newborns and can lead to severe neurological deficits, particularly sensorimotor dysfunction. Previous studies have shown that bilirubin (BIL) enhances the intrinsic excitability of central neurons and this can potentially contribute to their overexcitation, Ca2+ overload, and neurotoxicity. However, the cellular mechanisms underlying elevated neuronal excitability remain unknown. By performing patch-clamp recordings from neonatal neurons in the rat medial vestibular nucleus (MVN), a crucial relay station for locomotor and balance control, we found that BIL (3 μM) drastically increases the spontaneous firing rates by upregulating the current-mediated voltage-gated sodium channels (VGSCs), while shifting their voltage-dependent activation toward more hyperpolarized potentials. Immunofluorescence labeling and western immunoblotting with an anti-NaV1.1 antibody, revealed that BIL elevates the expression of VGSCs by promoting their recruitment to the membrane. Furthermore, we found that this VGSC-trafficking process is Ca2+ dependent because preloading MVN neurons with the Ca2+ buffer BAPTA-AM, or exocytosis inhibitor TAT-NSF700, prevents the effects of BIL, indicating the upregulated activity and density of functional VGSCs as the core mechanism accountable for the BIL-induced overexcitation of neonatal neurons. Most importantly, rectification of such overexcitation with a low dose of VGSC blocker lidocaine significantly attenuates BIL-induced cell death. We suggest that this enhancement of VGSC currents directly contributes to the vulnerability of neonatal brain to hyperbilirubinemia, implicating the activity and trafficking of NaV1.1 channels as a potential target for neuroprotection in cases of severe jaundice.
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37
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Caspase-1 involves in bilirubin-induced injury of cultured rat cortical neurons. Pediatr Res 2019; 86:492-499. [PMID: 31195405 DOI: 10.1038/s41390-019-0451-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bilirubin encephalopathy, the most serious complication of hyperbilirubinemia during the neonatal period, with high mortality and morbidity, often causes irreversible neurological damage. Currently, caspase-1, a member of the cysteinyl aspartate-specific protease caspase family, is regarded as a key mediator of inflammatory processes, attracting widespread attention. The purpose of this study was to investigate whether caspase-1 is involved in bilirubin-induced neuronal injury. METHODS VX-765, a highly potent and selective inhibitor of caspase-1, was used to investigate the effects of unconjugated bilirubin (UCB) on rat cortical neurons, including cell viability, morphological changes in the cell membrane, and nuclear factor-kappa B (NF-κB) activation. RESULTS Neurons treated with UCB showed increased caspase-1 activity without the secretion of interleukin (IL)-1β and IL-18, and caspase-1 was significantly inhibited by pretreatment with VX-765. The cell viability of the VX-765-pretreated neurons was improved, and cell membrane rupture was prevented, as detected by lactate dehydrogenase release and ethidium bromide uptake. Moreover, NF-κB activation by UCB exposure, was attenuated by VX-765 pretreatment. CONCLUSION Bilirubin-induced neuronal injury involves the activation of caspase-1 and NF-κB, leading to membrane leakage, independently of IL-1β and IL-18.
