The induced prostaglandin E2 pathway is a key regulator of the respiratory response to infection and hypoxia in neonates

Infection during the neonatal period commonly induces apnea episodes, and the proinflammatory cytokine IL-1 beta may serve as a critical mediator between these events. To determine the mechanism by which IL-1 beta depresses respiration, we examined a prostaglandin E-2, (PGE(2))-dependent pathway in newborn mice and human neonates. IL-1 beta and transient anoxia rapidly induced brainstem-specific microsomal prostaglandin E-2 synthase-1 (mPGES-1) activity in neonatal mice. Furthermore, IL-1 beta reduced respiratory frequency during hyperoxia and depressed hypoxic gasping and autoresuscitation in mPGES-1 wild-type mice, but not in mPGES-1 knockout mice. In wild-type mice, PGE(2) induced apnea and irregular breathing patterns in vivo and inhibited brainstem respiratory rhythm generation in vitro. Mice lacking the EP3 receptor (EP3R) for PGE(2) exhibited fewer apneas and sustained brainstem respiratory activity, demonstrating that PGE(2) exerts its respiratory effects via EP3R. In human neonates, the infectious marker C-reactive protein was correlated with elevated PGE(2) in the cerebrospinal fluid, and elevated central PGE(2) was associated with an increased apnea frequency. We conclude that IL-1 beta adversely affects breathing and its control by mPGES-1 activation and PGE(2) binding to brainstem EP3 receptors, resulting in increased apnea frequency and hypoxia-induced mortality.