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, 24 (42), 4787-4797

Mode of Delivery by an Ulcerative Colitis Mother in a Case of Twins: Immunological Differences in Cord Blood and Placenta

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Case Reports

Mode of Delivery by an Ulcerative Colitis Mother in a Case of Twins: Immunological Differences in Cord Blood and Placenta

Garett Dunsmore et al. World J Gastroenterol.

Abstract

Aim: To understand the effects of delivery mode on the immune cells frequency and function in cord blood and placenta.

Methods: We evaluated immunological differences in cord blood and placental tissues for a case of twins one of which delivered vaginally while the other delivered by caesarian section (C-section). Cord blood mononuclear cells were isolated and placenta tissues were processed for cell isolation. Immune phenotyping was performed by flow cytometry methods following staining for T cells, natural killer (NK) cells, monocytes, neutrophils and CD71+ erythroid cells in both cord blood and placenta tissues. In addition, fetal calprotectin of twins was measured 12 wk after birth.

Results: We found lower percentages of immune cells (e.g. T cells, monocytes and neutrophils) in the cord blood of C-section delivered compared to vaginally delivered newborn. In contrast, percentages of monocytes and neutrophils were > 2 folds higher in the placental tissues of C-section delivered newborn. More importantly, we observed lower percentages of CD71+ erythroid cells in both cord blood and placental tissues of C-section delivered case. Lower CD71+ erythroid cells were associated with a more pro-inflammatory milieu at the fetomaternal interface reflected by higher expression of inhibitory receptors on CD4+ T cells, higher frequency of monocytes and neutrophils. Furthermore, type of delivery impacted the gene expression profile in CD71+ erythroid cells. Finally, we found that C-section delivered child had > 20-fold higher FCP in his fecal sample at 12 wk of age.

Conclusion: Mode of delivery impacted immune cells profile in cord blood/placenta. In particular frequency of immunosuppressive CD71+ erythroid cells was reduced in C-section delivered newborn.

Keywords: CD71+ erythroid cells; Caesarian section; Cord blood; Immunophenotyping; Placental tissues; Twins; Vaginal delivery.

Conflict of interest statement

Conflict-of-interest statement: All authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Immunophenotyping of cord blood cells. A: Showing flow cytometry gating strategy for different immune cells in cord blood. B: Representative dot plots showing T cells (CD3, CD4 and CD8), monocytes (CD14 and CD16) and NK cells (CD56 and CD16) in cord blood of vaginally or C-section delivered newborns. C: Cumulative data showing percentages of different immune cells in cord blood. D: Representative dot plots showing expression of PD-1/LAG-3 and PD-1/TIM-3 on CD4+ T cells. E: Percentages of PD-1, LAG-3 and TIM-3 on CD4+ T cells from cord blood of twins. F: Representative dot plots showing expression of PD-1/LAG-3 and PD-1/TIM-3 on CD8+ T cells. G: Percentages of PD-1, LAG-3 and TIM-3 on CD8+ T cells from cord blood of twins. H: Representative dot plots showing percentages of CD71+CD235+ cells in cord blood of vaginally vs C-section delivered twins. I: qPCR data showing fold gene expression for TGF-β, NOX2, arginase-2, VISTA and VEGFα in enriched CD71+ erythroid cells from cord blood. NK: Natural killer; C-section: Caesarean section; PD-1: Program death-1; LAG-3: Lymphocyte-activation gene 3; TIM-3: T-cell immunoglobulin and mucin-domain containing-3; qPCR: Quantitative polymerase chain reaction; TGF-β: Transforming growth factor beta; NOX-2: The phagocyte NADPH oxidase; VISTA: V-domain Ig suppressor of T cell activation; VEGFα: Vascular endothelial growth factor A.
Figure 2
Figure 2
Immunophenotyping of placental cells. A: Showing flow cytometry gating strategy for different immune cells in placenta. B: Representative dot plots showing T cells (CD3, CD4 and CD8), monocytes (CD14 and CD16) and NK cells (CD56 and CD16) in placenta of vaginally or C-section delivered newborns. C: Cumulative data showing percentages of different immune cells in placenta. D: Representative dot plots showing expression of PD-1/LAG-3 and PD-1/TIM-3 on CD4+ T cells. E: Percentages of PD-1, LAG-3 and TIM-3 on CD4+ T cells from placental tissues of twins. F: Representative dot plots showing expression of PD-1/LAG-3 and PD-1/TIM-3 on CD8+ T cells. G: Percentages of PD-1, LAG-3 and TIM-3 on CD8+ T cells from placental tissues of twins. H: Representative dot plots showing percentages of CD71+CD235+ cells in placental tissues of vaginally vs C-section delivered twins. I: Data showing levels of FCP in fecal samples of twins as measured by ELISA. NK: Natural killer; C-section: Caesarean section; PD-1: Program death-1; LAG-3: Lymphocyte-activation gene 3; TIM-3: T-cell immunoglobulin and mucin-domain containing-3; FCP: Fecal calprotectin; ELISA: Enzyme-linked immuno sorbent assay.

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