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Doughty C, O'Driscoll DN, Smith S, O'Currain E, Grant T, O'Hare FM, Culliton M, Watson RWG, O'Neill A, Molloy EJ. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in neonatal sepsis. J Matern Fetal Neonatal Med 2020; 35:2485-2492. [PMID: 32674630 DOI: 10.1080/14767058.2020.1786520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Efficient and accurate diagnosis of neonatal sepsis is challenging. The potential impact for a reduction in morbidity and mortality as well as antibiotic usage has stimulated the ongoing search for biomarkers of early sepsis. The objective of this pilot study was to quantify the levels of sTREM-1 and correlate with blood cultures and inflammatory markers in neonates evaluated for sepsis. METHODS Neonates with suspected sepsis were enrolled (n = 83; Preterm n = 35; Term n = 48). Routine bloods for sepsis evaluation were included and plasma sTREM-1 levels were quantified by ELISA. RESULTS Term and preterm neonates (n = 83; Preterm n = 35; Term n = 48) were enrolled and 16 neonates had positive blood cultures (preterm n = 15; term n = 1). sTREM-1 levels were not significantly different in infants with culture-positive or culture-negative sepsis (356 ± 218 pg/mL and 385 ± 254 pg/mL respectively). The immature-to-total granulocyte (I/T) ratio showed a significant positive correlation with sTREM-1 in the preterm group with positive blood cultures. Additionally, sTREM-1 showed a positive correlation with CRP in the preterm group with negative blood cultures. CONCLUSIONS sTREM-1 was associated with traditional markers of inflammation (I/T ratio and CRP). However, in this cohort sTREM-1 did not improve the early detection of neonatal culture-positive sepsis.
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Affiliation(s)
- Catherine Doughty
- Department of Biochemistry, National Maternity Hospital, Dublin, Ireland
| | - David N O'Driscoll
- Department of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute; Trinity Research in Childhood Centre, Trinity College, Dublin, Ireland
| | - Sile Smith
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Eoin O'Currain
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Tim Grant
- Centre for Support and Training in Analysis and Research, University College Dublin, Dublin, Ireland
| | - Fiona M O'Hare
- Department of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute; Trinity Research in Childhood Centre, Trinity College, Dublin, Ireland.,Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - Marie Culliton
- Department of Biochemistry, National Maternity Hospital, Dublin, Ireland
| | - R William G Watson
- School of Medicine and Medical Sciences, Conway Institute of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Amanda O'Neill
- School of Medicine and Medical Sciences, Conway Institute of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Department of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.,Trinity Translational Medicine Institute; Trinity Research in Childhood Centre, Trinity College, Dublin, Ireland.,Department of Neonatology, National Maternity Hospital, Dublin, Ireland.,Department of Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland.,Department of Neonatology, Children's Health Ireland at Crumlin and Tallaght, Dublin, Ireland
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2
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Brennan K, O'Leary BD, Mc Laughlin D, Breen EP, Connolly E, Ali N, O'Driscoll DN, Ozaki E, Mahony R, Mulfaul K, Ryan AM, Ni Chianain A, McHugh A, Molloy EJ, Hogan AE, Paran S, McAuliffe FM, Doyle SL. Type 1 IFN Induction by Cytosolic Nucleic Acid Is Intact in Neonatal Mononuclear Cells, Contrasting Starkly with Neonatal Hyporesponsiveness to TLR Ligation Due to Independence from Endosome-Mediated IRF3 Activation. J Immunol 2018; 201:1131-1143. [PMID: 29980613 DOI: 10.4049/jimmunol.1700956] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 06/10/2018] [Indexed: 12/25/2022]
Abstract
Two million infants die each year from infectious diseases before they reach 12 mo; many of these diseases are vaccine preventable in older populations. Pattern recognition receptors represent the critical front-line defense against pathogens. Evidence suggests that the innate immune system does not fully develop until puberty, contributing to impaired response to infection and impaired vaccine responses in neonates, infants, and children. The activity of the pattern recognition receptor family of cytosolic nucleic acid (CNA) sensors in this pediatric population has not been reported. We show that in direct contrast to weak TLR-induced type I IFN in human cord blood mononuclear cells, cord blood mononuclear cells are capable of initiating a potent response to CNA, inducing both antiviral type I IFN and, unexpectedly, proinflammatory TNF-α. A deficiency in Rab11-GTPase endosome formation and consequent lack of IRF3 activation in neonatal monocytes is at least in part responsible for the marked disparity in TLR-induced IFN production between neonatal and adult monocytes. CNA receptors do not rely on endosome formation, and therefore, these responses remain intact in neonates. Heightened neonatal responses to CNA challenge are maintained in children up to 2 y of age and, in marked contrast to TLR4/9 agonists, result in IL-12p70 and IFN-γ generation. CNA sensors induce robust antiviral and proinflammatory pathways in neonates and children and possess great potential for use as immunostimulants or vaccine adjuvants for targeted neonatal and pediatric populations to promote cell-mediated immunity against invasive infectious disease.
