Neuronal Exosome Proteins: Novel Biomarkers for Predicting Neonatal Response to Therapeutic Hypothermia.

ObjectiveCentral nervous system (CNS) derived exosomes can be purified from peripheral blood and have been used widely in adult neurological disease. Application to neonatal neurological disease deserves investigation in the setting of hypoxic–ischaemic encephalopathy (HIE).DesignObservational cohort.SettingLevel III neonatal intensive care unit.ParticipantsTerm/near-term neonates undergoing therapeutic hypothermia (TH) for HIE.InterventionsBlood samples were collected at 0–6, 12, 24, 48 and 96 hours of life.Main outcomes and measuresCNS exosomes were purified from serum using previously described methods. Biomarker protein levels were quantified using standard ELISA methods and normalised to exosome marker CD-81. The slope of change for biomarker levels was calculated for each time interval. Our primary outcome was MRI basal ganglia/watershed score of ≥3.Results26 subjects were included (umbilical artery pH range 6.6–7.29; 35% seizures). An increasing MRI injury score was significantly associated with decreasing levels of synaptopodin between 0–6 and 12 hours (p=0.03) and increasing levels of lipocalin-2 (NGAL) between 12 and 48 hours (p<0.0001). Neuronal pentraxin was not significant. The negative predictive values for increasing synaptopodin and decreasing NGAL was 70.0% and 90.9%, respectively.Conclusions and relevanceOur results indicate that CNS exosome cargo has the potential to act as biomarkers of the severity of brain injury and response to TH as well as quantify pharmacological response to neuroactive therapeutic/adjuvant agents. Rigorous prospective trials are critical to evaluate potential clinical use of exosome biomarkers.