Role of Netrin-1 in staging hypoxic ischemic encephalopathy

The diagnosis and prognosis of neonatal hypoxic-ischemic encephalopathy are established through clinical evidence and laboratory, imaging, and electrophysiological assessments of the nervous system. Netrin-1 was the first axon guidance molecule identified as a critical component of embryonic development in vertebrates and has a solid chemotropic function for angiogenesis, morphogenesis, cell migration, and axonal guidance. It was hypothesized that Netrin-1 will differ at different hypoxic-ischemic encephalopathy stages.

This study included 75 hospitalized hypoxic-ischemic encephalopathy newborns and 48 healthy newborns born at the same hospital and followed up only by their mothers. Demographic, laboratory, and Netrin-1 data were evaluated for all hypoxic-ischemic encephalopathy stages.

Serum Netrin-1 concentrations were significantly greater in patients with moderate and severe hypoxic-ischemic encephalopathy who underwent therapeutic hypothermia than in controls and patients with severe hypoxic-ischemic encephalopathy. However, serum Netrin-1 concentrations were not significantly greater in patients with mild hypoxic-ischemic encephalopathy than in controls. In 75 hypoxic-ischemic encephalopathy patients, correlations of Netrin-1 with lactate, uric acid, and lactate dehydrogenase were statistically significant (p=0.0001, 0.008, and 0.043, respectively).

Netrin-1 significantly increased in moderate and severe patients. Therefore, this marker could be a biomarker for staging hypoxic-ischemic encephalopathy and therapeutic hypothermia and predicting the prognosis of neonatal hypoxic-ischemic encephalopathy patients.