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Clinical value of dysregulated miR-125b-5p in severe pneumonia children

BMC Immunology volume 26, Article number: 31 (2025) Cite this article

Abstract

Background

Severe pneumonia is an important contributor to the high mortality of sick young children. The microRNA-125b-5p (miR-125b-5p), which is widely involved in various cancers, is closely related to a variety of lung diseases. However, its role in severe pneumonia children remains to be studied.

Objective

This study focused on the expression and clinical value of miR-125b-5p in severe pneumonia children.

Materials and methods

The study subjects included 96 pneumonia children and 127 severe pneumonia children. These children were aged between 2-10 years. The expression level of serum miR-125b-5p was assessed by qRT-PCR. The receiver operator characteristic (ROC) curve was employed to identify severe pneumonia children from pneumonia individuals. Kaplan-Meier curve was plotted based on follow-up results and multivariate Cox regression analysis was applied to evaluate the contribution of miR-125b-5p to poor prognostic in severe pneumonia children.

Results

MiR-125b-5p was remarkedly reduced in severe pneumonia children compared to pneumonia individuals. The area under the curve (AUC) was 0.9267 and the sensitivity and specificity were 84.25% and 89.58%, respectively. The accumulative survival rate in low miR-125b-5p group showed a remarkable decrease compared to the high miR-125b-5p group (P = 0.033). Increased procalcitonin (PCT, HR: 2.631, 95% CI: 1.029–6.732, P = 0.043) and reduced miR-125b-5p (HR: 0.301, 95% CI: 0.110–0.826, P = 0.020) were found to be related to the poor prognosis in severe pneumonia children.

Conclusion

The reduced miR-125b-5p was an underlying diagnostic indicator of severe pneumonia and was an independent risk factor of poor prognosis in severe pneumonia children.

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Introduction

Severe pneumonia in children is a severe pulmonary inflammatory disease caused by pathogens. It can disrupt the respiratory function [1] and result in symptoms such as shortness of breath and difficulty breathing [2]. In severe cases, respiratory failure, cardiac function damage, sepsis, meningitis, shock and other serious complications may occure [3]. Pneumonia has been reported to be the leading cause of death in children under 5 years old worldwide [4]. Early identification of risk factors for severe pneumonia contributes to timely prevention and treatment, thus effectively improving survival rate.

MicroRNAs (miRNAs), as endogenous conserved RNAs, have been found to be closely related to a variety of human diseases in recent studies. It has been shown that declined miR-320a/b/c are identified to be associated with the severity level of respiratory failure patients caused by COVID-19 [5]. In severe pneumonia children, highly expressed serum miR-483-3p has been shown to be positively associated with a lower progression-free survival probability and shows promising sensitivity and specificity in clinical diagnosis [6]. Previous studies have highlighted the potential of specifically expressed miRNAs for disease prediction and as biomarkers.

Emerging reports in recent years have confirmed the role of miR-125b-5p dysregulation in various cancers. Downregulated miR-125b-5p has been confirmed in laryngeal squamous cell carcinoma [7], breast cancer [8] and lung squamous cell carcinoma [9]. The miR-125b-5p is also found to play an important role in regulating the normal differentiation of tracheal chondrocytes [10]. A series of studies on lung diseases have also highlighted the regulatory role of miR-125b-5p. It has been demonstrated that miR-125b-5p is down-regulated in both mouse models of pulmonary fibrosis [11] and sepsis-induced lung inflammation and injury [12]. There is also evidence that the upregulation of endothelial cell-derived exosomal miR-125b-5p inhibits sepsis-induced acute lung injury [13]. It is also confirmed that miR-125b-5p is down-regulated in lung adenocarcinoma and is correlated to the level of inflammatory factor Interleukin-6 (IL-6) [14]. Based on the existing reports, we hypothesized that miR-125b-5p expression might be involved in pneumonia or severe pneumonia.

In this study, we focused on the expression level of serum miR-125b-5p in patients and preliminarily explored the potential clinical application of miR-125b-5p in severe pneumonia children.

Materials and methods

Study population

The study objects in this research included 96 pneumonia children and 127 severe pneumonia children. These children were aged between 2-10 years at Taihe Hospital, Affiliated Hospital of Hubei University of Medicine. The diagnosis of severe pneumonia children was based on the PIDS/IDSA criteria [15]. Inclusion criteria: (1) hypoxemia, (2) disturbance of consciousness, (3) significantly increased respiratory rate or dyspnea, (4) food refusal or dehydration, (5) pleural effusion, (6) extrapulmonary complications. Exclusion criteria: (1) asthma, (2) bronchitis, (3) tuberculosis. In addition, 96 patients with common pneumonia who mainly had cough or expectoration during the same period served as controls and the inclusion criteria was dyspnea or abnormal auscultation of the lungs. Before children’s enrollment, permission and informed consent were obtained from the ethics committee and parents or legal guardians, respectively.