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Affiliation(s)
- Kiva Brennan
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | | | - Danielle Mc Laughlin
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Eamon P Breen
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Emma Connolly
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Nusrat Ali
- National Maternity Hospital, Dublin 2, Ireland
| | | | - Ema Ozaki
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Rebecca Mahony
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Kelly Mulfaul
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Aoife M Ryan
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
| | | | | | - Eleanor J Molloy
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,School of Medicine, Trinity College Dublin, Dublin 2, Ireland.,Women and Infants University Hospital, Dublin 8, Ireland
| | - Andrew E Hogan
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Education and Research Centre and Conway Institute, St. Vincent's University Hospital, University College Dublin, Dublin 4, Ireland; and
| | - Sri Paran
- Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Fionnuala M McAuliffe
- National Maternity Hospital, Dublin 2, Ireland.,Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Sarah L Doyle
- National Children's Research Centre, Crumlin, Dublin 12, Ireland; .,School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Abstract
INTRODUCTION In neonatology, males exhibit a more severe disease course and poorer prognosis in many pathological states when compared to females. Perinatal brain injury, respiratory morbidity, and sepsis, among other complications, preferentially affect males. Preterm neonates (born <37 weeks gestation) display a particularly marked sexual disparity in pathology, especially at the borders of viability. The sex biases in preterm neonatal outcomes and underlying multifactorial mechanisms have been incompletely explored. Sex-specific clinical phenomena may be partially explained by intrinsic differences in immune function. The distinct immune system of preterm neonates renders this patient population vulnerable, and it is increasingly important to consider biological sex in disease processes and to strive for improved outcomes for both sexes. Areas covered: We discuss the cellular responses and molecular intermediates in immune function which are strongly dependent on sex-specific factors such as the genetic and hormonal milieu of premature birth and consider novel findings in a clinical context. Expert commentary: The role of immune function in the manifestation of sex-specific disease manifestations and outcomes in preterm neonates is a critical prognostic variable. Further mechanistic elucidation will yield valuable translational and clinical information of disease processes in preterm neonates which may be harnessed for modulation.
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Affiliation(s)
- David N O'Driscoll
- a Neonatology , National Maternity Hospital , Dublin , Ireland.,b Pediatrics, Trinity College, Trinity Centre for Health Sciences , The University of Dublin, National Children's Hospital, AMNCH , Dublin , Ireland
| | - Catherine M Greene
- c Clinical Microbiology , Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital , Dublin , Ireland
| | - Eleanor J Molloy
- a Neonatology , National Maternity Hospital , Dublin , Ireland.,b Pediatrics, Trinity College, Trinity Centre for Health Sciences , The University of Dublin, National Children's Hospital, AMNCH , Dublin , Ireland.,d Neonatology , Coombe Women and Infants' University Hospital , Dublin , Ireland.,e Neonatology , Our Lady's Children's Hospital Crumlin , Dublin , Ireland
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O'Driscoll DN, McGovern M, Greene CM, Molloy EJ. Gender disparities in preterm neonatal outcomes. Acta Paediatr 2018; 107:1494-1499. [PMID: 29750838 DOI: 10.1111/apa.14390] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 01/04/2023]
Abstract
AIM From birth to old age, males generally have poorer disease outcomes compared to females. Preterm infants display a marked gender disparity in disease outcomes, and the underlying mechanisms are not well delineated. Our aim was to review the literature on clinical outcomes between preterm infants of different genders and discuss the potential mechanisms underlying the differences observed. METHODS A literature review was undertaken for experimental and clinical research related to gender differences in preterm outcomes. RESULTS Preterm male infants appear to have consistently worse outcomes compared to females, and the aetiology of these differences, while mostly undetermined, is likely multifactorial. CONCLUSION The male disadvantage in preterm outcomes is likely multifactorial with hormonal, genetic and immunological differences likely playing key roles. Gender is an important variable in preterm outcome and should be considered when designing clinical and experimental research.
