Aberrant expression of miR-199a in newborns with hypoxic-ischemic encephalopathy and its diagnostic and prognostic significance when combined with S100B and NSE

Neonatal hypoxic-ischemic encephalopathy (HIE) is a disorder mainly due to asphyxia during the perinatal period, and late diagnosis leads to high mortality. In this study, the expression of microRNA-199a (miR-199a) in HIE newborns was investigated, as well as its clinical significance in HIE diagnosis and prognosis. Circulating levels of S100B and NSE in HIE newborns were measured using enzyme-linked immunosorbent assay, and the expression of miR-199a was analyzed using quantitative real-time PCR. The diagnostic value of miR-199a, S100B and NSE was evaluated using the receiver operating characteristic (ROC) analysis, and their prognostic value was assessed by the evaluation of Gesell intellectual development of the HIE newborns. HIE newborns possessed significantly increased levels of S100B and NSE and decreased miR-199a (all P < 0.01). The Neonatal Behavioral Neurological Assessment (NBNA) score of HIE newborns was negatively correlated with S100B and NSE, while was positively correlated miR-199a. The ROC analysis results showed the diagnostic value of serum miR-199a, and the combined detection of miR-199a, S100B and NSE could obtained the highest diagnostic accuracy in HIE newborns. miR-199a expression was lowest in newborns with severe HIE, and it had diagnostic potential to distinguish HIE cases with different severity. Regarding the prognosis of neonatal HIE, the correlation of miR-199a, S100B, NSE with Gesell intellectual development was found in HIE newborns. The decreased miR-199a in HIE newborns serves as a potential diagnostic biomarker and may help to improve the diagnostic and prognostic value of S100B and NSE in neonatal HIE.

Up-Regulation of Nfat5 mRNA and Fzd4 mRNA as a Marker of Poor Outcome in Neonatal Hypoxic-Ischemic Encephalopathy

OBJECTIVE

To evaluate umbilical cord messenger RNA (mRNA) expression as biomarkers for the grade of hypoxic-ischemic encephalopathy (HIE) and long-term neurodevelopment outcome.

STUDY DESIGN

Infants were recruited from the BiHiVE1 study, Ireland (2009-2011), and the BiHiVE2 study, Ireland, and Sweden (2013-2015). Infants with HIE were assigned modified Sarnat scores at 24 hours and followed at 18-36 months. mRNA expression from cord blood was measured using quantitative real-time polymerase chain reaction.

RESULTS

We studied 124 infants (controls, n = 37; perinatal asphyxia, n = 43; and HIE, n = 44). Fzd4 mRNA increased in severe HIE (median relative quantification, 2.98; IQR, 2.23-3.68) vs mild HIE (0.88; IQR, 0.46-1.37; P = .004), and in severe HIE vs moderate HIE (1.06; IQR, 0.81-1.20; P = .003). Fzd4 mRNA also increased in infants eligible for therapeutic hypothermia (1.20; IQR, 0.92-2.37) vs those who were ineligible for therapeutic hypothermia group (0.81; IQR, 0.46-1.53; P = .017). Neurodevelopmental outcome was analyzed for 56 infants. Nfat5 mRNA increased in infants with severely abnormal (1.26; IQR, 1.17-1.39) vs normal outcomes (0.97; IQR, 0.83-1.24; P = .036), and also in infants with severely abnormal vs mildly abnormal outcomes (0.96; IQR, 0.80-1.06; P = .013). Fzd4 mRNA increased in infants with severely abnormal (2.51; IQR, 1.60-3.56) vs normal outcomes (0.74; IQR, 0.48-1.49; P = .004) and in infants with severely abnormal vs mildly abnormal outcomes (0.97; IQR, 0.75-1.34; P = .026).

CONCLUSIONS

Increased Fzd4 mRNA expression was observed in cord blood of infants with severe HIE; Nfat5 mRNA and Fzd4 mRNA expression were increased in infants with severely abnormal long-term outcomes. These mRNA may augment current measures as early objective markers of HIE severity at delivery.

