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Ghezzi M, Garancini N, De Santis R, Gianolio L, Zirpoli S, Mandelli A, Farolfi A, D’Auria E, Zuccotti GV. Recurrent Respiratory Infections in Children with Down Syndrome: A Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:246. [PMID: 38397357 PMCID: PMC10888118 DOI: 10.3390/children11020246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.
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Affiliation(s)
- Michele Ghezzi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Nicolò Garancini
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Raffaella De Santis
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Laura Gianolio
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Salvatore Zirpoli
- Pediatric Radiology Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Anna Mandelli
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Andrea Farolfi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Enza D’Auria
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
| | - Gian Vincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (N.G.); (R.D.S.); (L.G.); (A.F.); (E.D.); (G.V.Z.)
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
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2
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Yang R, Liu Q, Wang D, Zhao Z, Su Z, Fan D, Liu Q. The Toll-like Receptor-2/4 Antagonist, Sparstolonin B, and Inflammatory Diseases: A Literature Mining and Network Analysis. Cardiovasc Drugs Ther 2024:10.1007/s10557-023-07535-z. [PMID: 38270691 DOI: 10.1007/s10557-023-07535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Sparstolonin B (SsnB) is characterized as a new toll-like receptor (TLR)-2/4 antagonist. However, the effects of SsnB on different inflammatory diseases have not been systemically reviewed. METHODS We investigated the effects of SsnB on inflammatory diseases with data mining and network analysis of literature, including frequency description, cluster analysis, association rule mining, functional enrichment, and protein-protein interaction (PPI) mining. RESULTS A total of 27 experimental reports were included. The ARRIVE 2.0 guidelines were used to evaluate the quality of animal studies. Frequency analysis revealed 13 different diseases (cardio-cerebrovascular system diseases account for 23.53%), 12 pharmacological effects (anti-inflammatory effect accounts for 53.85%), and 67 therapeutic targets. The overview of investigation sequence of SsnB studies was depicted by Sankey diagram. Cluster analysis classified the therapeutic targets for SsnB into four main categories: (1) NF-κB; (2) IL-1β, IL-6, and TNF-α; (3) TLR2, TLR4, and MyD88; (4) the other targets. Moreover, the Apriori association discovered two main association pairs: (1) TNF-α, IL-1β, and IL-6 and (2) TLR2, TLR4, and MyD88 (support range 33.33-50%, confidence range 83.33-88.89%). Functional enrichment of the therapeutic targets for SsnB showed that the top enriched items in the biological process were mainly the response to lipopolysaccharide (LPS)/bacterial origin and regulation of cytokine production. Finally, the PPI network and hub gene selection by maximal clique centrality (MCC) algorithm indicated the top ranked proteins were TNF-α, IL-1β, IL-6, AKT1, PPAR-γ, TLR4, CCL2, and TLR2. CONCLUSION These results emphasized the importance of TLR2/TLR4-MyD88-NF-κB-IL-1β/IL-6/TNF-α pathways as therapeutic targets of SsnB in inflammatory diseases.
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Affiliation(s)
- Rongyuan Yang
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Qingqing Liu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Dawei Wang
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangdong, 510405, China
| | - Zhen Zhao
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Zhaohai Su
- Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou, 341000, China
| | - Daping Fan
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, SC, 29209, USA.
| | - Qing Liu
- State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Clinical School of Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
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Chakraborty S, Tabrizi Z, Bhatt NN, Franciosa SA, Bracko O. A Brief Overview of Neutrophils in Neurological Diseases. Biomolecules 2023; 13:biom13050743. [PMID: 37238612 DOI: 10.3390/biom13050743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Neutrophils are the most abundant leukocyte in circulation and are the first line of defense after an infection or injury. Neutrophils have a broad spectrum of functions, including phagocytosis of microorganisms, the release of pro-inflammatory cytokines and chemokines, oxidative burst, and the formation of neutrophil extracellular traps. Traditionally, neutrophils were thought to be most important for acute inflammatory responses, with a short half-life and a more static response to infections and injury. However, this view has changed in recent years showing neutrophil heterogeneity and dynamics, indicating a much more regulated and flexible response. Here we will discuss the role of neutrophils in aging and neurological disorders; specifically, we focus on recent data indicating the impact of neutrophils in chronic inflammatory processes and their contribution to neurological diseases. Lastly, we aim to conclude that reactive neutrophils directly contribute to increased vascular inflammation and age-related diseases.
