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Garegrat R, Londhe A, Manerkar S, Fattepur S, Deshmukh L, Joshi A, Chandriah S, Kariyappa M, Devadas S, Ethirajan T, Srivasan K, Kamalarathnam C, Balachandran A, Krishnan E, Sahayaraj D, Bandiya P, Shivanna N, Burgod C, Thayyil A, Alocious A, Lanza M, Muraleedharan P, Pant S, Venkateswaran H, Morales MM, Montaldo P, Krishnan V, Kalathingal T, Joshi AR, Vare A, Patil GC, Satyanathan BP, Hapat P, Deshmukh A, Shivarudhrappa I, Annayappa MK, Baburaj M, Muradi C, Fernandes E, Thale N, Jahan I, Shahidullah M, Choudhury SM, Dey SK, Neogi SB, Banerjee R, Rameh V, Alobeidi F, Grant E, Juul SE, Wilson M, Vita ED, Pressler R, Bassett P, Shankaran S, Thayyil S. Early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy: a multicentre double-blind pilot randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327107. [PMID: 38729748 DOI: 10.1136/archdischild-2024-327107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To examine the feasibility of early and extended erythropoietin monotherapy after hypoxic ischaemic encephalopathy (HIE). DESIGN Double-blind pilot randomised controlled trial. SETTING Eight neonatal units in South Asia. PATIENTS Neonates (≥36 weeks) with moderate or severe HIE admitted between 31 December 2022 and 3 May 2023. INTERVENTIONS Erythropoietin (500 U/kg daily) or to the placebo (sham injections using a screen) within 6 hours of birth and continued for 9 days. MRI at 2 weeks of age. MAIN OUTCOMES AND MEASURES Feasibility of randomisation, drug administration and assessment of brain injury using MRI. RESULTS Of the 154 neonates screened, 56 were eligible; 6 declined consent and 50 were recruited; 43 (86%) were inborn. Mean (SD) age at first dose was 4.4 (1.2) hours in erythropoietin and 4.1 (1.0) hours in placebo. Overall mortality at hospital discharge occurred in 5 (19%) vs 11 (46%) (p=0.06), and 3 (13%) vs 9 (40.9%) (p=0.04) among those with moderate encephalopathy in the erythropoietin and placebo groups. Moderate or severe injury to basal ganglia, white matter and cortex occurred in 5 (25%) vs 5 (38.5%); 14 (70%) vs 11 (85%); and 6 (30%) vs 2 (15.4%) in the erythropoietin and placebo group, respectively. Sinus venous thrombosis was seen in two (10%) neonates in the erythropoietin group and none in the control group. CONCLUSIONS Brain injury and mortality after moderate or severe HIE are high in South Asia. Evaluation of erythropoietin monotherapy using MRI to examine treatment effects is feasible in these settings. TRIAL REGISTRATION NUMBER NCT05395195.
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Affiliation(s)
- Reema Garegrat
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Atul Londhe
- Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Swati Manerkar
- Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | | | - Laxmikant Deshmukh
- Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Amol Joshi
- Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | | | - Mallesh Kariyappa
- Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Sahana Devadas
- Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | | | | | | | | | | | | | - Prathik Bandiya
- Neonatology, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Niranjan Shivanna
- Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Constance Burgod
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | | | - Annie Alocious
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Marianna Lanza
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Pallavi Muraleedharan
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | | | - Maria Moreno Morales
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Vaisakh Krishnan
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Thaslima Kalathingal
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Anagha Rajeev Joshi
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Ajay Vare
- Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - G C Patil
- Karnataka Institute of Medical Sciences Hubballi, Hubli, Karnataka, India
| | | | - Pavan Hapat
- Perinatal Brain Research Centre, Hisar, India
| | | | | | | | | | | | | | | | - Ismat Jahan
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka District, Bangladesh
| | | | | | - Sanjoy Kumer Dey
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka District, Bangladesh
| | - Sutapa B Neogi
- International Institute of Health Management Research-New Delhi, New Delhi, Delhi, India
| | - Rupsa Banerjee
- International Institute of Health Management Research-New Delhi, New Delhi, Delhi, India
| | - Vanessa Rameh
- Medicine and Radiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Ellen Grant
- Medicine and Radiology, Harvard University, Cambridge, Massachusetts, USA
| | | | | | - Enrico De Vita
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - Seetha Shankaran
- Pediatrics/Neonatology, University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
