Activation of microglia/macrophages is important in neonatal hypoxic-ischemic (HI)
brain injury. Based on experimental studies, we identified macrophage/microglia-derived mediators with potential neurotoxic effects after neonatal HI and examined them in cerebrospinal fluid (CSF) from newborn infants after birth
asphyxia.
Galectin-3 is a novel inflammatory mediator produced by microglia/macrophages.
Galectin-3 is chemotactic for inflammatory cells and activates
nicotinamide adenine dinucleotide phosphate (
NADPH) oxidase resulting in production and release of
reactive oxygen species (ROS).
Matrix metalloproteinase-9 (MMP-9) is a tissue-degrading
protease expressed by activated microglia in the immature brain after HI. Both
galectin-3 and MMP-9 contribute to
brain injury in animal models for neonatal HI.
Quinolinic acid (QUIN) is a neurotoxic
N-methyl-D-aspartate (
NMDA) receptor agonist also produced by activated microglia/macrophages.
Galectin-3 and MMP-9 were measured by ELISA and QUIN by mass spectrometry. Asphyxiated infants (n=20) had higher levels of
galectin-3 (mean (SEM) 2.64 (0.43) ng/mL) and QUIN (335.42 (58.9) nM) than controls (n=15) (1.36 (0.46) ng/mL and 116.56 (16.46) nM, respectively), p<0.05 and p<0.01. Infants with septic
infections (n=10) did not differ from controls. Asphyxiated infants with abnormal outcome had higher levels of
galectin-3 (3.96 (0.67) ng/mL) than those with normal outcome (1.76 (0.32) ng/mL), p=0.02, and the difference remained significant in the clinically relevant group of infants with moderate
encephalopathy. MMP-9 was detected in few infants with no difference between groups. The potentially neurotoxic macrophage/microglia-derived mediators
galectin-3 and QUIN are increased in CSF after birth
asphyxia and could serve as markers and may contribute to injury.