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Affiliation(s)
| | - Zeynab Tabrizi
- Department of Biology, University of Miami, Coral Gables, FL 33146, USA
| | | | | | - Oliver Bracko
- Department of Biology, University of Miami, Coral Gables, FL 33146, USA
- Department of Neurology, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
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4
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Rughwani RR, Cholan PK, Victor DJ. Congenital Heart Diseases and Periodontal Diseases—Is There a Link? Front Cardiovasc Med 2022; 9:937480. [PMID: 35845078 PMCID: PMC9279652 DOI: 10.3389/fcvm.2022.937480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022] Open
Abstract
An understanding in the field of periodontal medicine explains the fact that the oral cavity serves as a niche for numerous pathogenic microorganisms. When these microorganisms or their by-products disseminate to the various parts of the body, they are capable of triggering diseases characterized by an altered host immune-inflammatory response in the anatomically distinct organ. This mechanism is reported in the propagation of cardiovascular diseases with respect to periodontal medicine. Abundant amount of literature suggests an association between atherosclerotic cardiovascular disease and periodontal diseases. However, there is very less data available to highlight the association between periodontal disease and non-atherosclerotic cardiovascular disease, such as congenital anomalies of the heart. This review outlines the relationship between periodontal diseases and congenital heart diseases and also helps us understand whether the presence of periodontal disease can worsen the preexisting congenital cardiac disease.
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Biselli JM, Zampieri BL, Biselli-Chicote PM, de Souza JES, Bürger MC, da Silva WA, Goloni-Bertollo EM, Pavarino ÉC. Differential microRNA expression profile in blood of children with Down syndrome suggests a role in immunological dysfunction. Hum Cell 2022; 35:639-648. [PMID: 35060072 PMCID: PMC8773395 DOI: 10.1007/s13577-022-00672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/09/2022] [Indexed: 11/18/2022]
Abstract
Down syndrome (DS), caused by trisomy of chromosome 21 (HSA21), results in a broad range of phenotypes. However, the determinants contributing to the complex and variable phenotypic expression of DS are still not fully known. Changes in microRNAs (miRNAs), short non-coding RNA molecules that regulate gene expression post-transcriptionally, have been associated with some DS phenotypes. Here, we investigated the genome-wide mature miRNA expression profile in peripheral blood mononuclear cells (PBMCs) of children with DS and controls and identified biological processes and pathways relevant to the DS pathogenesis. The expression of 754 mature miRNAs was profiled in PBMCs from six children with DS and six controls by RT-qPCR using TaqMan® Array Human MicroRNA Cards. Functions and signaling pathways analyses were performed using DIANA-miRPath v.3 and DIANA-microT-CDS software. Children with DS presented six differentially expressed miRNAs (DEmiRs): four overexpressed (miR-378a-3p, miR-130b-5p, miR-942-5p, and miR-424-3p) and two downregulated (miR-452-5p and miR-668-3p). HSA21-derived miRNAs investigated were not found to be differentially expressed between the groups. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses showed potential target genes involved in biological processes and pathways pertinent to immune response, e.g., toll-like receptors (TLRs) signaling, Hippo, and transforming growth factor β (TGF-β) signaling pathways. These results suggest that altered miRNA expression could be contributing to the well-known immunological dysfunction observed in individuals with DS.