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Costescu OC, Manea AM, Boia ER, Cioboata DM, Doandes FM, Enatescu I, Costescu S, Prodan M, Boia M. Early Postnatal Administration of Erythropoietin and Its Association with Neurodevelopmental Outcomes and Incidence of Intraventricular Hemorrhage and Hypoxic-Ischemic Encephalopathy: A Four-Week Observational Study. Pediatr Rep 2024; 16:339-352. [PMID: 38804373 PMCID: PMC11130859 DOI: 10.3390/pediatric16020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
This study aimed to investigate the impact of early erythropoietin (EPO) administration on the neurodevelopment of newborns, specifically focusing on its effects on hypoxic-ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH). The primary objective was to determine whether early EPO administration could impact the short-term neurodevelopmental outcomes and provide safety in neonates at risk for neurodevelopmental disorders. Conducted at the "Louis Turcanu" Children's Emergency Clinical Hospital in Timisoara, Romania, this observational study included 121 neonates receiving EPO and 130 No EPO controls. EPO was administered within the first 48 h of life, with doses of 1000 U/kg that escalated to 2000 U/kg if necessary. Besides observing the occurrence of IVH and HIE, this study measured clinical and biochemical markers, including LDH, blood glucose, urea, creatinine, CPK, CRP, PCT, and erythropoietin levels alongside hematology and coagulation profiles. There were no significant differences in baseline characteristics between the groups. The EPO group showed significant reductions in LDH levels from days 1-3 to 7-10 (695.0 U/L to 442.0 U/L) and the APTT value (54.0 s) compared with the No EPO group (38.0 s). Notably, early EPO administration was associated with a significant decrease in HIE severity (beta coefficient: -0.38, p = 0.001). Additionally, lower gestational ages and hemoglobin levels correlated with increased severity of HIE. By week four, there was a significant reduction in moderate and severe HIE cases in the EPO group compared with controls (p = 0.001). Early administration of EPO in neonates significantly reduced the severity of IVH and HIE, suggesting its potential as a neuroprotective agent in neonatal care.
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Affiliation(s)
- Oana Cristina Costescu
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Aniko Maria Manea
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
| | - Eugen Radu Boia
- ENT Department, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Daniela Mariana Cioboata
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Florina Marinela Doandes
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
| | - Ileana Enatescu
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
| | - Sergiu Costescu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department of Obstetrics and Gynecology, Oravita City Hospital, 325600 Oravita, Romania
| | - Mihaela Prodan
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, No. 2, 300041 Timisoara, Romania;
| | - Marioara Boia
- Department of Neonatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.C.); (D.M.C.); (F.M.D.); (I.E.); (M.B.)
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Marsia S, Kumar D, Raheel H, Salman A, Aslam B, Ikram A, Kumar P, Aslam A, Shafiq A, Gul A. Evaluating the Safety and Efficacy of Erythropoietin Therapy for Neonatal Hypoxic-Ischemic Encephalopathy: A Systematic Review and Meta-Analysis. Pediatr Neurol 2024; 152:4-10. [PMID: 38171084 DOI: 10.1016/j.pediatrneurol.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Erythropoietin (EPO) is a proposed drug for the treatment of neonatal hypoxic-ischemic encephalopathy (HIE). Multiple studies have linked its use, either as a monotherapy or in conjunction with therapeutic hypothermia (TH), with improved neonatal outcomes including death and neurodisability. However, there is also evidence in the literature that raises concerns about its efficacy and safety for the treatment of neonatal encephalopathy (NE). METHODS We searched MEDLINE, Cochrane CENTRAL, and Embase for both observational studies and randomized controlled trials (RCTs) investigating the effectiveness of EPO in treating NE. Only studies in which at least 300 U/kg of EPO was used and reported any one of the following outcomes: death, death or neurodisability, and cerebral palsy, were included. RESULTS Seven studies with 903 infants with the diagnosis of NE were included in our meta-analysis. EPO did not reduce the risk of death or neurodisability (risk ratio 0.68 [95% confidence interval [CI]: 0.43 to 1.09]) (P = 0.11). Similarly, the risk of cerebral palsy was not reduced by the administration of EPO (risk ratio 0.68 [95% CI: 0.33 to 1.40]) (P = 0.30). The risk of death was also not reduced at any dose of EPO regardless of the use of TH. CONCLUSIONS The results of our meta-analysis do not support the use of EPO for the treatment of neonatal encephalopathy. However, future large-scale RCTs are needed to strengthen these findings.
