1
|
Perrone S, Grassi F, Caporilli C, Boscarino G, Carbone G, Petrolini C, Gambini LM, Di Peri A, Moretti S, Buonocore G, Esposito SMR. Brain Damage in Preterm and Full-Term Neonates: Serum Biomarkers for the Early Diagnosis and Intervention. Antioxidants (Basel) 2023; 12:antiox12020309. [PMID: 36829868 PMCID: PMC9952571 DOI: 10.3390/antiox12020309] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The Brain is vulnerable to numerous insults that can act in the pre-, peri-, and post-natal period. There is growing evidence that demonstrate how oxidative stress (OS) could represent the final common pathway of all these insults. Fetuses and newborns are particularly vulnerable to OS due to their inability to active the antioxidant defenses. Specific molecules involved in OS could be measured in biologic fluids as early biomarkers of neonatal brain injury with an essential role in neuroprotection. Although S-100B seems to be the most studied biomarker, its use in clinical practice is limited by the complexity of brain damage etiopathogenesis and the time of blood sampling in relation to the brain injury. Reliable early specific serum markers are currently lacking in clinical practice. It is essential to determine if there are specific biomarkers that can help caregivers to monitor the progression of the disease in order to active an early neuroprotective strategy. We aimed to describe, in an educational review, the actual evidence on serum biomarkers for the early identification of newborns at a high risk of neurological diseases. To move the biomarkers from the bench to the bedside, the assays must be not only be of a high sensitivity but suitable for the very rapid processing and return of the results for the clinical practice to act on. For the best prognosis, more studies should focus on the association of these biomarkers to the type and severity of perinatal brain damage.
Collapse
Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | - Federica Grassi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Caporilli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giovanni Boscarino
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Giulia Carbone
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Lucia Maria Gambini
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Antonio Di Peri
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Sabrina Moretti
- Neonatology Unit, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | | |
Collapse
|
2
|
The Usefulness of Serum Brain Damage Biomarkers in Detection and Evaluation of Hypoxic Ischemic Encephalopathy in Calves with Perinatal Asphyxia. Animals (Basel) 2022; 12:ani12223223. [PMID: 36428450 PMCID: PMC9686605 DOI: 10.3390/ani12223223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
The purpose of the present study was to determine hypoxic brain damage in calves with perinatal asphyxia using brain-specific damage biomarkers. Ten healthy and 25 calves with perinatal asphyxia were enrolled in the study. Clinical examination, neurological status score, and laboratory analysis were performed at admission, 24, 48, and 72 h. Serum concentrations of ubiquitin carboxy-terminal hydrolysis 1 (UCHL1), calcium-binding protein B (S100B), adrenomodullin (ADM), activitin A (ACTA), neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP) and creatine kinase-brain (CK-B) were measured. Histopathological and immunohistochemical examinations of the brain tissue were performed in 13 nonsurvivor calves. The neurological status score of the calves with asphyxia was significantly (p < 0.05) lower. Mix metabolic-respiratory acidosis and hypoxemia were detected in calves with asphyxia. Serum UCHL1 and S100B were significantly (p < 0.05) increased, and NSE, ACTA, ADM, and CK-B were decreased (p < 0.05) in calves with asphyxia. Histopathological and immunohistochemical examinations confirmed the development of mild to severe hypoxic-ischemic encephalopathy. In conclusion, asphyxia and hypoxemia caused hypoxic-ischemic encephalopathy in perinatal calves. UCHL1 and S100B concentrations were found to be useful markers for the determination of hypoxic-ischemic encephalopathy in calves with perinatal asphyxia. Neurological status scores and some blood gas parameters were helpful in mortality prediction.
Collapse
|
3
|
Bersani I, Gasparroni G, Bashir M, Aboulgar H, Mufeed H, Iskander I, Kornacka M, Gruzfeld D, Dotta A, Campi F, Longo D, Savarese I, Braguglia A, Tina LG, Nigro F, Serpero L, Strozzi MC, Maconi A, Ianniello P, Di Battista C, D'Adamo E, Gavilanes D, Gazzolo D. Early predictors of abnormal MRI patterns in asphyxiated infants: S100B protein urine levels. Clin Chem Lab Med 2022; 60:1745-1752. [PMID: 35977430 DOI: 10.1515/cclm-2022-0559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The early detection and stratification of asphyxiated infants at higher risk for impaired neurodevelopment is challenging. S100B protein is a well-established biomarker of brain damage, but lacks conclusive validation according to the "gold standard" methodology for hypoxic-ischemic encephalopathy (HIE) prognostication, i.e. brain MRI. The aim of the present study was to investigate the predictive role of urinary S100B concentrations, assessed in a cohort of HIE infants receiving therapeutic hypothermia (TH), compared to brain MRI. METHODS Assessment of urine S100B concentrations was performed by immunoluminometric assay at first void and at 4, 8, 12, 16, 20, 24, 48, 72, 96, 108 and 120-h after birth. Neurologic evaluation, routine laboratory parameters, amplitude-integrated electroencephalography, and cerebral ultrasound were performed according to standard protocols. Brain MRI was performed at 7-10 days of life. RESULTS Overall, 74 HIE neonates receiving TH were included in the study. S100B correlated, already at first void, with the MRI patterns with higher concentrations in infants with the most severe MRI lesions. CONCLUSIONS High S100B urine levels soon after birth constitute trustable predictors of brain injury as confirmed by MRI. Results support the reliability of S100B in clinical daily practice and open the way to its inclusion in the panel of parameters used for the selection of cases suitable for TH treatment.
Collapse
Affiliation(s)
- Iliana Bersani
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù; Children's Hospital, Rome, Italy
| | | | - Moataza Bashir
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Hanna Aboulgar
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Hala Mufeed
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Iman Iskander
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Maria Kornacka
- Department of Neonatology and Intensive Care of Neonate, Warsaw University, Warsaw, Poland
| | - Darek Gruzfeld
- Department of Neonatology and Intensive Care of Neonate, Warsaw University, Warsaw, Poland
| | - Andrea Dotta
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù; Children's Hospital, Rome, Italy
| | - Francesca Campi
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù; Children's Hospital, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Department of Imaging, Bambino Gesù; Children's Hospital, Rome, Italy
| | - Immacolata Savarese
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù; Children's Hospital, Rome, Italy
| | - Annabella Braguglia
- Department of Neonatology, Neonatal Intensive Care Unit, Bambino Gesù; Children's Hospital, Rome, Italy
| | - Lucia Gabriella Tina
- Department of Maternal Fetal and Neonatal Health, G. Garibaldi Hospital, Catania, Italy
| | - Francesco Nigro
- Department of Maternal Fetal and Neonatal Health, G. Garibaldi Hospital, Catania, Italy
| | - Laura Serpero
- Department of Maternal Fetal and Neonatal Medicine C. Arrigo Children's Hospital, Alessandria, Italy
| | - Maria Chiara Strozzi
- Department of Maternal Fetal and Neonatal Medicine C. Arrigo Children's Hospital, Alessandria, Italy
| | - Antonio Maconi
- Department of Maternal Fetal and Neonatal Medicine C. Arrigo Children's Hospital, Alessandria, Italy
| | - Patrizia Ianniello
- Department of Maternal Fetal and Neonatal Medicine C. Arrigo Children's Hospital, Alessandria, Italy
| | | | - Ebe D'Adamo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | - Danilo Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University, Maastricht, The Netherlands
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| |
Collapse
|
4
|
Mineyko A, Nettel-Aguirre A, de Jesus P, Benseler S, Yusuf K, Narendran A, Kirton A. Association of neonatal inflammatory markers and perinatal stroke subtypes. Neurology 2020; 95:e1163-e1173. [PMID: 32727836 DOI: 10.1212/wnl.0000000000010309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the relationship between neonatal inflammatory cytokines and perinatal stroke using a systems biology approach analyzing serum and blood-spot cytokines from 47 patients. METHODS This was a population-based, controlled cohort study with prospective and retrospective case ascertainment. Participants were recruited through the Alberta Perinatal Stroke Project. Stroke was classified as neonatal arterial ischemic stroke (NAIS), arterial presumed perinatal ischemic stroke (APPIS), or periventricular venous infarction (PVI). Biosamples were stored blood spots (retrospective) and acute serum (prospective). Controls had comparable gestational and maternal ages. Sixty-five cytokines were measured (Luminex). Hierarchical clustering analysis was performed to create heat maps. The Fisher linear discriminant analysis was used to create projection models to determine discriminatory boundaries between stroke types and controls. RESULTS A total of 197 participants were analyzed (27 with NAIS, 8 with APPIS, 12 with PVI, 150 controls). Cytokines were quantifiable with quality control measures satisfied (standards testing, decay analysis). Linear discriminant analysis had high accuracy in using cytokine profiles to separate groups. Profiles in participants with PVI and controls were similar. NAIS separation was accurate (sensitivity 77%, specificity 97%). APPIS mapping was also distinguishable from NAIS (sensitivity 86%, specificity 99%). Classification tree analysis generated similar diagnostic accuracy. CONCLUSIONS Unique inflammatory biomarker signatures are associated with specific perinatal stroke diseases. Findings support an acquired pathophysiology and suggest the possibility that at-risk pregnancies might be identified to develop prevention strategies. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that differences in acute neonatal serum cytokine profiles can discriminate between patients with specific perinatal stroke diseases and controls.
Collapse
Affiliation(s)
- Aleksandra Mineyko
- From the Departments of Pediatrics (A.M., A.N.-A., S.B., K.Y., A.N., A.K.), Clinical Neurosciences (A.M., P.d.J., A.K.), and Community Health Sciences (A.N.-A.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
| | - Alberto Nettel-Aguirre
- From the Departments of Pediatrics (A.M., A.N.-A., S.B., K.Y., A.N., A.K.), Clinical Neurosciences (A.M., P.d.J., A.K.), and Community Health Sciences (A.N.-A.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Pauline de Jesus
- From the Departments of Pediatrics (A.M., A.N.-A., S.B., K.Y., A.N., A.K.), Clinical Neurosciences (A.M., P.d.J., A.K.), and Community Health Sciences (A.N.-A.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susanne Benseler
- From the Departments of Pediatrics (A.M., A.N.-A., S.B., K.Y., A.N., A.K.), Clinical Neurosciences (A.M., P.d.J., A.K.), and Community Health Sciences (A.N.-A.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kamran Yusuf
- From the Departments of Pediatrics (A.M., A.N.-A., S.B., K.Y., A.N., A.K.), Clinical Neurosciences (A.M., P.d.J., A.K.), and Community Health Sciences (A.N.-A.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Aru Narendran
- From the Departments of Pediatrics (A.M., A.N.-A., S.B., K.Y., A.N., A.K.), Clinical Neurosciences (A.M., P.d.J., A.K.), and Community Health Sciences (A.N.-A.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adam Kirton
- From the Departments of Pediatrics (A.M., A.N.-A., S.B., K.Y., A.N., A.K.), Clinical Neurosciences (A.M., P.d.J., A.K.), and Community Health Sciences (A.N.-A.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| |
Collapse
|
5
|
Bersani I, Pluchinotta F, Dotta A, Savarese I, Campi F, Auriti C, Chuklantseva N, Piersigilli F, Gazzolo F, Varrica A, Satriano A, Gazzolo D. Early predictors of perinatal brain damage: the role of neurobiomarkers. Clin Chem Lab Med 2020; 58:471-486. [PMID: 31851609 DOI: 10.1515/cclm-2019-0725] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/31/2019] [Indexed: 09/17/2023]
Abstract
The early detection of perinatal brain damage in preterm and term newborns (i.e. intraventricular hemorrhage, periventricular leukomalacia and perinatal asphyxia) still constitute an unsolved issue. To date, despite technological improvement in standard perinatal monitoring procedures, decreasing the incidence of perinatal mortality, the perinatal morbidity pattern has a flat trend. Against this background, the measurement of brain constituents could be particularly useful in the early detection of cases at risk for short-/long-term brain injury. On this scenario, the main European and US international health-care institutions promoted perinatal clinical and experimental neuroprotection research projects aimed at validating and including a panel of biomarkers in the clinical guidelines. Although this is a promising attempt, there are several limitations that do not allow biomarkers to be included in standard monitoring procedures. The main limitations are: (i) the heterogeneity of neurological complications in the perinatal period, (ii) the small cohort sizes, (iii) the lack of multicenter investigations, (iv) the different techniques for neurobiomarkers assessment, (iv) the lack of consensus for the validation of assays in biological fluids such as urine and saliva, and (v), the lack of reference curves according to measurement technique and biological fluid. In the present review we offer an up-to-date overview of the most promising developments in the use of biomarkers in the perinatal period such as calcium binding proteins (S100B protein), vasoactive agents (adrenomedullin), brain biomarkers (activin A, neuron specific enolase, glial fibrillary acidic protein, ubiquitin carboxyl-terminal hydrolase-L1) and oxidative stress markers.