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Affiliation(s)
- Joice Matos Biselli
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
| | - Bruna Lancia Zampieri
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Patrícia Matos Biselli-Chicote
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
| | - Jorge Estefano Santana de Souza
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Metrópole Digital Institute (IMD), UFRN, Natal, RN, Brazil
- National Institute of Science and Technology in Stem Cell and Cell Therapy and Center for Cell Based Therapy, Ribeirao Preto, São Paulo, Brazil
| | - Matheus Carvalho Bürger
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute of Science and Technology in Stem Cell and Cell Therapy and Center for Cell Based Therapy, Ribeirao Preto, São Paulo, Brazil
| | - Wilson Araújo da Silva
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- National Institute of Science and Technology in Stem Cell and Cell Therapy and Center for Cell Based Therapy, Ribeirao Preto, São Paulo, Brazil
| | - Eny Maria Goloni-Bertollo
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil
| | - Érika Cristina Pavarino
- Department of Molecular Biology, Faculdade de Medicina de São José Do Rio Preto , Genetics and Molecular Biology Research Unit (UPGEM), São José Do Rio Preto Medical School (FAMERP), Avenida Brigadeiro Faria Lima, nº 5416 - UPGEM/Bloco U-6, CEP: 15.090-000, São José Do Rio Preto, São Paulo, Brazil.
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Huggard D, Kelly L, Worrall A, Gallagher E, Fallah L, Yoo LL, McGrane F, Lagan N, Roche E, Balfe J, Doherty DG, Molloy EJ. Melatonin as an immunomodulator in children with Down syndrome. Pediatr Res 2022; 91:1812-1820. [PMID: 34400791 PMCID: PMC9270227 DOI: 10.1038/s41390-021-01611-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Down syndrome (DS) is a disorder characterised by marked immune dysfunction, increased mortality from sepsis, chronic inflammation, increased oxidative stress, sleep disturbance and possibly abnormal endogenous melatonin levels. Melatonin has a myriad of immune functions, and we hypothesised that this therapeutic agent could modulate the innate immune system in this cohort. METHODS We investigated neutrophil and monocyte function (CD11b, TLR4 expression by flow cytometry), genes involved in TLR signalling (MyD88, IRAK4, TRIF), the inflammasome (NLRP3, IL-1β), and circadian rhythm (BMAL, CLOCK, CRY) by qPCR, and inflammatory cytokines (IL-2, IL-6, IL-8, IL-18, IL-1β, TNF-α, IFN-γ, IL-10, IL-1ra, VEGF, Epo, GM-CSF) by enzyme-linked immunosorbent assay (ELISA) following immunomodulation with LPS endotoxin and melatonin. 47 children with DS and 23 age- and sex-matched controls were recruited. RESULTS We demonstrated that melatonin has several significant effects by reducing CD11b and TLR4 expression, attenuating TLR signalling, genes involved in the inflammasome and has the potential to reduce LPS-induced inflammatory responses. CONCLUSIONS Immunomodulatory effects of melatonin were found in both paediatric cohorts with more marked effects in the children with DS. Melatonin mediates immune response through a wide array of mechanisms and this immunomodulator may buffer the inflammatory response by regulating pro and anti-inflammatory signalling. IMPACT We highlight that melatonin mediates its immune response through a wide array of mechanisms, its effects appear to be dose dependant and children with Down syndrome may be more receptive to treatment with it. Immunomodulatory effects of melatonin were demonstrated with marked effects in the children with Down syndrome with a reduction of MyD88, IL-1ß and NLRP3 expression in whole-blood samples. Melatonin is a proposed anti-inflammatory agent with a well-established safety profile, that has the potential for mitigation of pro- and anti-inflammatory cytokines in paediatric Down syndrome cohorts, though further clinical trials are warranted.
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Affiliation(s)
- Dean Huggard
- Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland. .,Trinity Translational Medicine Institute (TTMI), St James Hospital, Trinity College Dublin, Dublin, Ireland. .,Paediatrics, Children's health Ireland (CHI) at Tallaght, Dublin, Ireland. .,National Children's Research Centre, Dublin, Crumlin, Ireland.