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Affiliation(s)
- Shayan Marsia
- Department of Neurology, Spectrum Health/Michigan State University, Grand Rapids, Michigan.
| | - Danisha Kumar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Hamna Raheel
- Dow University of Health Sciences, Karachi, Pakistan
| | - Ali Salman
- Dow University of Health Sciences, Karachi, Pakistan
| | - Baseer Aslam
- Dow University of Health Sciences, Karachi, Pakistan
| | - Armeen Ikram
- Dow University of Health Sciences, Karachi, Pakistan
| | - Piresh Kumar
- Bahria University Of Medical and Dental College, Karachi city, Pakistan
| | - Aimun Aslam
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Areeba Shafiq
- Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Gul
- Jinnah Sindh Medical University, Karachi, Pakistan
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Melemed AL, Slaughter JL, Benninger KL, Conroy S. Is erythropoietin beneficial and safe as an adjunctive therapy to therapeutic hypothermia in newborns with hypoxic ischemic injury? J Perinatol 2023; 43:1552-1555. [PMID: 37773520 DOI: 10.1038/s41372-023-01773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Abigail L Melemed
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Jonathan L Slaughter
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio Perinatal Research Network, Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kristen L Benninger
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio Perinatal Research Network, Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Sara Conroy
- The Ohio Perinatal Research Network, Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Biostatistics Resource at Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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5
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Chung LM, Hariharan G. EBNEO Commentary: Safety and efficacy of erythropoietin in neonates with hypoxic-ischaemic encephalopathy. Acta Paediatr 2023; 112:885-886. [PMID: 36748724 DOI: 10.1111/apa.16683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Lorraine Marie Chung
- Department of Child and Adolescent Health Unit, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Gopakumar Hariharan
- Department of Child and Adolescent Health Unit, Mackay Base Hospital, Mackay, Queensland, Australia.,James Cook University, Mackay, Queensland, Australia
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6
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Kukka AJ, Waheddoost S, Brown N, Litorp H, Wrammert J, KC A. Incidence and outcomes of intrapartum-related neonatal encephalopathy in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2022-010294. [PMID: 36581333 PMCID: PMC9806096 DOI: 10.1136/bmjgh-2022-010294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/23/2022] [Indexed: 12/30/2022] Open
Abstract
AIM To examine the incidence of intrapartum-related neonatal encephalopathy, and neonatal mortality and neurodevelopmental outcomes associated with it in low-income and middle-income countries. METHODS Reports were included when neonatal encephalopathy diagnosed clinically within 24 hours of birth in term or near-term infants born after intrapartum hypoxia-ischaemia defined as any of the following: (1) pH≤7.1 or base excess ≤-12 or lactate ≥6, (2) Apgar score ≤5 at 5 or 10 min, (3) continuing resuscitation at 5 or 10 min or (4) no cry from baby at 5 or 10 min. Peer-reviewed articles were searched from Ovid MEDLINE, Cochrane, Web of Science and WHO Global Index Medicus with date limits 1 November 2009 to 17 November 2021. Risk of bias was assessed using modified Newcastle Ottawa Scale. Inverse variance of heterogenicity was used for meta-analyses. RESULTS There were 53 reports from 51 studies presenting data on 4181 children with intrapartum-related neonatal encephalopathy included in the review. Only five studies had data on incidence, which ranged from 1.5 to 20.3 per 1000 live births. Neonatal mortality was examined in 45 studies and in total 636 of the 3307 (19.2%) infants died. Combined outcome of death or moderate to severe neurodevelopmental disability was reported in 19 studies and occurred in 712 out of 1595 children (44.6%) with follow-up 1 to 3.5 years. CONCLUSION Though there has been progress in some regions, incidence, case mortality and morbidity in intrapartum-related neonatal encephalopathy has been static in the last 10 years. PROSPERO REGISTRATION NUMBER CRD42020177928.
