1
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Jiao D, Zhang R, Wang M, Zhang X, Ma H, Li M, Chang H. Compact photometric detector integrated with separation microchip for potential portable liquid chromatography system. J Chromatogr A 2024; 1731:465175. [PMID: 39032217 DOI: 10.1016/j.chroma.2024.465175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 07/22/2024]
Abstract
In recent years, miniaturized analytical instruments have been developing to meet the needs of portable and rapid analysis. The key of miniaturized analytical equipment is the miniaturization and integration of functional modules. This paper aims to develop a miniaturized photometric detector and separation microfluidic chip for a liquid chromatography (LC) system. The detector uses a light-emitting diode to emit ultraviolet light, which is collimated by an internal double lens. A Z-shaped flow cell with a long optical path is designed and fabricated in the separation microfluidic chip with a three-layer structure, which provides a tubing-free connection between the separation and detection unit. Detector performance is evaluated using hemoglobin (Hb) samples, with an upper limit of detection linearity (95 %) of 0.345 AU and stray light level as low as 0.08 %. Additionally, the microchip channel can be filled with cation exchange resin and C18 particles. Finally, an ion LC system and a reversed-phase LC system were constructed based on the miniaturized photometric detector and two microchips with different packed columns, respectively, and were successfully used in the separation and detection of two metabolic markers (glycated hemoglobin or bilirubin). The results of this study are expected to facilitate the development of a portable LC system and their application in community health services and family health management of chronic diseases.
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Affiliation(s)
- Dezhao Jiao
- The Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, Department of Microsystem Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Ruirong Zhang
- The Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, Department of Microsystem Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Mengbo Wang
- The Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, Department of Microsystem Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Xiaorui Zhang
- The Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, Department of Microsystem Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Haoquan Ma
- The Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, Department of Microsystem Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Mingyang Li
- Industry Engineering Department, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Honglong Chang
- The Ministry of Education Key Laboratory of Micro/Nano Systems for Aerospace, Department of Microsystem Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China.
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2
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Ebbesen F, Donneborg ML. Clinical overview of phototherapy for neonatal hyperbilirubinaemia. Acta Paediatr 2024. [PMID: 38924152 DOI: 10.1111/apa.17331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
The most efficient emission spectrum of light for phototherapy is blue-green light emission diode light with peak emission at 478 nm. In the irradiance interval of phototherapy, the relationship between efficacy and irradiance is almost linear, and it is negatively related to the haemoglobin. The action sites of phototherapy are the extravascular compartment and cutaneous blood. The most immature neonates treated aggressively had not only a lower frequency of neurodevelopmental impairment than conservatively treated, but also greater mortality. Intermittent and continuous phototherapy are assumed to be equally efficient. Home-based fibreoptic phototherapy is effective and safe. Important progress is still occurring in phototherapy.
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Affiliation(s)
- Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mette Line Donneborg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Pediatrics, North Denmark Regional Hospital, Hjoerring, Denmark
- Centre for Clinical Research, North Denmark Regional Hospital, Aalborg, Denmark
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3
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Insights into the Structures of Bilirubin and Biliverdin from Vibrational and Electronic Circular Dichroism: History and Perspectives. Molecules 2023; 28:molecules28062564. [PMID: 36985535 PMCID: PMC10054127 DOI: 10.3390/molecules28062564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
In this work we review research activities on a few of the most relevant structural aspects of bilirubin (BR) and biliverdin (BV). Special attention is paid to the exocyclic C=C bonds being in mostly Z rather than E configurations, and to the overall conformation being essentially different for BR and BV due to the presence or absence of the double C=C bond at C-10. In both cases, racemic mixtures of each compound of either M or P configuration are present in achiral solutions; however, imbalance between the two configurations may be easily achieved. In particular, results based on chiroptical spectroscopies, both electronic and vibrational circular dichroism (ECD and VCD) methods, are presented for chirally derivatized BR and BV molecules. Finally, we review deracemization experiments monitored with ECD data from our lab for BR in the presence of serum albumin and anesthetic compounds.
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4
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Blue-Green (~480 nm) versus Blue (~460 nm) Light for Newborn Phototherapy-Safety Considerations. Int J Mol Sci 2022; 24:ijms24010461. [PMID: 36613904 PMCID: PMC9820095 DOI: 10.3390/ijms24010461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 12/29/2022] Open
Abstract
We have previously shown that the phototherapy of hyperbilirubinemic neonates using blue-green LED light with a peak wavelength of ~478 nm is 31% more efficient for removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of ~452 nm. Based on these results, we recommended that the phototherapy of hyperbilirubinemic newborns be practiced with light of ~480 nm. Aim: Identify and discuss the most prominent potential changes that have been observed in the health effects of phototherapy using either blue fluorescent- or blue LED light and speculate on the expected effects of changing to blue-green LED light phototherapy. Search the phototherapy literature using the terms neonate, hyperbilirubinemia, and phototherapy in the PubMed and Embase databases. Transitioning from blue fluorescent light to blue-green LED light will expose neonates to less light in the 400-450 nm spectral range, potentially leading to less photo-oxidation and geno-/cytotoxicity, reduced risk of cancer, and decreased mortality in extremely low-birthweight neonates. The riboflavin level may decline, and the increased production and retention of bronze pigments may occur in predisposed neonates due to enhanced lumirubin formation. The production of pre-inflammatory cytokines may rise. Hemodynamic responses and transepidermal water loss are less likely to occur. The risk of hyperthermia may decrease with the use of blue-green LED light and the risk of hypothermia may increase. Parent-neonate attachment and breastfeeding will be positively affected because of the shortened duration of phototherapy. The latter may also lead to a significant reduction in the cost of phototherapy procedures as well as the hospitalization process.
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5
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Uchida Y, Takahashi Y, Morimoto Y, Greimel P, Tosaki A, Kumagai A, Nishikubo T, Miyawaki A. Noninvasive monitoring of bilirubin photoisomer excretion during phototherapy. Sci Rep 2022; 12:11798. [PMID: 35821401 PMCID: PMC9276810 DOI: 10.1038/s41598-022-16180-9] [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: 03/01/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Lumirubin is the most prevalently excreted hydrophilic bilirubin photoisomer in phototherapy for neonatal jaundice caused by excess hydrophobic unconjugated bilirubin (ZZ-bilirubin). We developed a simple method to estimate the amount of lumirubin by monitoring the reverse photoisomerization of lumirubin to ZZ-bilirubin. Although lumirubin formation was long considered irreversible, exposure to blue light in the presence of the fluorescent protein UnaG, which binds specifically and tightly to ZZ-bilirubin, enables the reverse photoisomerization of lumirubin. This reaction was first detected using a fluorescence assay of neonatal urine sampled during phototherapy and purified lumirubin. The phenomenon of reverse photoisomerization of lumirubin was validated using liquid chromatography–mass spectrometry, which confirmed that lumirubin is reconverted to ZZ-bilirubin in the presence of UnaG. Analyses of 20 urine samples from 17 neonates revealed a significant correlation (correlation coefficient [r] = 0.978; 95% confidence interval 0.867–0.979; P < .001) between lumirubin and ZZ-bilirubin concentration before and after reverse photoisomerization. In general, the rate of photo-reconversion of lumirubin to ZZ-bilirubin is approximately 40%. In conclusion, we demonstrate here that lumirubin can be photo-reconverted to ZZ-bilirubin via exposure to blue light in the presence of UnaG. Utilizing this approach, urinary lumirubin levels can be estimated using an easy-to-perform fluorescence assay.