| | - Lynne Kelly
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland ,grid.416409.e0000 0004 0617 8280Trinity Translational Medicine Institute (TTMI), St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - Amy Worrall
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - Eleanor Gallagher
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - Lida Fallah
- grid.416409.e0000 0004 0617 8280Trinity Translational Medicine Institute (TTMI), St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - Lucas Lu Yoo
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
| | - Fiona McGrane
- Paediatrics, Children’s health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Niamh Lagan
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland ,Paediatrics, Children’s health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Edna Roche
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland ,Paediatrics, Children’s health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Joanne Balfe
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland ,Paediatrics, Children’s health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Derek G. Doherty
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland ,grid.416409.e0000 0004 0617 8280Trinity Translational Medicine Institute (TTMI), St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - Eleanor J. Molloy
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland ,grid.416409.e0000 0004 0617 8280Trinity Translational Medicine Institute (TTMI), St James Hospital, Trinity College Dublin, Dublin, Ireland ,Paediatrics, Children’s health Ireland (CHI) at Tallaght, Dublin, Ireland ,grid.452722.4National Children’s Research Centre, Dublin, Crumlin, Ireland ,grid.411886.20000 0004 0488 4333Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland ,Neonatology, CHI at Crumlin, Dublin, Ireland
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7
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Zakharchenko L, EL-Khuffash A, Hurley T, Kelly L, Melo A, Padden M, Franklin O, Molloy EJ. Infants with Down syndrome and congenital heart disease have altered peri-operative immune responses. Pediatr Res 2022; 92:1716-1723. [PMID: 35352006 PMCID: PMC9771806 DOI: 10.1038/s41390-022-02000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infants with Down syndrome (DS) have an altered immune response. We aimed to characterise the inflammatory response in infants with DS and congenital heart disease (CHD) peri-operatively in comparison to infants with CHD and a normal chromosomal complement, and to healthy infants pre-operatively. METHODS Infants with DS/CHD, infants without DS but with CHD (CHD only) and healthy infants were prospectively recruited and serial serum cytokines evaluated peri-operatively using multiplex ELISA: tumour necrosis factor (TNF)-α and TNF-β; interferon (IFN)-γ, interleukin (IL)-1α, IL-2, IL-6, IL-8, IL-18, IL-1β, IL-10, and IL-1ra; vascular endothelial growth factor (VEGF); granulocyte macrophage colony-stimulating factor (GM-CSF); and erythropoietin (EPO). RESULTS Ninety-four infants were recruited including age-matched controls (n = 10), DS/CHD (n = 55), and CHD only (n = 29). Children with DS/CHD had significantly lower concentrations of several cytokines (IL-10, IL-6, IL-8, IL-1β, VEGF) in the pre- and post-operatively vs CHD only and controls. EPO and GM-CSF were significantly higher in DS/CHD (p value <0.05). CONCLUSIONS Children with DS/CHD had significantly lower concentrations of several cytokines compared to controls or children with CHD only. EPO and GM-CSF were significantly higher in children with DS/CHD. The assessment of the immune response may be suitable for the predictable clinical outcomes in these children. IMPACT This study demonstrated that children with Down syndrome (DS) and congenital heart disease (CHD) have significant alterations in pro-inflammatory and anti-inflammatory immune responses peri-operatively. These changes may contribute to adverse clinical outcomes, including sepsis, chylothorax, and autoimmunity. They may impact the pathogenesis and outcome post-operatively and long term in this population. Children with DS and CHD have significantly lower cytokine concentrations, increased EPO and GM-CSF, and decreased VEGF pre- and post-operatively. Assessing their inflammatory state peri-operatively may facilitate the development of a predictive model that can inform tailored management of these infants using novel therapies including immunomodulation.