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Thanh LN, Trung KN, Duy CV, Van DN, Hoang PN, Phuong ANT, Ngo MD, Thi TN, Viet AB. Improvement in gross motor function and muscle tone in children with cerebral palsy related to neonatal icterus: an open-label, uncontrolled clinical trial. BMC Pediatr 2019; 19:290. [PMID: 31438885 PMCID: PMC6704727 DOI: 10.1186/s12887-019-1669-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background Although stem cell transplantation has been successfully performed for cerebral palsy (CP) related to oxygen deprivation, clinical trials involving the use of stem cell transplantation for CP related to neonatal icterus have not been reported. The aim of this study was to evaluate the effectiveness of transplantation of autologous bone marrow mononuclear cell (BMMC) for improving gross motor function and muscle tone in children with CP related to neonatal icterus. Methods This open-label, uncontrolled clinical trial, which included 25 patients with CP related to neonatal icterus who had a Gross Motor Function Classification System (GMFCS) score between level II and level V, was conducted between July 2014 and July 2017 at Vinmec International Hospital (Vietnam). BMMC were harvested from the patients’ iliac crests. Two procedures involving BMMC transplantation via the intrathecal route were performed: the first transplantation was performed at baseline, and the second transplantation was performed 6 months after the first transplantation. Gross motor function and muscle tone were measured at three time points (baseline, 6 months, and 12 months) using the Gross Motor Function Measure (GMFM) and the Modified Ashworth Scale. Results In this trial, we observed significant improvement in gross motor function and a significant decrease in muscle tone values. Total score on the 88-item GMFM (GMFM-88), scores on each GMFM-88 domain, and the 66-item GMFM (GMFM-66) percentile were significantly enhanced at 6 months and 12 months after the first transplantation compared with the corresponding baseline measurements (p-values < 0.05). In addition, a significant reduction was observed in muscle tone score after the transplantations (p-value < 0.05). Conclusion Autologous BMMC transplantation can improve gross motor function and muscle tone in children with CP related to neonatal icterus. Trial registration ClinicalTrials.gov identifier: NCT03123562. Retrospectively registered on December 26, 2017. Electronic supplementary material The online version of this article (10.1186/s12887-019-1669-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liem Nguyen Thanh
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam.
| | - Kien Nguyen Trung
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
| | - Chinh Vu Duy
- Vinmec International Hospital, 458 Minh Khai Street, Hanoi, Vietnam
| | - Doan Ngo Van
- Vinmec International Hospital, 458 Minh Khai Street, Hanoi, Vietnam
| | | | | | - Minh Duy Ngo
- Vinmec International Hospital, 458 Minh Khai Street, Hanoi, Vietnam
| | - Thinh Nguyen Thi
- Vinmec International Hospital, 458 Minh Khai Street, Hanoi, Vietnam
| | - Anh Bui Viet
- Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
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Hayashida M, Miyaoka T, Tsuchie K, Araki T, Izuhara M, Miura S, Kanayama M, Ohtsuki K, Nagahama M, Azis IA, Abdullah RA, Jaya MA, Arauchi R, Hashioka S, Wake R, Tsumori T, Horiguchi J, Oh-Nishi A, Inagaki M. Parvalbumin-positive GABAergic interneurons deficit in the hippocampus in Gunn rats: A possible hyperbilirubinemia-induced animal model of schizophrenia. Heliyon 2019; 5:e02037. [PMID: 31321330 PMCID: PMC6612903 DOI: 10.1016/j.heliyon.2019.e02037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/18/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022] Open
Abstract
A reduction of GABAergic markers in postmortem tissue is consistently found in schizophrenia. Importantly, these alterations in GABAergic neurons are not global, which means they are more prevalent among distinct subclasses of interneurons, including those that express the calcium binding protein parvalbumin. A decreased expression of parvalbumin in the hippocampus is a consistent observation not only in postmortem human schizophrenia patients, but also in a diverse number of rodent models of the disease. Meanwhile, previously we reported that the congenital hyperbilirubinemia model rats (Gunn rats), which is a mutant of the Wistar strain, showed behavioral abnormalities, for instance, hyperlocomotor activity, deficits of prepulse inhibition, inappropriate social interaction, impaired recognition memory similar with several rodent models of schizophrenia. Several animal studies linked the importance of palvalbumin in relation to abnormal hippocampal activity and schizophrenia-like behavior. Here, we show that parvalbumin positive cell density was significantly lower in the CA1, CA3 and the total hippocampus of Gunn rats (congenital hyperbilirubinemia model rats) compared to Wistar control rats. The correlations between serum UCB levels and loss of PV expression in the hippocampus were also detected. The decreases in the PV-expression in the hippocampus might suggest an association of the behavioral abnormalities as schizophrenia-like behaviors of Gunn rats, compared to the Wistar control rats.
