Abstract
Toll-like receptors (TLRs) are crucial transmembrane receptors that form part of the innate immune response. They play a role in the recognition of various microorganisms and their elimination from the host. TLRs have been proposed as vital immunomodulators in the regulation of multiple neonatal stressors that extend beyond infection such as oxidative stress and pain. The immune system is immature at birth and takes some time to become fully established. As such, babies are especially vulnerable to sepsis at this early stage of life. Findings suggest a gestational age-dependent increase in TLR expression. TLRs engage with accessory and adaptor proteins to facilitate recognition of pathogens and their activation of the receptor. TLRs are generally upregulated during infection and promote the transcription and release of proinflammatory cytokines. Several studies report that TLRs are epigenetically modulated by chromatin changes and promoter methylation upon bacterial infection that have long-term influences on immune responses. TLR activation is reported to modulate cardiorespiratory responses during infection and may play a key role in driving homeostatic instability observed during sepsis. Although complex, TLR signaling and downstream pathways are potential therapeutic targets in the treatment of neonatal diseases. By reviewing the expression and function of key Toll-like receptors, we aim to provide an important framework to understand the functional role of these receptors in response to stress and infection in premature infants.
Highlights
Life requires complex physiological integration and adaptation to maintain homeostasis
Sexual dimorphisms within the immune system of preterm neonates may account for the sex disparity in the incidence of several morbidities observed in this population, including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity, and cerebral hemorrhage [60]
Human and murine TLR2 gene expression is controlled by distinct, nonconserved regulatory elements, with some regions located in a cytosine-phosphate-guanine (CpG) island that modulates TLR2 gene repression (Fig. 4)
Summary
Am J Physiol Regul Integr Comp Physiol 321: R879–R902, 2021. Targeting the Toll-like receptor pathway as a therapeutic strategy for neonatal infection.
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