Collapse
Affiliation(s)
- Iliana Bersani
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Pluchinotta
- Laboratory Research Department of Pediatric Cardiovascular Surgery, SanDonato Milanese Univerity Hospital, San Donato Milanese, Milan, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Savarese
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Natalia Chuklantseva
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fiammetta Piersigilli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Alessandro Varrica
- Laboratory Research Department of Pediatric Cardiovascular Surgery, SanDonato Milanese Univerity Hospital, San Donato Milanese, Milan, Italy
| | - Angela Satriano
- Laboratory Research Department of Pediatric Cardiovascular Surgery, SanDonato Milanese Univerity Hospital, San Donato Milanese, Milan, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
- Neonatal Intesive Care Unit, AO S.S. Antonio, Biagio, C. Arrigo Hospital, Spalto Marengo 46, 15100 Alessandria, Italy
| |
Collapse
|
6
|
Bersani I, Ferrari F, Lugli L, Ivani G, Conio A, Moataza B, Aboulgar H, Mufeed H, Iskander I, Kornacka M, Gruzfeld D, Dotta A, Savarese I, Chukhlantseva N, Tina LG, Nigro F, Livolti G, Galvano F, Serpero L, Colivicchi M, Ianniello P, Pluchinotta F, Anastasia L, Baryshnikova E, Gazzolo D. Monitoring the effectiveness of hypothermia in perinatal asphyxia infants by urinary S100B levels. Clin Chem Lab Med 2020; 57:1017-1025. [PMID: 30753152 DOI: 10.1515/cclm-2018-1094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/18/2019] [Indexed: 01/09/2023]
Abstract
Background Perinatal asphyxia is a major cause of mortality and morbidity in neonates: The aim of the present study was to investigate, by means of longitudinal assessment of urinary S100B, the effectiveness of hypothermia, in infants complicated by perinatal asphyxia and hypoxic-ischemic encephalopathy. Methods We performed a retrospective case-control study in 108 asphyxiated infants, admitted to nine tertiary departments for neonatal intensive care from January 2004 to July 2017, of whom 54 underwent hypothermia treatment and 54 did not. The concentrations of S100B protein in urine were measured using an immunoluminometric assay at first urination and 4, 8, 12, 16, 20, 24, 48, 72, 96, 108 and 120 h after birth. The results were correlated with the achievement of S100B levels within normal ranges at 72 h from hypothermia treatment. Routine laboratory parameters, longitudinal cerebral function monitoring, cerebral ultrasound and neurologic patterns were assessed according to standard protocols. Results Higher S100B concentrations were found in hypothermia-treated infants in both moderate (up to 12 h) and severe (up to 24 h) hypoxic-ischemic encephalopathy. S100B levels returned to normal ranges starting from 20 h of hypothermia treatment in moderate and from 36 h in severe hypoxic-ischemic encephalopathy. Conclusions The present results offer additional support to the usefulness of longitudinal neuro-biomarkers monitoring in asphyxiated infants treated by hypothermia. The pattern of S100B concentrations during hypothermia supports the need for further investigations aimed at reconsidering the time-window for patient recruitment and treatment, and the optimal duration of the cooling and rewarming phases of the hypothermia procedure.
Collapse
Affiliation(s)
- Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fabrizio Ferrari
- Division of Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Licia Lugli
- Division of Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital, Modena, Italy
| | - Giorgio Ivani
- Pediatric Intensive Care Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Alessandra Conio
- Pediatric Intensive Care Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Bashir Moataza
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Hanna Aboulgar
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Hala Mufeed
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Iman Iskander
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Maria Kornacka
- Department of Neonatology and Intensive Care of Neonate, Warsaw University, Warsaw, Poland
| | - Darek Gruzfeld
- Department of Neonatology and Intensive Care of Neonate, Warsaw University, Warsaw, Poland
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Immacolata Savarese
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Natalia Chukhlantseva
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lucia Gabriella Tina
- Department of Maternal Fetal and Neonatal Health G. Garibaldi Hospital, Catania, Italy
| | - Francesco Nigro
- Department of Maternal Fetal and Neonatal Health G. Garibaldi Hospital, Catania, Italy
| | | | - Fabio Galvano
- Department of Biochemistry, Catania University, Catania, Italy
| | - Laura Serpero
- Department of Maternal, Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Micaela Colivicchi
- Department of Maternal, Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Patrizia Ianniello
- Department of Maternal, Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Francesca Pluchinotta
- Department of Cardiology and Laboratory Research, S. Donato Milanese University Hospital, Milan, Italy
| | - Luigi Anastasia
- Department of Cardiology and Laboratory Research, S. Donato Milanese University Hospital, Milan, Italy
| | - Ekaterina Baryshnikova
- Department of Cardiology and Laboratory Research, S. Donato Milanese University Hospital, Milan, Italy
| | - Diego Gazzolo
- Department of Maternal, Fetal and Neonatal Medicine, C. Arrigo Children's Hospital, Alessandria, Italy.,Neonatal Intensive Care Unit, G. d'Annunzio University, Chieti, Italy
| | | |
Collapse
|
7
|
Anuriev AM, Gorbachev VI. [Hypoxic-ischemic brain damage in premature newborns]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:63-69. [PMID: 31825364 DOI: 10.17116/jnevro201911908263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
One of the main causes of cerebral dysfunction in premature newborns is hypoxia. High mortality and lifelong morbidity in these children is a frequent result of neonatal hypoxic brain damage. The article presents some data on the prevalence of neurological diseases that have arisen in the perinatal period, and highlights the key etiological factors leading to hypoxia in both the intranatal and early postnatal periods. The pathogenesis of hypoxic-ischemic brain lesions in premature infants is described in detail. At the same time, more careful consideration is given to the glutathione system, which protects against lipid peroxidation, the glutamate-calcium cascade, and the excitotoxicity mediated by it, as well as the processes of necrosis and apoptosis of nerve cells. The advantages and disadvantages of modern methods for diagnosing cerebral lesions are noted, and the principles of treatment of these disorders are analyzed.
Collapse
Affiliation(s)
- A M Anuriev
- Irkutsk State Medical Academy of Postgraduate Education - Branch Campus of the Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia
| | - V I Gorbachev
- Irkutsk State Medical Academy of Postgraduate Education - Branch Campus of the Russian Medical Academy of Continuing Professional Education, Irkutsk, Russia
| |
Collapse
|
8
|
Auriti C, Prencipe G, Inglese R, Moriondo M, Nieddu F, Mondì V, Longo D, Bucci S, Del Pinto T, Timelli L, Di Ciommo VM. Mannose Binding Lectin, S100 B Protein, and Brain Injuries in Neonates With Perinatal Asphyxia. Front Pediatr 2020; 8:527. [PMID: 33042903 PMCID: PMC7527601 DOI: 10.3389/fped.2020.00527] [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: 03/31/2020] [Accepted: 07/24/2020] [Indexed: 11/13/2022] Open
Abstract
Perinatal asphyxia triggers an acute inflammatory response in the injured brain. Complement activation and neuroinflammation worsen brain damage after a systemic ischemia/reperfusion insult. The increase of mannose binding lectin (MBL) during asphyxia may contribute to the brain damage, via activation of the complement lectin pathway. The possible role of MBL2 gene variants in influencing the severity of post-asphyxia brain injuries is still unexplored. This retrospective study included 53 asphyxiated neonates: 42 underwent therapeutic hypothermia (TH) and 11 did not because they were admitted to the NICU later than 6 h after the hypoxic insult. Blood samples from TH-treated and untreated patients were genotyped for MBL2 gene variants, and biomarker plasma levels (MBL and S100 B protein) were measured at different time points: during hypothermia, during rewarming, and at 7-10 days of life. The timing of blood sampling, except for the T1 sample, was the same in untreated infants. Highest (peak) levels of MBL and MBL2 genotypes were correlated to neuroimaging brain damage or death and long-term neurodevelopmental delay. MBL2 wild-type genotype was associated with the highest MBL levels and worst brain damage on MRI (p = 0.046) at 7-10 days after hypoxia. MBL increased in both groups and S100B decreased, slightly more in treated than in untreated neonates. The progressive increase of MBL (p = 0.08) and to be untreated with TH (p = 0.08) increased the risk of brain damage or death at 7-10 days of life, without affecting neurodevelopmental outcomes at 1 year. The effect of TH on MBL plasma profiles is uncertain.
Collapse
Affiliation(s)
- Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giusi Prencipe
- Laboratory of Rheumatology Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Inglese
- Laboratory of Chemical Chemistry, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Moriondo
- Laboratory of Immunology, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesco Nieddu
- Laboratory of Immunology, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Vito Mondì
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino Hospital, Rome, Italy
| | - Daniela Longo
- Neuroimaging Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Bucci
- Clinical Psychology Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tamara Del Pinto
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Timelli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | |
Collapse
|
9
|
Bellissima V, Visser GHA, Ververs T, Pluchinotta F, Varrica A, Baryshnikova E, Gabriella Tina L, Nigro F, Gavilanes D, Godos J, Gazzolo D. Antenatal maternal antidepressants drugs treatment affects S100B levels in maternal-fetal biological fluids in a dose dependent manner. Clin Chim Acta 2019; 501:20-26. [PMID: 31809746 DOI: 10.1016/j.cca.2019.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The increased use of antidepressant treatment during pregnancy occurred without firm evidence on safety/efficacy. The present study investigated the correlation among S100B and paroxetine blood levels with the occurrence of short-term post-natal neurological abnormalities. METHODS We conducted a cross-sectional study in 50 pregnant women using paroxetine because of depression and in 150 controls. Standard laboratory parameters and S100B were measured at seven monitoring time-points (maternal blood: T1, 16-20 wks; T2, 27-30 wks; T3, 35-40 wks; T4, at delivery; amniotic fluid, T5; venous and arterial cord blood, T6-T7). Paroxetine levels were measured at T1-T6. Neurological outcome was set at 7th day from birth. RESULTS Higher S100B concentrations at T1-T7 were found in the paroxetine-treated group. S100B correlated with paroxetine blood levels. The paroxetine/S100B ratio cut-off of 1.31 at T2 achieved sensitivity 100%, specificity 96.5% and positive/negative predictive values 87.5-100, respectively, as a single marker to predict adverse neonatal neurological outcome. CONCLUSIONS The present study offers additional support to the usefulness of longitudinal S100B and drug level monitoring in depressed pregnant women and in the early detection of cases at risk for short-term neurological abnormalities. Results open the way at further investigations correlating antidepressant drugs and neurobiomarkers in the maternal bloodstream.