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Affiliation(s)
- Maiko Hayashida
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Tsuyoshi Miyaoka
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Keiko Tsuchie
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Tomoko Araki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Muneto Izuhara
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Shoko Miura
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Misako Kanayama
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Koji Ohtsuki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Michiharu Nagahama
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | | | | | - Muhammad Alim Jaya
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Ryosuke Arauchi
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Sadayuki Hashioka
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Rei Wake
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
| | - Toshiko Tsumori
- Department of Nursing, Faculty of Health and Welfare, Prefectural University of Hiroshima, Japan
| | - Jun Horiguchi
- Division of Immune-Neuropsychiatry, Faculty of Medicine, Shimane University, Japan
| | - Arata Oh-Nishi
- Division of Immune-Neuropsychiatry, Faculty of Medicine, Shimane University, Japan
- RESVO Inc., Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Japan
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Lin Y, Wang S, Yang Z, Gao L, Zhou Z, Yu P, Wu B. Bilirubin alleviates alum-induced peritonitis through inactivation of NLRP3 inflammasome. Biomed Pharmacother 2019; 116:108973. [PMID: 31121485 DOI: 10.1016/j.biopha.2019.108973] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022] Open
Abstract
Bilirubin is an endogenous substance derived from heme catabolism. In this study, we aimed to assess the anti-inflammatory activity of bilirubin, and to determine the mechanism thereof. The anti-inflammatory activity of bilirubin was evaluated using lipopolysaccharide (LPS)-treated peritoneal macrophages (PMs) and Raw264.7 cells, and mice with alum-induced peritonitis. The mRNA and proteins of NOD-like receptor family pyrin domain containing 3 (Nlrp3) and inflammatory cytokines were determined using qPCR and Western blotting, respectively. Distribution of phosphorylated (p) p65 [a NF-κB (nuclear factor-κB) subunit] in the cytoplasm and nucleus were evaluated by immunofluorescence analysis and electrophoretic mobility shift assay. Bilirubin prior to LPS treatment decreased protein expressions of Nlrp3, pro-interleukin (IL)-1β and mature IL-1β in PMs, whereas bilirubin post LPS treatment showed no effects. Bilirubin prior to LPS treatment dose-dependently repressed expressions of Nlrp3 and IL-1β, and inhibited translocation of p-p65 to nucleus in Raw264.7 cells. Bilirubin treatment decreased myeloperoxidase activity and reduced the levels of inflammatory cytokines (i.e., IL-1β, TNFα and IL-6) in lavage fluid in mice with alum-induced peritonitis. This was accompanied by a lower mortality rate. In addition, the mRNAs of Nlrp3 and IL-1β in peritoneal exudates cells were decreased, and the levels of p-p65 and mature IL-1β proteins were reduced. In conclusion, bilirubin acted on inflammation and alleviated alum-induced peritonitis through inactivation of Nlrp3 inflammasome.
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Affiliation(s)
- Yanke Lin
- Reserach Center for Biopharmaceutics and Pharmacokinetics, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Shuai Wang
- Reserach Center for Biopharmaceutics and Pharmacokinetics, College of Pharmacy, Jinan University, Guangzhou 510632, China; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), College of Pharmacy , Jinan University, Guangzhou, 510632, China
| | - Zemin Yang
- Reserach Center for Biopharmaceutics and Pharmacokinetics, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Lu Gao
- Reserach Center for Biopharmaceutics and Pharmacokinetics, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Ziyue Zhou
- Reserach Center for Biopharmaceutics and Pharmacokinetics, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Pei Yu
- Reserach Center for Biopharmaceutics and Pharmacokinetics, College of Pharmacy, Jinan University, Guangzhou 510632, China; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), College of Pharmacy , Jinan University, Guangzhou, 510632, China.
| | - Baojian Wu
- Reserach Center for Biopharmaceutics and Pharmacokinetics, College of Pharmacy, Jinan University, Guangzhou 510632, China; International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), College of Pharmacy , Jinan University, Guangzhou, 510632, China.
