Bacterial sepsis is a significant concern for neonates that exhibit a unique immune profile in the first days of life that does not provide adequate protection from infection1. Neonatal sepsis continues to be a significant U.S. healthcare problem accounting for greater than 75,000 cases annually in the U.S alone2. To study these infections in depth, novel animal models that recapitulate aspects of human disease are required. We have established a neonatal mouse infection model using Escherichia coli, O1:K1:H73. E. coli is the second leading cause of neonatal sepsis in the U.S., but responsible for the majority of sepsis-associated mortality4,5. However, it is the leading cause when pre-term and very low birth-weight (VLBW) babies are considered independently5. The K1 serotype is most frequently associated with invasive bloodstream infections and meningitis in neonates6,7. Currently, there are no other treatment options beyond antibiotics and supportive care. Meanwhile, rates of antibiotic resistance continue to rise for many pathogenic bacteria, with some strains of E. coli resistant to a multitude of antibiotics commonly used in treatment8. Thus, it is imperative that we continue to generate methods to study the mechanisms of sepsis and the host response in neonates. These results can help to improve upon current treatments and infection outcomes.
The immune state of neonates is characterized by both phenotypic and functional differences compared to adults. For instance, elevated levels of anti-inflammatory and regulatory cytokines, such as interleukin (IL)-10 and IL-27, have been shown to be produced by cord blood-derived macrophages and are present at greater levels in the serum of murine neonates9,10,11. This is consistent with lower levels of IFN-α, IFN-ɣ, IL-12, and TNF-α that are frequently reported from neonatal cells compared with adult counterparts10. Additionally, the neonatal immune system is skewed toward a Th2 and regulatory T cell response as compared to adults12. Elevated numbers of neutrophils, T cells, B cells, NK cells, and monocytes are also present in neonates, but with significant functional impairments. This includes defects in expression of cell surface markers and antigen presentation that suggest immaturity13,14,15. Additionally, neonatal neutrophils are significantly deficient in their ability to migrate to chemotactic factors16. Myeloid-derived suppressor cells (MDSCs) are also found at elevated levels in neonates and recently shown to be a source of IL-2711. MDSCs are highly suppressive toward T cells17. Collectively, these data demonstrate limitations in neonatal immunity that lend to increased susceptibility to infection.
To study the progression of the bacterial burden and dissect protective host immune responses during neonatal sepsis, we have developed a novel infection model. Neonatal mice at days 3-4 of life are difficult to inject in the intraperitoneal space or tail vein. In our model, day 3 or 4 pups are administered the bacterial inoculum or PBS subcutaneously into the scapular region. A systemic infection develops and using luminescent E. coli O1:K1:H7, we can longitudinally image individual neonatal mice to follow the disseminated bacterial burden in peripheral tissues. This is the first reported model to utilize intravital imaging to understand the kinetics of dissemination of bacteria during sepsis in murine neonates3.
Here, we describe a protocol to induce septic E. coli infections in neonatal mice3. We describe how to prepare the bacterial inoculum for injection, and how to harvest tissue for assessment of pathology, measurement of inflammatory markers by gene expression analysis, and enumeration of the bacterial burden. In addition, the use of luminescent E. coli for intravital imaging of infected neonates and quantification of bacterial killing by neonatal immune cells is also described. These protocols may also be adapted to study other important bacterial infections in neonates. The data presented here represents an overall novel approach to understanding infection dynamics in a translatable neonatal sepsis model.