A discussion of immune tolerance and the layered immune system hypothesis

Transfusing maternal blood to her newborn baby-irrespective of ABO mismatch

Background: Though blood transfusions are the common procedures in pediatric patients, transfusion reactions are rare in children. Though in adults, uncross-matched ABO group-specific blood is used in emergencies, there are no such reports in neonates and children. There are stray case reports about transfusing maternal blood for her baby and maternal blood is de facto compatible regardless of an ABO mismatchObjective: Confirming our previous hypothesis that maternal blood is compatible with her baby's blood; and maternal blood can be used for transfusion in her newborn baby irrespective of ABO match/ mismatch.Design: Prospective interventional study.Setting and Participants: Fifty-one mother-baby pairs were recruited attending Pediatric Unit of our Community Hospital from 15 July 2013 to 13 July 2015. After obtaining consent from the parents, all the required lab tests were done. Since all lab reports were favourable; these babies qualified for transfusion of maternal blood.Interventions: Fifty-one sick newborns were transfused fresh whole maternal blood as a part of treatment; irrespective of mother-baby ABO match or mismatch.Results: All babies tolerated maternal blood well and showed significant and rapid improvement. Minimum period of observation was from a minimum of 32 to a maximum of 56 months. All the babies showed good growth and development.Conclusion: By observing a particular protocol and procedural techniques, mother's blood may be used for transfusion in her own baby in neonatal period, irrespective of ABO mismatch.Significance: This is probably the largest series in world literature of 51 newborns being transfused maternal blood either ABO match or mismatch.

Fetoscopic versus Ultrasound-Guided Intravascular Delivery of Maternal Bone Marrow Cells in Fetal Macaques: A Technical Model for Intrauterine Haemopoietic Cell Transplantation

INTRODUCTION

Significant limitations with existing treatments for major haemoglobinopathies motivate the development of effective intrauterine therapy. We assessed the feasibility of fetoscopic and ultrasound-guided intrauterine haemopoietic cell transplantation (IUHCT) in macaque fetuses in early gestation when haemopoietic and immunological ontogeny is anticipated to enable long-term donor cell engraftment.

MATERIAL AND METHODS

Fluorescent-labelled bone marrow-derived mononuclear cells from 10 pregnant Macaca fascicularis were injected into their fetuses at E71-114 (18.9-170.0E+6 cells/fetus) by fetoscopic intravenous (n = 7) or ultrasound (US)-guided intracardiac injections, with sacrifice at 24 h to examine donor-cell distribution.

RESULTS

Operating times ranged from 35 to 118 min. Chorionic membrane tenting and intrachorionic haemorrhage were observed only with fetoscopy (n = 2). Labelled cells were stereoscopically visualised in lung, spleen, liver, and placenta. Donor-cell chimerism was highest in liver, spleen, and heart by flow cytometry, placenta by unique polymorphism qPCR, and was undetected in blood. Chimerism was 2-3 log-fold lower in individual organs by qPCR than by flow cytometry.

DISCUSSION

Both fetoscopic and US-guided IUHCT were technically feasible, but fetoscopy caused more intraoperative complications in our pilot series. The discrepancy in chimerism detection predicts the challenges in long-term surveillance of donor-cell chimerism. Further studies of long-term outcomes in the non-human primate are valuable for the development of clinical protocols for IUHCT.

Effect of embryonic thermal manipulation on heat shock protein 70 expression and immune system development in Pekin duck embryos

Two experiments were conducted to study the effects of thermal manipulation on heat shock protein 70 (HSP70) transcription and immune cell characteristics' in Pekin duck embryos. In experiments I and II, fertile duck eggs were incubated at either a standard (S; 37°C) or high (H; 38.0°C) temperature from embryonic day (ED) 1 to 10. At ED11, half the eggs incubated at 37.5°C or 38.0°C were either kept at 37.5°C (SS) or 38.0°C (HH) respectively, or moved to the opposite incubator/temperature of either 38.0°C (SH) or 37.5°C (HS). Beginning on ED 21, all eggs (embryos) were incubated at 37.5°C. In experiments I and II, the mean egg shell temperature (EST) of eggs incubated at 38.0°C was higher than that from 37.5°C at ED10 (P < 0.01). In both experiments, the yolk free wet embryo body weight (YFWEBW) of embryos from the HS treatment was increased while that in the HH treatments was decreased compared with the SS treatment at ED25 (P < 0.01). In experiment II, embryos from the HH treatment had increased HSP70 mRNA compared with the SS treatment in the liver, thymus, and bursa (P < 0.05). The thymus and bursa from embryos in the SH treatment had increased MHCI mRNA when compared with the SS treatment (P < 0.05). The thymus from HH and SH treatments had increased MHCII mRNA while the bursa from the HH and SH treatments had decreased MHCII mRNA when compared with the SS treatment (P < 0.05). The spleen and bursa from the HH treatment had increased IL-6, IFNγ, and IL-10 mRNA when compared with the SS treatment (P < 0.05). The thymus and spleen from embryos in the HH treatment had increased CD8+/CD4+ ratios and CD4+CD25+ cell percentages compared with the SS treatment (P < 0.05). In conclusion, embryos incubated at 0.5°C higher than the standard incubation temperature from ED1 to 21 had increased HSP70 mRNA, MHCI, and inflammatory cytokines, and the immune response was skewed toward cell-mediated immunity.

Increased Susceptibility to Plasmodium falciparum in Infants is associated with Low, not High, Placental Malaria Parasitemia

Risk of malaria in infants can be influenced by prenatal factors. In this study, the potential for placental parasitemia at delivery in predicting susceptibility of infants to Plasmodium falciparum (Pf) infections was evaluated. Seventy-two newborns of mothers who were placental malaria negative (PM-) and of mothers who were PM+ with below (PM+ Lo) and above (PM + Hi) median placental parasitemia, were actively monitored during their first year of life. Median time to first PCR-detected Pf infection was shorter in PM + Lo infants (2.8 months) than in both PM- infants (4.0 months, p = 0.002) and PM + Hi infants (4.1 months, p = 0.01). Total number of new infections was also highest in the PM + Lo group. Only 24% of infants experienced clinical malaria episodes but these episodes occurred earlier in PM + Lo infants than in PM + Hi infants (p = 0.05). The adjusted hazard ratio (95% CI) of having Pf infection was 3.9 (1.8-8.4) and 1.5 (0.7-3.4) for infants in the PM + Lo and PM + Hi groups, respectively. Collectively, low placental parasitemia was associated with increased susceptibility to malaria during infancy. Therefore, malaria in pregnancy preventive regimens, such as sulfadoxine-pyremethamine, that reduce but do not eliminate placental Pf in areas of drug resistance may increase the risk of malaria in infants.