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Karamavuş Y, Özkan M. Newborn jaundice determination by reflectance spectroscopy using multiple polynomial regression, neural network, and support vector regression. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2019.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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A Gold Nanoclusters Film Supported on Polydopamine for Fluorescent Sensing of Free Bilirubin. SENSORS 2019; 19:s19071726. [PMID: 30974923 PMCID: PMC6480062 DOI: 10.3390/s19071726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 02/07/2023]
Abstract
Serum bilirubin is an important biomarker for the diagnosis of various types of liver diseases and blood disorders. A polydopamine/gold nanoclusters composite film was fabricated for the fluorescent sensing of free bilirubin. Bovine serum albumin (BSA)-stabilized gold nanoclusters (AuNCs) were used as probes for biorecognition. The polydopamine film was utilized as an adhesion layer for immobilization of AuNCs. When the composite film was exposed to free bilirubin, due to the complex that was formed between BSA and free bilirubin, the fluorescence intensity of the composite film was gradually weakened as the bilirubin concentration increased. The fluorescence quenching ratio (F0/F) was linearly proportional to free bilirubin over the concentration range of 0.8~50 μmol/L with a limit of detection of 0.61 ± 0.12 μmol/L (S/N = 3). The response was quick, the film was recyclable, and common ingredients in human serum did not interfere with the detection of free bilirubin.
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Dani C, Becciani S, Pratesi S. Changes in total serum bilirubin during phototherapy in late preterm and term infants with non-haemolytic hyperbilirubinemia. Early Hum Dev 2019; 131:41-44. [PMID: 30831388 DOI: 10.1016/j.earlhumdev.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is no standardized method for total serum bilirubin (TSB) monitoring during phototherapy for neonatal hyperbilirubinemia and national guidelines give heterogeneous indications. AIM To assess the hypothesis that TSB values do not exceed exsanguino-transfusion (EXT) threshold during phototherapy and that it is possible to decrease its monitoring frequency in jaundiced infants. STUDY DESIGN We carried out a prospective observational study in which changes in TSB during phototherapy for non-haemolytic hyperbilirubinemia were recorded in a cohort of late preterm and term infants. TSB values after 6, 12, 18, and 24 h of phototherapy were compared to the EXT threshold matched to infants' gestational and postnatal age according to the specific nomogram of the Italian Society of Neonatology guidelines. RESULTS We studied 105 infants who started phototherapy at a mean age of 89 ± 37 h when mean TSB was 17.1 ± 2.5 mg/dL. We found that TSB decreased during phototherapy and the difference between mean TSB and EXT threshold progressively increased during phototherapy; TSB exceeded EXT threshold in none of our patients (0%). CONCLUSIONS Our study demonstrates that differences between mean TSB and EXT threshold increased during phototherapy in late preterm and term infants with non-haemolytic hyperbilirubinemia; in none of our patients TSB exceeded EXT threshold. Our findings support the possibility of safely decreasing TSB monitoring during phototherapy, thus limiting noxious painful stimuli in neonates.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Sabrina Becciani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Simone Pratesi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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Modulation of Ca v2.3 channels by unconjugated bilirubin (UCB) - Candidate mechanism for UCB-induced neuromodulation and neurotoxicity. Mol Cell Neurosci 2019; 96:35-46. [PMID: 30877033 DOI: 10.1016/j.mcn.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 12/15/2018] [Accepted: 03/10/2019] [Indexed: 11/23/2022] Open
Abstract
Elevated levels of unbound unconjugated bilirubin (UCB) can lead to bilirubin encephalopathy and kernicterus. In spite of a large number of studies demonstrating UCB-induced changes in central neurotransmission, it is still unclear whether these effects involve alterations in the function of specific ion channels. To assess how different UCB concentrations and UCB:albumin (U/A) molar ratios affect neuronal R-type voltage-gated Ca2+ channels, we evaluated their effects on whole-cell currents through recombinant Cav2.3 + β3 channel complexes and ex-vivo electroretinograms (ERGs) from wildtype and Cav2.3-deficient mice. Our findings show that modestly elevated levels of unbound UCB (U/A = 0.5) produce subtle but significant changes in the voltage-dependence of activation and prepulse inactivation, resulting in a stimulation of currents activated by weak depolarization and inhibition at potentials on the plateau of the activation curve. Saturation of the albumin binding capacity (U/A = 1) produced additional suppression that became significant when albumin was omitted completely and might involve a complete loss of channel function. Acutely administered UCB (U/A = 0.5) has recently been shown to affect transsynaptic signaling in the isolated vertebrate retina. The present report reveals that sustained exposure of the murine retina to UCB significantly suppresses also late responses of the inner retina (b-wave) from wildtype compared to Cav2.3-deficient mice. In addition, recovery during washout was significantly more complete and faster in retinae lacking Cav2.3 channels. Together, these findings show that UCB affects cloned and native Cav2.3 channels at clinically relevant U/A molar ratios and indicate that supersaturation of albumin is not required for modulation but associated with a loss of channel functional that could contribute to chronic neuronal dysfunction.
