Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2018; 24(42): 4787-4797
Published online Nov 14, 2018. doi: 10.3748/wjg.v24.i42.4787
Mode of delivery by an ulcerative colitis mother in a case of twins: Immunological differences in cord blood and placenta
Garett Dunsmore, Petya Koleva, Reed Taylor Sutton, Lindsy Ambrosio, Vivian Huang, Shokrollah Elahi
Garett Dunsmore, Shokrollah Elahi, Department of Dentistry and Department of Medical Microbiology and Immunology, University of Alberta, Edmonton T6G2E1, Alberta, Canada
Petya Koleva, Department of Dentistry, University of Alberta, Edmonton T6G2E1 Alberta, Canada
Reed Taylor Sutton, Lindsy Ambrosio, Division of Gastroenterology, University of Alberta, Edmonton T6G2E1, Alberta, Canada
Vivian Huang, Division of Gastroenterology, University of Alberta, Edmonton, T6G 2E1, Alberta, Canada and Division of Gastroenterology, University of Toronto, Mount Sinai Hospital, Sinai Health System, Toronto, M5G 1X5, Ontario, Canada
Author contributions: Dunsmore G performed immunology research, analyzed data, wrote the first draft of paper; Koleva P performed PCR research and analyzed data; Sutton TR and Ambrosio L recruited patient and collected clinical data; Huang V designed and performed research; Elahi S conceived and designed research, analyzed data and wrote the manuscript.
Supported by a Foundation Scheme grant and a New Investigator Salary Award from the Canadian Institutes of Health Research (both to Elahi S); and an innovation grant from Women and Children’s Health Research Institute (to Huang V and Elahi S).
Institutional review board statement: This study was reviewed and approved by the review board of the University of Alberta.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: All authors declare that there are no competing interests.
Data sharing statement: No additional data are available to share.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shokrollah Elahi, MD, PhD, Associate Professor, Department of Dentistry and Department of Medical Microbiology and Immunology, University of Alberta, 7020L, Katz Group Centre for Pharmacology and Health Research, 11361-87th Ave NW, Edmonton T6G2E1, Alberta, Canada. elahi@ualberta.ca
Telephone: +1-780-4921336 Fax: +1-780-4927466
Received: July 23, 2018
Peer-review started: July 23, 2018
First decision: August 25, 2018
Revised: August 29, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: November 14, 2018
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: Caesarian section, Twins, Vaginal delivery, Immunophenotyping, CD71+ erythroid cells, Cord blood, Placental tissues

Core tip: Mode of delivery may influence the immune system of offspring with possible long-term consequences. We report a case of twins one of which delivered vaginally while the other delivered by caesarian section (C-section). We found lower frequency of immune cells in the cord blood and placenta of C-section delivered compared to vaginally delivered newborn. However, higher percentage of neutrophils was observed in the placenta of C-section delivered newborn. Interestingly, for the very first time we found lower percentages of immunosuppressive CD71+ erythroid cells in both cord blood and placenta tissues of C-section delivered offspring. Thus, mode of delivery can modulate the immune system of newborn. In particular, lower frequency of CD71+ erythroid cells and its potential impact on adaptation to microbiome merits further investigations.