Akhil Maheshwari

Akhil Maheshwari is a neonatologist.

Academic career

In 2004, Maheshwari joined the University of Alabama at Birmingham, Alabama as an assistant professor. He studied innate immunity and the pathogenesis of gut mucosal and systemic inflammation in newborn infants, with a particular focus on a disease called necrotizing enterocolitis (NEC). In this disease, the intestines of a premature or critically-ill infant become inflamed and lose viability. His research was supported by the American Gastroenterological Association and the National Institutes of Health.

In 2010, he moved to the University of Illinois College of Medicine at Chicago, Illinois as the Head of Neonatology.

In 2014, he was recruited to the University of South Florida as the Pamela and Leslie Muma Professor, Head of Neonatology, and Assistant Dean for Medical Education. He administered the academic and the clinical programs at the neonatal intensive care unit at Tampa General Hospital. In his laboratory, he investigated the role of intestinal macrophages and platelets in intestinal inflammation.

In 2018, he relocated to the Johns Hopkins University School of Medicine, Baltimore, Maryland as the Josephine S. Sutland Professor of Newborn Medicine, Head of Neonatology, and Vice-Chairman of the Department of Pediatrics.

After having led neonatology programs at several institutions over a decade, Maheshwari relinquished these administrative positions to pursue his academic goals and to found the Global Newborn Society, In recognition of his academic and public health efforts, he was made a Fellow of the Royal College of Physicians, Edinburgh in 2022.

Research

Maheshwari has researched the mechanisms of inflammation in newborn infants, particularly in their intestinal tract. He has published over 150 peer-reviewed articles, as well as medical textbooks on neonatology. His research work has covered the following topics:

Inflammatory changes in the intestine of newborn infants

Maheshwari has investigated the mechanisms involved in the recruitment of white blood cells into the inflamed intestine during NEC. He has also evaluated the importance of decreased blood monocyte and platelet counts for early diagnosis of NEC in these patients. Some of his studies have focused on intracellular molecular mechanisms of NEC, and helped identify some genetic markers or changes in gene expression as risk/diagnostic markers of NEC.

Inflammatory hyper-reactivity of white blood cells such as macrophages in the newborn intestine

Maheshwari has shown that immature macrophages in a newborn infant’s intestinal wall get overly activated upon exposure to bacteria because the intestines of newborn infants are deficient in a suppressant protein called transforming growth factor-beta (TGF-β), especially the isoform, TGF-β2. This hyper-reactivity of the white blood cells can explain the intense inflammation seen in NEC. His team has identified many ways to increase the expression and activity of TGF-β in the newborn intestine and human milk.

Intestinal inflammation in severely anemic infants after RBC transfusions

Premature and critically ill babies often develop severe anemia. In anemic infants, insufficient tissue oxygenation can disrupt the intestinal barrier and the bacteria normally present in the gut lumen can then invade the intestinal wall and the bloodstream. The intestine of a newborn infant does contain macrophages to defend against these bacteria, but these cells are functionally immature and can get overly activated if blood transfusions are given to correct this anemia. Maheshwari and his coworkers have confirmed these findings in human infants and laboratory models.

Role of platelets in intestinal inflammation

Most premature infants with NEC-related intestinal inflammation have decreased blood platelet counts, which increases the risk of bleeding both locally and in vital organs such as the brain. Decreased platelet counts are dangerous, but platelet transfusions are also not safe. Transfused platelets can augment inflammation both in the NEC-affected bowel and in other organ systems. Maheshwari and his team has investigated the involved mechanisms and identified potential treatment approaches.

See also

• Newborn infants
• Child mortality