Blood sample collection

Fasting venous blood from all participants was collected and allowed to stand at room temperature for half an hour before centrifugation at the low temperature (4 ℃) of 3500 rpm for 12 min. Collected serum samples were then transferred into a −80 ℃ refrigerator for longer storage.

Data collection of study objects

The basic information of patients was recorded when they were enrolled including age and gender. The automatic biochemical analyzer was employed for the measurement of white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), lymphocyte and neutrophils. The measurement of erythrocyte sedimentation rate (ESR) was by automatic ESR analyzer while D-dimer was detected by enzyme-linked immunosorbent assay (ELISA).

qRT-PCR

To estimate the expression level of miR-125b-5p, Trizol (Invitrogen, 12183555CN) was used for RNA extraction. The concentration and purity of each RNA sample were evaluated by the absorbance value at A260nm and the A260/280 ratio measured using a Nanodrop (Thermofisher). Obtained RNAs were timely transcribed into cDNA by reverse transcription kit (Qiagen, 218061), which were stored at −20 conditions. Then, a quantitative analysis kit (Takara, RR420A) was employed for the measurement of miR-125b-5p expression level with the U6 internal reference by 2−ΔΔCt methods. It should be noted that nuclease-free ddH2O was essential for the accuracy of results.

Follow-up

The hospitalized children with severe pneumonia were followed up for 4 weeks. According to the average expression of miR-125b-5p, severe pneumonia children were classified as high miR-125b-5p group and low miR-125b-5p group. During the follow-up, the number of deaths was recorded.

Statistical analysis

Data processing was accomplished via GraphPad Prism 7.0 and SPSS Statistics 23.0. Results were shown as mean ± SD. Student’s t-test and Chi-Square test were used for comparison of continuous variables and categorical variables, respectively. Kaplan-Meier curve with log-rank test was employed to exhibit 4-week follow-up results. Multivariate Cox regression analysis was applied for risk factors of prognosis in severe pneumonia. P < 0.05 indicated statistical difference.

Results

Clinical statistics of study population

A total of 96 children with pneumonia and 127 children with severe pneumonia were enrolled in this study. The clinical characteristics of the patients were compared and exhibited in Table 1. No difference was found in age (P = 0.083), gender (P = 0.941) and lymphocyte (P = 0.073) between 2 groups. On the contrary, a significant increase (P < 0.001) was exhibited in severe pneumonia children in many indicators including C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), neutrophils, erythrocyte sedimentation rate (ESR) and D-dimer, compared to the pneumonia children. Additionally, the white blood cells (WBC) also showed obvious elevation in severe pneumonia group than that in pneumonia group (P = 0.001).

Table 1 Clinical characteristics of the study population
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Expression level of miR-125b-5p

The relative expression level of serum miR-125b-5p was calculated by qRT-PCR. Data showed that the miR-125b-5p was remarkedly suppressed in severe pneumonia children by contrast to children with pneumonia individuals (Fig. 1A, P < 0.001). The above result suggested a possible association between dysregulated miR-125b-5p and severe pneumonia.

Fig. 1
figure 1

Relative expression of miR-125b-5p and diagnostic performance. A The miR-125b-5p was markedly suppressed in severe pneumonia children (n = 127) by contrast to pneumonia children (n = 96) (P < 0.001). B Receiver operator characteristic (ROC) curve of miR-125b-5p. The area under the curve (AUC) was 0.9267 with high sensitivity (84.25%) and specificity (89.58%). *** means P < 0.001

Full size image

Diagnostic performance of miR-125b-5p

Further receiver operator characteristic (ROC) curve was plotted to estimate the potential clinical diagnostic significance of miR-125b-5p. The area under the curve (AUC) was 0.9267 and the sensitivity and specificity were 84.25% and 89.58%, respectively (Fig. 1B), highlighting its potential clinical diagnostic performance for severe pneumonia.