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Affiliation(s)
- David N O'Driscoll
- Paediatrics, Academic Centre, Tallaght Hospital, Trinity College and Trinity Translational Medicine Institute, St James' Hospital, the University of Dublin, Dublin, Ireland
| | - Matthew McGovern
- Paediatrics, Academic Centre, Tallaght Hospital, Trinity College and Trinity Translational Medicine Institute, St James' Hospital, the University of Dublin, Dublin, Ireland
| | - Catherine M Greene
- Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Eleanor J Molloy
- Paediatrics, Academic Centre, Tallaght Hospital, Trinity College and Trinity Translational Medicine Institute, St James' Hospital, the University of Dublin, Dublin, Ireland
- Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland
- Neonatology, Our Lady's Children's Hospital, Dublin, Ireland
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Borriello F, Pietrasanta C, Lai JCY, Walsh LM, Sharma P, O'Driscoll DN, Ramirez J, Brightman S, Pugni L, Mosca F, Burkhart DJ, Dowling DJ, Levy O. Identification and Characterization of Stimulator of Interferon Genes As a Robust Adjuvant Target for Early Life Immunization. Front Immunol 2017; 8:1772. [PMID: 29312305 PMCID: PMC5732947 DOI: 10.3389/fimmu.2017.01772] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022] Open
Abstract
Immunization is key to preventing infectious diseases, a leading cause of death early in life. However, due to age-specific immunity, vaccines often demonstrate reduced efficacy in newborns and young infants as compared to adults. Here, we combined in vitro and in vivo approaches to identify adjuvant candidates for early life immunization. We employed newborn and adult bone marrow-derived dendritic cells (BMDCs) to perform a screening of pattern recognition receptor agonists and found that the stimulator of interferon genes ligand 2′3′-cGAMP (hereafter cGAMP) induces a comparable expression of surface maturation markers in newborn and adult BMDCs. Then, we utilized the trivalent recombinant hemagglutinin (rHA) influenza vaccine, Flublok, as a model antigen to investigate the role of cGAMP in adult and early life immunization. cGAMP adjuvantation alone could increase rHA-specific antibody titers in adult but not newborn mice. Remarkably, as compared to alum or cGAMP alone, immunization with cGAMP formulated with alum (Alhydrogel) enhanced newborn rHA-specific IgG2a/c titers ~400-fold, an antibody subclass associated with the development of IFNγ-driven type 1 immunity in vivo and endowed with higher effector functions, by 42 days of life. Highlighting the amenability for successful vaccine formulation and delivery, we next confirmed that cGAMP adsorbs onto alum in vitro. Accordingly, immunization early in life with (cGAMP+alum) promoted IFNγ production by CD4+ T cells and increased the proportions and absolute numbers of CD4+ CXCR5+ PD-1+ T follicular helper and germinal center (GC) GL-7+ CD138+ B cells, suggesting an enhancement of the GC reaction. Adjuvantation effects were apparently specific for IgG2a/c isotype switching without effect on antibody affinity maturation, as there was no effect on rHA-specific IgG avidity. Overall, our studies suggest that cGAMP when formulated with alum may represent an effective adjuvantation system to foster humoral and cellular aspects of type 1 immunity for early life immunization.
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Affiliation(s)
- Francesco Borriello
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Napoli, Italy.,WAO Center of Excellence, Naples, Italy
| | - Carlo Pietrasanta
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Jacqueline C Y Lai
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States.,Department of Physiology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Lois M Walsh
- Biomedical & Pharmaceutical Science Skaggs School of Pharmacy, University of Montana, Missoula, MT, United States
| | - Pankaj Sharma
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States
| | - David N O'Driscoll
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States
| | - Juan Ramirez
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States
| | - Spencer Brightman
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States
| | - Lorenza Pugni
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - David J Burkhart
- Biomedical & Pharmaceutical Science Skaggs School of Pharmacy, University of Montana, Missoula, MT, United States
| | - David J Dowling
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Ofer Levy
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Precision Vaccines Program, Divisions of Infectious Diseases, Boston Children's Hospital, Boston, MA, United States
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6
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O'Driscoll DN, De Santi C, McKiernan PJ, McEneaney V, Molloy EJ, Greene CM. Expression of X-linked Toll-like receptor 4 signaling genes in female vs. male neonates. Pediatr Res 2017; 81:831-837. [PMID: 28060792 DOI: 10.1038/pr.2017.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/03/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Male neonates display poorer disease prognosis and outcomes compared with females. Immune genes which exhibit higher expression in umbilical cord blood (UCB) of females may contribute to the female immune advantage during infection and inflammation. The aim of this study was to quantify expression of Toll-like receptor (TLR) 4 signaling genes encoded on the X-chromosome in UCB from term female vs. male neonates. METHODS UCB samples were collected from term neonates (n = 26) born by elective Caesarean section and whole blood was collected from adults (n = 20). Leukocyte RNA was isolated and used in quantitative PCR reactions for IκB kinase γ (IKKγ), Bruton's tyrosine kinase (BTK), and IL-1 receptor associated kinase (IRAK)1. IRAK1 protein was analyzed by Western blot and confocal microscopy. RESULTS In neonates there was no significant difference in the relative expression of IKKγ or BTK mRNA between genders. IRAK1 gene and protein expression was significantly higher in female vs. male UCB, with increased cytosolic IRAK1 expression also evident in female UCB mononuclear cells. Adults had higher expression of all three genes compared with neonates. CONCLUSION Increased expression of IRAK1 could be responsible, in part, for sex-specific responses to infection and subsequent immune advantage in female neonates.
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Affiliation(s)
- David N O'Driscoll
- Neonatology, National Maternity Hospital, Dublin, Ireland.,Respiratory Research, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.,Paediatrics, Academic Centre, Tallaght Hospital, Trinity College, The University of Dublin, Dublin, Ireland
| | - Chiara De Santi
- Clinical Microbiology, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Paul J McKiernan
- Respiratory Research, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Victoria McEneaney
- Paediatrics, Academic Centre, Tallaght Hospital, Trinity College, The University of Dublin, Dublin, Ireland
| | - Eleanor J Molloy
- Neonatology, National Maternity Hospital, Dublin, Ireland.,Respiratory Research, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.,Paediatrics, Academic Centre, Tallaght Hospital, Trinity College, The University of Dublin, Dublin, Ireland.,Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland.,Neonatology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Catherine M Greene
- Clinical Microbiology, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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