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Affiliation(s)
- Antti Juhani Kukka
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .,Department of Pediatrics, Region Gävleborg, Gävle, Sweden
| | | | - Nick Brown
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Department of Pediatrics, Region Gävleborg, Gävle, Sweden
| | - Helena Litorp
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Johan Wrammert
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ashish KC
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Rasineni GK, Panigrahy N, Rath SN, Chinnaboina M, Konanki R, Chirla DK, Madduri S. Diagnostic and Therapeutic Roles of the “Omics” in Hypoxic–Ischemic Encephalopathy in Neonates. Bioengineering (Basel) 2022; 9:bioengineering9100498. [PMID: 36290466 PMCID: PMC9598631 DOI: 10.3390/bioengineering9100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Perinatal asphyxia and neonatal encephalopathy remain major causes of neonatal mortality, despite the improved availability of diagnostic and therapeutic tools, contributing to neurological and intellectual disabilities worldwide. An approach using a combination of clinical data, neuroimaging, and biochemical parameters is the current strategy towards the improved diagnosis and prognosis of the outcome in neonatal hypoxic–ischemic encephalopathy (HIE) using bioengineering methods. Traditional biomarkers are of little use in this multifactorial and variable phenotype-presenting clinical condition. Novel systems of biology-based “omics” approaches (genomics, transcriptome proteomics, and metabolomics) may help to identify biomarkers associated with brain and other tissue injuries, predicting the disease severity in HIE. Biomarker studies using omics technologies will likely be a key feature of future neuroprotective treatment methods and will help to assess the successful treatment and long-term efficacy of the intervention. This article reviews the roles of different omics as biomarkers of HIE and outlines the existing knowledge of our current understanding of the clinical use of different omics molecules as novel neonatal brain injury biomarkers, which may lead to improved interventions related to the diagnostic and therapeutic aspects of HIE.
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Affiliation(s)
- Girish Kumar Rasineni
- LCMS Division, Tenet Medcorp Pvt. Ltd., 54 Kineta Towers Road No 3, Banjara Hills, Hyderabad 500034, India
| | - Nalinikanta Panigrahy
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad 500034, India
- Correspondence: (N.P.); (S.N.R.)
| | - Subha Narayan Rath
- Regenerative Medicine and Stem Cell Laboratory, Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Telangana 502284, India
- Correspondence: (N.P.); (S.N.R.)
| | - Madhurarekha Chinnaboina
- LCMS Division, Tenet Medcorp Pvt. Ltd., 54 Kineta Towers Road No 3, Banjara Hills, Hyderabad 500034, India
| | - Ramesh Konanki
- Department of Pediatric Neurology, Rainbow Children’s Hospital, Hyderabad 500034, India
| | - Dinesh Kumar Chirla
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad 500034, India
| | - Srinivas Madduri
- Bioengineering and Regenerative Medicine, Department of Biomedical Engineering, University of Basel, University Hospital Basel, 4001 Basel, Switzerland
- Department of Surgery, Bioengineering and Neuroregeneration, University of Geneva, University Hospital Geneva, 1211 Geneva, Switzerland
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Davidson JO, van den Heuij LG, Dhillon SK, Miller SL, Lim R, Jenkin G, Gunn AJ, Bennet L. Lack of Neuroprotection with a Single Intravenous Infusion of Human Amnion Epithelial Cells after Severe Hypoxia–Ischemia in Near-Term Fetal Sheep. Int J Mol Sci 2022; 23:ijms23158393. [PMID: 35955531 PMCID: PMC9369428 DOI: 10.3390/ijms23158393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Hypoxic–ischemic encephalopathy (HIE) around the time of birth results from loss of oxygen (hypoxia) and blood supply (ischemia). Exogenous infusion of multi-potential cells, including human amnion epithelial cells (hAECs), can reduce hypoxic–ischemic (HI) brain injury. However, there are few data on treatment of severe HI in large animal paradigms at term. The aim of the current study was to determine whether infusion of hAECs early after injury may reduce brain damage after ischemia in near-term fetal sheep. Methods: Chronically instrumented fetal sheep (0.85 gestation) received 30 min of global cerebral ischemia followed by intravenous infusion of hAECs from 2 h after the end of ischemia (ischemia-hAEC, n = 6) or saline (ischemia-vehicle, n = 7). Sham control animals received sham ischemia with vehicle infusion (sham control, n = 8). Results: Ischemia was associated with significant suppression of EEG power and spectral edge frequency until the end of the experiment and a secondary rise in cortical impedance from 24 to 72 h, which were not attenuated by hAEC administration. Ischemia was associated with loss of neurons in the cortex, thalamus, striatum and hippocampus, loss of white matter oligodendrocytes and increased microglial numbers in the white matter, which were not affected by hAEC infusion. Conclusions: A single intravenous administration of hAECs did not reduce electrographic or histological brain damage after 30 min of global cerebral ischemia in near-term fetal sheep.
