Journal Article

Differential Role of the Lectin Pathway of Complement Activation in Susceptibility to Neonatal Sepsis

Luregn J. Schlapbach, Maika Mattmann, Steffen Thiel, Colette Boillat, Margrith Otth, Mathias Nelle, Bendicht Wagner, Jens C. Jensenius and Aebi Christoph

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 2, pages 153-162
Published in print July 2010 | ISSN: 1058-4838
Published online July 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/653531
Differential Role of the Lectin Pathway of Complement Activation in Susceptibility to Neonatal Sepsis

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Background. The incidence of bacterial sepsis during the neonatal period is high. Mannan-binding lectin (MBL), L-ficolin, and H-ficolin recognize microorganisms and activate the complement system viaMBL-associated serine proteases (MASPs). This study investigated whether cord blood concentrations of the lectin pathway proteins are associated with neonatal sepsis.

>Methods. This was a case-control study including 47 infants with culture-proven sepsis during the first month of life and 94 matched controls. MBL, L-ficolin, H-ficolin, MASP-2, and MASP-3 levels were measured in cord blood with use of enzyme-linked immunosorbent assay and time-resolved immunofluorometric assay. Multivariate logistic regression was performed.

Results. Infants with gram-positive sepsis had significantly lower H-ficolin cord blood concentrations than controls (multivariate odds ratio [OR], 4.00; 95% confidence interval [CI], 1.51–10.56; P=.005), whereas infants with gram-negative sepsis had lower MBL cord blood concentrations (OR, 2.99; 95% CI, 0.86–10.33; P=.084). When excluding patients with postoperative sepsis, multivariate analysis confirmed that low H-ficolin was associated with a significantly higher risk of gram-positive sepsis (OR, 3.71; 95% CI, 1.26–10.92; P=.017) and late-onset sepsis (OR, 3.14; 95% CI, 1.07–9.21; P=.037). In contrast, low MBL was associated with a significantly higher risk of gram-negative sepsis (OR, 4.39; 95% CI, 1.10–17.45; P=.036) and early-onset sepsis (OR, 3.87; 95% CI, 1.05–14.29; P=.042). The concentrations of all the lectin pathway proteins increased with gestational age (P<.01).

Conclusions. These preliminary results indicate that low MBL concentrations are a susceptibility factor for gram-negative sepsis, and low H-ficolin concentrations indicate susceptibility to gram-positive sepsis. The decreased expression of lectin pathway proteins in neonates must be considered to be an additional form of neonatal immunodeficiency.

Journal Article.  4338 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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