Collapse
Affiliation(s)
| | - Gerard H A Visser
- Department of Obstetrics, Utrecht Medical Center, Utrecht, The Netherlands
| | - Tessa Ververs
- Department of Pharmacology Utrecht Medical Center, Utrecht, The Netherlands
| | - Francesca Pluchinotta
- Department of Pediatric Cardiovascular Surgery, Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Varrica
- Department of Pediatric Cardiovascular Surgery, Policlinico San Donato, San Donato Milanese, Italy
| | - Ekaterina Baryshnikova
- Department of Pediatric Cardiovascular Surgery, Policlinico San Donato, San Donato Milanese, Italy
| | | | - Francesco Nigro
- Neonatal Intensive Care Unit, Garibaldi Hospital, Catania, Italy
| | - Danilo Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University, Maastricht, The Netherlands
| | | | - Diego Gazzolo
- AO SS Antonio, Biagio e C. Arrigo Hospital, Alessandria, Italy.
| |
Collapse
|
10
|
Satriano A, Franchini S, Lapergola G, Pluchinotta F, Anastasia L, Baryshnikova E, Livolti G, Gazzolo D. Glutathione Blood Concentrations: A Biomarker of Oxidative Damage Protection during Cardiopulmonary Bypass in Children. Diagnostics (Basel) 2019; 9:diagnostics9030118. [PMID: 31540197 PMCID: PMC6787732 DOI: 10.3390/diagnostics9030118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 01/18/2023] Open
Abstract
Background. Pediatric open-heart surgery with cardiopulmonary bypass (CPB) still remains a risky interventional procedure at high mortality/morbidity. To date, there are no clinical, laboratory, and/or monitoring parameters providing useful information on perioperative stress. We therefore investigated whether blood concentrations of glutathione (GSH), a powerful endogenous antioxidant, changed in the perioperative period. Methods. We conducted an observational study in 35 congenital heart disease (CHD) children in whom perioperative standard laboratory and monitoring parameters and GSH blood levels were assessed at five monitoring time points. Results. GSH showed a pattern characterized by a progressive increase from pre-surgery up to 24 h after surgery, reaching its highest peak at the end of CPB. GSH measured at the end of CPB correlated with CPB duration, cross-clamping, arterial oxygen partial pressure, and with body core temperature. Conclusions. The increase in GSH levels in the perioperative period suggests a compensatory mechanism to oxidative damage during surgical procedure. Caution is needed in controlling different CPB phases, especially systemic reoxygenation in a population that is per se more prone to oxidative stress/damage. The findings may point the way to detecting the optimal temperature and oxygenation target by biomarker monitoring.
Collapse
Affiliation(s)
- Angela Satriano
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, San Donato Milanese, 20097 Milan, Italy
| | - Simone Franchini
- Neonatal Intensive Care Unit, G. d'Annunzio University of Chieti, 65100 Chieti, Italy
| | - Giuseppe Lapergola
- Neonatal Intensive Care Unit, G. d'Annunzio University of Chieti, 65100 Chieti, Italy
| | - Francesca Pluchinotta
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, San Donato Milanese, 20097 Milan, Italy
| | - Luigi Anastasia
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, San Donato Milanese, 20097 Milan, Italy
| | - Ekaterina Baryshnikova
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, San Donato Milanese, 20097 Milan, Italy
| | - Giovanni Livolti
- Department of Biomedical and Biotechnological Sciences Section of Biochemistry University of Catania, 95100 Catania, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, G. d'Annunzio University of Chieti, 65100 Chieti, Italy.
- AO SS Antonio, Biagio and C. Arrigo Hospital Alessandria, 15121 Alessandria, Italy.
| |
Collapse
|
11
|
Niwa Y, Imai K, Kotani T, Miki R, Nakano T, Ushida T, Moriyama Y, Kikkawa F. Relationship between cytokine profiles of cord blood and cord S100B levels in preterm infants. Early Hum Dev 2019; 129:65-70. [PMID: 30684905 DOI: 10.1016/j.earlhumdev.2019.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 02/09/2023]
Affiliation(s)
- Yuri Niwa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Rika Miki
- Laboratory of Bell Research Centre-Department of Obstetrics and Gynecology Collaborative Research, Bell Research Centre for Reproductive Health and Cancer, Department of Reproduction, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tomoko Nakano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| |
Collapse
|
12
|
Bertino E, Peila C, Cresi F, Maggiora E, Sottemano S, Gazzolo D, Arslanoglu S, Coscia A. Donor Human Milk: Effects of Storage and Heat Treatment on Oxidative Stress Markers. Front Pediatr 2018; 6:253. [PMID: 30345262 PMCID: PMC6182067 DOI: 10.3389/fped.2018.00253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/28/2018] [Indexed: 01/03/2023] Open
Abstract
Mother's own milk is the first choice for the feeding and nutrition of preterm and term newborns. When mother's own milk is unavailable or in short supply donor human milk (DM) could represent a solution. Heat treatment and cold storage are common practices in Human Milk Banks (HMBs). Currently, Holder pasteurization process is the recommended heat treatment in all international guidelines. This method is thought to lead to a good compromise between the microbiological safety and nutritional/biological quality of DM. Moreover, storage of refrigerated milk is a common practice in HMBs and in NICUs. Depending on the length and on the type of storage, human milk may lose some important nutritional and functional properties. The available data on oxidative stress markers confirm that pasteurization and refrigeration affected this important elements to variable degrees, even though it is rather difficult to quantify the level of deterioration. Nonetheless, clinical practice demonstrates that many beneficial properties of human milk are preserved, even after cold storage and heat treatment. Future studies should be focused on the evaluation of new pasteurization techniques, in order to achieve a better compromise between biological quality and safety of DM.
Collapse
Affiliation(s)
- Enrico Bertino
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Chiara Peila
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
- Department of Maternal, Fetal and Neonatal Health, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesco Cresi
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Elena Maggiora
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Stefano Sottemano
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
| | - Sertac Arslanoglu
- Department of Pediatrics, Division of Neonatology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Alessandra Coscia
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, Turin, Italy
| |
Collapse
|
13
|
Swol J, Marschall C, Strauch JT, Schildhauer TA. Hematocrit and impact of transfusion in patients receiving extracorporeal life support. Perfusion 2018; 33:546-552. [DOI: 10.1177/0267659118772457] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this study was to evaluate the relationship between hematocrit and hospital mortality via subgroup analyses of trauma and non-trauma patients. Methods: The hospital length of stay (LOS) and LOS in the intensive care unit (ICU) and hospital after extracorporeal life support (ECLS) treatment of 81 patients were analyzed and compared. In-hospital survival until extracorporeal membrane oxygen (ECMO) weaning and hospital discharge were defined as the clinical outcome. Results: Significantly increased mortality, with a relative risk of 1.73 with a 95% confidence interval of 1.134 to 2.639, was identified in the group with an hematocrit greater than 31%. However, no significant differences in relative risk (95% confidence interval) of death for each group were found among groups with an hematocrit less than or equal to 25%, 26-28% and 29-31%. Additionally, no significant relationship between survival and median hematocrit level was observed at a significance level of 0.413 and an Exp (B) of 1.089 at a 95% confidence interval of 0.878 to 1.373 in binary logistic regression analysis; a model was established with a -2 log likelihood of 40.687 for the entire group of patients. Moreover, a significant increase in mortality was observed as the average number of transfusions per day in the hospital increased (significance level 0.024, Exp (B) 4.378, 95% confidence interval for Exp (B) 1.212 to 15.810). Conclusion: Because a variety of factors influence therapy, the indication for transfusion should be re-evaluated and adapted repeatedly on a case-by-case basis. Further studies are needed to demonstrate whether an acceptable outcome from ECLS device therapy can also be achieved with a low hematocrit and a restrictive indication for transfusion.
Collapse
Affiliation(s)
- Justyna Swol
- Department of Pulmonology, Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Christopher Marschall
- Department of Surgery and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Justus T. Strauch
- Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Thomas A. Schildhauer
- Department of Surgery and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| |
Collapse
|
14
|
Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management. Crit Care Res Pract 2018; 2018:3237810. [PMID: 29744226 PMCID: PMC5878897 DOI: 10.1155/2018/3237810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/24/2018] [Accepted: 02/12/2018] [Indexed: 12/12/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique that is widely being used in centers throughout the world. However, there is a paucity of literature surrounding the mechanisms affecting cerebral physiology while on ECMO. Studies have shown alterations in cerebral blood flow characteristics and subsequently autoregulation. Furthermore, the mechanical aspects of the ECMO circuit itself may affect cerebral circulation. The nature of these physiological/pathophysiological changes can lead to profound neurological complications. This review aims at describing the changes to normal cerebral autoregulation during ECMO, illustrating the various neuromonitoring tools available to assess markers of cerebral autoregulation, and finally discussing potential neurological complications that are associated with ECMO.
Collapse
|
15
|
Varrica A, Satriano A, Gavilanes ADW, Zimmermann LJ, Vles HJS, Pluchinotta F, Anastasia L, Giamberti A, Baryshnikova E, Gazzolo D. S100B increases in cyanotic versus noncyanotic infants undergoing heart surgery and cardiopulmonary bypass (CPB). J Matern Fetal Neonatal Med 2017; 32:1117-1123. [PMID: 29183208 DOI: 10.1080/14767058.2017.1401604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS S100B has been proposed as a consolidated marker of brain damage in infants with congenital heart disease (CHD) undergoing cardiac surgery and cardiopulmonary bypass (CPB). The present study aimed to investigate whether S100B blood levels in the perioperative period differed in infants complicated or not by cyanotic CHD (CHDc) and correlated with oxygenation status (PaO2). METHODS We conducted a case-control study of 48 CHD infants without pre-existing neurological disorders undergoing surgical repair and CPB. 24 infants were CHDc and 24 were CHD controls. Blood samples for S100B assessment were collected at six monitoring time-points: before the surgical procedure (T0), after sternotomy but before CPB (T1), at the end of the cross-clamp CPB phase (T2), at the end of CPB (T3), at the end of the surgical procedure (T4), at 24 h postsurgery (T5). RESULTS In the CHDc group, S100B multiples of median (MoM) were significantly higher (p < .05, for all) from T0 to T5. PaO2 was significantly lower (p < .05, for all) in CHDc infants at T0-T1 and at T4 while no differences (p > .05, for all) were found at T2, T3, T5. Linear regression analysis showed a positive correlation between S100B MoM at T3 and PaO2 (R = 0.84; p < .001). CONCLUSIONS The present data showing higher hypoxia/hyperoxia-mediated S100B concentrations in CHDc infants suggest that CHDc are more prone to perioperative brain stress/damage and suggest the usefulness of further investigations to detect the "optimal" PaO2 target in order to avoid the side effects associated with reoxygenation during CPB.