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Affiliation(s)
- Lyudmyla Zakharchenko
- grid.417322.10000 0004 0516 3853Paediatric Cardiology, Children’s Health Ireland at Crumlin & Tallaght, Dublin, Ireland ,grid.452722.4National Children’s Research Centre, Crumlin, Dublin, Ireland
| | - Afif EL-Khuffash
- grid.452722.4National Children’s Research Centre, Crumlin, Dublin, Ireland ,grid.416068.d0000 0004 0617 7587Department of Neonatology, Rotunda Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland ,grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood Centre (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland
| | - Tim Hurley
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood Centre (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland
| | - Lynne Kelly
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood Centre (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland
| | - Ashanti Melo
- grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood Centre (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland
| | - Maureen Padden
- grid.452722.4National Children’s Research Centre, Crumlin, Dublin, Ireland
| | - Orla Franklin
- grid.417322.10000 0004 0516 3853Paediatric Cardiology, Children’s Health Ireland at Crumlin & Tallaght, Dublin, Ireland ,grid.452722.4National Children’s Research Centre, Crumlin, Dublin, Ireland ,grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood Centre (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland ,grid.411886.20000 0004 0488 4333Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Eleanor J. Molloy
- grid.452722.4National Children’s Research Centre, Crumlin, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland ,grid.8217.c0000 0004 1936 9705Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood Centre (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland ,grid.411886.20000 0004 0488 4333Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland ,grid.417322.10000 0004 0516 3853Neonatology, Children’s Health Ireland at Crumlin & Tallaght, Dublin, Ireland
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8
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Singampalli KL, Jui E, Shani K, Ning Y, Connell JP, Birla RK, Bollyky PL, Caldarone CA, Keswani SG, Grande-Allen KJ. Congenital Heart Disease: An Immunological Perspective. Front Cardiovasc Med 2021; 8:701375. [PMID: 34434978 PMCID: PMC8380780 DOI: 10.3389/fcvm.2021.701375] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022] Open
Abstract
Congenital heart disease (CHD) poses a significant global health and economic burden-despite advances in treating CHD reducing the mortality risk, globally CHD accounts for approximately 300,000 deaths yearly. Children with CHD experience both acute and chronic cardiac complications, and though treatment options have improved, some remain extremely invasive. A challenge in addressing these morbidity and mortality risks is that little is known regarding the cause of many CHDs and current evidence suggests a multifactorial etiology. Some studies implicate an immune contribution to CHD development; however, the role of the immune system is not well-understood. Defining the role of the immune and inflammatory responses in CHD therefore holds promise in elucidating mechanisms underlying these disorders and improving upon current diagnostic and treatment options. In this review, we address the current knowledge coinciding CHDs with immune and inflammatory associations, emphasizing conditions where this understanding would provide clinical benefit, and challenges in studying these mechanisms.
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Affiliation(s)
- Kavya L. Singampalli
- Department of Bioengineering, Rice University, Houston, TX, United States
- Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, United States
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Elysa Jui
- Department of Bioengineering, Rice University, Houston, TX, United States
| | - Kevin Shani
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States
| | - Yao Ning
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | | | - Ravi K. Birla
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
- Division of Congenital Heart Surgery, Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Paul L. Bollyky
- Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Christopher A. Caldarone
- Division of Congenital Heart Surgery, Departments of Surgery and Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Sundeep G. Keswani
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
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9
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Illouz T, Biragyn A, Iulita MF, Flores-Aguilar L, Dierssen M, De Toma I, Antonarakis SE, Yu E, Herault Y, Potier MC, Botté A, Roper R, Sredni B, London J, Mobley W, Strydom A, Okun E. Immune Dysregulation and the Increased Risk of Complications and Mortality Following Respiratory Tract Infections in Adults With Down Syndrome. Front Immunol 2021; 12:621440. [PMID: 34248930 PMCID: PMC8267813 DOI: 10.3389/fimmu.2021.621440] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
The risk of severe outcomes following respiratory tract infections is significantly increased in individuals over 60 years, especially in those with chronic medical conditions, i.e., hypertension, diabetes, cardiovascular disease, dementia, chronic respiratory disease, and cancer. Down Syndrome (DS), the most prevalent intellectual disability, is caused by trisomy-21 in ~1:750 live births worldwide. Over the past few decades, a substantial body of evidence has accumulated, pointing at the occurrence of alterations, impairments, and subsequently dysfunction of the various components of the immune system in individuals with DS. This associates with increased vulnerability to respiratory tract infections in this population, such as the influenza virus, respiratory syncytial virus, SARS-CoV-2 (COVID-19), and bacterial pneumonias. To emphasize this link, here we comprehensively review the immunobiology of DS and its contribution to higher susceptibility to severe illness and mortality from respiratory tract infections.
