RESUMEN
OBJECTIVE: There is growing evidence on the usefulness of biomarkers in the early detection of preterm infants at risk for brain damage. However, among different tools Activin A, S100B protein and adrenomedullin assessment offer the possibility to investigate brain/multiorgan function and development. This could be especially useful in perinatal medicine that requires even more non-invasive techniques in order to fulfill the minimal handling in diagnostic and therapeutic strategy performance. MATERIALS AND METHODS: The concept of Unconventional Biological Fluid (UBF: urine and saliva) is becoming even stronger and regards the assessment in non-invasive biological fluids of biochemical markers involved in the cascade of events leading to brain damage. RESULTS: Activin A, S100B protein and adrenomedullin in UBF were increased in preterm newborns developing brain damage and/or ominous outcome. CONCLUSIONS: The present manuscript offers an update on the usefulness of Activin A, S100B protein an adrenomedullin in UBF as brain damage markers. The findings open a new cue on the use of these markers in daily neonatal intensive care unit (NICU) activities.
Asunto(s)
Biomarcadores/análisis , Lesiones Encefálicas/diagnóstico , Enfermedades del Prematuro/diagnóstico , Recien Nacido Prematuro , Activinas/análisis , Activinas/genética , Activinas/metabolismo , Adrenomedulina/análisis , Adrenomedulina/genética , Adrenomedulina/metabolismo , Biomarcadores/líquido cefalorraquídeo , Biomarcadores/metabolismo , Biomarcadores/orina , Lesiones Encefálicas/líquido cefalorraquídeo , Lesiones Encefálicas/metabolismo , Lesiones Encefálicas/orina , Humanos , Recién Nacido , Recien Nacido Prematuro/líquido cefalorraquídeo , Recien Nacido Prematuro/metabolismo , Recien Nacido Prematuro/orina , Enfermedades del Prematuro/líquido cefalorraquídeo , Enfermedades del Prematuro/metabolismo , Enfermedades del Prematuro/orina , Factores de Crecimiento Nervioso/análisis , Factores de Crecimiento Nervioso/genética , Factores de Crecimiento Nervioso/metabolismo , Subunidad beta de la Proteína de Unión al Calcio S100 , Proteínas S100/análisis , Proteínas S100/genética , Proteínas S100/metabolismo , Saliva/química , Saliva/metabolismoRESUMEN
Hypoxia-ischemia (H-I) constitutes the main phenomenon responsible for brain-blood barrier permeability modifications leading to cerebral vascular auto-regulation loss in newborns. Hypotension, cerebral ischemia, and reperfusion are the main events involved in vascular auto-regulation loss leading to cell death and tissue damage. Reperfusion could be critical since organ damage, particularly of the brain, may be amplified during this period. An exaggerated activation of vasoactive agents, of calcium mediated effects could be responsible for reperfusion injury (R-I), which, in turns, leads to cerebral hemorrhage and damage. These phenomena represent a common repertoire in newborns complicated by perinatal acute or chronic hypoxia treated by risky procedures such as mechanical ventilation, nitric oxide supplementation, brain cooling, and extracorporeal membrane oxygenation (ECMO). Despite accurate monitoring, the post-insult period is crucial, as clinical symptoms and standard monitoring parameters may be silent at a time when brain damage is already occurring and the therapeutic window for pharmacological intervention is limited. Therefore, the measurement of circulating biochemical markers of brain damage, such as vasoactive agents and nervous tissue peptides is eagerly awaited in clinical practice to detect high risk newborns. The present review is aimed at investigating the role of biochemical markers such as adrenomedullin, a vasoactive peptide; S100B, a calcium binding protein, activin A, a glycoprotein, in the cascade of events leading to I-R injury in newborns complicated by perinatal asphyxia.