Blood sLOX-1 Is Beneficial for Determining Severity of Neonatal Hypoxic-Ischemic Encephalopathy: A Nationwide Prospective Cohort Study.

Background/Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) is a major cause of neurodevelopmental diseases. In a previous retrospective study, we revealed that the levels of the soluble form of lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) are linked to HIE severity. We conducted a prospective investigation to evaluate the association between sLOX-1 levels and HIE severity using the Sarnat staging system, as well as a multicenter study to assess neurodevelopmental sequelae in the short term. Methods: A total of 193 infants were enrolled in the study between April 2018 and March 2021. We divided the infants into groups as follows: infants without HIE were assigned to a normal control group, and those with HIE to mild, moderate, and severe HIE groups. We measured 191 samples, excluding three participants. The distribution of 191 participants was as follows: 88 normal samples of 50 umbilical cord (UC) arteries and 38 venous blood samples (control; CTL), as well as 103 HIE samples of 34 mild, 55 moderate, and 14 severe HIE samples. All the plasma samples were collected until 6 h after birth. Results: The mean sLOX-1 value in the CTL group was 613 pg/mL (IQR: 474-925 pg/mL) and that in the UC group was 497 pg/mL (IQR: 337-693 pg/mL), with no significant difference (p = 0.136). The mean sLOX-1 value in the mild HIE group was 1030 pg/mL (IQR: 658-1547 pg/mL), 1026 pg/mL (IQR: 710-2051 pg/mL) in the moderate HIE group, and 1444 pg/mL (IQR: 766-3927 pg/mL) in the severe HIE group. There were significant differences between the CTL and HIE groups (p = 0.006) and between the CTL and mild HIE groups (p < 0.05), but not between the mild HIE and the moderate and severe HIE groups (p = 0.088). The other blood markers exhibited no correlation with Sarnat severity. Interestingly, blood sLOX-1 levels increased with Sarnat severity. Conclusions: The results of this study indicated that sLOX-1 level was correlated with Sarnat severity. Moreover, early assessment of sLOX-1 level may be useful for deciding whether to induce therapeutic hypothermia and/or other treatments, and sLOX-1 may serve as a short-term outcome biomarker of HIE.
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Oshima Oshima, Aoki Aoki, Akamatsu Akamatsu, Matsuyama Matsuyama, Takahashi Takahashi, Obonai Obonai, Shimizu Shimizu, Okazaki Okazaki, Shibasaki Shibasaki, Iwata Iwata, Sakakibara Sakakibara, Kushima Kushima, Masumoto Masumoto, Kinoshita Kinoshita, Kajikawa Kajikawa, Kono Kono, Maeno Maeno, Nagaya Nagaya, Shirai Shirai, Naito Naito, Oka Oka, Itoh Itoh
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