Collapse
Affiliation(s)
- Alessandro Varrica
- a Department of Pediatric Cardiac Surgery IRCCS San Donato Milanese Hospital , San Donato Milanese , Italy
| | - Angela Satriano
- a Department of Pediatric Cardiac Surgery IRCCS San Donato Milanese Hospital , San Donato Milanese , Italy
| | - Antonio D W Gavilanes
- b Department of Pediatrics, Neonatology and Child Neurology , Maastricht University , Maastricht , The Netherlands
| | - Luc J Zimmermann
- b Department of Pediatrics, Neonatology and Child Neurology , Maastricht University , Maastricht , The Netherlands
| | - Hans J S Vles
- b Department of Pediatrics, Neonatology and Child Neurology , Maastricht University , Maastricht , The Netherlands
| | - Francesca Pluchinotta
- a Department of Pediatric Cardiac Surgery IRCCS San Donato Milanese Hospital , San Donato Milanese , Italy
| | - Luigi Anastasia
- a Department of Pediatric Cardiac Surgery IRCCS San Donato Milanese Hospital , San Donato Milanese , Italy
| | - Alessandro Giamberti
- a Department of Pediatric Cardiac Surgery IRCCS San Donato Milanese Hospital , San Donato Milanese , Italy
| | - Ekaterina Baryshnikova
- a Department of Pediatric Cardiac Surgery IRCCS San Donato Milanese Hospital , San Donato Milanese , Italy
| | - Diego Gazzolo
- c Department of Maternal Fetal and Neonatal Medicine , C. Arrigo Children's Hospital , Alessandria , Italy.,d Neonatal Intensive Care Unit , G. d'Annunzio University of Chieti , Italy
| |
Collapse
|
16
|
Peila C, Coscia A, Bertino E, Li Volti G, Galvano F, Barbagallo I, Gazzolo D. Human Milk Adrenomedullin Is Unstable During Cold Storage at 4°C. Breastfeed Med 2017; 12:561-565. [PMID: 28956619 DOI: 10.1089/bfm.2017.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Under some circumstances human milk (HM) extraction and refrigerated storage may be necessary. Depending on the length and on the type of cold storage, milk may lose some important properties, but current advices on safe HM storage are discordant. Moreover until now no data in literature were present on the effect of prolonged cold storage on biologically active components of the HM such as adrenomedullin (AM). This important peptide is involved in response to hypoxia and inflammation, associated with neovascularization, in several tissues. The aim is to evaluate: (a) the presence of AM in preterm and term HM and (b) the concentration of AM in refrigerated milk at 4°C at 24-hour intervals, up to 96 hours of storage. MATERIALS AND METHODS The experiment was repeated four times. Immediately after collection, each HM sample deriving from each mother was divided into two parts as follows: "Pool" line and "Single Mother" line. One part (Pool line) was pooled and then divided into five aliquots. The other part (Single Mother line) was divided into five aliquots. From each line, one aliquot was analyzed within 3 hours, while the others were stored in the refrigerator for 24, 48, 72, and 96 hours, respectively, and then analyzed. AM levels were determined using a specific ELISA test. RESULTS AM was detectable in all samples. Its concentration was significantly higher in preterm milk with respect to term milk (p < 0.05). Significant differences were observed during the cold storage: the AM levels decreased steadily during the storage and the remaining concentration at 96 hours is ∼2%. DISCUSSION This study provides evidences regarding the presence of AM in HM, regardless of the gestational age. In particular, the refrigeration of fresh HM in controlled conditions significantly affected its bioactivity and nutritional quality related with AM, already at 24 hours.
Collapse
Affiliation(s)
- Chiara Peila
- 1 Neonatology Unit, Department of Public Health and Pediatrics, University of Turin , Turin, Italy
| | - Alessandra Coscia
- 1 Neonatology Unit, Department of Public Health and Pediatrics, University of Turin , Turin, Italy
| | - Enrico Bertino
- 1 Neonatology Unit, Department of Public Health and Pediatrics, University of Turin , Turin, Italy
| | - Giovanni Li Volti
- 2 Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania , Catania, Italy
| | - Fabio Galvano
- 2 Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania , Catania, Italy
| | - Ignazio Barbagallo
- 2 Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania , Catania, Italy
| | - Diego Gazzolo
- 3 Department of Maternal, Fetal and Neonatal Health, C. Arrigo Children's Hospital , Alessandria, Italy .,4 Neonatal Intensive Care Unit, G. d'Annunzio University , Chieti, Italy
| |
Collapse
|
17
|
Serpero LD, Bianchi V, Pluchinotta F, Conforti E, Baryshnikova E, Guaschino R, Cassinari M, Trifoglio O, Calevo MG, Gazzolo D. S100B maternal blood levels are gestational age- and gender-dependent in healthy pregnancies. Clin Chem Lab Med 2017; 55:1770-1776. [PMID: 28282292 DOI: 10.1515/cclm-2016-1127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/23/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND S100B is a well-established biomarker of central nervous system (CNS) development and damage in the perinatal period. Because the fetal CNS induces an overproduction of S100B measurable in the maternal bloodstream we evaluated S100B protein in healthy pregnancies in order to provide a reference curve of the protein in the second and third trimesters and to provide information on CNS development when standard monitoring procedures could be silent or unavailable. METHODS Between July 2012 and December 2014 we conducted a prospective study in 1213 healthy pregnancies delivering healthy newborns. Maternal blood samples were collected for standard monitoring procedures and S100B assessment. S100B correlations with selected outcomes (gestational age at sampling, gender of fetus, gestational age and weight at birth, delivery mode) were calculated using multiple forward stepwise regression analysis. RESULTS S100B concentrations in the second and third trimesters of pregnancy were found to be gestational age-, gender- and delivery mode-dependent (p<0.05, for all). Multiple forward stepwise regression analysis with S100B as the dependent variable and gestational age at sampling, gender, delivery mode, gestational age and weight at birth as independent variables, showed a significant correlation between S100B and gestational age at sampling (R=0.13; p<0.001). CONCLUSIONS The present findings offering a S100B protein reference curve in maternal blood suggest that non-invasive fetal CNS monitoring is becoming feasible and open the way to further research in neuro-biomarker assessment in the maternal bloodstream.
Collapse
|
18
|
Zaigham M, Lundberg F, Olofsson P. Protein S100B in umbilical cord blood as a potential biomarker of hypoxic-ischemic encephalopathy in asphyxiated newborns. Early Hum Dev 2017; 112:48-53. [PMID: 28756088 DOI: 10.1016/j.earlhumdev.2017.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/29/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neonatal hypoxic ischemic encephalopathy (HIE) is a devastating condition resulting from a sustained lack of oxygen during birth. The interest in identifying a relevant biomarker of HIE has thrown into limelight the role of protein S100B as a clinical diagnostic marker of hypoxic brain damage in neonates. AIMS To evaluate the diagnostic value of protein S100B, measured in umbilical cord blood immediately after birth, as a useful biomarker in the diagnosis of HIE Sarnat stages II-III as well as a marker for long-term mortality and morbidity. STUDY DESIGN Protein S100B was analyzed in cord blood sampled at birth from 13 newborns later diagnosed with stage II-III HIE and compared with 21 healthy controls. S100B concentrations were related to cord artery pH, amplitude-integrated electroencephalography (aEEG), stage of HIE, and death/sequelae up to an age of 6years. Both parametric and non-parametric statistics were used with a two-sided P<0.05 considered significant. RESULTS The difference in S100B concentration was marginally statistically significant between HIE cases and controls (P=0.056). Cord blood acidosis (P=0.046), aEEG pattern severity (P=0.030), HIE severity (P=0.027), and condition at 6-year follow-up (healthy/permanent sequelae/death; P=0.027) were all related to an increase in S100B concentration. CONCLUSIONS Protein S100B in neonates suffering from HIE stages II-III appeared elevated in umbilical cord blood at birth. The S100B concentrations were positively associated to the severity of disease and the risk of suffering from neurodevelopmental sequelae and even death.
Collapse
Affiliation(s)
- Mehreen Zaigham
- Institution of Clinical Sciences Malmö, Lund University, Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.
| | - Fredrik Lundberg
- Institution of Clinical Sciences Malmö, Lund University, Dept. of Pediatric Medicine, Skåne University Hospital, Malmö, Sweden
| | - Per Olofsson
- Institution of Clinical Sciences Malmö, Lund University, Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
19
|
Lei J, Paules C, Nigrini E, Rosenzweig JM, Bahabry R, Farzin A, Yang S, Northington FJ, Oros D, McKenney S, Johnston MV, Graham EM, Burd I. Umbilical Cord Blood NOS1 as a Potential Biomarker of Neonatal Encephalopathy. Front Pediatr 2017; 5:112. [PMID: 28649562 PMCID: PMC5466059 DOI: 10.3389/fped.2017.00112] [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] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There are no definitive markers to aid in diagnosis of neonatal encephalopathy (NE). The purpose of our study was (1) to identify and evaluate the utility of neuronal nitric oxide synthase (NOS1) in umbilical cord blood as a NE biomarker and (2) to identify the source of NOS1 in umbilical cord blood. METHODS This was a nested case-control study of neonates >35 weeks of gestation. ELISA for NOS1 in umbilical cord blood was performed. Sources of NOS1 in umbilical cord were investigated by immunohistochemistry, western blot, ELISA, and quantitative PCR. Furthermore, umbilical cords of full-term neonates were subjected to 1% hypoxia ex vivo. RESULTS NOS1 was present in umbilical cord blood and increased in NE cases compared with controls. NOS1 was expressed in endothelial cells of the umbilical cord vein, but not in artery or blood cells. In ex vivo experiments, hypoxia was associated with increased levels of NOS1 in venous endothelial cells of the umbilical cord as well as in ex vivo culture medium. CONCLUSION This is the first study to investigate an early marker of NE. NOS1 is elevated with hypoxia, and further studies are needed to investigate it as a valuable tool for early diagnosis of neonatal brain injury.
Collapse
Affiliation(s)
- Jun Lei
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cristina Paules
- Aragón Health Research Institute, SAMID Network ref RD12/0026/001, Zaragoza, Spain
| | - Elisabeth Nigrini
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason M Rosenzweig
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rudhab Bahabry
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Azadeh Farzin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samuel Yang
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frances J Northington
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Oros
- Aragón Health Research Institute, SAMID Network ref RD12/0026/001, Zaragoza, Spain
| | - Stephanie McKenney
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael V Johnston
- Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurosciences, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ernest M Graham
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Burd
- Integrated Research Center for Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Neurosciences Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurosciences, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
20
|
Calik M, Sen Dokumaci D, Sarikaya S, Demir M, Isik I, Kazanasmaz H, Kaya C, Kandemir H. Brain metabolite values in children with breath-holding spells. Neuropsychiatr Dis Treat 2017; 13:1655-1660. [PMID: 28721046 PMCID: PMC5499924 DOI: 10.2147/ndt.s135842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Breath-holding spells are benign, paroxysmal events with apnea and postural tone changes after a crying episode in infants. The objective of this study was to investigate the pathologies in brain metabolite values in the absence of seizure in children with breath-holding spells by using magnetic resonance spectroscopy (MRS). Brain MRS examination was performed on 18 children with breath-holding spells and 13 neurologically normal children who were included as the control group. There was no significant difference in terms of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and myoinositol (mI) levels and also in terms of NAA/Cr, Cho/Cr, and mI/Cr ratios between the patients and the control group (all P>0.05). Our study suggested that there is no permanent neuronal damage in patients with breath-holding spells. This result confirms the previous studies, which reported no permanent neuronal damage in patients with breath-holding spells.