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Affiliation(s)
- Joanne O. Davidson
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland 1010, New Zealand; (L.G.v.d.H.); (S.K.D.); (A.J.G.); (L.B.)
- Correspondence:
| | - Lotte G. van den Heuij
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland 1010, New Zealand; (L.G.v.d.H.); (S.K.D.); (A.J.G.); (L.B.)
| | - Simerdeep K. Dhillon
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland 1010, New Zealand; (L.G.v.d.H.); (S.K.D.); (A.J.G.); (L.B.)
| | - Suzanne L. Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (S.L.M.); (R.L.); (G.J.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3800, Australia
| | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (S.L.M.); (R.L.); (G.J.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3800, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (S.L.M.); (R.L.); (G.J.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3800, Australia
| | - Alistair J. Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland 1010, New Zealand; (L.G.v.d.H.); (S.K.D.); (A.J.G.); (L.B.)
| | - Laura Bennet
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland 1010, New Zealand; (L.G.v.d.H.); (S.K.D.); (A.J.G.); (L.B.)
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9
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Ma Y, Zhou Z, Yang GY, Ding J, Wang X. The Effect of Erythropoietin and Its Derivatives on Ischemic Stroke Therapy: A Comprehensive Review. Front Pharmacol 2022; 13:743926. [PMID: 35250554 PMCID: PMC8892214 DOI: 10.3389/fphar.2022.743926] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/19/2022] [Indexed: 12/17/2022] Open
Abstract
Numerous studies explored the therapeutic effects of erythropoietin (EPO) on neurodegenerative diseases. Few studies provided comprehensive and latest knowledge of EPO treatment for ischemic stroke. In the present review, we introduced the structure, expression, function of EPO, and its receptors in the central nervous system. Furthermore, we comprehensively discussed EPO treatment in pre-clinical studies, clinical trials, and its therapeutic mechanisms including suppressing inflammation. Finally, advanced studies of the therapy of EPO derivatives in ischemic stroke were also discussed. We wish to provide valuable information on EPO and EPO derivatives’ treatment for ischemic stroke for basic researchers and clinicians to accelerate the process of their clinical applications.
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Affiliation(s)
- Yuanyuan Ma
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiyuan Zhou
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Guo-Yuan Yang, ; Jing Ding,
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Guo-Yuan Yang, ; Jing Ding,
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of The State Key Laboratory of Medical Neurobiology, The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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Berthou C, Iliou JP, Barba D. Iron, neuro‐bioavailability and depression. EJHAEM 2022; 3:263-275. [PMID: 35846210 PMCID: PMC9175715 DOI: 10.1002/jha2.321] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 12/14/2022]
Abstract
Medical management of iron deficiency (ID) requires to consider its consequences in biochemical and physiological plural functions, beyond heme/hemoglobin disrupted synthesis. Fatigue, muscle weakness, reduced exercise capacity, changes in thymia and modified emotional behaviors are the commonest symptoms integrated in the history of ID, dependent or not of the hemoglobin concentration. The relationship between depression and absolute ID (AID) is a condition which is often unrecognized. Neuro‐bioavailability and brain capture of blood iron are necessary for an appropriate synthesis of neurotransmitters (serotonin, dopamine, noradrenaline). These neurotransmitters, involved in emotional behaviors, depend on neuron aromatic hydoxylases functioning with iron as essential cofactor. Noradrenaline also has impact on neuroplasticity via brain‐derived neurotrophic factor (BDNF), which is key for prefrontal and hippocampus neurons playing a role in depression. Establishing the formal relationship between depression and AID remains difficult. Intracerebral reduced iron is still hard to quantify by neuroimaging and single‐photon emission computed tomography (SPECT) now tends to explore the neurotransmission pathways. AID has to be looked for and identified in the context of depression, major episode or resistant to conventional treatment such as serotonin reuptake inhibitor, and even in the absence of anemia, microcytosis or hypochromia (non‐anemic ID). Confronted to brain imaging, blood iron status evaluation is indicated, especially in depressed, treatment‐resistant, iron‐deficient young women. In patients suffering from depression, increase in the prevalence of AID should be considered, in order to deliver a suitable treatment, considering both anti‐depressive program and iron supplementation if AID.