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Das S, van Landeghem FKH. Clinicopathological Spectrum of Bilirubin Encephalopathy/Kernicterus. Diagnostics (Basel) 2019; 9:diagnostics9010024. [PMID: 30823396 PMCID: PMC6468386 DOI: 10.3390/diagnostics9010024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022] Open
Abstract
Bilirubin encephalopathy/kernicterus is relatively rare, but continues to occur despite universal newborn screening. What is more interesting is the spectrum of clinical and even neuropathological findings that have been reported in the literature to be associated with bilirubin encephalopathy and kernicterus. In this review, the authors discuss the array of clinicopathological findings reported in the context of bilirubin encephalopathy and kernicterus, as well as the types of diagnostic testing used in patients suspected of having bilirubin encephalopathy or kernicterus. The authors aim to raise the awareness of these features among both pediatric neurologists and neuropathologists.
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Affiliation(s)
- Sumit Das
- Division of Neuropathology, University of Alberta and Stollery Children's Hospital, Edmonton, AB T6G 2B7, Canada.
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Frank K H van Landeghem
- Division of Neuropathology, University of Alberta and Stollery Children's Hospital, Edmonton, AB T6G 2B7, Canada.
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2B7, Canada.
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Cayabyab R, Ramanathan R. High unbound bilirubin for age: a neurotoxin with major effects on the developing brain. Pediatr Res 2019; 85:183-190. [PMID: 30518884 DOI: 10.1038/s41390-018-0224-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/30/2023]
Abstract
Neonatal hyperbilirubinemia is one of the most frequent diagnoses made in neonates. A high level of unconjugated bilirubin that is unbound to albumin is neurotoxic when the level exceeds age-specific thresholds or at lower levels in neonates with neurotoxic risk factors. Lower range of unbound bilirubin results in apoptosis, while moderate-to-high levels result in neuronal necrosis. Basal ganglia and various brain stem nuclei are more susceptible to bilirubin toxicity. Proposed mechanisms of bilirubin-induced neurotoxicity include excessive release of glutamate, mitochondrial energy failure, release of proinflammatory cytokines, and increased intracellular calcium concentration. These mechanisms are similar to the events that occur following hypoxic-ischemic insult in neonates. Severe hyperbilirubinemia in term neonates has been shown to be associated with increased risk for autism spectrum disorders. The neuropathological finding of bilirubin-induced neurotoxicity also includes cerebellar injury with a decreased number of Purkinje cells, and disruption of multisensory feedback loop between cerebellum and cortical neurons which may explain the clinical characteristics of autism spectrum disorders. Severe hyperbilirubinemia occurs more frequently in infants from low- and middle-income countries (LMIC). Simple devices to measure bilirubin, and timely treatment are essential to reduce neurotoxicity, and improve outcomes for thousands of neonates around the world.
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Affiliation(s)
- Rowena Cayabyab
- Keck School of Medicine of University of Southern California, Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Keck School of Medicine of University of Southern California, Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Los Angeles, CA, USA.