Prognostic value of miR-125b-5p

During follow-up, a total of 17 individuals died. All of these deceased patients were from the severe pneumonia group, and their deaths were primarily attributed to severe pneumonia and its related complications, including respiratory failure and sepsis. Further analysis on the expression level of miR-125b-5p showed an obvious decrease in non-survival compared to individuals in survival group (Fig. 2A, P < 0.001). The Kaplan-Meier curve proved that the accumulative survival rate in low miR-125b-5p group showed a remarkable decrease compared to the high miR-125b-5p group (Fig. 2B, P = 0.033). Thus, reduced miR-125b-5p might serve as an indicator of poor prognosis in children with severe pneumonia. Additional assessment on clinical characteristics confirmed that in the non-survival group, an aberrant increase was observed in PCT (P = 0.003), LDH (P = 0.009) and lymphocyte (P = 0.030) compared to individuals in the survival group (Table 2). Thus, we sought to explore potential risk factors for poor prognosis in children with severe pneumonia. Subsequent multivariate Cox regression analysis demonstrated that increased PCT (HR: 2.631, 95% CI: 1.029–6.732, P = 0.043) and inhibited miR-125b-5p (HR: 0.301, 95% CI: 0.110–0.826, P = 0.020) were independent risk factors of prognosis (Table 3), which were more intuitively displayed in the forest plot (Fig. 2C). Individuals in severe pneumonia group were divided into high miR-125b-5p group (n = 52) and low miR-125b-5p group (n = 75) based on the average miR-125b-5p level. After statistical analysis, we found that 3 deceased individuals were from the high miR-125b-5p group while the remaining were from the low miR-125b-5p group, further highlighting the association between low miR-125b expression and high mortality risk.

Fig. 2
figure 2

Kaplan-Meier curve based on the follow-up results in severe pneumonia children. A Relative miR-125b-5p expression level between survival and non-survival group. B Accumulative survival rate in low miR-125b-5p group was significantly reduced compared to high miR-125b-5p group (P = 0.033). C Forest plot of Cox’s regression results. *** means P < 0.001

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Table 2 Clinical characteristics between survival and non-survival children with severe pneumonia
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Table 3 Multivariate cox regression analysis for overall survival in severe pneumonia children
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Association of miR-125b-5p with clinical indicators

Given the diagnostic performance of miR-125b-5p in severe pneumonia children and its significant reduction in non-survival individuals, we further investigated the correlation between miR-125b-5p expression level and clinical characteristics. Comparison between groups manifested that children in low miR-125b-5p group had higher CRP (P = 0.023), PCT (P = 0.001) and LDH (P < 0.001) as shown in Table 4. Furthermore, a correlation analysis also indicated the close relationship of serum miR-125b-5p levels with CRP (P < 0.0001, r=−0.5828), PCT (P < 0.0001, r=−0.6748) as well as LDH (P < 0.001, r=−0.7154) as presented in Fig. 3.

Table 4 Association of miR-125b-5p level with clinical characteristics in severe pneumonia children
Full size table
Fig. 3
figure 3

The correlation analysis of miR-125b-5p level with CRP (A), PCT(B) as well as LDH (C)

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Discussion

Severe pneumonia is a common critical illness of the respiratory system, which can disrupt the function of multiple organs other than the lungs and lead to serious complications. Besides, it is also a major contributor to mortality in young children. Identification of potential biomarkers can help to take preventive measures in advance and improve prognosis. In this study, we found that the dysregulated miR-125b-5p exhibited promising diagnostic and prognostic performance for children with severe pneumonia.

Given the differential expression of miR-125b-5p in a variety of lung diseases, we first evaluated its expression level in children with pneumonia and severe pneumonia, respectively. Our data indicated that the miR-125b-5p was remarkedly suppressed in children with severe pneumonia by contrast to children with pneumonia. Further ROC curve analysis showing high sensitivity and specificity highlighted its clinical diagnostic significance. Similar findings can also be found in existing reports. For instance, the expression of miR-125b-5p in hepatocellular carcinoma [16] and ovarian cancer [17] showed a downward trend. It has also been reported that in a study of non-small cell lung cancer patients, low miR-125b-5p showed promising diagnostic and prognostic value [18]. In addition, there is also a functional study that the declined miR-125b-5p can aggravate the invasiveness of non-small cell lung cancer [19]. We obtained results consistent with previous reports.