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Affiliation(s)
- Christian Berthou
- Department of Immuno‐Hematology INSERM UMR 12 27 LBAI University Brest Brest France
| | | | - Denis Barba
- Health and Medical Center Le Guilvinec France
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11
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Mathew JL, Suman Rao PN, Vinayan KP. Randomized Controlled Trial Evaluating Hypothermia for Neonatal Encephalopathy in Low- and Middle-Income Countries. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2335-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Krishnan V, Kumar V, Variane GFT, Carlo WA, Bhutta ZA, Sizonenko S, Hansen A, Shankaran S, Thayyil S. Need for more evidence in the prevention and management of perinatal asphyxia and neonatal encephalopathy in low and middle-income countries: A call for action. Semin Fetal Neonatal Med 2021; 26:101271. [PMID: 34330679 PMCID: PMC8650826 DOI: 10.1016/j.siny.2021.101271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although low- and middle-income countries (LMICs) shoulder 90 % of the neonatal encephalopathy (NE) burden, there is very little evidence base for prevention or management of this condition in these settings. A variety of antenatal factors including socio-economic deprivation, undernutrition and sub optimal antenatal and intrapartum care increase the risk of NE, although little is known about the underlying mechanisms. Implementing interventions based on the evidence from high-income countries to LMICs, may cause more harm than benefit as shown by the increased mortality and lack of neuroprotection with cooling therapy in the hypothermia for moderate or severe NE in low and middle-income countries (HELIX) trial. Pooled data from pilot trials suggest that erythropoietin monotherapy reduces death and disability in LMICs, but this needs further evaluation in clinical trials. Careful attention to supportive care, including avoiding hyperoxia, hypocarbia, hypoglycemia, and hyperthermia, are likely to improve outcomes until specific neuroprotective or neurorestorative therapies available.
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Affiliation(s)
- Vaisakh Krishnan
- Centre of Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK.
| | - Vijay Kumar
- Centre of Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK.
| | | | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, USA.
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | | | - Anne Hansen
- Division of Newborn Medicine, Boston Children's Hospital, Boston, USA.
| | | | - Sudhin Thayyil
- Centre of Perinatal Neuroscience, Department of Brain Sciences, Imperial College London, London, UK.
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13
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Thayyil S, Pant S, Montaldo P, Shukla D, Oliveira V, Ivain P, Bassett P, Swamy R, Mendoza J, Moreno-Morales M, Lally PJ, Benakappa N, Bandiya P, Shivarudhrappa I, Somanna J, Kantharajanna UB, Rajvanshi A, Krishnappa S, Joby PK, Jayaraman K, Chandramohan R, Kamalarathnam CN, Sebastian M, Tamilselvam IA, Rajendran UD, Soundrarajan R, Kumar V, Sudarsanan H, Vadakepat P, Gopalan K, Sundaram M, Seeralar A, Vinayagam P, Sajjid M, Baburaj M, Murugan KD, Sathyanathan BP, Kumaran ES, Mondkar J, Manerkar S, Joshi AR, Dewang K, Bhisikar SM, Kalamdani P, Bichkar V, Patra S, Jiwnani K, Shahidullah M, Moni SC, Jahan I, Mannan MA, Dey SK, Nahar MN, Islam MN, Shabuj KH, Rodrigo R, Sumanasena S, Abayabandara-Herath T, Chathurangika GK, Wanigasinghe J, Sujatha R, Saraswathy S, Rahul A, Radha SJ, Sarojam MK, Krishnan V, Nair MK, Devadas S, Chandriah S, Venkateswaran H, Burgod C, Chandrasekaran M, Atreja G, Muraleedharan P, Herberg JA, Kling Chong WK, Sebire NJ, Pressler R, Ramji S, Shankaran S. Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh. LANCET GLOBAL HEALTH 2021; 9:e1273-e1285. [PMID: 34358491 PMCID: PMC8371331 DOI: 10.1016/s2214-109x(21)00264-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. METHODS We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18-22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02387385. FINDINGS We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87-1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. INTERPRETATION Therapeutic hypothermia did not reduce the combined outcome of death or disability at 18 months after neonatal encephalopathy in low-income and middle-income countries, but significantly increased death alone. Therapeutic hypothermia should not be offered as treatment for neonatal encephalopathy in low-income and middle-income countries, even when tertiary neonatal intensive care facilities are available. FUNDING National Institute for Health Research, Garfield Weston Foundation, and Bill & Melinda Gates Foundation. TRANSLATIONS For the Hindi, Malayalam, Telugu, Kannada, Singhalese, Tamil, Marathi and Bangla translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College London, London, UK.