Collapse
Affiliation(s)
| | | | | | - Mahmut Demir
- Department of Pediatrics, Harran University School of Medicine
| | - Ilhan Isik
- Department of Pediatric Neurology, Eyyubiye Training and Research Hospital
| | | | - Cemil Kaya
- Department of Pediatrics, Harran University School of Medicine
| | - Hasan Kandemir
- Department of Child and Adolescent Psychiatry, Harran University School of Medicine, Sanliurfa, Turkey
| |
Collapse
|
21
|
Zhao M, Zhu P, Fujino M, Zhuang J, Guo H, Sheikh I, Zhao L, Li XK. Oxidative Stress in Hypoxic-Ischemic Encephalopathy: Molecular Mechanisms and Therapeutic Strategies. Int J Mol Sci 2016; 17:ijms17122078. [PMID: 27973415 PMCID: PMC5187878 DOI: 10.3390/ijms17122078] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 12/14/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of morbidity and mortality in neonates. Because of high concentrations of sensitive immature cells, metal-catalyzed free radicals, non-saturated fatty acids, and low concentrations of antioxidant enzymes, the brain requires high levels of oxygen supply and is, thus, extremely sensitive to hypoxia. Strong evidence indicates that oxidative stress plays an important role in pathogenesis and progression. Following hypoxia and ischemia, reactive oxygen species (ROS) production rapidly increases and overwhelms antioxidant defenses. A large excess of ROS will directly modify or degenerate cellular macromolecules, such as membranes, proteins, lipids, and DNA, and lead to a cascading inflammatory response, and protease secretion. These derivatives are involved in a complex interplay of multiple pathways (e.g., inflammation, apoptosis, autophagy, and necrosis) which finally lead to brain injury. In this review, we highlight the molecular mechanism for oxidative stress in HIE, summarize current research on therapeutic strategies utilized in combating oxidative stress, and try to explore novel potential clinical approaches.
Collapse
Affiliation(s)
- Mingyi Zhao
- Department of Pediatrics, the Third Xiangya Hospital, Central South University, Changsha 410006, China.
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
| | - Masayuki Fujino
- National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
- National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
| | - Jian Zhuang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
| | - Huiming Guo
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
| | - IdrisAhmed Sheikh
- Department of Pediatrics, the Third Xiangya Hospital, Central South University, Changsha 410006, China.
| | - Lingling Zhao
- Department of Pediatrics, the Third Xiangya Hospital, Central South University, Changsha 410006, China.
| | - Xiao-Kang Li
- Department of Pediatrics, the Third Xiangya Hospital, Central South University, Changsha 410006, China.
- National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
| |
Collapse
|
22
|
Peila C, Coscia A, Bertino E, Li Volti G, Galvano F, Barbagallo I, Visser GHA, Gazzolo D. The Effect of Holder Pasteurization on Activin A Levels in Human Milk. Breastfeed Med 2016; 11:469-473. [PMID: 27529435 DOI: 10.1089/bfm.2016.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is evidence that mother's own milk is the best nutrient in terms of multiorgan protection and infection prevention. However, when maternal milk is scarce, the solution can be represented by donor milk (DM), which requires specific storage procedures such as Holder Pasteurization (HoP). HoP is not free from side effects since it is widely known that it causes qualitative/quantitative changes in milk composition, particularly in the protein content. Therefore, the aim of this study is to investigate the effects of HoP on Activin A, a neurobiomarker known to play an important role in the development and protection of the central nervous system. METHODS In 24 mothers who delivered preterm (n = 12) and term (n = 12) healthy newborns, we conducted a pretest/test study where the milk donors acted as their own controls. Each sample was divided into two parts: the first was frozen at -80°C (Group 1); the second was Holder-pasteurized before freezing at -80°C (Group 2). Activin A was quantified using an ELISA test. RESULTS Activin A was detected in all samples. There were no significant differences (p > 0.05) between the two groups, also when the analysis was stratified for gestational age at delivery and milk maturation degree (p > 0.05, for both). CONCLUSION The present findings on the absence of any side effects of HoP on the milk concentration of Activin A offer additional support to the efficacy of HoP in DM storage. Our data open up to further investigations on neurobiomarkers' assessment in human milk and their preanalytical stability according to storage procedures.
Collapse
Affiliation(s)
- Chiara Peila
- 1 Neonatology Unit, Department of Public Health and Pediatrics, University of Turin , Turin, Italy
| | - Alessandra Coscia
- 1 Neonatology Unit, Department of Public Health and Pediatrics, University of Turin , Turin, Italy
| | - Enrico Bertino
- 1 Neonatology Unit, Department of Public Health and Pediatrics, University of Turin , Turin, Italy
| | - Giovanni Li Volti
- 2 Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania , Catania, Italy
| | - Fabio Galvano
- 2 Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania , Catania, Italy
| | - Ignazio Barbagallo
- 2 Department of Biological Chemistry, Medical Chemistry and Molecular Biology, University of Catania , Catania, Italy
| | - Gerard H A Visser
- 3 Department of Obstetrics, University Medical Center , Utrecht, the Netherlands
| | - Diego Gazzolo
- 4 Department of Maternal, Fetal and Neonatal Health, C. Arrigo Children's Hospital , Alessandria, Italy
| |
Collapse
|
23
|
Ramy N, Al Sharany W, Mohamed MA, Madani H, Saleh E, Aly H. Lipid peroxides in the serum of asphyxiated neonates. J Perinatol 2016; 36:849-52. [PMID: 27309626 DOI: 10.1038/jp.2016.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Lipid peroxides (LPOs) are released when free radicals react with unsaturated fatty acids in cell membranes during hypoxic ischemic insult in neonates. We aimed to assess LPO concentrations in the serum of asphyxiated and non-asphyxiated neonates and examine their correlation with the severity of asphyxia. STUDY DESIGN This prospective cross-sectional study was conducted on a group of asphyxiated neonates and controls. Serum LPO concentrations was measured by enzyme-linked immunosorbent assay at 4-6 h of life in all subjects. Encephalopathy was classified according to Sarnat's stages into mild, moderate and severe at 12-24 h of life. LPO was compared between groups and was correlated with severity of encephalopathy and mortality. RESULTS A total of 90 infants were enrolled; of them 45 had asphyxia. Serum LPO (nmol ml(-1)) was significantly greater in the asphyxia group (6.9±3.01 vs 1.78±1.09, P<0.001). It correlated positively with severity of encephalopathy (P<0.001) and negatively with Apgar score at 5 min (r=-0.532, P<0.001) and with initial blood gases pH (r=-0.664, P<0.001). LPO measured greater concentrations in infants who died compared with asphyxiated survivors (11.64±1.31 vs 6.18±2.48, P=0.0004). CONCLUSION LPO was increased and correlated with severity of asphyxia as well as with mortality. Further studies are warranted to examine whether it is only a marker for outcome or a contributor in the pathogenesis of hypoxic-ischemic brain injury.
Collapse
Affiliation(s)
- N Ramy
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - W Al Sharany
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - M A Mohamed
- Division of Newborn Services, The George Washington University Hospital and Children's National Medical Center, Washington, DC, USA
| | - H Madani
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt
| | - E Saleh
- Department of Pediatrics, Matareya Hospital, Cairo, Egypt
| | - H Aly
- Division of Newborn Services, The George Washington University Hospital and Children's National Medical Center, Washington, DC, USA
| |
Collapse
|
24
|
Ponnusamy V, Kapellou O, Yip E, Evanson J, Wong LF, Michael-Titus A, Yip PK, Shah DK. A study of microRNAs from dried blood spots in newborns after perinatal asphyxia: a simple and feasible biosampling method. Pediatr Res 2016; 79:799-805. [PMID: 26720606 DOI: 10.1038/pr.2015.276] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/28/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The potential of microRNAs (miRNAs) as bedside biomarkers in selecting newborns with hypoxic-ischemic encephalopathy (HIE) for neuroprotection has yet to be explored. Commonly, blood-based biomarker tests use plasma or serum which don't allow evaluation of both intracellular and extracellular changes. METHODS We describe a technique to extract and compare expression of miRNAs from a single small 6-mm-diameter dried blood spot (DBS) stored at room temperature with those from EDTA-blood, plasma, and urine. Three miRNAs (RNU6B, let7b, and miR-21) were quantified via extraction and quantitative RT-PCR performed from a DBS and compared with levels from EDTA-blood, plasma, and urine. Secondarily, candidate miRNAs let7b, miR-21, miR-29b, miR-124, and miR-155 in DBS were evaluated as potential biomarkers for HIE. RESULTS Candidate miRNAs were extractable in all biosamples from newborns, with the highest expression in DBS. There was a good correlation between miRNAs' levels in DBS and EDTA-blood at -80 °C. No significant difference was observed in the miRNA levels between the favorable and unfavorable outcome groups for babies with HIE. CONCLUSION DBS may be useful for studying the potential of miRNAs as biomarkers for brain injury.
Collapse
Affiliation(s)
- Vennila Ponnusamy
- Center of Paediatrics, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK.,Neonatal Intensive Care Unit, Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Olga Kapellou
- Neonatal Intensive Care Unit, Homerton University Hospitals NHS Foundation Trust, London, UK
| | - Ellen Yip
- Center of Paediatrics, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jane Evanson
- Imaging Services, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Liang-Fong Wong
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Adina Michael-Titus
- Center of Neuroscience and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ping K Yip
- Center of Neuroscience and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Divyen K Shah
- Center of Paediatrics, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Neonatal Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
25
|
Ahearne CE, Boylan GB, Murray DM. Short and long term prognosis in perinatal asphyxia: An update. World J Clin Pediatr 2016; 5:67-74. [PMID: 26862504 PMCID: PMC4737695 DOI: 10.5409/wjcp.v5.i1.67] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/18/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy (NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy (HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and long-term outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.
Collapse
|
26
|
Heme oxygenase levels and metaflammation in benign prostatic hyperplasia patients. World J Urol 2015; 34:1183-92. [DOI: 10.1007/s00345-015-1736-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022] Open
|
27
|
Barbagallo I, Parenti R, Zappalà A, Vanella L, Tibullo D, Pepe F, Onni T, Li Volti G. Combined inhibition of Hsp90 and heme oxygenase-1 induces apoptosis and endoplasmic reticulum stress in melanoma. Acta Histochem 2015; 117:705-11. [PMID: 26493719 DOI: 10.1016/j.acthis.2015.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 12/16/2022]
Abstract
Heat shock proteins are ubiquitous molecular chaperones involved in post-translational folding, stability, activation and maturation of many proteins that are essential mediators of signal transduction and cell cycle progression. Heat shock protein 90 (Hsp90) has recently emerged as an attractive therapeutic target in cancer treatment since it may act as a key regulator of various oncogene products and cell-signaling molecules. Heme oxygenase-1 (HO-1; also known as Hsp32) is an inducible enzyme participating in heme degradation and involved in oxidative stress resistance. Recent studies indicate that HO-1 activation may play a role in tumor development and progression. In the present study we investigated the chemotherapic effects of combining an Hsp90 inhibitor (NMS E973) and an HO-1 inhibitor (SnMP) on A375 melanoma cells. NMS E973 treatment was able to reduce cell viability and induce endoplasmic reticulum (ER) stress (i.e. Ire1α, ERO1, PDI, BIP and CHOP). Interestingly, no significant effect was observed in reactive oxygen species (ROS) formation. Finally, NMS E973 treatment resulted in a significant HO-1 overexpression, which in turn serves as a possible chemoresistance molecular mechanism. Interestingly, the combination of NMS E973 and SnMP produced an increase of ROS and reduced cell viability compared to NMS E973 treatment alone. The inhibitors combination exhibited higher ER stress, apoptosis as evidenced by bifunctional apoptosis regulator (BFAR) mRNA expression and lower phosphorylation of Akt when compared to NMS E973 alone. In conclusion, these data suggest that HO-1 inhibition potentiates NMS E973 toxicity and may be exploited as a strategy for melanoma treatment.