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Affiliation(s)
- Yumiko Uchida
- Division of Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Yukihiro Takahashi
- Division of Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yukihiro Morimoto
- R&D Division, Ushio Inc., Himeji, Japan.,SANKEN, Osaka University, Osaka, Japan
| | - Peter Greimel
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
| | - Asako Tosaki
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
| | - Akiko Kumagai
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
| | - Toshiya Nishikubo
- Division of Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Atsushi Miyawaki
- Cell Function Dynamics, Brain Science Institute, RIKEN, Wako, Japan
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6
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Aronson SJ, Junge N, Trabelsi M, Kelmemi W, Hubert A, Brigatti KW, Fox MD, de Knegt RJ, Escher JC, Ginocchio VM, Iorio R, Zhu Y, Özçay F, Rahim F, El-Shabrawi MHF, Shteyer E, Di Giorgio A, D'Antiga L, Mingozzi F, Brunetti-Pierri N, Strauss KA, Labrune P, Mrad R, Baumann U, Beuers U, Bosma PJ. Disease burden and management of Crigler-Najjar syndrome: Report of a world registry. Liver Int 2022; 42:1593-1604. [PMID: 35274801 DOI: 10.1111/liv.15239] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Sem J Aronson
- Department of Gastroenterology & Hepatology and Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Norman Junge
- Division for Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Mediha Trabelsi
- Laboratoire de Génétique Humaine, Faculté de Médecine de Tunis (Laboratory of Human Genetics, Faculty of Medicine of Tunis, Université de Tunis El Manar (University of Tunis El Manar), Tunis, Tunisia.,Service des Maladies Congénitales et Héréditaires (Department of Hereditary and Congenital Disorders), Hôpital Charles Nicolle (Charles Nicolle Hospital), Tunis, Tunisia
| | - Wided Kelmemi
- Laboratoire de Génétique Humaine, Faculté de Médecine de Tunis (Laboratory of Human Genetics, Faculty of Medicine of Tunis, Université de Tunis El Manar (University of Tunis El Manar), Tunis, Tunisia
| | - Aurelie Hubert
- Department of Hereditary Diseases of Hepatic Metabolism, Hôpital Antoine Béclère, Clamart, France
| | | | - Michael D Fox
- Clinic for Special Children, Strasburg, Pennsylvania, USA.,Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Virginia M Ginocchio
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| | - Raffaele Iorio
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| | - Yan Zhu
- Third Military Medical University, Chongqing, China
| | - Figen Özçay
- Department of Pediatric Gastroenterology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Fakher Rahim
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Health research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mortada H F El-Shabrawi
- Department of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eyal Shteyer
- Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Angelo Di Giorgio
- Department of Paediatric Gastroenterology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Paediatric Gastroenterology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Nicola Brunetti-Pierri
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Kevin A Strauss
- Clinic for Special Children, Strasburg, Pennsylvania, USA.,Departments of Pediatrics and Molecular, Cell & Cancer Biology, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA
| | - Philippe Labrune
- Department of Hereditary Diseases of Hepatic Metabolism, Hôpital Antoine Béclère, Clamart, France
| | - Ridha Mrad
- Laboratoire de Génétique Humaine, Faculté de Médecine de Tunis (Laboratory of Human Genetics, Faculty of Medicine of Tunis, Université de Tunis El Manar (University of Tunis El Manar), Tunis, Tunisia.,Service des Maladies Congénitales et Héréditaires (Department of Hereditary and Congenital Disorders), Hôpital Charles Nicolle (Charles Nicolle Hospital), Tunis, Tunisia
| | - Ulrich Baumann
- Division for Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Ulrich Beuers
- Department of Gastroenterology & Hepatology and Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Piter J Bosma
- Department of Gastroenterology & Hepatology and Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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7
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Chen Z, Zhang S, Fang A, Shao J, Shen H, Sun B, Guo G, Liu L. Early changes in left ventricular myocardial function by 2D speckle tracking layer-specific technique in neonates with hyperbilirubinemia. Quant Imaging Med Surg 2022; 12:796-809. [PMID: 34993119 DOI: 10.21037/qims-21-197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/10/2021] [Indexed: 11/06/2022]
Abstract
Background Hyperbilirubinemia (HBN) can cause myocardial injury in neonates. Advancement in myocardial deformation imaging allows the detection of subclinical changes in myocardial contractility. The present study aimed to evaluate the changes in left ventricular contractility in newborns with hyperbilirubinemia by 2D speckle tracking imaging (STI). Methods A group of 134 neonates who reached the diagnostic level of HBN as the HBN group was selected. The control group included 56 healthy newborns. The interventricular septum, anterior partition, anterior wall, sidewall, posterior wall, and inferior wall were separated into the basal, middle, and apical segments. In each segment, speckle tracking analysis was performed in the subintimal, middle, and subadventitial myocardium. The overall longitudinal strain of the myocardium in different ventricular walls and segments and global longitudinal strain (GLS) were computed. At the same time, the laboratory results of blood gas analysis, blood routine tests, liver function, and myocardial enzyme spectrum in HBN neonates were collected and correlated with the left ventricular stratified strain parameters. Results The gradient of the left ventricular GLS had the same characteristics in both groups of newborns. There was a decreasing trend of longitudinal strain (LS) from the intima to the adventitia (i.e., GLSendo > GLSmid > GLSepi). This gradient was also present in stratified LS in each myocardial segment (P<0.001). The LS showed an increasing trend from the basal to the apical segment (P<0.001). The LS of the ventricular septum, anterior wall (or anterior septum), inferior wall, lateral wall, and posterior wall showed a decreasing trend (P<0.001). Stratified strain parameters of the ventricular wall (i.e., the 3-layer myocardium: LSendo-SEPT, LSmid-SEPT, and LSepi-SEPT) were all significantly lower in the HBN group than in the control group (P=0.019, P=0.019, and P=0.023, respectively). LSedo-ANT, LSmid-ANT, and LSepi-ANT were also reduced, and the difference between LSendo-ANT and LSepi-ANT was statistically significant. The segmental stratified strain parameters (i.e., the apical 3-layer myocardium: LSepi-a, LSmid-a, and LSepi-a) decreased, and the difference in LSepi-a was statistically significant (P=0.043). Overall strain parameters (i.e., the 3-layer myocardial overall strain: GLSendo, GLSmid, and GLSepi) were reduced, but the difference was not statistically significant (P=0.612, P=0.653, and P=0.585, respectively). The subclinical changes in systolic function in the HBN group, reflected by the parameters of longitudinal myocardial strain, correlate to some extent with multiple results of laboratory tests. Conclusions 2DSTI stratified strain technology can quantitively evaluate changes in the LS of the left ventricle in different ventricular walls, wall segments, and layers of the myocardium.