Lack of the brain-specific isoform of apoptosis-inducing factor aggravates cerebral damage in a model of neonatal hypoxia-ischemia

Apoptosis-inducing factor (AIF) may contribute to neuronal cell death, and its influence is particularly prominent in the immature brain after hypoxia-ischemia (HI). A brain-specific AIF splice-isoform (AIF2) has recently been discovered, but has not yet been characterized at the genetic level. The aim of this study was to determine the functional and regulatory profile of AIF2 under physiological conditions and after HI in mice. We generated AIF2 knockout (KO) mice by removing the AIF2-specific exon and found that the relative expression of Aif1 mRNA increased in Aif2 KO mice and that this increase became even more pronounced as Aif2 KO mice aged compared to their wild-type (WT) littermates. Mitochondrial morphology and function, reproductive function, and behavior showed no differences between WT and Aif2 KO mice. However, lack of AIF2 enhanced brain injury in neonatal mice after HI compared to WT controls, and this effect was linked to increased oxidative stress but not to caspase-dependent or -independent apoptosis pathways. These results indicate that AIF2 deficiency exacerbates free radical production and HI-induced neonatal brain injury.

The role of genetic determinant in the development of severe perinatal asphyxia

The frequency of GSTT1 and GSTM1 gene deletion polymorphism was determined in a case-control study of full-term Ukrainian newborns including patients with perinatal asphyxia. Multiplex polymerase chain reaction was used for genotyping 245 full-term newborns. The investigated full-term newborns with perinatal asphyxia were subdivided in the subgroups depending of severity of perinatal asphyxia and neonatal outcome. No significant differences in allele frequencies of homorygous null genotypes of GSTT1 and GSTM1 gene were detected among newborns with moderate perinatal asphyxia and healthy control. However, association with the development of severe perinatal asphyxia was detected for the deletion polymorphism in GSTT1 gene and the combination of the GSTT1 absent/GSTM1 absent in the newborns. The study shows that severe perinatal asphyxia may develop in the consequence of genetic predisposition to this condition as compare with moderate.

Reversible asphyxial status in a newborn due to neonatal form of carnitine palmitoyltransferase II deficiency

OBJECTIVES

To present a term newborn with severe asphyxial status due to dysrrhythmia induced by the neonatal form of carnitine palmitoyltransferase II deficiency (CPT II).

RESULTS

Term newborn delivered spontaneously (birth weight 3450 grams, birth length 52 cm, values of Apgar score 10/10) with good direct adaptation, on second day of life he manifested severe asphyxial status followed by cardiorespiratory insufficiency with circulatory failure. After prolonged resuscitation of 3 hours, the child was admitted to our neonatological department. Diagnosis of CPT II was confirmed (free carnitine level in blood 12.2 micromol/l; ratio (C16+C18):1/C2 was 0.760 by tandem mass spectrometry; activity of CPT II in leukocytes was 0.082 micromol/min x gram protein). After appropriate treatment the patient survived the critical period.

CONCLUSIONS

Neonatal form of CPT II deficiency is the most severe form and is considered to be invariably fatal. This kind of metabolic disease is congenital, but cardiac problems are not detectable during the prenatal period. Fasting in the early newborn period is a main trigger of CPT II deficiency signs. The authors emphasise the relevance of investigating acylcarnitine profiles and carnitine in serum in all cases of severe postnatal asphyxia and in cases of unusual newborn arrhythmias since some forms of disturbances in beta oxidation of fatty acids are partially treatable.

Hypoxia-induced modification of poly (ADP-ribose) polymerase and dna polymerase beta activity in cerebral cortical nuclei of newborn piglets: role of nitric oxide