Collapse
Affiliation(s)
- Ignazio Barbagallo
- Department of Drug Sciences, University of Catania, Via Andrea Doria 6, 95125 Catania, Italy; EuroMediterranean Institute of Science and Technology, Via Emerico Amari 123, 90139 Palermo, Italy
| | - Rosalba Parenti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Andrea Doria 6, 95125 Catania, Italy
| | - Agata Zappalà
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Andrea Doria 6, 95125 Catania, Italy
| | - Luca Vanella
- Department of Drug Sciences, University of Catania, Via Andrea Doria 6, 95125 Catania, Italy
| | - Daniele Tibullo
- Division of Hematology, AOU "Policlinico-Vittorio Emauele", University of Catania, Via Santa Sofia 78, 95125 Catania, Italy
| | - Francesco Pepe
- Department of Biomedical Sciences, Section of Physiology, University of Catania, Via Andrea Doria 6, 95125 Italy
| | - Toniangelo Onni
- Department of Biomedical Sciences, Section of Physiology, University of Catania, Via Andrea Doria 6, 95125 Italy
| | - Giovanni Li Volti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Andrea Doria 6, 95125 Catania, Italy; EuroMediterranean Institute of Science and Technology, Via Emerico Amari 123, 90139 Palermo, Italy.
| |
Collapse
|
28
|
Assessment of both serum S-100B protein and neuropeptide-Y levels in childhood breath-holding spells. Epilepsy Behav 2015; 47:34-8. [PMID: 26021463 DOI: 10.1016/j.yebeh.2015.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/03/2015] [Accepted: 04/19/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Breath-holding spells are common paroxysmal events in children. Although the spells have a benign prognosis in the long term, they may be complicated by loss of consciousness, tonic-clonic movements, and occasionally seizures. Hence, this study aimed to measure the levels of serum S-100B proteins and neuropeptide-Y in the blood of children who experience breath-holding spells. METHODS The study groups consisted of 45 patients (13 females, 32 males) with breath-holding spells and a control group of 32 healthy individuals (12 females, 20 males). The serum S-100B levels were measured using commercially available ELISA kits. The neuropeptide-Y levels in the serum were measured with RayBio® Human/Mouse/Rat Neuropeptide Y ELISA kits. RESULTS The mean serum S-100B protein level of the breath-holding spells group was 56.38 ± 13.26 pg/mL, and of the control group, 48.53 ± 16.77 pg/mL. The mean neuropeptide-Y level was 62.29 ± 13.89 pg/mL in the breath-holding spells group and 58.24 ± 12.30 pg/mL in the control group. There were significant differences between the groups with respect to serum S-100B protein levels (p = 0.025), while there was no statistically significant difference in neuropeptide-Y levels between the breath-holding spells group and the control group (p = 0.192). CONCLUSIONS The findings of this study suggest that frequent and lengthy breath-holding may lead to the development of neuronal metabolic dysfunction or neuronal damage which is most likely related to hypoxia. In light of these findings, future studies should be conducted using biochemical and radiological imaging techniques to support these results.
Collapse
|
29
|
Use of early biomarkers in neonatal brain damage and sepsis: state of the art and future perspectives. BIOMED RESEARCH INTERNATIONAL 2015; 2015:253520. [PMID: 25685774 PMCID: PMC4313065 DOI: 10.1155/2015/253520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/11/2014] [Indexed: 12/19/2022]
Abstract
The identification of early noninvasive biochemical markers of disease is a crucial issue of the current scientific research, particularly during the first period of life, since it could provide useful and precocious diagnostic information when clinical and radiological signs are still silent. The ideal biomarker should be practical and sensitive in the precocious identification of at risk patients. An earlier diagnosis may lead to a larger therapeutic window and improve neonatal outcome. Brain damage and sepsis are common causes of severe morbidity with poor outcome and mortality during the perinatal period. A large number of potential biomarkers, including neuroproteins, calcium binding proteins, enzymes, oxidative stress markers, vasoactive agents, and inflammatory mediators, have been so far investigated. The aim of the present review was to provide a brief overview of some of the more commonly investigated biomarkers used in case of neonatal brain damage and sepsis.
Collapse
|
30
|
Gazzolo D, Pluchinotta F, Bashir M, Aboulgar H, Said HM, Iman I, Ivani G, Conio A, Tina LG, Nigro F, Li Volti G, Galvano F, Michetti F, Di Iorio R, Marinoni E, Zimmermann LJ, Gavilanes ADW, Vles HJS, Kornacka M, Gruszfeld D, Frulio R, Sacchi R, Ciotti S, Risso FM, Sannia A, Florio P. Neurological abnormalities in full-term asphyxiated newborns and salivary S100B testing: the "Cooperative Multitask against Brain Injury of Neonates" (CoMBINe) international study. PLoS One 2015; 10:e0115194. [PMID: 25569796 PMCID: PMC4287626 DOI: 10.1371/journal.pone.0115194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Perinatal asphyxia (PA) is a leading cause of mortality and morbidity in newborns: its prognosis depends both on the severity of the asphyxia and on the immediate resuscitation to restore oxygen supply and blood circulation. Therefore, we investigated whether measurement of S100B, a consolidated marker of brain injury, in salivary fluid of PA newborns may constitute a useful tool for the early detection of asphyxia-related brain injury. METHODS We conducted a cross-sectional study in 292 full-term newborns admitted to our NICUs, of whom 48 suffered PA and 244 healthy controls admitted at our NICUs. Saliva S100B levels measurement longitudinally after birth; routine laboratory variables, neurological patterns, cerebral ultrasound and, magnetic resonance imaging were performed. The primary end-point was the presence of neurological abnormalities at 12-months after birth. RESULTS S100B salivary levels were significantly (P<0.001) higher in newborns with PA than in normal infants. When asphyxiated infants were subdivided according to a good (Group A; n = 15) or poor (Group B; n = 33) neurological outcome at 12-months, S100B was significantly higher at all monitoring time-points in Group B than in Group A or controls (P<0.001, for all). A cut-off >3.25 MoM S100B achieved a sensitivity of 100% (CI5-95%: 89.3%-100%) and a specificity of 100% (CI5-95%: 98.6%-100%) as a single marker for predicting the occurrence of abnormal neurological outcome (area under the ROC curve: 1.000; CI5-95%: 0.987-1.0). CONCLUSIONS S100B protein measurement in saliva, soon after birth, is a useful tool to identify which asphyxiated infants are at risk of neurological sequelae.
Collapse
Affiliation(s)
- Diego Gazzolo
- Department of Maternal, Fetal and Neonatal Medicine, “C. Arrigo” Children’s Hospital Alessandria, Italy
- * E-mail:
| | - Francesca Pluchinotta
- Department of Cardiology and Laboratory Reasearch S. Donato Milanese University Hospital, Milan, Italy
| | - Moataza Bashir
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Hanna Aboulgar
- Department of Neonatology, Cairo University, Cairo, Egypt
| | | | - Iskander Iman
- Department of Neonatology, Cairo University, Cairo, Egypt
| | - Giorgio Ivani
- Pediatric Intensive Care Unit, “Regina Margherita” Children’s Hospital Turin, Turin, Italy
| | - Alessandra Conio
- Pediatric Intensive Care Unit, “Regina Margherita” Children’s Hospital Turin, Turin, Italy
| | - Lucia Gabriella Tina
- Department of Maternal Fetal and Neonatal Health “G. Garibaldi” Hospital, Catania, Italy
| | - Francesco Nigro
- Department of Maternal Fetal and Neonatal Health “G. Garibaldi” Hospital, Catania, Italy
| | | | - Fabio Galvano
- Department of Biochemistry, Catania University, Catania, Italy
| | - Fabrizio Michetti
- Institute of Anatomy and Cell Biology, Catholic University, Rome, Italy
| | - Romolo Di Iorio
- Laboratory of Perinatal Medicine, Department of Obstetrics and Gynecology, University “La Sapienza”, Rome, Italy
| | - Emanuela Marinoni
- Laboratory of Perinatal Medicine, Department of Obstetrics and Gynecology, University “La Sapienza”, Rome, Italy
| | - Luc J. Zimmermann
- Department of Pediatrics and Neonatology, Maastricht University, Maastricht, The Netherlands
| | - Antonio D. W. Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University, Maastricht, The Netherlands
| | - Hans J. S. Vles
- Department of Child Neurology, Maastricht University, Maastricht, The Netherlands
| | - Maria Kornacka
- Department of Neonatology and Intensive Care of Neonate, Warsaw University, Warsaw, Poland
| | - Darek Gruszfeld
- Department of Neonatology and Intensive Care of Neonate, Warsaw University, Warsaw, Poland
| | - Rosanna Frulio
- Department of Pediatrics “G. Gaslini” Children’s University Hospital, Genoa, Italy
| | - Renata Sacchi
- Department of Pediatrics “G. Gaslini” Children’s University Hospital, Genoa, Italy
| | - Sabina Ciotti
- Department of Pediatrics “G. Gaslini” Children’s University Hospital, Genoa, Italy
| | - Francesco M. Risso
- Department of Pediatrics “G. Gaslini” Children’s University Hospital, Genoa, Italy
| | - Andrea Sannia
- Department of Pediatrics “G. Gaslini” Children’s University Hospital, Genoa, Italy
| | - Pasquale Florio
- UOC of Obstetrics and Gynecology, “S. Iacopo” Hospital, Pistoia, Italy
| |
Collapse
|
31
|
Wood CE, Rabaglino MB, Richards E, Denslow N, Zarate MA, Chang EI, Keller-Wood M. Transcriptomics of the fetal hypothalamic response to brachiocephalic occlusion and estradiol treatment. Physiol Genomics 2014; 46:523-32. [PMID: 24824211 DOI: 10.1152/physiolgenomics.00186.2013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Estradiol (E2) is a well-known modulator of fetal neuroendocrine activity and has been proposed as a critical endocrine signal readying the fetus for birth and postnatal life. To investigate the modulatory role of E2 on fetal stress responsiveness and the response of the fetal brain to asphyxic stress, we subjected chronically catheterized fetal sheep to a transient (10 min) brachiocephalic artery occlusion (BCO) or sham occlusion. Half of the fetuses received subcutaneous pellets that increased plasma E2 concentrations within the physiological range. Hypothalamic mRNA was analyzed using the Agilent 8x15k ovine array (019921), processed and annotated as previously reported by our laboratory. Analysis of the data by ANOVA revealed that E2 differentially regulated (DR) 561 genes, and BCO DR 894 genes compared with control and E2+BCO DR 1,153 genes compared with BCO alone (all P < 0.05). E2 upregulated epigenetic pathways and downregulated local steroid biosynthesis but did not significantly involve genes known to directly respond to the estrogen receptor. Brachiocephalic occlusion upregulated kinase pathways as well as genes associated with lymphocyte infiltration into the brain and downregulated neuropeptide synthesis. E2 upregulated immune- and apoptosis-related pathways after BCO and reduced kinase and epigenetic pathway responses to the BCO. Responses to BCO are different from responses to hypoxic hypoxia suggesting that mechanisms of responses to these two forms of brain hypoxia are distinct. We conclude that cerebral ischemia caused by BCO might stimulate lymphocyte infiltration into the brain and that this response appears to be modified by estradiol.
