Airway nitrite is increased in extremely preterm infants with bronchopulmonary dysplasia
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LETTER TO THE EDITOR
Open Access
Airway nitrite is increased in extremely preterm infants with bronchopulmonary dysplasia Samuel J. Gentle1* , Amelia Freeman1, Rakesh P. Patel2, Namasivayam Ambalavanan1 and Charitharth V. Lal1
Abstract Rationale: Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity and significantly contributes to mortality and morbidity with few predictive biomarkers. Given that nitrites have been implicated in pathways associated with lung disease, we hypothesized that nitrite levels would be altered in the airways of premature infants diagnosed with BPD. Methods: This was a prospective cohort study of extremely low birth infants (< 28 weeks’ gestation) at the University of Alabama at Birmingham. Nitrite levels from tracheal aspirates (TAs) were compared between intubated and ventilated infants with BPD and gestation matched full term (FT) controls. TA derived nitrite levels from day one after birth were also compared between preterm infants who did and did not develop BPD. Results: Infants with BPD were found to have significantly elevated nitrite levels in their tracheal aspirates compared to gestation matched FT controls (p < 0.05). There was a trend for increased nitrite levels on postnatal day one in infants that developed BPD compared to infants that did not develop BPD (p = 0.05). Conclusions: In conclusion, nitrite levels are significantly increased in airways of infants with BPD. Data from a larger cohort are needed to further support the utility of nitrite for BPD prediction. Trial registration: Not applicable. Keywords: Bronchopulmonary dysplasia, Preterm infants, Nitrite, Nitric oxide
Introduction Bronchopulmonary dysplasia (BPD) is a common morbidity of preterm infants for which few biomarkers exist. Development of BPD results from a multitude of factors including inflammation, hyperoxia, disrupted pulmonary angiogenesis, and microbial dysbiosis. In addition to a paucity of biomarkers that predict disease, few therapies prevent disease development. Nitric oxide (NO), as well as precursors to NO production, have been evaluated as potential markers of disease and therapies for prevention. * Correspondence: [email protected] 1 Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, al 35233, USA Full list of author information is available at the end of the article
Nitric oxide a signaling molecule produced throughout the airway, has many physiologic roles in the lung including vasodilatation and anti-inflammation. Moreover, in addition to other angiogenic growth factors, NO influences both pre- and postnatal pathways critical to lung development including airway branching morphogenesis and alveolarization [1, 2]. Nitric oxide production from L-arginine is catalyzed by nitric oxide synthase isoforms including neuronal, inducible, and endothelial nitric oxide synthase. In parallel, NO can be produced via reduction of nitrite, the source of which is either dietary intake, reported to be low in all
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