Previous studies have shown that poly (ADP-ribose) polymerase (PARP) and DNA polymerase beta, nuclear enzymes, are associated with cell replication and DNA repair. The present study tests the hypothesis that hypoxia results in increased PARP and DNA polymerase activity in cerebral cortical neuronal nuclei to repair the hypoxia-induced damage to genomic DNA. Studies were conducted in 13 anesthetized and ventilated newborn piglets (age 3-5 days) divided into normoxic (n=5) and hypoxic (n=8) groups. Hypoxia was induced by decreasing inspired oxygen from 21% to 7% for 60 min. Cerebral tissue hypoxia was documented biochemically by determining the tissue levels of ATP and phosphocreatine (PCr). Following isolation of the cortical neuronal nuclei, the activity of PARP and DNA polymerase beta was determined. During hypoxia, the tissue ATP level decreased by 73% from 4.12+/-0.67 micromol/g brain to 1.12+/-0.34 micromol/g brain, and PCr decreased by 78% from 4.14+/-0.68-0.90+/-0.20 micromol/g brain. In hypoxic neuronal nuclei, PARP activity significantly increased from 5.88+/-0.51 pmol NAD/mg protein/h in normoxic nuclei to 10.04+/-2.02 (P=0.001). PARP activity inversely correlated with tissue ATP (r=0.78) and PCr levels (r=0.81). Administration of N-nitro-L-arginine prior to hypoxia decreased the hypoxia-induced increase in PARP activity by 67%. Endogenous DNA polymerase beta activity increased from 0.96+/-0.13 in normoxic nuclei to 1.39+/-0.18 nmol/mg protein/h in hypoxic nuclei (P<0.005). DNA polymerase beta activity in the presence of exogenous template increased from 1.54+/-0.14 in the normoxic to 2.42+/-0.26 nmol/mg protein/h in the hypoxic group (P<0.005). DNA polymerase beta activity in the presence or absence of template inversely correlated with the tissue ATP (r=0.95 and 0.84, respectively) and PCr levels (r=0.93 and 0.77, respectively). These results demonstrate that the activity of PARP and DNA polymerase beta enzymes increase with the increase in degree of cerebral tissue hypoxia. Furthermore, the results demonstrate a direct correlation between the PARP and the DNA polymerase beta activity. We conclude that tissue hypoxia results in increased PARP and DNA polymerase beta activities indicating activation of DNA repair mechanisms that may result in potential neuronal recovery following hypoxia and the hypoxia-induced increase in PARP activity is NO-mediated.

Familial asphyxiating thoracic dysplasia: clinical variability and impact of improved neonatal intensive care

We describe 3 siblings with asphyxiating thoracic dysplasia whose neonatal symptoms range from mild respiratory distress to asphyxia and death. The youngest sibling received aggressive modern respiratory intensive care, survived, and at 2 years showed no respiratory symptoms. Improved neonatal intensive care has implications for clinical decision making and genetic counseling.

Perinatal asphyxia induces region-specific long-term changes in mRNA levels of tyrosine hydroxylase and dopamine D(1) and D(2) receptors in rat brain

To study the effects of neonatal asphyxia on gene expression of the dopaminergic systems, we determined quantitatively the mRNA levels of tyrosine hydroxylase, dopamine transporter, dopamine D(1) and D(2) receptors in substantia nigra/ventral tegmental area, striatum and limbic area. The mRNA levels were determined at one and 4 weeks after asphyxia by a quantitative reverse transcription polymerase chain reaction method. Spontaneously and Caesarean section born rats showed similar mRNA levels with the exception of an increase of tyrosine hydroxylase mRNA levels in the limbic area of 4-week-old animals. Five min of asphyxia did not change the mRNA levels in any region compared to that in the spontaneously born rats. Fifteen and twenty min of asphyxia induced region-specific alterations in mRNA levels. In SN/VTA an increase of tyrosine hydroxylase mRNA levels in the 1-week-old rats and in striatum an increase of D(1) and D(2) dopamine receptor mRNA levels in the 4-week-old rats were observed. Fifteen min of asphyxia induced a selective increase of D(1) and D(2) dopamine receptor mRNA levels in the limbic area of 4-week-old rats. These observations indicate that neonatal asphyxia triggers a cascade of gene expressions for tyrosine hydroxylase and D(1) and D(2) dopamine receptors. In 1-week-old rats, the gene expression of tyrosine hydroxylase increased in the cell body region substantia nigra/ventral tegmental area. This change may increase the D(1) and D(2) dopamine receptor expression in the target regions striatum and limbic area during further development.

C-fos gene expression in rat brain around birth: effect of asphyxia and catecholamines

At birth, the mammalian nervous system must adapt rapidly to the new conditions it encounters in the extra-uterine environment. One aspect of this adaptation, known as arousal, is mediated by catecholamines, the levels of which in the brain increase rapidly after birth. The pattern of gene expression also changes. Shortly after birth, expression of the immediate early gene c-fos, known to reflect general neural activity, is up-regulated. Furthermore, asphyxia often occurs in connection with birth. In order to examine the effects of this phenomenon on the expression of c-fos, as well as on the rate of noradrenaline (NA) turnover, asphyxia was induced in rat pups delivered by caesarean section. Northern blot analysis and in situ hybridization revealed that the increase in expression of c-fos in certain areas of the brain was greatly enhanced by asphyxia of moderate duration; whereas more prolonged asphyxia lowered the level of c-fos mRNA. Asphyxia had a similar effect on the rate of NA turnover. Adrenergic receptor antagonists administered prior to birth attenuated the birth-related induction of c-fos mRNA. However, the potentiation of c-fos expression by asphyxia was not altered by these antagonists. Therefore, we propose that while catecholamines play an important role in the induction of c-fos in the brain at birth, the effects of asphyxia involve a different mechanism.