Collapse
Affiliation(s)
- Charles E Wood
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida;
| | - Maria Belen Rabaglino
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida
| | - Elaine Richards
- Department of Pharmacodynamics, University of Florida College of Pharmacy, Gainesville, Florida; and
| | - Nancy Denslow
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine and the University of Florida Genetics Institute, Gainesville, Florida
| | - Miguel A Zarate
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida
| | - Eileen I Chang
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, Florida
| | - Maureen Keller-Wood
- Department of Pharmacodynamics, University of Florida College of Pharmacy, Gainesville, Florida; and
| |
Collapse
|
32
|
Interictal serum S-100B protein levels in intractable epilepsy: A case-control study. Neurosci Lett 2014; 558:58-61. [DOI: 10.1016/j.neulet.2013.10.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/05/2013] [Accepted: 10/17/2013] [Indexed: 11/23/2022]
|
33
|
Beharier O, Shusterman E, Eshcoli T, Szaingurten-Solodkin I, Aricha-Tamir B, Weintraub AY, Sheiner E, Holcberg G, Hershkovitz R. Detection of S100B in maternal blood before and after fetal death. Prenat Diagn 2013; 34:94-7. [PMID: 24178516 DOI: 10.1002/pd.4266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/23/2013] [Accepted: 10/21/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND S100B is a brain damage biomarker. When measured immediately after birth, it reflects neonatal brain damage following asphyxia. In this study, we used feticide as a novel model of fetal brain damage. We examined whether such damage is reflected by a rise in S100B in maternal blood before delivery. METHODS Eight pregnant women were recruited between January and July 2012. Maternal blood samples were drawn before and after feticide at predetermined time points (0, 15, 30, 60, 120, and 240 min). S100B, lactate dehydrogenase, creatine kinase, and creatinine concentrations were measured by standard human ELISA and chemical analyzer. RESULTS No significant difference was noted between S100B levels before and after feticide, neither in non-specific cell death markers (lactate dehydrogenase and creatine kinase), which remained within normal range. S100B ranged between 0.015-0.04 µg/L through all the predetermined time points. CONCLUSION No statistically significant differences were demonstrated in S100B levels before and after feticide.
Collapse
Affiliation(s)
- Ofer Beharier
- Department of Obstetrics & Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Risso FM, Serpero LD, Zimmermann LJI, Gavilanes AWD, Frulio R, Michetti F, Florio P, Bashir M, Iskander I, Mufeed H, Aboulgar H, Gazzolo D. Urine S100 BB and A1B dimers are valuable predictors of adverse outcome in full-term asphyxiated infants. Acta Paediatr 2013; 102:e467-72. [PMID: 23826805 DOI: 10.1111/apa.12343] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/20/2013] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
AIM To investigate whether S100A1B and BB dimers are predictors of early perinatal death in newborns with perinatal asphyxia (PA). METHODS The study compared 38 full-term newborns with PA [neonatal death n = 11; hypoxic ischaemic encephalopathy (HIE): n = 27] with a control group of 38 healthy infants. Clinical and laboratory parameters were recorded at eight time points and urine collected for S100B assessment. Multivariate analysis was performed in order to analyse the influence of various clinical parameters on the occurrence of neonatal death. RESULTS A1B and BB in PA nonsurvivor infants were significantly higher (p < 0.001) than in controls at all monitoring time points. BB at first void (cut-off>42 ng/L) was the best predictor of early neonatal death (p < 0.05) of all the clinical and laboratory parameters studied. CONCLUSION These results suggest that S100s are valuable predictors of adverse outcome in PA infants. It is also suggested that these biomarkers be used in daily clinical practice, due to their low cost and stress, reproducibility and the possibility of longitudinal monitoring.
Collapse
Affiliation(s)
- Francesco M Risso
- Department of Neonatology; G Gaslini Children's University Hospital; Genoa; Italy
| | - Laura D Serpero
- Department of Neurology Ophthalmology and Genetics; Genoa University; Genoa; Italy
| | - Luc JI Zimmermann
- Department of Pediatrics and Neonatology; School for Oncology and Developmental Biology; Maastricht University Medical Center; Maastricht; The Netherlands
| | - Antonio WD Gavilanes
- Department of Pediatrics and Neonatology; School for Oncology and Developmental Biology; Maastricht University Medical Center; Maastricht; The Netherlands
| | - Rosanna Frulio
- Institute of Anatomy and Molecular Biology; Catholic University; Rome; Italy
| | - Fabrizio Michetti
- Institute of Anatomy and Molecular Biology; Catholic University; Rome; Italy
| | - Pasquale Florio
- Department of Pediatrics Obstetrics and Reproductive Medicine; University of Siena; Siena; Italy
| | - Moataza Bashir
- Department of Neonatology; University of Cairo; Cairo; Egypt
| | - Iman Iskander
- Department of Neonatology; University of Cairo; Cairo; Egypt
| | - Hala Mufeed
- Department of Neonatology; University of Cairo; Cairo; Egypt
| | - Hanna Aboulgar
- Department of Neonatology; University of Cairo; Cairo; Egypt
| | - Diego Gazzolo
- Department of Maternal Fetal and Neonatal Medicine; C. Arrigo Children's Hospital; Alessandria; Italy
| |
Collapse
|
35
|
Serpero LD, Bellissima V, Colivicchi M, Sabatini M, Frigiola A, Ricotti A, Ghiglione V, Strozzi MC, Li Volti G, Galvano F, Gazzolo D. Next generation biomarkers for brain injury. J Matern Fetal Neonatal Med 2013; 26 Suppl 2:44-9. [PMID: 24059552 DOI: 10.3109/14767058.2013.829688] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
36
|
MR spectroscopy, S100B protein and NSE analysis as early predictors of hypoxic ishaemic encephalopathy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
37
|
Risso FM, Sannia A, Gavilanes DAW, Vles HJ, Colivicchi M, Ricotti A, Li Volti G, Gazzolo D. Biomarkers of brain damage in preterm infants. J Matern Fetal Neonatal Med 2013; 25 Suppl 4:101-4. [PMID: 22958034 DOI: 10.3109/14767058.2012.715024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is growing evidence on the usefulness of biomarkers in the early detection of preterm infants at risk for brain damage. However, among different tools Activin A, S100B protein and adrenomedullin assessment offer the possibility to investigate brain/multiorgan function and development. This could be especially useful in perinatal medicine that requires even more non-invasive techniques in order to fulfill the minimal handling in diagnostic and therapeutic strategy performance. MATERIALS AND METHODS The concept of Unconventional Biological Fluid (UBF: urine and saliva) is becoming even stronger and regards the assessment in non-invasive biological fluids of biochemical markers involved in the cascade of events leading to brain damage. RESULTS Activin A, S100B protein and adrenomedullin in UBF were increased in preterm newborns developing brain damage and/or ominous outcome. CONCLUSIONS The present manuscript offers an update on the usefulness of Activin A, S100B protein an adrenomedullin in UBF as brain damage markers. The findings open a new cue on the use of these markers in daily neonatal intensive care unit (NICU) activities.
Collapse
Affiliation(s)
- Francesco M Risso
- Department of Neonatology, G Gaslini Children's University Hospital, Genoa, Italy
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abella R, Satriano A, Frigiola A, Varrica A, Gavilanes AD, Zimmermann LJ, Vles HJ, Florio P, Calevo MG, Gazzolo D. Adrenomedullin alterations related to cardiopulmonary bypass in infants with low cardiac output syndrome. J Matern Fetal Neonatal Med 2012; 25:2756-61. [PMID: 22881718 DOI: 10.3109/14767058.2012.718393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Low cardiac output syndrome (LCOS) remains a major perioperative complications in infants subjected to open-heart surgery with cardiopulmonary bypass (CPB). The present study investigated whether perioperative blood assessment of a potent vasoactive peptide namely adrenomedullin (AM) can predict the risk of LCOS. METHODS We measured AM levels in 48 patients (LCOS: n = 9; controls: n = 39) undergone to open-heart surgery with CPB at five predetermined time points before, during and after the surgery. Clinical, laboratory and perioperative data were analyzed by a multiple logistic regression model. RESULTS AM significantly decreased (p < 0.01) during and after the surgical procedure exhibiting a dip at the end of the CPB. Multivariable analysis demonstrated significant correlations among LCOS, AM measured at the end of CPB (p < 0.001), and cooling duration (p < 0.05). AM at 27 pg/L cutoff achieved a sensitivity of 100% and a specificity of 64.1%, while cooling at 11-min cutoff combined a sensitivity of 55.6% and a specificity of 92.3% for LCOS prediction. CONCLUSIONS This study suggests that AM can constitute, alone or combined with standard parameters, a promising predictor of LCOS in infants subjected to open-heart surgery with CPB.
Collapse
Affiliation(s)
- Raul Abella
- Department of Pediatric Cardiac Surgery IRCCS, San Donato Milanese Hospital, San Donato Milanese, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Picone S, Ritieni A, Fabiano A, Troise AD, Graziani G, Paolillo P, Li Volti G, D'Orazio N, Galvano F, Gazzolo D. Arterial cord blood lutein levels in preterm and term healthy newborns are sex and gestational age dependent. Clin Biochem 2012; 45:1558-63. [PMID: 22885018 DOI: 10.1016/j.clinbiochem.2012.07.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 07/18/2012] [Accepted: 07/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Lutein is an antioxidant carotenoid exerting a key role in eye health, but no reference curve in the perinatal period is available. DESIGN AND METHODS We conducted a prospective study on the distribution of lutein and its metabolite 3'-oxolutein in arterial cord blood of preterm (n=40) and term (n=76) newborns according to gestational age, sex and delivery modalities. RESULTS Lutein and 3'-oxolutein concentrations peaked at the beginning of third trimester (P<0.01, for both) being higher in the preterm than in term group. From 36 weeks onwards, lutein and 3'-oxolutein levels progressively decreased reaching the lowest levels at term between 41 and 42 weeks (P<0.01, for both). Lutein and 3'-oxolutein significantly (P<0.01, for all) correlated with each other (R=0.33) and with gestational age at sampling (R=0.31 and R=0.38 for lutein and 3-oxolutein, respectively) (P<0.001, for all). Indeed, lutein and 3'-oxolutein concentrations were significantly higher (P<0.05, for all) in female than in male and significantly lower (P<0.01, for both) in newborns delivered by caesarean section when compared to vaginal delivery. CONCLUSIONS Since macula densa and retina are sites of lutein accumulation, the present findings open-up a new cue on the potential role of lutein in the prevention of the retinopathy of prematurity.