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Affiliation(s)
- Zimian Chen
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Suming Zhang
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Aijuan Fang
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Jun Shao
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Hong Shen
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Bugao Sun
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Guanjun Guo
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
| | - Lei Liu
- Department of Ultrasound Diagnosis, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China.,Department of Ultrasound Diagnosis, Affiliated Drum Tower Hospital of Nanjing University, Nanjing, China
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8
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The Effects of Bilirubin and Lumirubin on the Differentiation of Human Pluripotent Cell-Derived Neural Stem Cells. Antioxidants (Basel) 2021; 10:antiox10101532. [PMID: 34679668 PMCID: PMC8532948 DOI: 10.3390/antiox10101532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
The ‘gold standard’ treatment of severe neonatal jaundice is phototherapy with blue–green light, which produces more polar photo-oxidation products that are easily excreted via the bile or urine. The aim of this study was to compare the effects of bilirubin (BR) and its major photo-oxidation product lumirubin (LR) on the proliferation, differentiation, morphology, and specific gene and protein expressions of self-renewing human pluripotent stem cell-derived neural stem cells (NSC). Neither BR nor LR in biologically relevant concentrations (12.5 and 25 µmol/L) affected cell proliferation or the cell cycle phases of NSC. Although none of these pigments affected terminal differentiation to neurons and astrocytes, when compared to LR, BR exerted a dose-dependent cytotoxicity on self-renewing NSC. In contrast, LR had a substantial effect on the morphology of the NSC, inducing them to form highly polar rosette-like structures associated with the redistribution of specific cellular proteins (β-catenin/N-cadherin) responsible for membrane polarity. This observation was accompanied by lower expressions of NSC-specific proteins (such as SOX1, NR2F2, or PAX6) together with the upregulation of phospho-ERK. Collectively, the data indicated that both BR and LR affect early human neurodevelopment in vitro, which may have clinical relevance in phototherapy-treated hyperbilirubinemic neonates.
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9
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Diagnostic methods for neonatal hyperbilirubinemia: benefits, limitations, requirements, and novel developments. Pediatr Res 2021; 90:277-283. [PMID: 33948000 DOI: 10.1038/s41390-021-01546-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/20/2021] [Accepted: 04/10/2021] [Indexed: 11/09/2022]
Abstract
Invasive bilirubin measurements remain the gold standard for the diagnosis and treatment of infants with severe neonatal hyperbilirubinemia. The present paper describes different methods currently available to assess hyperbilirubinemia in newborn infants. Novel point-of-care bilirubin measurement methods, such as the BiliSpec and the Bilistick, would benefit many newborn infants, especially in low-income and middle-income countries where the access to costly multi-analyzer in vitro diagnostic instruments is limited. Total serum bilirubin test results should be accurate within permissible limits of measurement uncertainty to be fit for clinical purposes. This implies correct implementation of internationally endorsed reference measurement systems as well as participation in external quality assessment programs. Novel analytic methods may, apart from bilirubin, include the determination of bilirubin photoisomers and bilirubin oxidation products in blood and even in other biological matrices. IMPACT: Key message: Bilirubin measurements in blood remain the gold standard for diagnosis and treatment of severe neonatal hyperbilirubinemia (SNH). External quality assessment (EQA) plays an important role in revealing inaccuracies in diagnostic bilirubin measurements. What does this article add to the existing literature? We provide analytic performance data on total serum bilirubin (TSB) as measured during recent EQA surveys. We review novel diagnostic point-of-care (POC) bilirubin measurement methods and analytic methods for determining bilirubin levels in biological matrices other than blood. Impact: Manufacturers should make TSB test results traceable to the internationally endorsed total bilirubin reference measurement system and should ensure permissible limits of measurement uncertainty.
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10
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Dvořák A, Pospíšilová K, Žížalová K, Capková N, Muchová L, Vecka M, Vrzáčková N, Křížová J, Zelenka J, Vítek L. The Effects of Bilirubin and Lumirubin on Metabolic and Oxidative Stress Markers. Front Pharmacol 2021; 12:567001. [PMID: 33746746 PMCID: PMC7969661 DOI: 10.3389/fphar.2021.567001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
For severe unconjugated hyperbilirubinemia the gold standard treatment is phototherapy with blue-green light, producing more polar photo-oxidation products, believed to be non-toxic. The aim of the present study was to compare the effects of bilirubin (BR) and lumirubin (LR), the major BR photo-oxidation product, on metabolic and oxidative stress markers. The biological activities of these pigments were investigated on several human and murine cell lines, with the focus on mitochondrial respiration, substrate metabolism, reactive oxygen species production, and the overall effects on cell viability. Compared to BR, LR was found to be much less toxic, while still maintaining a similar antioxidant capacity in the serum as well as suppressing activity leading to mitochondrial superoxide production. Nevertheless, due to its lower lipophilicity, LR was less efficient in preventing lipoperoxidation. The cytotoxicity of BR was affected by the cellular glycolytic reserve, most compromised in human hepatoblastoma HepG2 cells. The observed effects were correlated with changes in the production of tricarboxylic acid cycle metabolites. Both BR and LR modulated expression of PPARα downstream effectors involved in lipid and glucose metabolism. Proinflammatory effects of BR, evidenced by increased expression of TNFα upon exposure to bacterial lipopolysaccharide, were observed in murine macrophage-like RAW 264.7 cells. Collectively, these data point to the biological effects of BR and its photo-oxidation products, which might have clinical relevance in phototherapy-treated hyperbilirubinemic neonates and adult patients.
