Transcription factor T-bet is a diagnostic marker for necrotizing enterocolitis development in premature newborns

Abstract

Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease that mainly affects preterm infants. The non-specificity of the clinical picture and the high percentage of complications determine the need for early diagnosis and prevention of the disease. Purpose - to establish a relationship between the T-bet expression level in the cells of the buccal mucosa, the development of HEC and the method of feeding in premature newborn infants. Materials and methods. We examined 74 newborns, who were treated in neonatal departments. We selected three groups for comparison: the Group 1 consisted of 32 newborns up to 37 weeks of gestation on breastfeeding (BF); the Group 2 - 30 preterm newborns on artificial feeding (AF); the control group - 12 full-term newborns on BF. We determined the expression level of T-bet transcription gene factor in the cells of the buccal mucosa scrapings of the newborns. Thereafter, we have calculated the T-bet normalized expression levels in the cells of the mucous membranes of infants of the Group 1 and the Group 2 in relation to the control group, where the expression level of the specified factors was taken as 1 c.u. Results. The gestational age median of the Group 1 children was 33 (31; 34) weeks; the Group 2 - 32.5 (32; 35) weeks; and it was comparatively higher versus in the Group 1 (p<0.001) - 40 (39; 41) weeks. NEC has significantly more often developed in premature children on AF than on BF (p<0.05) - 30.0±8.4% versus 9.4±5.2%. The T-bet expression in the cells of the buccal mucosa scrapings was higher in preterm children, and the highest level was in the Group 2 - 2.4 (1.98; 3.84) c.u. versus 1.48 (1.13; 2.22) c.u. in the Group 1. We have proved a direct relationship between AF and T-bet level (r=0.370; p<0.004). Pairwise comparison revealed a higher level of T-bet in children with NEC (p=0.002): 2.36 (1.94; 3.17) c.u versus 1.74 (1.01; 3.27) c.u. without signs of NEC. We found a direct correlation between the T-bet level and the development of HEC (r=0,271; p=0.021). Conclusions. The T-bet expression level in the cells of the buccal mucosa increases in newborns with the appearance of the clinical signs of NEC. The level of T-bet expression in the buccal mucosa cells can be a marker of the inflammatory process development in intestine of infants. The expression of T-bet in the buccal mucosa cells of newborns with clinical signs of NEC is higher than in full-term newborns that reflects the tendency to NEC development. We have demonstrated that the T-bet expression level is higher in preterm neonates on AF. Therefore, AF can be considered as a risk factor for the development of NEC in preterm infants. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.