Abstract
BACKGROUND: Non-infectious neuroinflammation (NINI) in early life and neonatal neural iron deficiency (nID) have been proposed to contribute to neurodevelopmental dysfunction and disorders, including autism, through toxic effects on neural cells and impaired molecular signaling. Early detection of NINI and nID may enable interventions to restore neurodevelopmental homeostasis and reduce long-term impact. However, such diagnoses are impossible due to ethical reason to access to the central nervous system (e.g., lumbar puncture) when there is no suspicion of brain infection (e.g., meningitis). METHODS: We refined a methodology to isolate and quantify inflammatory and iron-regulatory proteins in high-quality brain-derived extracellular vesicles (BDEVs) from human umbilical cord blood. A preclinical model was used to validate that BDEV contents reflect the brain microenvironment. We then applied this approach to evaluate biomarkers of NINI and nID in BDEVs isolated from cord plasma of newborns of mothers with obesity, a non-infectious pro-inflammatory gestational condition and a risk factor for nID. FINDINGS: Plasma BDEV analytes correlated more strongly with brain analytes and showed stronger associations among functionally related molecules compared with whole plasma analytes. Maternal obesity induced an anti-inflammatory response in the brain compartment, a pro-inflammatory response in the periphery, and functional nID. INTERPRETATION: BDEVs may provide a more sensitive representation of the brain microenvironment than blood-based measures (e.g., plasma), enabling non-invasive, early detection of infants with NINI and neonatal nID. FUNDING: Supported by NIH, the Masonic Institute for Developing Brain, Hennepin Healthcare Research Institute, UnityPoint Health Meriter Foundation, and American Academy of Pediatrics Resident Research Grant. RESEARCH IN CONTEXT: Evidence before this study: Previous studies hypothesized that gestational inflammatory environments (e.g., maternal obesity) increase risk of neonatal neural iron deficiency (nID), neuroinflammation, and neurodevelopmental disorders. However, assessing non-infectious neuroinflammation (NINI) in infants from these high-risk groups is not feasible or clinically justifiable using invasive methods (e.g., cerebrospinal fluid collection), and analytes from whole blood or plasma may not accurately reflect brain physiological status.Added value of this study: We refined a protocol to isolate brain-derived extracellular vesicles (BDEVs) from a small amount of plasma sample (100 µL) and characterized their contents to approximate brain physiology. We demonstrated that BDEVs more accurately reflect brain status compared with whole plasma. In newborns of mothers with obesity during pregnancy, we found evidence of a low-grade peripheral inflammation accompanied by a protective anti-inflammatory response in the brain. Maternal obesity was also found to induce neonatal nID.Implications of all the available evidence: BDEVs can serve as an accurate, non-invasive tool to assess brain condition. In clinical settings, this approach may be used for early diagnosis, monitoring disease progression, and evaluating treatment effects.