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Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation
K Sävman1, M Blennow, H Hagberg
1Perinatal Center, Department of Pediatrics, Göteborg University, The Queen Silvia Children's Hospital, SE-416 85 Göteborg, Sweden. karin.savman@pediat.gu.se
Insights
Elevated proinflammatory cytokines in cerebrospinal fluid (CSF) of preterm infants with posthaemorrhagic ventricular dilatation (PHVD) indicate an inflammatory response. This inflammation is linked to white matter injury and neurological deficits in these vulnerable infants.
Area of Science:
- Neonatal Neurology
- Pediatric Neuroinflammation
- Cerebrospinal Fluid Analysis
Background:
- Posthaemorrhagic ventricular dilatation (PHVD) in preterm infants is associated with white matter damage and neurological disability.
- Proinflammatory cytokines are implicated in the pathogenesis of white matter injury and cerebral palsy.
Purpose of the Study:
- To determine levels of proinflammatory cytokines in CSF of preterm infants with PHVD.
- To correlate cytokine levels with white matter damage and neurodevelopmental outcomes.
Main Methods:
- Cerebrospinal fluid (CSF) samples collected from preterm infants with PHVD and controls.
- Enzyme-linked immunosorbent assay (ELISA) and bioassay used to measure TNF-alpha, IL-1beta, IL-6, IL-8, and IFN-gamma.
Main Results:
- Significantly elevated concentrations of TNF-alpha, IL-1beta, IL-6, and IL-8 in CSF of infants with PHVD compared to controls.
- Specific detection rates and concentrations for each cytokine were higher in the PHVD group.
- No correlation found between cytokine concentrations and white matter lesions, shunt dependence, or neurological outcome.
Conclusions:
- Preterm infants with PHVD exhibit an intense and prolonged inflammatory reaction in their CSF.
- This inflammatory response is associated with a high risk of subsequent white matter injury and permanent neurological impairment.
Aim:
Posthaemorrhagic ventricular dilatation (PHVD) is closely associated with white matter damage and neurological disability in the preterm infant. Proinflammatory cytokines have been implicated in the pathogenesis of white matter injury and subsequent cerebral palsy. The aim of this study was to determine the levels of proinflammatory cytokines in cerebrospinal fluid (CSF) from preterm infants with PHVD and to correlate the levels to white matter damage and neurodevelopmental outcome.
Methods:
CSF samples were obtained from 24 preterm infants with expanding PHVD and 19 preterm infants with normal ultrasound. Tumour necrosis factor-alphaa (TNF-alpha ), interleukin-1beta (IL-1beta), interleukin-8 (IL-8) and interferon-gamma (IFN-gamma) in CSF were measured by enzyme-linked immunosorbent assay, and IL-6 was measured by bioassay.
Results:
The concentrations of TNF-alpha, IL-1beta, IL-6 and IL-8 were significantly elevated in CSF from infants with PHVD. TNF-alpha was detected in 43% of PHVD infants and 11% of controls (p = 0.04). IL-1beta was detected in 67% of PHVD infants and 0% of controls (p < 0.0001). The concentrations of IL-6 were 368 (145-460) pg ml(-1) in the PHVD group and 30 (25-41) pg ml(-1) in the control group (p < 0.0001), and those of IL-8 were 3000 (1620-3400) pg ml(-1) in the PHVD group and 35 (0-230) pg ml(-1) in the control group (p < 0.0001). Cytokine concentrations did not correlate with white matter lesions on ultrasound, shunt dependence or neurological outcome within the PHVD group.
Conclusion:
There was an intense and prolonged inflammatory reaction in CSF from preterm infants with PHVD and a high risk for subsequent white matter injury and permanent neurological impairment.