| | - Stuti Pant
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Paolo Montaldo
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Deepika Shukla
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Vania Oliveira
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Phoebe Ivain
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Ravi Swamy
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India
| | - Josephine Mendoza
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Peter J Lally
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Naveen Benakappa
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Prathik Bandiya
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Indramma Shivarudhrappa
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India; Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India; Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Jagadish Somanna
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | | | - Ankur Rajvanshi
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Sowmya Krishnappa
- Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | | | | | | | | | - Monica Sebastian
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India; Institute of Child Health, Madras Medical College, Chennai, India
| | | | - Usha D Rajendran
- Institute of Child Health, Madras Medical College, Chennai, India
| | | | - Vignesh Kumar
- Institute of Child Health, Madras Medical College, Chennai, India
| | | | - Padmesh Vadakepat
- Institute of Child Health, Madras Medical College, Chennai, India; Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Kavitha Gopalan
- Institute of Child Health, Madras Medical College, Chennai, India
| | - Mangalabharathi Sundaram
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Arasar Seeralar
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Prakash Vinayagam
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Mohamed Sajjid
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Mythili Baburaj
- Perinatal Epidemiology Unit, Bengaluru, Karnataka, India; Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | - Kanchana D Murugan
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Madras Medical College, Chennai, India
| | | | | | - Jayashree Mondkar
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Swati Manerkar
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Anagha R Joshi
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Kapil Dewang
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | | | - Pavan Kalamdani
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Vrushali Bichkar
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Saikat Patra
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Kapil Jiwnani
- Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | | | - Sadeka C Moni
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ismat Jahan
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Sanjoy K Dey
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mst N Nahar
- National Institute of Neurosciences, Dhaka, Bangladesh
| | | | - Kamrul H Shabuj
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | | | | | | | - Radhika Sujatha
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Sobhakumar Saraswathy
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Aswathy Rahul
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Saritha J Radha
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Manoj K Sarojam
- Sree Avittom Thirunal Hospital and Government Medical College, Thiruvananthapuram, Kerala, India
| | - Vaisakh Krishnan
- Institute of Maternal and Child Health, Government Medical College, Kozhikode, Kerala, India
| | - Mohandas K Nair
- Institute of Maternal and Child Health, Government Medical College, Kozhikode, Kerala, India
| | - Sahana Devadas
- Vanivilas Hospital, Bangalore Medical College and Research Institute, Karnataka, India
| | - Savitha Chandriah
- Vanivilas Hospital, Bangalore Medical College and Research Institute, Karnataka, India
| | | | - Constance Burgod
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Gaurav Atreja
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Jethro A Herberg
- Section of Paediatric Infectious Disease, Imperial College London, London, UK
| | - W K Kling Chong
- Centre for Perinatal Neuroscience, Imperial College London, London, UK; Department of Neuroradiology, Great Ormond Street Hospital, London, UK
| | - Neil J Sebire
- Perinatal Pathology, National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital for Children, University College London, London, UK
| | - Ronit Pressler
- Department of Neurophysiology, Great Ormond Street Hospital, London, UK
| | | | - Seetha Shankaran
- Neonatal-Perinatal Medicine, Wayne State University, Detroit, MI, USA
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