title: Hyperferritinemia and markers of inflammation and oxidative stress in the cord blood of HIV-exposed, uninfected (HEU) infants.
abstract: OBJECTIVE
  The purpose of this study was to evaluate markers of iron status and inflammation/oxidative stress in maternal and cord blood (CB) of HIV-infected and HIV-uninfected women as potential mechanisms for poor outcomes among HIV-exposed, uninfected (HEU) infants.
  
  
  METHODS
  Maternal venous blood and CB specimens were obtained from 87 pregnant women (45 HIV-infected and 42 HIV-uninfected) enrolled at Kalafong Hospital, Pretoria, South Africa. Iron status [serum iron, ferritin and transferrin concentrations, transferrin saturation, soluble transferrin receptor (sTfR) concentration and the sTfR/log ferritin (sTfR/F) index], antenatal exposure to inflammation (CB C-reactive protein and interleukin-6 concentrations and haptoglobin switch-on status) and oxidative stress [total radical trapping ability of CB plasma (TRAP) and chronic oxidative stress (soluble receptor of advanced glycation end-products (sRAGE) concentration] were assessed in laboratory studies.
  
  
  RESULTS
  There were no differences between the HIV-infected and HIV-uninfected groups in maternal haematological and iron indices, except that HIV-infected mothers had decreased white blood cell counts (P = 0.048) and increased serum ferritin concentrations (P = 0.032). Ferritin levels were significantly higher in CB than in maternal blood (P < 0.001) in both groups and further elevated in the CB of HEU infants (P = 0.044). There was also an inverse relationship between CB sTfR/F index and sRAGE (r = -0.43; P = 0.003) in the HIV-infected but not in the HIV-uninfected group.
  
  
  CONCLUSIONS
  Our study showed for the first time that ferritin was significantly elevated in CB of HEU infants. The inverse relationship between sTfR/F index and sRAGE in CB suggests that chronic oxidative stress or RAGE axis activation in HIV-infected mothers may play a role in modulating ferritin levels.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Selvam
authors.affiliation: Center for Perinatal Research, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
authors.forename: I A
authors.initials: IA
authors.lastname: Buhimschi
authors.affiliation: Department of Obstetrics and Gynaecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa.
authors.forename: J D
authors.initials: JD
authors.lastname: Makin
authors.affiliation: Department of Obstetrics and Gynaecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa.
authors.forename: R C
authors.initials: RC
authors.lastname: Pattinson
authors.affiliation: Medical Research Council Unit for Inflammation and Immunity, Department of Immunology, University of Pretoria, Pretoria, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Anderson
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Forsyth
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D005260:Female; D005293:Ferritins / Q000097:blood*; D005312:Fetal Blood / Q000737:chemistry*; D015658:HIV Infections / Q000097:blood*; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007501:Iron / Q000097:blood*; D018384:Oxidative Stress / Q000502:physiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood*; D061250:Transferrins / Q000097:blood*
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D061250:Transferrins; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron
keywords: HIV-exposed; cord blood markers; ferritin; inflammation in HIV infection; iron status in HIV infection; oxidative stress in HIV infection; uninfected (HEU) infants