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2016 ; 18
(ä): e12
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The immunological landscape in necrotising enterocolitis
#MMPMID27341512
Cho SX
; Berger PJ
; Nold-Petry CA
; Nold MF
Expert Rev Mol Med
2016[Jun]; 18
(ä): e12
PMID27341512
show ga
Necrotising enterocolitis (NEC) is an uncommon, but devastating intestinal
inflammatory disease that predominantly affects preterm infants. NEC is sometimes
dubbed the spectre of neonatal intensive care units, as its onset is insidiously
non-specific, and once the disease manifests, the damage inflicted on the baby's
intestine is already disastrous. Subsequent sepsis and multi-organ failure entail
a mortality of up to 65%. Development of effective treatments for NEC has
stagnated, largely because of our lack of understanding of NEC pathogenesis. It
is clear, however, that NEC is driven by a profoundly dysregulated immune system.
NEC is associated with local increases in pro-inflammatory mediators, e.g.
Toll-like receptor (TLR) 4, nuclear factor-?B, tumour necrosis factor,
platelet-activating factor (PAF), interleukin (IL)-18, interferon-gamma, IL-6,
IL-8 and IL-1?. Deficiencies in counter-regulatory mechanisms, including IL-1
receptor antagonist (IL-1Ra), TLR9, PAF-acetylhydrolase, transforming growth
factor beta (TGF-?)1&2, IL-10 and regulatory T cells likely facilitate a
pro-inflammatory milieu in the NEC-afflicted intestine. There is insufficient
evidence to conclude a predominance of an adaptive Th1-, Th2- or Th17-response in
the disease. Our understanding of the accompanying regulation of systemic
immunity remains poor; however, IL-1Ra, IL-6, IL-8 and TGF-?1 show promise as
biomarkers. Here, we chart the emerging immunological landscape that underpins
NEC by reviewing the involvement and potential clinical implications of innate
and adaptive immune mediators and their regulation in NEC.