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Dani C, Pratesi S, Ilari A, Lana D, Giovannini MG, Nosi D, Buonvicino D, Landucci E, Bani D, Mannaioni G, Gerace E. Neurotoxicity of Unconjugated Bilirubin in Mature and Immature Rat Organotypic Hippocampal Slice Cultures. Neonatology 2019; 115:217-225. [PMID: 30645995 DOI: 10.1159/000494101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The physiopathology of bilirubin-induced neurological disorders is not completely understood. OBJECTIVES The aim of our study was to assess the effect on bilirubin neurotoxicity of the maturity or immaturity of exposed cells, the influence of different unconjugated bilirubin (UCB) and human serum albumin (HSA) concentrations, and time of UCB exposure. METHODS Organotypic hippocampal slices were exposed for 48 h to different UCB and HSA concentrations after 14 (mature) or 7 (immature) days of in vitro culture. Immature slices were also exposed to UCB and HSA for 72 h. The different effects of exposure time to UCB on neurons and astrocytes were evaluated. RESULTS We found that 48 h of UCB exposure was neurotoxic for mature rat organotypic hippocampal slices while 72 h of exposure was neurotoxic for immature slices. Forty-eight-hour UCB exposure was toxic for astrocytes but not for neurons, while 72-h exposure was toxic for both astrocytes and neurons. HSA prevented UCB toxicity when the UCB:HSA molar ratio was ≤1 in both mature and immature slices. CONCLUSIONS We confirmed UCB neurotoxicity in mature and immature rat hippocampal slices, although immature ones were more resistant. HSA was effective in preventing UCB neurotoxicity in both mature and immature rat hippocampal slices.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy, .,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy,
| | - Simone Pratesi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Alice Ilari
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Daniele Lana
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Maria Grazia Giovannini
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Daniele Nosi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Buonvicino
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Elisa Landucci
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Daniele Bani
- Department of Clinical and Experimental Medicine, Research Unit of Histology and Embryology, University of Florence, Florence, Italy
| | - Guido Mannaioni
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Elisabetta Gerace
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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Bilirubin-Induced Oxidative Stress Leads to DNA Damage in the Cerebellum of Hyperbilirubinemic Neonatal Mice and Activates DNA Double-Strand Break Repair Pathways in Human Cells. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:1801243. [PMID: 30598724 PMCID: PMC6287157 DOI: 10.1155/2018/1801243] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 12/27/2022]
Abstract
Unconjugated bilirubin is considered a potent antioxidant when present at moderate levels. However, at high concentrations, it produces severe neurological damage and death associated with kernicterus due to oxidative stress and other mechanisms. While it is widely recognized that oxidative stress by different toxic insults results in severe damage to cellular macromolecules, especially to DNA, no data are available either on DNA damage in the brain triggered by hyperbilirubinemia during the neonatal period or on the activation of DNA repair mechanisms. Here, using a mouse model of neonatal hyperbilirubinemia, we demonstrated that DNA damage occurs in vivo in the cerebellum, the brain region most affected by bilirubin toxicity. We studied the mechanisms associated with potential toxic action of bilirubin on DNA in in vitro models, which showed significant increases in DNA damage when neuronal and nonneuronal cells were treated with 140 nM of free bilirubin (Bf), as determined by γH2AX Western blot and immunofluorescence analyses. Cotreatment of cells with N-acetyl-cysteine, a potent oxidative-stress inhibitor, prevented DNA damage by bilirubin, supporting the concept that DNA damage was caused by bilirubin-induced oxidative stress. Bilirubin treatment also activated the main DNA repair pathways through homologous recombination (HR) and nonhomologous end joining (NHEJ), which may be adaptive responses to repair bilirubin-induced DNA damage. Since DNA damage may be another important factor contributing to neuronal death and bilirubin encephalopathy, these results contribute to the understanding of the mechanisms associated with bilirubin toxicity and may be of relevance in neonates affected with severe hyperbilirubinemia.