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Affiliation(s)
- Aleš Dvořák
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Kateřina Pospíšilová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Kateřina Žížalová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Nikola Capková
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Lucie Muchová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Marek Vecka
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
- 4 Department of Internal Medicine, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Nikola Vrzáčková
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czechia
| | - Jana Křížová
- Department of Paediatrics and Inherited Metabolic Disorders, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav Zelenka
- Department of Biochemistry and Microbiology, University of Chemistry and Technology, Prague, Czechia
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
- 4 Department of Internal Medicine, Faculty General Hospital and 1 Faculty of Medicine, Charles University, Prague, Czechia
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11
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Turi KN, McKennan C, Gebretsadik T, Snyder B, Seroogy CM, Lemanske RF, Zoratti E, Havstad S, Ober C, Lynch S, McCauley K, Yu C, Jackson DJ, Gern JE, Hartert TV. Unconjugated bilirubin is associated with protection from early-life wheeze and childhood asthma. J Allergy Clin Immunol 2021; 148:128-138. [PMID: 33434532 DOI: 10.1016/j.jaci.2020.12.639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Wheeze and allergic sensitization are the strongest early-life predictors of childhood asthma development; the molecular origins of these early-life phenotypes are poorly understood. OBJECTIVES We sought to identify metabolites associated with early-life wheeze, allergic sensitization, and childhood asthma. METHODS We conducted a nested case-control study using Environmental influences on Child Health Outcomes Program cohorts for discovery and independent replication. Wheeze and allergic sensitization were defined by number of wheeze episodes and positive specific IgE at age 1 year, respectively. Asthma was defined as physician diagnosis of asthma at age 5 or 6 years. We used untargeted metabolomics, controlling for observed and latent confounding factors, to assess associations between the plasma metabolome and early-life wheeze, allergy, and childhood asthma. RESULTS Eighteen plasma metabolites were associated with first-year wheeze in the discovery cohort (n = 338). Z,Z unconjugated bilirubin (UCB) and its related metabolites exhibited a dose-response relationship with wheeze frequency; UCB levels were 13% (β = 0.87; 95% CI, 0.74-1.02) and 22% (β = 0.78; 95% CI, 0.68-0.91) lower in children with 1 to 3 and 4+ wheeze episodes compared with those who never wheezed, respectively. UCB levels were also associated with childhood asthma (β = 0.82; 95% CI, 0.68-0.98). Similar trends were observed in 2 independent cohorts. UCB was significantly negatively correlated with eicosanoid- and oxidative stress-related metabolites. There were no significant associations between metabolites and allergic sensitization. CONCLUSIONS We identified a novel inverse, dose-dependent association between UCB and recurrent wheeze and childhood asthma. Inflammatory lipid mediators and oxidative stress byproducts inversely correlated with UCB, suggesting that UCB modulates pathways critical to the development of early-life recurrent wheeze and childhood asthma.
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Affiliation(s)
- Kedir N Turi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Brittney Snyder
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | | | - Edward Zoratti
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Mich
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Susan Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, Calif
| | - Kathyrn McCauley
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, Calif
| | - Chang Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - James E Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wis.
| | - Tina V Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
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12
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Gazzin S, Dal Ben M, Montrone M, Jayanti S, Lorenzon A, Bramante A, Bottin C, Moretti R, Tiribelli C. Curcumin Prevents Cerebellar Hypoplasia and Restores the Behavior in Hyperbilirubinemic Gunn Rat by a Pleiotropic Effect on the Molecular Effectors of Brain Damage. Int J Mol Sci 2020; 22:ijms22010299. [PMID: 33396688 PMCID: PMC7795686 DOI: 10.3390/ijms22010299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 01/08/2023] Open
Abstract
Bilirubin toxicity to the central nervous system (CNS) is responsible for severe and permanent neurologic damage, resulting in hearing loss, cognitive, and movement impairment. Timely and effective management of severe neonatal hyperbilirubinemia by phototherapy or exchange transfusion is crucial for avoiding permanent neurological consequences, but these therapies are not always possible, particularly in low-income countries. To explore alternative options, we investigated a pharmaceutical approach focused on protecting the CNS from pigment toxicity, independently from serum bilirubin level. To this goal, we tested the ability of curcumin, a nutraceutical already used with relevant results in animal models as well as in clinics in other diseases, in the Gunn rat, the spontaneous model of neonatal hyperbilirubinemia. Curcumin treatment fully abolished the landmark cerebellar hypoplasia of Gunn rat, restoring the histological features, and reverting the behavioral abnormalities present in the hyperbilirubinemic rat. The protection was mediated by a multi-target action on the main bilirubin-induced pathological mechanism ongoing CNS damage (inflammation, redox imbalance, and glutamate neurotoxicity). If confirmed by independent studies, the result suggests the potential of curcumin as an alternative/complementary approach to bilirubin-induced brain damage in the clinical scenario.
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Affiliation(s)
- Silvia Gazzin
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (M.D.B.); (M.M.); (S.J.); (C.T.)
- Correspondence:
| | - Matteo Dal Ben
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (M.D.B.); (M.M.); (S.J.); (C.T.)
| | - Michele Montrone
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (M.D.B.); (M.M.); (S.J.); (C.T.)
| | - Sri Jayanti
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (M.D.B.); (M.M.); (S.J.); (C.T.)
| | - Andrea Lorenzon
- SPF Animal Facility, CBM Scarl, Bldg. Q2, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (A.L.); (A.B.)
| | - Alessandra Bramante
- SPF Animal Facility, CBM Scarl, Bldg. Q2, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (A.L.); (A.B.)
| | - Cristina Bottin
- Department of Medical Sciences, Ospedale di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Rita Moretti
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Claudio Tiribelli
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (M.D.B.); (M.M.); (S.J.); (C.T.)
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13
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Jayanti S, Vítek L, Tiribelli C, Gazzin S. The Role of Bilirubin and the Other "Yellow Players" in Neurodegenerative Diseases. Antioxidants (Basel) 2020; 9:E900. [PMID: 32971784 PMCID: PMC7555389 DOI: 10.3390/antiox9090900] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023] Open
Abstract
Bilirubin is a yellow endogenous derivate of the heme catabolism. Since the 1980s, it has been recognized as one of the most potent antioxidants in nature, able to counteract 10,000× higher intracellular concentrations of H2O2. In the recent years, not only bilirubin, but also its precursor biliverdin, and the enzymes involved in their productions (namely heme oxygenase and biliverdin reductase; altogether the "yellow players"-YPs) have been recognized playing a protective role in diseases characterized by a chronic prooxidant status. Based on that, there is an ongoing effort in inducing their activity as a therapeutic option. Nevertheless, the understanding of their specific contributions to pathological conditions of the central nervous system (CNS) and their role in these diseases are limited. In this review, we will focus on the most recent evidence linking the role of the YPs specifically to neurodegenerative and neurological conditions. Both the protective, as well as potentially worsening effects of the YP's activity will be discussed.
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Affiliation(s)
- Sri Jayanti
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (S.J.); (C.T.)
