Dual inhibition of complement C5 and CD14 attenuates inflammation in a cord blood model

Background Escherichia coli and Group B streptococci (GBS) are the main causes of neonatal early-onset sepsis (EOS). Despite antibiotic therapy, EOS is associated with high morbidity and mortality. Dual inhibition of complement C5 and the Toll-like receptor co-factor CD14 has in animal studies been a promising novel therapy for sepsis. Methods Whole blood was collected from the umbilical cord after caesarean section ( n = 30). Blood was anti-coagulated with lepirudin. C5 inhibitor (eculizumab) and anti-CD14 was added 8 min prior to, or 15 and 30 min after adding E. coli or GBS. Total bacterial incubation time was 120 min ( n = 16) and 240 min ( n = 14). Cytokines and the terminal complement complex (TCC) were measured using multiplex technology and ELISA. Results Dual inhibition significantly attenuated TCC formation by 25-79% when adding inhibitors with up to 30 min delay in both E. coli - and GBS-induced inflammation. TNF, IL-6 and IL-8 plasma concentration were significantly reduced by 28–87% in E. coli -induced inflammation when adding inhibitors with up to 30 min delay. The dual inhibition did not significantly reduce TNF, IL-6 and IL-8 plasma concentration in GBS-induced inflammation. Conclusion Dual inhibition of C5 and CD14 holds promise as a potential future treatment for severe neonatal EOS. Impact Neonatal sepsis can cause severe host inflammation with high morbidity and mortality, but there are still no effective adjunctive immunologic interventions available. Adding CD14 and complement C5 inhibitors up to 30 min after incubation of E. coli or Group B streptococci in a human umbilical cord blood model significantly reduced complement activation and cytokine release. Dual inhibition of C5 and CD14 is a potential future therapy to modulate systemic inflammation in severe cases of neonatal sepsis.