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Hong L, Huang Y, Jiang S, Han J, Li S, Zhang L, Zhou Q, Cao X, Yu W, Yang Y, Cao Y. Postnatal Dynamics and Clinical Associations of Fecal Calprotectin in Very Preterm Infants: Implications for Necrotizing Enterocolitis and Feeding Intolerance. Clin Transl Gastroenterol 2023; 14:e00604. [PMID: 37272666 PMCID: PMC10461937 DOI: 10.14309/ctg.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/17/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION To elucidate the postnatal dynamics and clinical associations of fecal calprotectin (FC) in very preterm infants, with a focus on necrotizing enterocolitis (NEC) and feeding intolerance (FI). METHODS We performed a prospective observational cohort study in infants with a gestational age of <32 weeks or birth weight <1,500 g with weekly feces collection. The relationships between FC, NEC, and FI were investigated, adjusting for demographic and clinical factors. RESULTS A total of 1,086 fecal samples were collected from 194 preterm infants. Postnatal FC levels of non-NEC infants were highly variable and followed an age-dependent patterned progression. FC levels were elevated in patients with NEC before and at NEC onset, distinguishing them from non-NEC infants and those at sepsis onset. Among infants without NEC or sepsis, those with FI exhibited lower FC concentrations throughout hospitalization and displayed a significant delay in reaching high FC levels after meconium compared with non-FI infants. The age to reach the first high nonmeconial FC levels was positively associated with the time to achieve full enteral feeding. DISCUSSION Postnatal FC dynamics among premature infants followed a patterned progression but were disturbed in patients with NEC and FI. Because of the high variations, the use of FC levels in NEC diagnosis should be implemented with caution in clinical practice. FC may help understand FI and feeding progression in very preterm infants. Further research is needed to validate these findings and explore the potential clinical applications of FC in this population.
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Affiliation(s)
- Luyang Hong
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Yihuang Huang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.
| | - Junyan Han
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Shujuan Li
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Qi Zhou
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Xincheng Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Weiyin Yu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
| | - Yi Yang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China;
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, China.
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Boeckel H, Karsten CM, Göpel W, Herting E, Rupp J, Härtel C, Hartz A. Increased Expression of Anaphylatoxin C5a-Receptor-1 in Neutrophils and Natural Killer Cells of Preterm Infants. Int J Mol Sci 2023; 24:10321. [PMID: 37373467 DOI: 10.3390/ijms241210321] [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: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Preterm infants are susceptible to infection and their defense against pathogens relies largely on innate immunity. The role of the complement system for the immunological vulnerability of preterm infants is less understood. Anaphylatoxin C5a and its receptors C5aR1 and -2 are known to be involved in sepsis pathogenesis, with C5aR1 mainly exerting pro-inflammatory effects. Our explorative study aimed to determine age-dependent changes in the expression of C5aR1 and C5aR2 in neonatal immune cell subsets. Via flow cytometry, we analyzed the expression pattern of C5a receptors on immune cells isolated from peripheral blood of preterm infants (n = 32) compared to those of their mothers (n = 25). Term infants and healthy adults served as controls. Preterm infants had a higher intracellular expression of C5aR1 on neutrophils than control individuals. We also found a higher expression of C5aR1 on NK cells, particularly on the cytotoxic CD56dim subset and the CD56- subset. Immune phenotyping of other leukocyte subpopulations revealed no gestational-age-related differences for the expression of and C5aR2. Elevated expression of C5aR1 on neutrophils and NK cells in preterm infants may contribute to the phenomenon of "immunoparalysis" caused by complement activation or to sustained hyper-inflammatory states. Further functional analyses are needed to elucidate the underlying mechanisms.