- Faculty of Medicine, Universitas Hasanuddin, Makassar 90245, Indonesia
- Molecular Biomedicine Ph.D. Program, University of Trieste, 34127 Trieste, Italy
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, and 4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, 12000 Prague, Czech Republic;
| | - Claudio Tiribelli
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (S.J.); (C.T.)
| | - Silvia Gazzin
- Fondazione Italiana Fegato-Onlus, Bldg. Q, AREA Science Park, ss14, Km 163.5, Basovizza, 34149 Trieste, Italy; (S.J.); (C.T.)
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14
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Seidel R, Ritter M, Joerk A, Kuschke S, Langguth N, Schulze D, Görls H, Bauer M, Witte OW, Westerhausen M, Holthoff K, Pohnert G. Photoisomerization Neutralizes Vasoconstrictive Activity of a Heme Degradation Product. ACS OMEGA 2020; 5:21401-21411. [PMID: 32905283 PMCID: PMC7469247 DOI: 10.1021/acsomega.0c01698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Delayed cerebral ischemia (DCI) caused by cerebral vasospasm is the leading determinant of poor outcome and mortality in subarachnoid hemorrhage (SAH) patients, but current treatment options lack effective prevention and therapy. Two substance families of heme degradation products (HDPs), bilirubin oxidation end products (BOXes) and propentdyopents (PDPs), are elicitors of pathologic cerebral hypoperfusion after SAH. Z-configured HDPs can be photoconverted into the corresponding E-isomers. We hypothesize that photoconversion is a detoxification mechanism to prevent and treat DCI. We irradiated purified Z-BOXes and Z-PDPs with UV/Vis light and documented the Z-E photoconversion. E-BOX A slowly reisomerizes to the thermodynamically favored Z-configuration in protein-containing media. In contrast to vasoconstrictive Z-BOX A, E-BOX A does not cause vasoconstriction in cerebral arterioles in vitro and in vivo in wild-type mice. Our results enable a critical assessment of light-induced intrathecal photoconversion and suggest the use of phototherapy to prevent and cure HDP-mediated cerebral vasospasms.
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Affiliation(s)
- Raphael
A. Seidel
- Institute
of Inorganic and Analytical Chemistry, Friedrich
Schiller University Jena, Lessingstraße 8, 07743 Jena, Germany
- Department
of Anesthesiology and Intensive Care Medicine/Center for Sepsis Control
and Care, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Devie
Medical, c/o Jena University Hospital, Bachstraße 18, 07743 Jena, Germany
| | - Marcel Ritter
- Institute
of Inorganic and Analytical Chemistry, Friedrich
Schiller University Jena, Lessingstraße 8, 07743 Jena, Germany
| | - Alexander Joerk
- Hans
Berger Department of Neurology, Jena University
Hospital, Am Klinikum
1, 07747 Jena, Germany
- Research
Program “Else Kröner-Forschungskolleg AntiAge”, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Stefan Kuschke
- Institute
of Inorganic and Analytical Chemistry, Friedrich
Schiller University Jena, Lessingstraße 8, 07743 Jena, Germany
| | - Niklas Langguth
- Hans
Berger Department of Neurology, Jena University
Hospital, Am Klinikum
1, 07747 Jena, Germany
| | - Daniel Schulze
- Institute
of Inorganic and Analytical Chemistry, Friedrich
Schiller University Jena, Humboldtstraße 8, 07743 Jena, Germany
| | - Helmar Görls
- Institute
of Inorganic and Analytical Chemistry, Friedrich
Schiller University Jena, Humboldtstraße 8, 07743 Jena, Germany
| | - Michael Bauer
- Department
of Anesthesiology and Intensive Care Medicine/Center for Sepsis Control
and Care, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Otto W. Witte
- Hans
Berger Department of Neurology, Jena University
Hospital, Am Klinikum
1, 07747 Jena, Germany
- Research
Program “Else Kröner-Forschungskolleg AntiAge”, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Matthias Westerhausen
- Institute
of Inorganic and Analytical Chemistry, Friedrich
Schiller University Jena, Humboldtstraße 8, 07743 Jena, Germany
| | - Knut Holthoff
- Hans
Berger Department of Neurology, Jena University
Hospital, Am Klinikum
1, 07747 Jena, Germany
| | - Georg Pohnert
- Institute
of Inorganic and Analytical Chemistry, Friedrich
Schiller University Jena, Lessingstraße 8, 07743 Jena, Germany
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15
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Hansen TWR, Wong RJ, Stevenson DK. Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn. Physiol Rev 2020; 100:1291-1346. [PMID: 32401177 DOI: 10.1152/physrev.00004.2019] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.
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Affiliation(s)
- Thor W R Hansen
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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16
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Jašprová J, Dvořák A, Vecka M, Leníček M, Lacina O, Valášková P, Zapadlo M, Plavka R, Klán P, Vítek L. A novel accurate LC-MS/MS method for quantitative determination of Z-lumirubin. Sci Rep 2020; 10:4411. [PMID: 32157102 PMCID: PMC7064611 DOI: 10.1038/s41598-020-61280-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
Although phototherapy (PT) is a standard treatment for neonatal jaundice, no validated clinical methods for determination of bilirubin phototherapy products are available. Thus, the aim of our study was to establish a such method for clinical use. To achieve this aim, a LC-MS/MS assay for simultaneous determination of Z-lumirubin (LR) and unconjugated bilirubin (UCB) was conducted. LR was purified after irradiation of UCB at 460 nm. The assay was tested on human sera from PT-treated neonates. Samples were separated on a HPLC system with a triple quadrupole mass spectrometer detector. The instrument response was linear up to 5.8 and 23.4 mg/dL for LR and UCB, respectively, with submicromolar limits of detection and validity parameters relevant for use in clinical medicine. Exposure of newborns to PT raised serum LR concentrations three-fold (p < 0.01), but the absolute concentrations were low (0.37 ± 0.16 mg/dL), despite a dramatic decrease of serum UCB concentrations (13.6 ± 2.2 vs. 10.3 ± 3.3 mg/dL, p < 0.01). A LC-MS/MS method for the simultaneous determination of LR and UCB in human serum was established and validated for clinical use. This method should help to monitor neonates on PT, as well as to improve our understanding of both the kinetics and biology of bilirubin phototherapy products.
