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
ARTICLE HIGHLIGHTS
Research background

The delivery mode may impact newborn’s immune system with possible short-term and long-term consequences. Several studies suggest that caesarian section (C-section) may come at a price for the newborn. C-section delivery prevents the exposure of newborn to the mother’s microbiome in the birth canal. Whereas vaginal delivery and exposure to maternal microbiota via breastfeeding are evolutionary important to the newborn’s development and health. However, the impacts of mode of delivery in twins is not fully understood.

Research motivation

Disrupting the mother-to-child transmission of microbiota by C-sections may result in increased risk of asthma, celiac disease, obesity and autoimmune diseases. Thus, investigating the impact of delivery mode on newborns immune system development is crucial for protecting this highly fragile population.

Research objectives

We investigated whether delivery mode by C-section compared to vaginal delivery in twins can influence the immunological components of their cord blood and placenta. In addition, our aim was to determine if C-section delivery impacts the frequency of CD71+ erythroid cells in cord blood and placenta tissues.

Research methods

We performed immune cells isolation from fresh cord blood and placenta tissues. Then, immunophenotyping was performed for different immune cell subsets in cord blood and placenta of twins. Finally, CD71+ erythroid cells were isolated for RNA isolation and quantitative polymerase chain reaction PCR (qPCR) analysis.

Research results

Our results indicated lower frequency of immune cells in cord blood of C-section delivered newborn compared to the vaginally delivered newborn. In contrast, we observed higher percentages of monocytes and neutrophils in placenta tissues of C-section delivered newborns and higher expression of inhibitory receptors on T cells. More importantly, we found lower frequency of CD71+ erythroid cells in both cord blood and placenta of C-section delivered newborn compared to the vaginally delivered newborn. Interestingly, CD71+ erythroid cells from C-section delivered newborn had a different gene profile compared to the vaginally delivered one.

Research conclusions

Our study provides another piece of evidence that delivery mode can influence the newborn’s immune system. In particular, we have investigated this in a case of twins one delivered by C-section while the other by vaginal route. We have shown for the very first time that mode of delivery impacts the frequency and functionality of CD71+ erythroid cells in cord blood and placenta tissues. Our findings suggest mode of delivery may result in immunological changes with possible long-term effects on the offspring.

Research perspectives

C-section delivery may negatively impact neonatal immune system. Our study is a clear example indicating immunological differences in cord blood and placenta tissues of twins. Further longitudinal studies are required to investigate potential short-term and long-term impacts of C-section vs vaginally delivery in twins.