Deficient transcription of subunit RPA 40 of RNA polymerase I and III in heart of rats with neonatal asphyxia

RNA polymerases transcribe nuclear genes for ribosomal RNA thus representing ribosomal biogenesis. RNA polymerase I transcribes class I genes, coding for large ribosomal RNA and is located in the nucleolus. RNA polymerase III transcribes class III genes, those that encode a number of small ribosomal RNA molecules. Both RNA polymerases form ribosomal biogenesis in a concerted action and have a common subunit, RPA40, essential for function and integrity. The aim of our study was to study the influence of hypoxia/asphyxia on transcription of this subunit as deterioration of ribosomal biogenesis may not be compatible with life. To test this hypothesis we used a nonsophisticated model of neonatal asphyxia. Rat pups were exposed to various asphyctic periods up to twenty minutes and heart tissue was taken for the evaluation of mRNA RPA40 levels, pH measurements and histological evaluation of the nucleolus by silver staining. mRNA RPA40 levels gradually decreased with the length of the asphyctic period paralleling the decrease of pH. Silver staining was remarkably decreased at the asphyctic period of 20 minutes. Our findings of decreased transcription of this essential RNA polymerase subunit indicate impairment of the ribosomal RNA synthetizing machinery and the histological findings suggest its structural relevance. This is the first in vivo observation of deteriorated RNA polymerase in asphyxia/hypoxia.

Asphyxiating thoracic dystrophy (Jeune's disease): a case report

A female infant with features of Jeune's disease is described. The pertinent clinical features were a long, narrow trunk, dystrophic rib cage with respiratory distress, short limbs, and polydactyly. Radiographically, she had only 11 pairs of short ribs which were expanded and flared anteriorly. There was a positive history of consanguinity. It is believed that she might still be alive, although no follow-up was undertaken.

Early cirrhosis in survivors with Jeune thoracic dystrophy

Two siblings with Jeune thoracic dystrophy had persistent evidence of hepatic dysfunction; one had cirrhosis. Liver disease, a significant problem in patients who survive this condition, may be progressive in some.

Jeune syndrome associated with cystinuria: report of two sisters

Jeune syndrome is generally lethal in the first months of life. Surviving patients develop progressive renal failure and hepatic fibrosis. We describe 2 sisters, aged 7 and 2 years, respectively, who had Jeune syndrome associated with cystinuria. To our knowledge, this is the first reported association of these 2 autosomal recessive disorders.

[Variance in the clinical picture and course of asphyxiating thoracic dysplasia (Jeune syndrome)]

The asphyxiating thoracic dysplasia (Jeune syndrome) is inherited as an autosomal recessive disorder. It's main characteristics are a narrow thorax with typical radiologic features resulting in respiratory problems of varying degrees. In addition typical changes of the pelvic bones and the phalanges may be demonstrated radiographically. The "major form" usually leads to respiratory failure in early infancy. If the patients survive the neonatal period they may suffer from recurrent infections of the respiratory tract. But there are also patients without respiratory problems. Renal abnormalities and renal failure are a significant feature and a hazard in later life. Patient 1, a female newborn infant with severe manifestation of the clinical and radiologic signs died from respiratory insufficiency on the 17, day of life despite of artificial ventilation. Patient 2, a now eight month old female child with typical radiologic features represents the "minor form". She had respiratory problems only during the first days of life when she required artificial ventilation and is now at a good general condition.