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Affiliation(s)
- Jana Jašprová
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aleš Dvořák
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Vecka
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Leníček
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Petra Valášková
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Miloš Zapadlo
- Department of Pediatrics and Neonatology, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Plavka
- Department of Pediatrics and Neonatology, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Klán
- Department of Chemistry and Recetox, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic. .,4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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17
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Lai NM, Lee SWH, Wai SX, Teh ZW, Chan MY, Lim YS, Ovelman C, Soll R. The Choice of Population and Outcomes in Neonatal Trials on Hyperbilirubinemia: Are They Relevant? An Analysis of Cochrane Neonatal Reviews. Neonatology 2020; 117:687-693. [PMID: 33264799 DOI: 10.1159/000511656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonates with jaundice are usually managed according to their serum bilirubin despite an unclear overall correlation between bilirubin levels and patient-important outcomes (PIOs) such as kernicterus spectrum disorder (KSD). OBJECTIVES We examined data from Cochrane Neonatal reviews to assess whether conditions that constituted KSD were included as key outcomes and how commonly they occurred in the population studied. METHODS We identified Cochrane reviews, published till November 2017 that evaluated interventions for neonatal jaundice (NNJ). We extracted the following information at the review and study levels: included population, outcomes assessed (in particular, whether PIOs such as KSD were listed as the primary outcomes), as well as their cumulative incidence in the reviews. RESULTS Out of 311 reviews, 11 evaluated interventions for NNJ with 78 randomized controlled trials (RCTs) included. Among the reviews, a total number of 148 outcomes were predefined and 30 (20.3%) were PIOs related to KSD, with 11 (36.7%) listed as primary outcomes. Among the 78 included RCTs (total participants = 8,232), 38 (48.7%) enrolled predominantly high-risk and 40 (51.3%) enrolled predominantly low-risk population. A total number of 431 outcomes were reported, and 40 (9.2%) were PIOs related to KSD (of which 37 were from studies with high-risk infants), with 13 (32.5%) listed as primary outcome. Cumulatively, no infant developed KSD across all studies. CONCLUSIONS There is suboptimal representation of PIOs such as KSD in neonatal trials and Cochrane reviews on NNJ. Over half of the trials included populations with very low risk of KSD, which does not represent judicious use of resources. Amidst our continued search for a more reliable surrogate marker for NNJ, studies should evaluate the whole spectrum KSD alongside serum bilirubin in high-risk populations with sufficiently significant event rates, as this will make the trial methodologically feasible, with findings that will impact the population concerned.
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Affiliation(s)
- Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia, .,School of Pharmacy, Monash University, Bandar Sunway, Malaysia,
| | | | - Sheng Xuan Wai
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Zhi Wei Teh
- Hospital Sultanah Nora Ismail, Ministry of Health, Batu Pahat, Malaysia
| | - Min Yao Chan
- Hospital Tawau, Ministry of Health, Tawau, Malaysia
| | - Yin Sear Lim
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | | | - Roger Soll
- Cochrane Neonatal, Burlington, Vermont, USA.,Division of Pediatrics-Neonatology, The University of Vermont Medical Center, Burlington, Vermont, USA
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18
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Rodríguez CE. New method for the determination of the net bilirubin absorbance in cerebrospinal fluid that minimizes the interference of oxyhaemoglobin and biliverdin. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 80:81-86. [PMID: 31738583 DOI: 10.1080/00365513.2019.1692367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The presence of oxyhaemoglobin and biliverdin interferes with the method recommended by the UK NEQAS Specialist Advisory group for EQA of CSF Proteins and Biochemistry for estimating of the net bilirubin absorbance in CSF. This is easily demonstrated by using solutions with different concentrations of these three substances.The two secondary peaks of the oxyhaemoglobin spectrum at 540 nm and 577 nm are used as reference to minimize these interferences. Those peaks have the same absorbance as at 456 nm in the oxyhaemoglobin spectrum, independent of its concentration. This wavelength is very close to the maximum absorption of bilirubin and, therefore, is suitable for estimating the net bilirubin absorbance.A preliminary study with 48 spectrophotometric analyses of CSF from patients who were suspected of having subarachnoid haemorrhage were used to compare both net bilirubin absorbance estimation methods.The new method is practically free of oxyhaemoglobin and biliverdin interference. This allows for higher sensitivity and a more realistic estimation of the bilirubin concentration in a sample.A better estimation of the bilirubin concentration can have special relevance for diminishing the amount of equivocal or inconclusive cases and also to improve the prematurity of the diagnosis.
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Affiliation(s)
- Carlos Emilio Rodríguez
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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19
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Gligorijević N, Minić S, Robajac D, Nikolić M, Ćirković Veličković T, Nedić O. Characterisation and the effects of bilirubin binding to human fibrinogen. Int J Biol Macromol 2019; 128:74-79. [PMID: 30684573 DOI: 10.1016/j.ijbiomac.2019.01.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 01/28/2023]
Abstract
Fibrinogen, a protein involved in blood coagulation, is very susceptible to oxidation. Oxidation alters its function and usually makes it more thrombogenic. Bilirubin, an end-product of the haem degradation in vertebrates, is known for its antioxidant properties. The present paper describes interaction between fibrinogen and bilirubin, and the influence of bilirubin on the formation of fibrin and protection against oxidation. The binding constant of 4.5 × 104 M-1 was determined for the fibrinogen/bilirubin complex at 37 °C. There is no change in secondary and tertiary structure of fibrinogen or its thermal stability upon bilirubin binding. The binding site of fibrinogen is not stereospecific for bilirubin and is able to accommodate both bilirubin conformers. A change in absorption maximum of bilirubin occurs upon its interaction with fibrinogen, suggesting an alteration in the conformation of bilirubin to the more cyclic one. Bilirubin exerts antioxidant effect on fibrinogen, preventing its carbonylation and aggregation. The presence of bilirubin induces the formation of fibrin with thicker fibres, as assessed by the coagulation assay. Fibrinogen and bilirubin interact at physiological concentrations, bilirubin may act as an antioxidant for fibrinogen and may modulate an important event in haemostasis, which altogether suggests possible physiological relevance of this interaction.
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Affiliation(s)
- Nikola Gligorijević
- Institute for the Application of Nuclear Energy, Department for Metabolism, University of Belgrade, Banatska 31b, 11080 Belgrade, Serbia.