Collapse
|
40
|
Fiala M, Baumert M, Walencka Z, Paprotny M. Umbilical activin A concentration as an early marker of perinatal hypoxia. J Matern Fetal Neonatal Med 2012; 25:2098-101. [DOI: 10.3109/14767058.2012.675373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
41
|
Beharier O, Kahn J, Shusterman E, Sheiner E. S100B - a potential biomarker for early detection of neonatal brain damage following asphyxia. J Matern Fetal Neonatal Med 2012; 25:1523-8. [PMID: 22348227 DOI: 10.3109/14767058.2012.664200] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Birth asphyxia results in a significant percentage of neonatal morbidity and mortality. A key factor in the management of this complication is the early and accurate detection of brain damage following asphyxia. Currently, reliable tools for such diagnosis are absent. Extensive research has focused on biomarkers in an attempt to solve this matter. Recent data marked serum and urine elevation of the S100B protein as an established peripheral biomarker for detection of brain injury including traumatic head injuries and brain damage following cardiac arrest and stroke. In the past decade, a substantial number of studies illustrated the potential use of S100B testing in order to detect brain damage in asphyxiated newborns. This review summarizes the available data regarding the use of S100B as a biomarker of brain damage following birth asphyxia.
Collapse
Affiliation(s)
- Ofer Beharier
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | | | | | | |
Collapse
|
42
|
Bellissima V, Visser GHA, Ververs TF, van Bel F, Termote JUM, van der Heide M, Florio P, Li Volti G, Gazzolo D. Antenatal maternal antidepressants drugs affect Activin A concentrations in maternal blood, in amniotic fluid and in fetal cord blood. J Matern Fetal Neonatal Med 2012; 24 Suppl 2:31-4. [PMID: 21767104 DOI: 10.3109/14767058.2011.604931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The use of antidepressant drugs during pregnancy is rapidly increasing both in Europe and in the USA, with controversial data regarding side-effects on fetus and newborn. We investigated, in pregnant women and in fetal biological fluids whether the concentrations of a brain protein, Activin A, changed in association with the use of selective serotonin re-uptake inhibitors (SSRI). METHODS We conducted a case control study in 24 women treated with SSRIs, matched with 24 healthy pregnancies as controls. Maternal blood (during labor, T1), fetal blood (venous (T2) and arterial [T3] umbilical cord blood) and amniotic fluid (T4) were drawn for standard laboratory assessment and for Activin A measurement. RESULTS Activin A concentrations in maternal and fetal biological fluids were significantly higher in SSRI users than in the control groups(P < 0.05, for all). CONCLUSIONS Activin A in maternal and fetal biological fluids is increased after SSRI administration in the third trimester of pregnancy. The present findings open up a new cue for further studies aimed at investigating protein's key role in central nervous system protection/damage in pregnant women using these drugs.
Collapse
Affiliation(s)
- Valentina Bellissima
- Department of Maternal, Fetal and Neonatal Medicine, Cesare Arrigo Children's Hospital, Alessandria, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Smits A, Allegaert K. Perinatal pharmacology: applications for neonatal neurology. Eur J Paediatr Neurol 2011; 15:478-86. [PMID: 21576027 DOI: 10.1016/j.ejpn.2011.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/15/2011] [Accepted: 04/22/2011] [Indexed: 10/18/2022]
Abstract
The principles of clinical pharmacology also apply to neonates, but their characteristics warrant a tailored approach. We focus on aspects of both developmental pharmacokinetics (concentration/time relationship) and developmental pharmacodynamics (concentration/effect relationship) in neonates. We hereby aimed to link concepts used in clinical pharmacology with compound-specific observations (anti-epileptics, analgosedatives) in the field of neonatal neurology. Although in part anecdotal, we subsequently illustrate the relevance of developmental pharmacology in the field of neonatal neurology by a specific intervention (e.g. whole body cooling), specific clinical presentations (e.g. short and long term outcome following fetal exposure to antidepressive agents, the development of new biomarkers for fetal alcohol syndrome) and specific clinical needs (e.g. analgosedation in neonates, excitocytosis versus neuro-apoptosis/impaired synaptogenesis).
Collapse
Affiliation(s)
- Anne Smits
- Neonatal Intensive Care Unit, Division of Woman and Child, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | | |
Collapse
|
44
|
S100B Protein maternal and fetal bloodstreams gradient in healthy and small for gestational age pregnancies. Clin Chim Acta 2011; 412:1337-40. [PMID: 21473859 DOI: 10.1016/j.cca.2011.03.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 11/20/2022]
|
45
|
Birth asphyxia as the major complication in newborns: moving towards improved individual outcomes by prediction, targeted prevention and tailored medical care. EPMA J 2011. [PMID: 23199149 PMCID: PMC3405378 DOI: 10.1007/s13167-011-0087-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Perinatal Asphyxia—oxygen deficit at delivery—can lead to severe hypoxic ischaemic organ damage in newborns followed by a fatal outcome or severe life-long pathologies. The severe insults often cause neurodegenerative diseases, mental retardation and epilepsies. The mild insults lead to so-called “minimal brain-damage disorders” such as attention deficits and hyperactivity, but can also be associated with the development of schizophrenia and life-long functional psychotic syndromes. Asphyxia followed by re-oxygenation can potentially lead to development of several neurodegenerative pathologies, diabetes type 2 and cancer. The task of individual prediction, targeted prevention and personalised treatments before a manifestation of the life-long chronic pathologies usually developed by newborns with asphyxic deficits, should be given the extraordinary priority in neonatology and paediatrics. Socio-economical impacts of educational measures and advanced strategies in development of robust diagnostic approaches targeted at effected molecular pathways, biomarker-candidates and potential drug-targets for tailored treatments are reviewed in the paper.
Collapse
|
46
|
Schlapbach LJ, Frey S, Bigler S, Manh-Nhi C, Aebi C, Nelle M, Nuoffer JM. Copeptin concentration in cord blood in infants with early-onset sepsis, chorioamnionitis and perinatal asphyxia. BMC Pediatr 2011; 11:38. [PMID: 21595972 PMCID: PMC3118890 DOI: 10.1186/1471-2431-11-38] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 05/19/2011] [Indexed: 11/30/2022] Open
Abstract
Background Vasopressin is one of the most important physiological stress and shock hormones. Copeptin, a stable vasopressin precursor, is a promising sepsis marker in adults. In contrast, its involvement in neonatal diseases remains unknown. The aim of this study was to establish copeptin concentrations in neonates of different stress states such as sepsis, chorioamnionitis and asphyxia. Methods Copeptin cord blood concentration was determined using the BRAHMS kryptor assay. Neonates with early-onset sepsis (EOS, n = 30), chorioamnionitis (n = 33) and asphyxia (n = 25) were compared to a control group of preterm and term (n = 155) neonates. Results Median copeptin concentration in cord blood was 36 pmol/l ranging from undetectable to 5498 pmol/l (IQR 7 - 419). Copeptin cord blood concentrations were non-normally distributed and increased with gestational age (p < 0.0001). Neonates born after vaginal compared to cesarean delivery had elevated copeptin levels (p < 0.0001). Copeptin correlated strongly with umbilical artery pH (Spearman's Rho -0.50, p < 0.0001), umbilical artery base excess (Rho -0.67, p < 0.0001) and with lactate at NICU admission (Rho 0.54, p < 0.0001). No difference was found when comparing copeptin cord blood concentrations between neonates with EOS and controls (multivariate p = 0.30). The highest copeptin concentrations were found in neonates with asphyxia (median 993 pmol/l). Receiver-operating-characteristic curve analysis showed that copeptin cord blood concentrations were strongly associated with asphyxia: the area under the curve resulted at 0.91 (95%-CI 0.87-0.96, p < 0.0001). A cut-off of 400 pmol/l had a sensitivity of 92% and a specifity of 82% for asphyxia as defined in this study. Conclusions Copeptin concentrations were strongly related to factors associated with perinatal stress such as birth acidosis, asphyxia and vaginal delivery. In contrast, copeptin appears to be unsuitable for the diagnosis of EOS.
Collapse
Affiliation(s)
- Luregn J Schlapbach
- Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University of Bern, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Cerebral hypothermia reduces brain injury and improves behavioral recovery after hypoxia-ischemia (HI) at birth. However, using current enrolment criteria many infants are not helped, and conversely, a significant proportion of control infants survive without disability. In order to further improve treatment we need better biomarkers of injury. A 'true' biomarker for the phase of evolving, 'treatable' injury would allow us to identify not only whether infants are at risk of damage, but also whether they are still able to benefit from intervention. Even a less specific measure that allowed either more precise early identification of infants at risk of adverse neurodevelopmental outcome would reduce the variance of outcome of trials, improving trial power while reducing the number of infants unnecessarily treated. Finally, valid short-term surrogates for long term outcome after treatment would allow more rapid completion of preliminary evaluation and thus allow new strategies to be tested more rapidly. Experimental studies have demonstrated that there is a relatively limited 'window of opportunity' for effective treatment (up to about 6-8h after HI, the 'latent phase'), before secondary cell death begins. We critically evaluate the utility of proposed biochemical, electronic monitoring, and imaging biomarkers against this framework. This review highlights the two central limitations of most presently available biomarkers: that they are most precise for infants with severe injury who are already easily identified, and that their correlation is strongest at times well after the latent phase, when injury is no longer 'treatable'. This is an important area for further research.
Collapse
Affiliation(s)
- L. Bennet
- Corresponding author. Dr Laura Bennet, Professor, Fetal Physiology and Neuroscience Group Department of Physiology, The University of Auckland, Private Bag 92019 Auckland, New Zealand Tel.: +64 9 373 7599 ext. 84890; fax: +64 9 373 7499. (L. Bennet)
| | | | | |
Collapse
|
48
|
[Cerebral palsy and perinatal asphyxia (I--diagnosis)]. ACTA ACUST UNITED AC 2010; 38:261-77. [PMID: 20378389 DOI: 10.1016/j.gyobfe.2010.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 02/12/2010] [Indexed: 11/23/2022]
Abstract
Cerebral palsy (CP) is a group of disorders of the development of movement and posture, causing activity limitations, that are attributed to nonprogressing disturbances that occurred in the developing fetal or infant brain. The motor abnormalies are often accompanied by disturbances of sensation, perception, cognition, behavior and/or by a seizure disorder. The prevalence of CP has not decreased in developed countries over the past 30 years, despite the widespread use of electronic fetal heart rate monitoring and a 5- to 6-fold increase in the cesarean delivery rate. In the term newborn, CP may be attributed to perinatal asphyxia in case of metabolic acidosis in the cord blood (pH<7,00 and base deficit>12 mmol/L), followed by a moderate or severe neonatal encephalopathy within 24 hours and a further neurological impairement characterized by spastic quadriplegia and dyskinesia/dystonia. Dating the time of fetal asphyxia during delivery is possible when there are acute catastrophic complications during labor and unexpected acute or progressive fetal heart rate anomalies after a normal admission test, when there is a need for intensive neonatal resuscitation, a multi-organ failure within 72 hours of birth and visualization of acute non focal cerebral abnormalities, mainly by early magnetic resonance imaging (MRI). MRI sequences show either a brain-damaged pattern of the central basal ganglia, thalami and posterior limbs of internal capsules with relative cortical sparing, in acute, near-total asphyxial insults manifested by a continuous bradycardia or a pattern of cortical injury in the watershed zones and relative sparing of the central grey matter, in prolonged partial asphyxia, manifested by late or atypical variable decelerations with progressive fetal tachycardia, loss of reactivity and absent fluctuation. Prolongation of either type of asphyxial insult results in more global brain damage. In order to differentiate a CP occurring after perinatal asphyxia from other neurological sequelae in relation with infection, hemorrhage, stroke, malformations, genetic or metabolic diseases, it is essential that a definitive information from the brain by MRI and an extensive histological examination of the placenta are at disposal.
Collapse
|