In this study, data from a 4-week follow-up indicated the accumulative survival rate in high miR-125b-5p group was higher than that of low miR-125b-5p group. Scilicet, severe pneumonia children with low miR-125b-5p level might face higher mortality. Our multivariate Cox regression analysis also identified miR-125b-5p as a risk factor of poor prognosis in children with severe pneumonia. From previous reports, we can also find similar conclusions. It has been confirmed that in hepatoma carcinoma the low miR-125b-5p facilitates cancer cell metastasis and is associated with poor prognosis of patients [16]. Furthermore, a study in patients with lung adenocarcinoma has declared that low expression of miR-125b-5p is associated with poor prognosis [20].

To further confirm the association between declined miR-125b-5p and severe pneumonia, 127 hospitalized children with severe pneumonia were divided into high miR-125b-5p group and low miR-125b-5p group according to the mean expression level. Comparison between groups showed higher level of CRP, PCT and LDH in low miR-125b-5p group, indicating the close relationship of miR-125b-5p levels with inflammation levels. Consistently, in a previous study, stem cell-derived exosomal miR-125b-5p is confirmed to alleviate sepsis-induced lung injury by inhibiting inflammation-induced apoptosis [21], indicating the relevance of miR-125b-5p to inflammation. In addition, some studies have found that miR125b-5p can regulate inflammation-related genes [22]. Furthermore, the downregulated miR-125b-5p may modulate the inflammatory response via the IL-6 pathway by targeting STAT3. Current research has verified that miR-125b-5p can target and negatively regulate STAT3 expression [23]. Additionally, both IL-6 and STAT3 are pivotal in inflammation [24] and elevated STAT3 levels drive IL-6 production, thereby amplifying the inflammatory response [25, 26]. It was concluded that the crucial role of miR-125b-5p in severe pneumonia might be related to its mediation in inflammatory response.

Our study also has its limitations. In this study, our focus was on the expression levels of miR-125b-5p in patients with pneumonia and those with severe pneumonia. Regrettably, due to the limitations of the availability of samples, we were unable to include healthy donors from the same period as this study in this analysis. Looking ahead, we intend to expand the sample size and include healthy control subjects in future research to gain a more comprehensive understanding of the role that miR-125b-5p plays in both pneumonia and severe pneumonia. In addition, we principally focused on the clinical diagnostic and poor prognostic value of miR-125b-5p in children with severe pneumonia. It is necessary to explore the mechanism of action in cell and animal models. Additionally, a multicenter study with a large sample size contributes to enhancing the reliability and generalization of the results. We expect to address these issues in future work.

In summary, our study first found the down-regulated miR-125b-5p had high clinical diagnostic value and was an independent risk factor for poor prognosis in severe pneumonia children.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

This study was supported by Grants from the Medical and Health Science and Technology Project of Shandong Province (No.202406031337) and Qin Chuangyuan Traditional Chinese Medicine Innovation Research and Development Transformation Project (No. 2022-QCYZH-037) and Shaanxi Provincial Science and Technology Research and Development Program(No. 2024SF-YBXM-509) and Traditional Chinese Medicine Research Project of Xi’an Municipal Health Commission (No. SZL202101) and Hospital level project of Xi’an Children’s Hospital (No. 2021H07).

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Author notes

  1. Meiqin Zhu and Ziyan Lu contributed equally to this work.

Authors and Affiliations

  1. Department of Respiratory, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), Zhenjiang, 212001, China

    Meiqin Zhu

  2. Department of Pediatrics, Women and Children’s Hospital, Qingdao University, Qingdao, 266011, China

    Ziyan Lu

  3. Department of Pediatrics, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan, 442000, China

    Xingjuan Liao, Qin Liang, Chao Xu & Xinbing Luo

  4. Department of Integrated Traditional Chinese and Western Medicine, Xi’an Children’s Hospital, The Affiliated Children’s Hospital of Xi’an Jiaotong University, No. 69, Xijuyuan Lane, Lianhu District, Xi’an, 710003, China

    Jun Li

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Contributions

X.J. L and Q. L designed the research study. M.Q. Z, Z.Y. L, C. X, X.B. L and J. L performed the research. X.J. L and Q. L analyzed the data and wrote the manuscript. M.Q. Z, Z.Y. L, X.B. L and J. L contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jun Li.

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Ethics approval and consent to participate

The study protocol was approved by The Ethics Committee of Taihe Hospital, Affiliated Hospital of Hubei University of Medicine. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and later versions. Before children’s enrollment, permission and informed consent were obtained from the ethics committee and parents or legal guardians, respectively.

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Zhu, M., Lu, Z., Liao, X. et al. Clinical value of dysregulated miR-125b-5p in severe pneumonia children. BMC Immunol 26, 31 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12865-025-00707-6

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BMC Immunology

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