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Affiliation(s)
- Hannah Boeckel
- Department of Pediatrics, University of Lübeck, 23538 Lübeck, Germany
- International Research Training Group 1911, University of Lübeck, 23538 Lübeck, Germany
| | - Christian M Karsten
- International Research Training Group 1911, University of Lübeck, 23538 Lübeck, Germany
- Institute for Systemic Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, 23538 Lübeck, Germany
| | - Egbert Herting
- Department of Pediatrics, University of Lübeck, 23538 Lübeck, Germany
- International Research Training Group 1911, University of Lübeck, 23538 Lübeck, Germany
- German Center of Infection Research, Hamburg-Lübeck-Borstel-Riems, 23538 Lübeck, Germany
| | - Jan Rupp
- International Research Training Group 1911, University of Lübeck, 23538 Lübeck, Germany
- German Center of Infection Research, Hamburg-Lübeck-Borstel-Riems, 23538 Lübeck, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck, 23538 Lübeck, Germany
| | - Christoph Härtel
- International Research Training Group 1911, University of Lübeck, 23538 Lübeck, Germany
- German Center of Infection Research, Hamburg-Lübeck-Borstel-Riems, 23538 Lübeck, Germany
- Interdisciplinary Center of Clinical Research, University of Würzburg, 97080 Würzburg, Germany
- Department of Pediatrics, University of Würzburg, 97080 Würzburg, Germany
| | - Annika Hartz
- Department of Pediatrics, University of Lübeck, 23538 Lübeck, Germany
- International Research Training Group 1911, University of Lübeck, 23538 Lübeck, Germany
- Institute for Systemic Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
- German Center of Infection Research, Hamburg-Lübeck-Borstel-Riems, 23538 Lübeck, Germany
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Imbalanced Inflammatory Responses in Preterm and Term Cord Blood Monocytes and Expansion of the CD14 +CD16 + Subset upon Toll-like Receptor Stimulation. Int J Mol Sci 2023; 24:ijms24054919. [PMID: 36902350 PMCID: PMC10002861 DOI: 10.3390/ijms24054919] [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: 01/16/2023] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Developmentally regulated features of innate immunity are thought to place preterm and term infants at risk of infection and inflammation-related morbidity. Underlying mechanisms are incompletely understood. Differences in monocyte function including toll-like receptor (TLR) expression and signaling have been discussed. Some studies point to generally impaired TLR signaling, others to differences in individual pathways. In the present study, we assessed mRNA and protein expression of pro- and anti-inflammatory cytokines in preterm and term cord blood (CB) monocytes compared with adult controls stimulated ex vivo with Pam3CSK4, zymosan, polyinosinic:polycytidylic acid, lipopolysaccharide, flagellin, and CpG oligonucleotide, which activate the TLR1/2, TLR2/6, TLR3, TLR4, TLR5, and TLR9 pathways, respectively. In parallel, frequencies of monocyte subsets, stimulus-driven TLR expression, and phosphorylation of TLR-associated signaling molecules were analyzed. Independent of stimulus, pro-inflammatory responses of term CB monocytes equaled adult controls. The same held true for preterm CB monocytes-except for lower IL-1β levels. In contrast, CB monocytes released lower amounts of anti-inflammatory IL-10 and IL-1ra, resulting in higher ratios of pro-inflammatory to anti-inflammatory cytokines. Phosphorylation of p65, p38, and ERK1/2 correlated with adult controls. However, stimulated CB samples stood out with higher frequencies of intermediate monocytes (CD14+CD16+). Both pro-inflammatory net effect and expansion of the intermediate subset were most pronounced upon stimulation with Pam3CSK4 (TLR1/2), zymosan (TR2/6), and lipopolysaccharide (TLR4). Our data demonstrate robust pro-inflammatory and yet attenuated anti-inflammatory responses in preterm and term CB monocytes, along with imbalanced cytokine ratios. Intermediate monocytes, a subset ascribed pro-inflammatory features, might participate in this inflammatory state.
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Gandecha H, Kaur A, Sanghera R, Preece J, Pillay T. Nutrition and Immunity in Perinatal Hypoxic-Ischemic Injury. Nutrients 2022; 14:nu14132747. [PMID: 35807927 PMCID: PMC9269416 DOI: 10.3390/nu14132747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Perinatal hypoxia ischaemia (PHI), acute and chronic, may be associated with considerable adverse outcomes in the foetus and neonate. The molecular and cellular mechanisms of injury and repair associated with PHI in the perinate are not completely understood. Increasing evidence is mounting for the role of nutrients and bioactive food components in immune development, function and repair in PHI. In this review, we explore current concepts around the neonatal immune response to PHI with a specific emphasis on the impact of nutrition in the mother, foetus and neonate.
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Affiliation(s)
- Hema Gandecha
- Department of Neonatology, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK
- East Midlands Deanery, Health Education England, Leicester LE3 5DR, UK
| | - Avineet Kaur
- Department of Neonatology, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK
- East Midlands Deanery, Health Education England, Leicester LE3 5DR, UK
| | - Ranveer Sanghera
- Department of Neonatology, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK
- East Midlands Deanery, Health Education England, Leicester LE3 5DR, UK
| | - Joanna Preece
- Department of Neonatology, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Thillagavathie Pillay
- Department of Neonatology, University Hospitals Leicester NHS Trust, Leicester LE1 5WW, UK
- Faculty of Science and Engineering, Research Institute for Healthcare Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, UK
- College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK
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Malavika M, Sanju S, Poorna MR, Vishnu Priya V, Sidharthan N, Varma P, Mony U. Role of myeloid derived suppressor cells in sepsis. Int Immunopharmacol 2022; 104:108452. [PMID: 34996010 DOI: 10.1016/j.intimp.2021.108452] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/05/2022]
Abstract
Sepsis is a serious and menacing organ dysfunction that occur due to dysregulated response of the host towards the infection. This organ dysfunction may lead to sepsis with intense cellular, metabolic and circulatory dysregulation, multiple organ failure and high mortality. Lymphopenia is observed in two-third of sepsis patients and a significant depletion of lymphocytes occurs in non-survivors compared to sepsis survivors. Myeloid derived suppressor cells (MDSCs) gave new insights into sepsis-associated lymphopenia. If MDSC expansion and its tissue-infiltration persist, it can induce significant pathophysiology including lymphopenia, host immunosuppression and immune-paralysis that contributes to worsened patient outcomes. This review focuses on MDSCs and its subsets, the role of MDSCs in infection, sepsis and septic shock.