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Affiliation(s)
- Tomer Illouz
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar-Ilan University, Ramat Gan, Israel
| | - Arya Biragyn
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institute of Health, Baltimore, MD, United States
| | - Maria Florencia Iulita
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center of Biomedical Investigation Network for Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Lisi Flores-Aguilar
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada
| | - Mara Dierssen
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), Barcelona, Spain
| | - Ilario De Toma
- Center for Genomic Regulation, The Barcelona Institute for Science and Technology, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- Biomedical Research Networking Center for Rare Diseases (CIBERER), Barcelona, Spain
| | - Stylianos E. Antonarakis
- Department of Genetic Medicine and Development, University of Geneva, Geneva, Switzerland
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
- iGE3 Institute of Genetics and Genomics of Geneva, Geneva, Switzerland
| | - Eugene Yu
- The Children’s Guild Foundation Down Syndrome Research Program, Genetics and Genomics Program and Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Genetics, Genomics and Bioinformatics Program, State University of New York at Buffalo, Buffalo, NY, United States
| | - Yann Herault
- Université de Strasbourg, CNRS, INSERM, Institut de Génétique Biologie Moléculaire et Cellulaire, IGBMC - UMR 7104 - Inserm U1258, Illkirch, France
| | - Marie-Claude Potier
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Alexandra Botté
- Paris Brain Institute (ICM), CNRS UMR7225, INSERM U1127, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Randall Roper
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Benjamin Sredni
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | - William Mobley
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Eitan Okun
- The Leslie and Susan Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- The Paul Feder Laboratory on Alzheimer’s Disease Research, Bar-Ilan University, Ramat Gan, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
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10
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Autoimmunity and Genetic Syndromes: A Focus on Down Syndrome. Genes (Basel) 2021; 12:genes12020268. [PMID: 33668420 PMCID: PMC7918365 DOI: 10.3390/genes12020268] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022] Open
Abstract
Within immune system-related diseases, autoimmunity has always represented a field of great interest, although many aspects remain poorly understood even today. Genetic syndromes associated with immunity disorders are common and represent an interesting model for a better understanding of the underlying mechanism of autoimmunity predisposition. Among these conditions, Down syndrome (DS) certainly deserves special attention as it represents the most common genetic syndrome associated with immune dysregulation, involving both innate and adaptive immunity. Autoimmunity represents a well-known complication of DS: it is estimated that people affected by this disease present a risk four to six times higher than the normal population to develop autoimmune diseases such as celiac disease, type 1 diabetes mellitus, and hypo- or hyperthyroidism. Several factors have been considered as possible etiology, including genetic and epigenetic modifications and immune dysregulation. In times in which the life expectancy of people with DS has been extremely prolonged, thanks to improvements in the diagnosis and treatment of congenital heart disease and infectious complications, knowledge of the mechanisms and proper management of autoimmune diseases within this syndrome has become essential. In this short review, we aim to report the current literature regarding the genetic, immune, and environmental factors that have been proposed as the possible underlying mechanism of autoimmunity in individuals with DS, with the intent to provide insight for a comprehensive understanding of these diseases in genetic syndromes.
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11
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Newville J, Maxwell JR, Kitase Y, Robinson S, Jantzie LL. Perinatal Opioid Exposure Primes the Peripheral Immune System Toward Hyperreactivity. Front Pediatr 2020; 8:272. [PMID: 32670993 PMCID: PMC7332770 DOI: 10.3389/fped.2020.00272] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022] Open
Abstract