| | - Simeon Minić
- Faculty of Chemistry, Department of Biochemistry, Centre of Excellence for Molecular Food Sciences, University of Belgrade, Studentski trg 12-16, 11000 Belgrade, Serbia
| | - Dragana Robajac
- Institute for the Application of Nuclear Energy, Department for Metabolism, University of Belgrade, Banatska 31b, 11080 Belgrade, Serbia
| | - Milan Nikolić
- Faculty of Chemistry, Department of Biochemistry, Centre of Excellence for Molecular Food Sciences, University of Belgrade, Studentski trg 12-16, 11000 Belgrade, Serbia
| | - Tanja Ćirković Veličković
- Faculty of Chemistry, Department of Biochemistry, Centre of Excellence for Molecular Food Sciences, University of Belgrade, Studentski trg 12-16, 11000 Belgrade, Serbia; Ghent University Global Campus, Yeonsu-gu, Incheon, South Korea; Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium; Serbian Academy of Sciences and Arts, Knez Mihailova 35, 11000 Belgrade, Serbia
| | - Olgica Nedić
- Institute for the Application of Nuclear Energy, Department for Metabolism, University of Belgrade, Banatska 31b, 11080 Belgrade, Serbia
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20
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Watchko JF. Emergency release uncross-matched packed red blood cells for immediate double volume exchange transfusion in neonates with intermediate to advanced acute bilirubin encephalopathy: timely but insufficient? J Perinatol 2018; 38:947-953. [PMID: 29997396 DOI: 10.1038/s41372-018-0168-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/09/2022]
Abstract
Given the urgency of double volume exchange transfusion (ExT) in an infant with intermediate to advanced stages of acute bilirubin encephalopathy (ABE), it has been suggested that emergency release uncross-matched packed red blood cells (ER-PRBC) be used. The efficacy of an ExT in removing bilirubin from the brain, however, is a direct function of the mass of albumin exchanged. The very low albumin content of ER-PRBC may fail to be neuroprotective. Predicted changes in total serum bilirubin (TSB), serum albumin, the bilirubin/albumin (B/A) ratio, plasma volume (PV), and bilirubin equilibration from the extravascular space during ER-PRBC ExT are described. ExT using ER-PRBC is efficacious in lowering the TSB. However, this result is falsely reassuring as significant concurrent serum albumin loss, resultant hypoalbuminemia, contraction of PV, limited bilirubin clearance from the extravascular space, and sustained B/A ratio elevations above recommended ExT treatment thresholds suggest that bilirubin neurotoxicity will continue.
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Affiliation(s)
- Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
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21
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Neuro-inflammatory effects of photodegradative products of bilirubin. Sci Rep 2018; 8:7444. [PMID: 29748620 PMCID: PMC5945592 DOI: 10.1038/s41598-018-25684-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/26/2018] [Indexed: 02/06/2023] Open
Abstract
Phototherapy was introduced in the early 1950’s, and is the primary treatment of severe neonatal jaundice or Crigler-Najjar syndrome. Nevertheless, the potential biological effects of the products generated from the photodegradation of bilirubin during phototherapy remain unknown. This is very relevant in light of recent clinical observations demonstrating that the use of aggressive phototherapy can increase morbidity or even mortality, in extremely low birthweight (ELBW) infants. The aim of our study was to investigate the effects of bilirubin, lumirubin (LR, its major photo-oxidative product), and BOX A and B (its monopyrrolic oxidative products) on the central nervous system (CNS) using in vitro and ex vivo experimental models. The effects of bilirubin photoproducts on cell viability and expression of selected genes were tested in human fibroblasts, three human CNS cell lines (neuroblastoma SH-SY5Y, microglial HMC3, and glioblastoma U-87 cell lines), and organotypic rat hippocampal slices. Neither bilirubin nor its photo-oxidative products affected cell viability in any of our models. In contrast, LR in biologically-relevant concentrations (25 μM) significantly increased gene expression of several pro-inflammatory genes as well as production of TNF-α in organotypic rat hippocampal slices. These findings might underlie the adverse outcomes observed in ELBW infants undergoing aggressive phototherapy.
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22
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Donneborg ML, Vandborg PK, Hansen BM, Rodrigo-Domingo M, Ebbesen F. Double versus single intensive phototherapy with LEDs in treatment of neonatal hyperbilirubinemia. J Perinatol 2018; 38:154-158. [PMID: 29095431 DOI: 10.1038/jp.2017.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We investigate whether double phototherapy reduces total serum bilirubin concentration faster than single light during intensive phototherapy with high levels of irradiance using light-emitting diodes. STUDY DESIGN Eighty-three infants with gestational age ⩾33 weeks and uncomplicated hyperbilirubinemia were randomized to either double (n=41) or single phototherapy (n=42) for 24 h. The mean irradiance was 64.8 μW cm-2 nm-1 from above and 39 μW cm-2 nm-1 from below. RESULTS The percentage decreases of total serum bilirubin after 12 h of double vs single phototherapy were (mean (95% confidence interval (CI))) 39% (37 to 42) vs 30% (27 to 32), respectively (P<0.001). After 24 h, the decreases were 58% (56 to 61) vs 47% (44 to 50), respectively (P<0.001). The results were still significant after adjustment for confounding. The only side effect was loose stools. CONCLUSION Even with intensive phototherapy increasing spectral power by increasing the irradiated body surface area, the efficacy of phototherapy is improved.
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Affiliation(s)
- M L Donneborg
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - P K Vandborg
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - B M Hansen
- Department of Pediatrics, Herlev Hospital, Copenhagen, Denmark
| | - M Rodrigo-Domingo
- Department of Research, Education and Innovation, Aalborg University Hospital, Aalborg, Denmark
| | - F Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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23
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Tewari D, Mocan A, Parvanov ED, Sah AN, Nabavi SM, Huminiecki L, Ma ZF, Lee YY, Horbańczuk JO, Atanasov AG. Ethnopharmacological Approaches for Therapy of Jaundice: Part I. Front Pharmacol 2017; 8:518. [PMID: 28860989 PMCID: PMC5559545 DOI: 10.3389/fphar.2017.00518 10.3389/2ffphar.2017.00518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/24/2017] [Indexed: 09/02/2023] Open
Abstract
Jaundice is a very common symptom especially in the developing countries. It is associated with several hepatic diseases which are still major causes of death. There are many different approaches to jaundice treatment and the growing number of ethnomedicinal studies shows the plant pharmacology as very promising direction. Many medicinal plants are used for the treatment of jaundice, however a comprehensive review on this subject has not been published. The use of medicinal plants in drug discovery is highly emphasized (based on their traditional and safe uses in different folk medicine systems from ancient times). Many sophisticated analytical techniques are emerging in the pharmaceutical field to validate and discover new biologically active chemical entities derived from plants. Here, we aim to classify and categorize medicinal plants relevant for the treatment of jaundice according to their origin, geographical location, and usage. Our search included various databases like Pubmed, ScienceDirect, Google Scholar. Keywords and phrases used for these searches included: "jaundice," "hyperbilirubinemia," "serum glutamate," "bilirubin," "Ayurveda." The first part of the review focuses on the variety of medicinal plant used for the treatment of jaundice (a total of 207 medicinal plants). In the second part, possible mechanisms of action of biologically active secondary metabolites of plants from five families for jaundice treatment are discussed.