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Affiliation(s)
- M Malavika
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - S Sanju
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - M R Poorna
- Centre for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - Veeraraghavan Vishnu Priya
- Department of Biochemistry, Saveetha Dental College, Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
| | - Neeraj Sidharthan
- Department of Clinical Hematology and Stem Cell Transplant, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi 682041, India
| | - Praveen Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi 682041, India
| | - Ullas Mony
- Centre of Molecular Medicine and Diagnostics (COMManD), Department of Biochemistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India.
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Lin Y, Wang K, Ji D, Gong Z, Wang Z. Correlation Between Plasma High Mobility Group Protein N1 Level and the Prognosis of Patients with Acute Cerebral Infarction: Preliminary Findings. Neuropsychiatr Dis Treat 2022; 18:907-913. [PMID: 35469241 PMCID: PMC9034887 DOI: 10.2147/ndt.s359879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/01/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To investigate the correlation between plasma levels of high mobility group protein N1 (HMGN1) and the severity of neurological deficits and prognosis in patients with acute cerebral infarction (ACI). PATIENTS AND METHODS The plasma HMGN1 levels of 108 patients with ACI were detected by ELISA. The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) were used to assess the neurological impairment and outcomes of these patients, respectively. The correlation between HMGN1 levels and clinical parameters was analyzed. RESULTS The plasma HMGN1 levels of patients with ACI were positively correlated with their NIHSS and mRS scores. Patients with the large artery atherosclerosis (LAA) subtype in the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification had higher plasma HMGN1 levels than patients with other subtypes. CONCLUSION HMGN1 levels are positively correlated with the severity of ACI and could be used to predict the prognosis of these patients. HMGN1 can be used as a biological marker and potential target for clinical assessment and therapy of ACI.
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Affiliation(s)
- Yufeng Lin
- Department of Neurology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Kaiyuan Wang
- Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Daowen Ji
- Department of Neurology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Zhongying Gong
- Department of Neurology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Zhiyun Wang
- Department of Neurology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, People's Republic of China
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Hong L, Zhang L, Zhou Q, Li S, Han J, Jiang S, Han X, Yang Y, Hong S, Cao Y. Impacts of Enriched Human Milk Cells on Fecal Metabolome and Gut Microbiome of Premature Infants with Stage I Necrotizing Enterocolitis: A Pilot Study. Mol Nutr Food Res 2021; 66:e2100342. [PMID: 34788490 DOI: 10.1002/mnfr.202100342] [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: 04/11/2021] [Revised: 10/08/2021] [Indexed: 11/07/2022]
Abstract
SCOPE Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants, occurring more often in formula-fed infants than in breastfed infants. Recent animal studies have shown that cells in fresh breast milk survive in the newborns' digestive tract. However, no clinical studies have been conducted on the effects of human milk cells, and their biological roles in the infants' intestines remain unexplored. METHODS AND RESULTS Twenty premature infants are enrolled. Cells from fresh milk of their own mothers are enriched and fed to infants with Bell's Stage I NEC once a day for 7 days since the onset of NEC. Fecal samples are collected at enrollment and 2 weeks later. Fecal sphingolipids are observed to be enriched in NEC patients and positively correlated with calprotectin levels. After intervention with enriched human milk cells, inflammation-associated sphingolipids and microbiome profiles are altered and resembled those of the controls. CONCLUSION These preliminary findings reveal the potential impacts of enriched human milk cells on premature infants with Bell's Stage I NEC and provide insight into the roles of fecal sphingolipid metabolism in the neonates' intestinal inflammation. However, the limited sample size of the study indicates the need for further investigation.
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Affiliation(s)
- Luyang Hong
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China
| | - Qi Zhou
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China
| | - Shujuan Li
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China
| | - Junyan Han
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China
| | - Xiao Han
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, 200032, China
| | - Yi Yang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, 200032, China
| | - Shangyu Hong
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 200032, China.,NHC Key Laboratory of Neonatal Diseases, Fudan University, Shanghai, 200032, China
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Comments on the ambiguity of selected surface markers, signaling pathways and omics profiles hampering the identification of myeloid-derived suppressor cells. Cell Immunol 2021; 364:104347. [PMID: 33838447 DOI: 10.1016/j.cellimm.2021.104347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
Myeloid-derived suppressor cells (MDSC) are important immune-regulatory cells but their identification remains difficult. Here, we provide a critical view on selected surface markers, transcriptional and translational pathways commonly used to identify MDSC by specific, their developmental origin and new possibilities by transcriptional or proteomic profiling. Discrimination of MDSC from their non-suppressive counterparts is a prerequisite for the development of successful therapies. Understanding the switch mechanisms that direct granulocytic and monocytic development into a pro-inflammatory or anti-inflammatory direction will be crucial for therapeutic strategies. Manipulation of these myeloid checkpoints are exploited by tumors and pathogens, such as M. tuberculosis (Mtb), HIV or SARS-CoV-2, that induce MDSC for immune evasion. Thus, specific markers for MDSC identification may reveal also novel molecular candidates for therapeutic intervention at the level of MDSC.
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