The increased incidence of opioid use during pregnancy warrants investigation to reveal the impact of opioid exposure on the developing fetus. Exposure during critical periods of development could have enduring consequences for affected individuals. Particularly, evidence is mounting that developmental injury can result in immune priming, whereby subsequent immune activation elicits an exaggerated immune response. This maladaptive hypersensitivity to immune challenge perpetuates dysregulated inflammatory signaling and poor health outcomes. Utilizing an established preclinical rat model of perinatal methadone exposure, we sought to investigate the consequences of developmental opioid exposure on in vitro activation of peripheral blood mononuclear cells (PBMCs). We hypothesize that PBMCs from methadone-exposed rats would exhibit abnormal chemokine and cytokine expression at baseline, with exaggerated chemokine and cytokine production following immune stimulation compared to saline-exposed controls. On postnatal day (P) 7, pup PMBCs were isolated and cultured, pooling three pups per n. Following 3 and 24 h, the supernatant from cultured PMBCs was collected and assessed for inflammatory cytokine and chemokine expression at baseline or lipopolysaccharide (LPS) stimulation using multiplex electrochemiluminescence. Following 3 and 24 h, baseline production of proinflammatory chemokine and cytokine levels were significantly increased in methadone PBMCs (p < 0.0001). Stimulation with LPS for 3 h resulted in increased tumor necrosis factor (TNF-α) and C-X-C motif chemokine ligand 1 (CXCL1) expression by 3.5-fold in PBMCs from methadone-exposed PBMCs compared to PBMCs from saline-exposed controls (p < 0.0001). Peripheral blood mononuclear cell hyperreactivity was still apparent at 24 h of LPS stimulation, evidenced by significantly increased TNF-α, CXCL1, interleukin 6 (IL-6), and IL-10 production by methadone PMBCs compared to saline control PBMCs (p < 0.0001). Together, we provide evidence of increased production of proinflammatory molecules from methadone PBMCs at baseline, in addition to sustained hyperreactivity relative to saline-exposed controls. Exaggerated peripheral immune responses exacerbate inflammatory signaling, with subsequent consequences on many organ systems throughout the body, such as the developing nervous system. Enhanced understanding of these inflammatory mechanisms will allow for appropriate therapeutic development for infants who were exposed to opioids during development. Furthermore, these data highlight the utility of this in vitro PBMC assay technique for future biomarker development to guide specific treatment for patients exposed to opioids during gestation.
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Affiliation(s)
- Jessie Newville
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Jessie R Maxwell
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, NM, United States.,Departments of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Yuma Kitase
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shenandoah Robinson
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lauren L Jantzie
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurology, Kennedy Krieger Institute, Baltimore, MD, United States
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12
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Huggard D, Doherty DG, Molloy EJ. Immune Dysregulation in Children With Down Syndrome. Front Pediatr 2020; 8:73. [PMID: 32175298 PMCID: PMC7056667 DOI: 10.3389/fped.2020.00073] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
Down syndrome (DS) is the most common genetic syndrome associated with immune defects. The extent of immune dysregulation in DS is substantial, spanning the innate and adaptive systems and including anomalies in: T and B cells, monocytes, neutrophil chemotaxis, circulating cytokines, and suboptimal antibody responses which all contribute to an increased risk of infections, poorer clinical outcomes and chronic inflammation in this vulnerable cohort. Other aspects of innate immunity may also be abnormal and contribute to the increased morbidity and warrant further interrogation such as: gamma delta T cell function, the inflammasome, Toll-like receptors and their pathways. Pharmacotherapies such as pavilizumab, pneumococcal and influenza immunizations, as well as potential immunoprophylactic agents such as pidotimod, azithromycin and Broncho-Vaxom may help alleviate the infectious consequences. Children with DS need to be managed with a heightened sense of awareness and urgency in the setting of sepsis and signs of chronic inflammation need regular screening and appropriate follow up.
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Affiliation(s)
- Dean Huggard
- Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Children's Hospital Ireland at Crumlin and Tallaght, Dublin, Ireland.,National Children's Research Centre Dublin, Dublin, Ireland
| | - Derek G Doherty
- Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Children's Hospital Ireland at Crumlin and Tallaght, Dublin, Ireland.,National Children's Research Centre Dublin, Dublin, Ireland.,Coombe Women and Infants University Hospital, Dublin, Ireland
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13
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O'Dea MI, Kelly L, McKenna E, Melo AM, Ni Bhroin M, Hurley T, Byrne AT, Colleran G, Vavasseur C, El-Khuffash A, Miletin J, Murphy J, Hickey F, Molloy EJ. Dysregulated Monocyte and Neutrophil Functional Phenotype in Infants With Neonatal Encephalopathy Requiring Therapeutic Hypothermia. Front Pediatr 2020; 8:598724. [PMID: 33659224 PMCID: PMC7917189 DOI: 10.3389/fped.2020.598724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/24/2020] [Indexed: 12/16/2022] Open