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Affiliation(s)
- Devesh Tewari
- Department of Pharmaceutical Sciences, Faculty of Technology, Kumaun UniversityNainital, India
| | - Andrei Mocan
- Department of Pharmaceutical Botany, “Iuliu Hatieganu” University of Medicine and PharmacyCluj-Napoca, Romania
- ICHAT and Institute for Life Sciences, University of Agricultural Sciences and Veterinary Medicine of Cluj-NapocaCluj-Napoca, Romania
| | - Emil D. Parvanov
- Division BIOCEV, Institute of Molecular Genetics, Academy of Sciences of the Czech RepublicPrague, Czechia
| | - Archana N. Sah
- Department of Pharmaceutical Sciences, Faculty of Technology, Kumaun UniversityNainital, India
| | - Seyed M. Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical SciencesTehran, Iran
| | - Lukasz Huminiecki
- Institute of Genetics and Animal Breeding of the Polish Academy of SciencesJastrzebiec, Poland
| | - Zheng Feei Ma
- School of Medical Sciences, Universiti Sains MalaysiaKota Bharu, Malaysia
- Department of Public Health, Xi'an Jiaotong-Liverpool UniversitySuzhou, China
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains MalaysiaKota Bharu, Malaysia
| | - Jarosław O. Horbańczuk
- Institute of Genetics and Animal Breeding of the Polish Academy of SciencesJastrzebiec, Poland
| | - Atanas G. Atanasov
- Institute of Genetics and Animal Breeding of the Polish Academy of SciencesJastrzebiec, Poland
- Department of Pharmacognosy, University of ViennaVienna, Austria
- Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of ViennaVienna, Austria
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24
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Tewari D, Mocan A, Parvanov ED, Sah AN, Nabavi SM, Huminiecki L, Ma ZF, Lee YY, Horbańczuk JO, Atanasov AG. Ethnopharmacological Approaches for Therapy of Jaundice: Part I. Front Pharmacol 2017; 8:518. [PMID: 28860989 PMCID: PMC5559545 DOI: 10.3389/fphar.2017.00518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022] Open
Abstract
Jaundice is a very common symptom especially in the developing countries. It is associated with several hepatic diseases which are still major causes of death. There are many different approaches to jaundice treatment and the growing number of ethnomedicinal studies shows the plant pharmacology as very promising direction. Many medicinal plants are used for the treatment of jaundice, however a comprehensive review on this subject has not been published. The use of medicinal plants in drug discovery is highly emphasized (based on their traditional and safe uses in different folk medicine systems from ancient times). Many sophisticated analytical techniques are emerging in the pharmaceutical field to validate and discover new biologically active chemical entities derived from plants. Here, we aim to classify and categorize medicinal plants relevant for the treatment of jaundice according to their origin, geographical location, and usage. Our search included various databases like Pubmed, ScienceDirect, Google Scholar. Keywords and phrases used for these searches included: “jaundice,” “hyperbilirubinemia,” “serum glutamate,” “bilirubin,” “Ayurveda.” The first part of the review focuses on the variety of medicinal plant used for the treatment of jaundice (a total of 207 medicinal plants). In the second part, possible mechanisms of action of biologically active secondary metabolites of plants from five families for jaundice treatment are discussed.
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Affiliation(s)
- Devesh Tewari
- Department of Pharmaceutical Sciences, Faculty of Technology, Kumaun UniversityNainital, India
| | - Andrei Mocan
- Department of Pharmaceutical Botany, "Iuliu Hatieganu" University of Medicine and PharmacyCluj-Napoca, Romania.,ICHAT and Institute for Life Sciences, University of Agricultural Sciences and Veterinary Medicine of Cluj-NapocaCluj-Napoca, Romania
| | - Emil D Parvanov
- Division BIOCEV, Institute of Molecular Genetics, Academy of Sciences of the Czech RepublicPrague, Czechia
| | - Archana N Sah
- Department of Pharmaceutical Sciences, Faculty of Technology, Kumaun UniversityNainital, India
| | - Seyed M Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical SciencesTehran, Iran
| | - Lukasz Huminiecki
- Institute of Genetics and Animal Breeding of the Polish Academy of SciencesJastrzebiec, Poland
| | - Zheng Feei Ma
- School of Medical Sciences, Universiti Sains MalaysiaKota Bharu, Malaysia.,Department of Public Health, Xi'an Jiaotong-Liverpool UniversitySuzhou, China
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains MalaysiaKota Bharu, Malaysia
| | - Jarosław O Horbańczuk
- Institute of Genetics and Animal Breeding of the Polish Academy of SciencesJastrzebiec, Poland
| | - Atanas G Atanasov
- Institute of Genetics and Animal Breeding of the Polish Academy of SciencesJastrzebiec, Poland.,Department of Pharmacognosy, University of ViennaVienna, Austria.,Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of ViennaVienna, Austria
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25
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Ebbesen F, Madsen PH, Vandborg PK, Jakobsen LH, Trydal T, Vreman HJ. Bilirubin isomer distribution in jaundiced neonates during phototherapy with LED light centered at 497 nm (turquoise) vs. 459 nm (blue). Pediatr Res 2016; 80:511-5. [PMID: 27331354 DOI: 10.1038/pr.2016.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/02/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Phototherapy using blue light is the treatment of choice worldwide for neonatal hyperbilirubinemia. However, treatment with turquoise light may be a desirable alternative. Therefore, the aim of this randomized, controlled study was to compare the bilirubin isomer distribution in serum of jaundiced neonates after 24 h of therapy with narrow-band (LED) light centered at 497 nm (turquoise) vs. 459 nm (blue), of essentially equal irradiance. MATERIALS Eighty-three neonates (≥33 wk gestational age) with uncomplicated hyperbilirubinemia were included in the study. Forty neonates were exposed to light centered at 497 nm and 43 infants with light centered at 459 nm. Irradiances were 5.2 × 10(15) and 5.1 × 10(15) photons/cm(2)/s, respectively. RESULTS After 24 h of treatment no significant differences in serum concentrations of total bilirubin isomers and Z,Z-bilirubin were observed between the 2 groups. Interestingly, concentrations of Z,E-bilirubin, and thus also total bilirubin isomers formed during therapy, were highest for infants receiving light centered at 459 nm, while the concentration of E,Z-bilirubin was highest for those receiving light centered at 497 nm. No significant difference was found between concentrations of E,Z-lumirubin. CONCLUSION Therapy with LED light centered at 497 nm vs. 459 nm, applied with equal irradiance on the infants, resulted in a different distribution of bilirubin isomers in serum.
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Affiliation(s)
- Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul H Madsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lasse H Jakobsen
- Department of Statistics, Aalborg University Hospital, Aalborg, Denmark
| | - Torleif Trydal
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Hendrik J Vreman
- Neonatal and Developmental Medicine Laboratory, Division of Neonatology, Department of Pediatrics, Stanford University Medical Center, Stanford, California
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