Measurement of serum soluble Fas and soluble Fas ligand as markers of apoptosis in children with congestive heart failure

Apoptosis plays a pivotal role in the progression of the pathogenesis of several cardiovascular diseases including heart failure. The aim of this study was to measure serum levels of soluble apoptosis mediators; Fas [sFas] and Fas ligand [sFasL] in children with congestive heart failure [CHF] of different etiologies, and their relation to each other and to the severity of heart failure in these patients. Sixty patients [29 males and 31 females, age; 6.73 +/- 3.18 years] complaining from congestive head failure [NYHA class III/IV] selected from the pediatric department in Al-Minya [university Hospital, from the period of February 2004 to July 2005. The patients were divided into 3 groups according to the etiology of heart failure. Group 1, caused by congenital heart disease [CHD] in 18 cases, group 2 caused by rheumatic valvular head disease [RHD] in 29 cases, and group 3, caused by dilated cardiomyopathy [DCM], in 13 cases. Twenty healthy children, matched for age and gender, were used as controls. Serum levels of soluble Fas [sFas] and Fas-ligand in patients and controls were determined by Enzyme-Linked lmmuno-Sorbent Assay. The results showed that the serum levels of sFas and sFasL were significantly higher in patients with CHF compared to controls [p: 0.001 and p: 0.04, respectively]. Patients with CHF due to CHD had significantly higher levels of sFas and sFasL compared to controls [p: 0.001 and p: 0.002 respectively]. Also, patients with CHF due to RHD had significantly higher levels of sFas and FasL compared to controls [p: 0.001 and p; 0.04 respectively]. Similarly, patients with DCM had significantly higher levels of sFas and FasL compared to control group [p: 0.001 and p: 0.005 respectively]. Serum FasL correlated positively to sFas [r: 0.32, p: 0.049], and heart rate [r: 0.30, p: 0.044], and correlated negatively to ejection fraction [r: -0.46, p: 0.03], but had no significant correlation with ESR, or CRP. Serum levels of sFas and sFasL are increased in children with CHF of different etiologies suggesting a potential role of Fas and FasL in this setting. Levels of sFasL are increased in proportion to the severity of heart failure and may provide a useful marker for evaluating the severity and prognosis of heart failure

Serum troponin in neonates of pre-eclamptic mothers

Cardiac troponin I, the biochemical marker of myocardial injury is characterized by high sensitivity and specificity in comparison with other markers used in the past. The aim of this study was to evaluate serum levels of troponin in neonates of pre-eclamptic mothers compared with levels in age and sex matched controls, and to correlate the levels of troponin I with Cardiac Creatine Kinase [CK-MB] and other markers of myocardial injury. Forty neonates of pre-eclamptic mothers were included in the study [group A]. Also, 30 age and sex matched healthy neonates were included as controls [group B]. All neonates were subjected to full clinical assessment and routine laboratory investigations. Echocardiographic study was done stressing on myocardial contractility, and calculating the E/A ratio where E= Mitral peak velocity of early diastole in centimeters per second, and A Peak velocity of the atrial contraction in centimeters per second. Cardiac troponin [was measured in serum by ELIZA. CK-MB was measured in serum by chemical analysis. The results showed that troponin I, CK-MB, and E/A levels were significantly higher in group A compared with group B [p=0.003, p=0.03, and p=0.01 respectively]. There were significant positive correlations between troponin I with CK-MB, C-reactive protein and the mean E/A value in group A [r=0.86; p=0.02, r=0.50; p=0.01, and r=0.75; p=0.05 respectively]. Troponin I had a sensitivity of 83.3% and a sensitivity of 86.6% in diagnosing myocardial injury while CK-MB had a sensitivity of 75% and a specificity of 76% in diagnosing myocardial injury. From the present study we conclude that cardiac Troponin I is a more specific and more sensitive marker for myocardial injury than the standard biochemical markers such as CK-MB and it can detect minor myocardial damage not diagnosed early by echo cardio graphic study. Also we conclude that preterm neonates of preeclamptic mothers are more susceptible to myocardial injury than full-term neonates. Troponin I may have prognostic significance because, if present, it identifies the neonates of pre-eclamptic mothers who are at risk of cardiac injury

Plasma interleukin-11 levels in thrombocytopenic and non-thrombocytopenic neonates

Thrombocytopenia is common in sick neonates, and affected neonates have adverse outcomes compared with those without thrombocytopenia. As impaired platelet production underlies many neonatal thrombocytopenias, affected neonates are potential candidates for hemopoietic growth factor therapy. The thrombopoietic cytokine recombinant human IL-11, which stimulates megakaryocytopoiesis and increases platelet counts after chemotherapy, is already licensed for clinical use. However, little is known about IL-11 in neonates. We therefore measured plasma IL-11 by ELISA in healthy term neonates, stable preterm neonates with or without thrombocytopenia, and preterm neonates with sepsis or necrotizing enterocolitis [NEC] with or without thrombocytopenia. At birth IL-11 was undertetable [<10pg/ml] in healthy term neonates [n = 15] and 21 of 25 [84%] stable preterm neonates. Three stable preterm neonates had detectable plasma IL-11[mean, 11.23 +/- 0.64 pg/ml], all three were born after pregnancies complicated by prolonged rupture of membranes or chorioamnionitis, the remaining neonate[IL-11, 15 pg/ml] being one of seven with early onset thrombocytopenia [presented by 72 h of age]. IL-11 was also measured in 50 preterm neonates with suspected sepsis or NEC. In 20 of 50, sepsis or NEC was unconfirmed and IL-11 was undetectable, in contrast, 14 of 30 with proven sepsis or NEC had elevated IL-11 [mean, 25.41 +/- 21.3; range, 11.3-93 pg/ml] [p = 0.0003]. Of the 30 neonates with proven sepsis or NEC, 19 developed thrombocytopenia: nine of 19 [47.4%] had detectable IL-11 and 10 of 19 [52.6%] did not [p = 0.746]. Although the role of IL-11 in platelet production in neonates remains unclear, these data suggest that IL-11 is involved in the endogenous cytokine response to sepsis or NEC in preterm neonates. Further studies of IL-11 in neonates are warranted to assess its role both in platelet production and in mediation of the endogenous inflammatory response