Necropsy findings in neonatal asphyxiating thoracic dystrophy

Asphyxiating thoracic dystrophy is an autosomal recessive disorder characterised by an abnormally small thorax, variable shortening of the extremities, and pelvic anomalies. Renal and pancreatic symptoms are found in longer survivors, although most cases die in infancy of respiratory failure. Seven neonatal cases were studied at necropsy. These cases ranged in gestational age from 32 to 40 weeks. One was stillborn and the other six survived from 1 hour to 10 days. Two were sibs born to consanguineous parents. Dwarfing was not pronounced and the extremities were shortened in only one infant who also had polydactyly. All seven showed visceral changes in addition to abnormalities of bone. Endochondral ossification was irregular in sections of femur, vertebra, and rib. Pulmonary hypoplasia was associated with the small thorax typical of this disorder. Periportal fibrosis and bile duct proliferation were seen in sections of liver, and in one case cirrhosis was found. Pancreatic fibrosis was variable. These necropsy findings correlate with later clinical manifestations of the disease and emphasise the multisystem nature of this disorder.

AB0 blood group incompatibility and inbreeding effects: evidence for an interaction

It is known that consanguinity reduces the chances of maternal-foetal incompatibility but it is not known whether inbreeding influences the expression of the effects of such incompatibility. This paper investigates and finds evidence for an interaction between inbreeding and AB0 blood group incompatibility on the expression of neonatal mortality, sibship precocious mortality, neonatal jaundice, asphyxia, and sex ratio, through screening of 3923 consecutive newborns. Inbreeding and incompatibility individually showed variable effects on the above parameters, but their interaction was such that, in the presence of inbreeding, incompatibility reduced the incidence/relative risk of all the above factors. Such a uniform negative interaction was presumed to be due to homozygosity of some pleiotropic genes caused by inbreeding.

Mechanisms of brain damage in twins

The brains of 18 twins dying in the perinatal period showed a variety of lesions. Eleven had subependymal cell plate hemorrhage which had ruptured into the lateral ventricles in five. Five had periventricular damage. Three had anoxic neuronal damage. One acardiac monster had bilateral cerebral infarction. One pair had unequal sized brains, probably due to unequal intrauterine nutrition. Twins have a high perinatal mortality and morbidity; as well, intrauterine events may alter brain growth and development in each twin unequally, so they are an imperfect model to study the effect of genes and environment on intelligence.

Perinatal mortality and XY/XX mosaicism. Report of two patients

An XX/XY mosaicism was detected in two phenotypically male newborns with perinatal death, The importance of chromosome studies at the paediatric necropsy and the significance of the present findings are discussed.

[Study of intellectual activity in twins. I. Developmental features]

The investigation of 234 twins and 100 singletons at the age from 7 till 16 years old was carried out by WISC method. The intellectual development of twins was established to fall behind singletons at the expense of lower level of verbal intellectual functions. It is due to organic changes of nervous system, arising as the result of the action of unfavourable factors during antenatal period. Slight asphyxia and prematurity as well as the order of birth do not exert essential effect on intellectual development of twins. Low weight at birth combines with lower intellectual index only in cases when lowering of weight is due to the action of unfavourable factors during intrauterine period. "Twins situation" apparently renders positive influence on twins intellectual activity during school are, distracting children's attention in cases of unfavourable psychological situation in family. Intellectual environment renders positive influence on intellectual development of twins.

Association of children's diseases in families from record linkage data

A method is described for determining which diseases cluster more frequently in families as indicated by data drawn from a large population of linked family records. First, a screening test determined which diseases were distributed differently in sibs than in the general population using a chi-squared test. Fisher's exact test was used for two subsequent analyses to handle the small expected values for affected sibs. One analysis identified index diseases which occurred more frequently than expected in the sibs of index cases and the other test identified which diseases other than those of the index case were actually associated with index diseases.The methods were tested-using data from a "Registry for Handicapped Children and Adults" and the vital registrations for the Canadian province of British Columbia, which had been linked by computer into family groups by Newcombe. The index disease occurred more frequently than expected in sibs for erythroblastosis, strabismus, immaturity, post-natal asphyxia and atelectasis and mental deficiency. Familial associations which had not been previously reported were: erythroblastosis with diseases of the digestive system, strabismus with diseases of the nervous system and sense organs, immaturity with both diseases of early infancy and stillbirths, post-natal asphyxia and atelectasis with stillbirths, congenital malformations of the digestive system with other congenital malformations and mental deficiency with diseases of the respiratory system.The shortcomings of the data are discussed, and instances in which the results are not conclusive, or are not readily interpretable, but are indicative of possible interesting problems in need of investigation, are noted.

Asphyxiating thoracic chondrodystrophy. Association with renal disease and evidence for possile heterozygous expression

Images