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

• Published in: Clinical infectious diseases 2010-07, Vol.51 (2), p.153-162
• Main Authors: Schlapbach, Luregn J., Mattmann, Maika, Thiel, Steffen, Boillat, Colette, Otth, Margrith, Nelle, Mathias, Wagner, Bendicht, Jensenius, Jens C., Christoph, Aebi
• Format: Article
• Language: English
• Subjects: ARTICLES AND COMMENTARIES; Babies; Bacteremia - immunology; Bacteremia - pathology; Bacteria; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Case-Control Studies; Chorioamnionitis; Complement Pathway, Mannose-Binding Lectin - immunology; Complement System Proteins - analysis; Cord blood; Enzyme-Linked Immunosorbent Assay; Female; Fluoroimmunoassay; Gestational age; Gram-Negative Bacterial Infections - immunology; Gram-Positive Bacterial Infections - immunology; Human bacterial diseases; Humans; Infant, Newborn; Infants; Infections; Infectious diseases; Lectins; Logistic regression; Male; Medical sciences; Operating rooms; Pathogens; Proteases; Proteins; Regression analysis; Risk factors; Sepsis; Sepsis - immunology; Sepsis - pathology
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/653531

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