Abstract
Neonatal encephalopathy (NE) is a significant cause of morbidity and mortality. Persistent inflammation and activation of leukocytes mediate brain injury in NE. The standard of care for NE, therapeutic hypothermia (TH), does not improve outcomes in nearly half of moderate to severe cases, resulting in the need for new adjuvant therapies, and immunomodulation holds promise. Our objective was to explore systemic leukocyte phenotype in infants with NE and healthy controls in response to lipopolysaccharide (LPS). Twenty-four infants with NE (NE II-20; NE III = 4) requiring TH and 17 term neonatal controls were enrolled, and blood samples were analyzed between days 1 and 4 of life at a mean (SD) timepoint of 2.1 (± 0.81) days of postnatal life at the time of the routine phlebotomy. Leukocyte cell surface expression levels of Toll-like receptor 4, NADPH oxidase (NOX2), CD11b, mitochondrial mass, and mitochondrial superoxide production were measured by flow cytometry. Gene expression of TRIF (TIR domain-containing adapter-inducing interferon-β), MyD88 and IRAK4 was measured by reverse transcription-polymerase chain reaction. Infants with NE had significantly lower expression of neutrophil CD11b and NOX2 with LPS stimulation compared to healthy term controls. Mitochondrial mass in neutrophils and monocytes was significantly increased in NE infants with LPS compared to controls, potentially indicating a dysregulated metabolism. Infants with NE had significantly lower IRAK4 at baseline than controls. NE infants display a dysregulated inflammatory response compared to healthy infants, with LPS hyporesponsiveness to CD11b and NOX2 and decreased IRAK4 gene expression. This dysregulated immune profile may indicate an adaptable response to limit hyperinflammation.
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Affiliation(s)
- Mary Isabel O'Dea
- Department of Paediatrics and Neonatology, Coombe Women & Infants University Hospital, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre (NCRC), Crumlin, Ireland
| | - Lynne Kelly
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Ellen McKenna
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Ashanty M Melo
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Megan Ni Bhroin
- Trinity College Institute of Neuroscience and Cognitive Systems Group, Discipline of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tim Hurley
- Department of Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
| | | | | | | | | | - Jan Miletin
- Department of Paediatrics and Neonatology, Coombe Women & Infants University Hospital, Dublin, Ireland
| | - John Murphy
- National Maternity Hospital, Dublin, Ireland
| | - Fionnuala Hickey
- Trinity Health Kidney Centre, Faculty of Health Sciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Department of Paediatrics and Neonatology, Coombe Women & Infants University Hospital, Dublin, Ireland.,Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre (NCRC), Crumlin, Ireland.,Our Lady's Children's Hospital (CHI), Crumlin, Ireland.,Department of Paediatrics, Tallaght University Hospital, Dublin, Ireland
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14
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Increased systemic inflammation in children with Down syndrome. Cytokine 2019; 127:154938. [PMID: 31785499 DOI: 10.1016/j.cyto.2019.154938] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022]
Abstract
Children with Down syndrome (DS) develop more infections, have an increased mortality from sepsis and an increased incidence of chronic inflammatory conditions. Cytokine dysregulation may underpin these clinical sequelae and raised pro-inflammatory biomarkers are a feature in adults with DS. The importance of the anti-inflammatory mediators IL-1ra and IL-10, as well as cytokines Epo and VEGF, which could impact on the pathogenesis and outcomes in congenital heart disease (CHD) which is more prevalent in DS, are less well known. We examined a comprehensive array of pro-(IL-2, IL-6, IL-8, IL-18, IL-1β, TNF-α, IFN-γ), and anti-inflammatory (IL-10 and IL-1ra) mediators, cytokines involved in inflammation in response to hypoxia (EPO), propagating angiogenesis (VEGF), and myelopoiesis (GM-CSF), by enzyme linked immunosorbent assay (ELISA), as well as discussing the potential impact of significant CHD and Lipopolysaccharide endotoxin on these mediators. 114 children with DS and 60 age and sex matched controls were recruited. Children with Down syndrome exhibit significantly greater levels of pro and anti-inflammatory cytokines; IL-2, IL-6, IL-10, IL-1ra, as well as increased Epo, VEGF and GM-CSF at baseline. CHD does not seem to have an impact on circulating cytokines beyond the acute surgical phase. Both cohorts had similar responses to LPS stimulation. These differences may contribute to varied clinical outcomes, acutely like in sepsis, and over time in autoimmunity.
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