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Introduction The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, measures innate-adaptive immune system balance. In this systematic review and meta-analysis, we aim to analyze the current literature to evaluate the diagnostic role of NLR in neonatal sepsis. Methods PubMed, Web of Science, and Scopus were used to conduct a systematic search for relevant publications published before May 14, 2022. Results Thirty studies, including 2328 neonates with sepsis and 1800 neonates in the control group, were included in our meta-analysis. The results indicated that NLR is higher in neonates with sepsis compared to healthy controls (SMD = 1.81, 95% CI = 1.14–2.48, P -value < 0.001) in either prospective (SMD = 2.38, 95% CI = 1.40–3.35, P -value < 0.001) or retrospective studies (SMD = 0.87, 95% CI = 0.63–1.12, P -value < 0.001) with a pooled sensitivity of 79% (95% CI = 62–90%), and a pooled specificity of 91% (95% CI = 73–97%). Also, we found that NLR is higher in neonates with sepsis compared to those who were suspected of sepsis but eventually had negative blood cultures (SMD =1.99, 95% CI = 0.76–3.22, P -value = 0.002) with a pooled sensitivity of 0.79% (95% CI = 0.69–0.86%), and a pooled specificity of 73% (95% CI = 54–85%). In addition, neonates with sepsis had elevated levels of NLR compared to other ICU admitted neonates (SMD = 0.73, 95% CI = 0.63–0.84, P  < 0.001). The pooled sensitivity was 0.65 (95% CI, 0.55–0.80), and the pooled specificity was 0.80 (95% CI, 0.68–0.88). Conclusion Our findings support NLR as a promising biomarker that can be readily integrated into clinical settings to aid in diagnosing neonatal sepsis. As evidenced by our results, restoring balance to the innate and adaptive immune system may serve as attractive therapeutic targets. Theoretically, a reduction in NLR values could be used to measure therapeutic efficacy, reflecting the restoration of balance within these systems.

Virtually all neuropsychiatric disorders display sex differences in prevalence, age of onset, and/or clinical symptomology. Although altered dopamine (DA) signaling is a feature of many of these disorders, sex-dependent mechanisms uniquely responsive to DA that drive sex-dependent behaviors remain unelucidated. Previously, we established that anomalous DA efflux (ADE) is a prominent feature of the DA transporter (DAT) variant Val559, a coding substitution identified in two male-biased disorders: attention-deficit/hyperactivity disorder and autism spectrum disorder. In vivo, Val559 ADE induces activation of nigrostriatal D2-type DA autoreceptors (D2ARs) that magnifies inappropriate, nonvesicular DA release by elevating phosphorylation and surface trafficking of ADE-prone DAT proteins. Here we demonstrate that DAT Val559 mice exhibit sex-dependent alterations in psychostimulant responses, social behavior, and cognitive performance. In a search for underlying mechanisms, we discovered that the ability of ADE to elicit D2AR regulation of DAT is both sex and circuit-dependent, with dorsal striatum D2AR/DAT coupling evident only in males, whereas D2AR/DAT coupling in the ventral striatum is exclusive to females. Moreover, systemic administration of the D2R antagonist sulpiride, which precludes ADE-driven DAT trafficking, can normalize DAT Val559 behavioral changes unique to each sex and without effects on the opposite sex or wildtype mice. Our studies support the sex- and circuit dependent capacity of D2ARs to regulate DAT as a critical determinant of the sex-biased effects of perturbed DA signaling in neurobehavioral disorders. Moreover, our work provides a cogent example of how a shared biological insult drives alternative physiological and behavioral trajectories as opposed to resilience.

Dopamine (DA) signaling dysfunction is believed to contribute to multiple neuropsychiatric disorders including attention-deficit/hyperactivity disorder (ADHD). The rare DA transporter (DAT) coding substitution Ala559Val found in subjects with ADHD, bipolar disorder and autism, promotes anomalous DA efflux in vitro and, in DAT Val559 mice, leads to increased reactivity to imminent handling, waiting impulsivity, and enhanced motivation for reward. Here, we report that, in contrast to amphetamine and methylphenidate, which induce significant locomotor activation, cocaine administration to these mice elicits no locomotor effects, despite retention of conditioned place preference (CPP). Additionally, cocaine fails to elevate extracellular DA. Given that amphetamine and methylphenidate, unlike cocaine, lack high-affinity interactions with the serotonin (5-HT) transporter (SERT), we hypothesized that the lack of cocaine-induced hyperlocomotion in DAT Val559 mice arises from SERT blockade and augmented 5-HT signaling relative to cocaine actions on wildtype animals. Consistent with this idea, the SERT blocker fluoxetine abolished methylphenidate-induced locomotor activity in DAT Val559 mice, mimicking the effects seen with cocaine. Additionally, a cocaine analog (RTI-113) with greater selectivity for DAT over SERT retains locomotor activation in DAT Val559 mice. Furthermore, genetic elimination of high-affinity cocaine interactions at SERT in DAT Val559 mice, or specific inhibition of 5-HT2C receptors in these animals, restored cocaine-induced locomotion, but did not restore cocaine-induced elevations of extracellular DA. Our findings reveal a significant serotonergic plasticity arising in the DAT Val559 model that involves enhanced 5-HT2C signaling, acting independently of striatal DA release, capable of suppressing the activity of cocaine-sensitive motor circuits.

Virtually all neuropsychiatric disorders display sex differences in prevalence, age of onset, and/or clinical symptomology. In sex-biased disorders, one sex is often suggested to harbor protective mechanisms, rendering them resilient to genetic and/or environmental risk factors. Here, we demonstrate sex-biased molecular, pharmacological and behavioral effects induced by the dopamine (DA) transporter (DAT) coding variant Ala559Val, previously identified in subjects diagnosed with the male-biased disorders attention-deficit/hyperactivity disorder and autism spectrum spectrum disorder. In DAT Val559 mice, we identified sex differences in response to psychostimulants, social behavior, and cognitive traits. We reveal a sex by circuit dissociation in D2-type autoreceptor (D2AR) regulation of DAT wherein D2AR-dependent DAT phosphorylation and trafficking, detectable in the male dorsal striatum, does not occur in females but rather is a property of the ventral striatum, predicting sex-specific changes in behavior. Consequently, we found that a subset of altered behaviors can be normalized using the D2R antagonist sulpiride in DAT Val559 mice. Our studies provide a cogent example of how sex shapes the behavioral trajectory of DA signaling perturbations and identify the sex-dependent, locality-selective capacity for D2AR regulation of DAT as an unrecognized determinant of this trajectory. Rather than identifying one sex as resilient, we find that sex can drive alterative behavioral patterns from shared signaling perturbations that may result in females being underreported. Our work underscores the utility of model systems to study the functional intrusions of rare genetic variation to gain insights into pathways underlying normal and perturbed trait domains associated with common neuropsychiatric conditions.