Spatial Transcriptomics and Network-Based Bioinformatics Differentiate Intestinal Phenotypes of Cardiac and Classical Necrotizing Enterocolitis

Classical necrotizing enterocolitis (classical NEC) is a devastating gastrointestinal disease of the neonatal period, and cardiac NEC is a subset of the disease occurring in infants with comorbid congenital heart disease. Despite nearly identical symptomatology, the two NEC subtypes may represent etiologically distinct diseases. We used spatial transcriptomics and network analyses to compare tissue regions of interest derived from surgically resected ileum of patients with cardiac and classical NEC, finding evidence classical and cardiac NEC may arise from differing etiologies. Overall design: Surgically resected ileum from 2 patients with cardiac NEC (14 total regions of interest) and 5 patients with classical NEC (42 total regions of interest) were used for spatial transcriptomics analysis. Roughly equal numbers of immune-rich (CD45+) and epithelial-rich (PanCK+) regions of interests were selected per patient.