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Nam GS, Kwak SH, Bae SH, Kim SH, Jung J, Choi JY. Hyperbilirubinemia and Follow-up Auditory Brainstem Responses in Preterm Infants. Clin Exp Otorhinolaryngol 2018; 12:163-168. [PMID: 30404412 PMCID: PMC6453789 DOI: 10.21053/ceo.2018.00899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/14/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives. Neonatal hyperbilirubinemia is considered one of the most common causative factors of hearing loss. Preterm infants are more vulnerable to neuronal damage caused by hyperbilirubinemia. This study aimed to evaluate the effect of hyperbilirubinemia on hearing threshold and auditory pathway in preterm infants by serial auditory brainstem response (ABR). In addition, we evaluate the usefulness of the unconjugated bilirubin (UCB) level compared with total serum bilirubin (TSB) on bilirubin-induced hearing loss. Methods. This study was conducted on 70 preterm infants with hyperbilirubinemia who failed universal newborn hearing screening by automated ABR. The diagnostic ABR was performed within 3 months after birth. Follow-up ABR was conducted in patients with abnormal results (30 cases). TSB and UCB concentration were compared according to hearing threshold by ABR. Results. The initial and maximal measured UCB concentration for the preterm infants of diagnostic ABR ≥40 dB nHL group (n=30) were statistically higher compared with ABR ≤35 dB nHL group (n=40) (P=0.031 and P=0.003, respectively). In follow-up ABR examination, 13 of the ABR ≥40 dB nHL group showed complete recovery, but 17 had no change or worsened. There was no difference in bilirubin level between the recovery group and non-recovery group. Conclusion. UCB is a better predictor of bilirubin-induced hearing loss than TSB in preterm infants as evaluated by serial ABR. Serial ABR testing can be a useful, noninvasive methods to evaluate early reversible bilirubin-induced hearing loss in preterm infants.
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Affiliation(s)
- Gi-Sung Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Sang Hyun Kwak
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Huhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsei Jung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Timmons Z, Timmons J, Conrad C, Miloh T. Epidemiology of Hyperbilirubinemia in a Quaternary Pediatric Emergency Department over a Three-Year Period. Pediatr Gastroenterol Hepatol Nutr 2018; 21:297-305. [PMID: 30345243 PMCID: PMC6182479 DOI: 10.5223/pghn.2018.21.4.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/25/2018] [Accepted: 05/16/2018] [Indexed: 11/14/2022] Open
Abstract
PURPOSE There is a lack of scholarly reports on pediatric emergency department (PED) exposure to hyperbilirubinemia. We aimed to describe the epidemiology of hyperbilirubinemia in patients presenting to a PED over a three-year period. METHODS This was a retrospective cohort study, completed at an urban quaternary academic PED. Patients were included if they presented to the PED from 2010 to 2012, were 0 to 18 years in age, and had an elevated serum bilirubin for age. A chart review was completed to determine the incidence of hyperbilirubinemia, etiology, diagnostic work up and prognosis. The data set was stratified into four age ranges. RESULTS We identified 1,534 visits where a patient was found to have hyperbilirubinemia (0.8% of all visits). In 47.7% of patients hyperbilirubinemia was determined to have arisen from an identifiable pathologic etiology (0.38% of all visits). First-time diagnosis of pathologic hyperbilirubinemia occurred in 14% of hyperbilirubinemia visits (0.11% of all visits). There were varying etiologies of hyperbilirubinemia across age groups but a male predominance in all (55.0%). 15 patients went on to have a liver transplant and 20 patients died. First-time pathologic hyperbilirubinemia patients had a mortality rate of 0.95% for their initial hospitalization. CONCLUSION Hyperbilirubinemia was not a common presentation to the PED and a minority of cases were pathologic in etiology. The etiologies of hyperbilirubinemia varied across each of our study age groups. A new discovery of pathologic hyperbilirubinemia and progression to liver transplant or death during the initial presentation was extremely rare.
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Affiliation(s)
- Zebulon Timmons
- Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Jaci Timmons
- Division of Pediatrics, Cardon Children's Medical Center, Mesa, AZ, United States
| | - Christina Conrad
- Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Tamir Miloh
- Division of Gastroenterology, Texas Children's Hospital, Houston, TX, United States
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