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A systematic review of immune-based interventions for perinatal neuroprotection: closing the gap between animal
Sharmony B Kelly1,2, Nhi T Tran1, Graeme R Polglase1,2
1The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, VIC, 3168, Australia.
Insights
Perinatal infection can cause brain injury. This review found anti-inflammatory therapies, especially anti-interleukin-1, show promise for neuroprotection, but better study design is needed for clinical use.
Area of Science:
- Neuroscience
- Immunology
- Developmental Biology
Background:
- Perinatal infection and inflammation increase the risk of neonatal neurological injury and neurodevelopmental impairment.
- Current anti-inflammatory interventions lack clinical establishment due to diverse therapeutic targets.
- Preclinical evidence for immunomodulation in the perinatal brain necessitates systematic review.
Conclusions:
- Anti-inflammatory therapies represent promising strategies for preventing and treating perinatal brain injury.
- Anti-IL-1 therapies show strong potential for neuroprotection in preclinical models.
- Improving preclinical study design, addressing methodological gaps, is crucial for successful clinical translation.
Background:
Perinatal infection/inflammation is associated with a high risk for neurological injury and neurodevelopmental impairment after birth. Despite a growing preclinical evidence base, anti-inflammatory interventions have not been established in clinical practice, partly because of the range of potential targets. We therefore systematically reviewed preclinical studies of immunomodulation to improve neurological outcomes in the perinatal brain and assessed their therapeutic potential.
Methods:
We reviewed relevant studies published from January 2012 to July 2023 using PubMed, Medline (OvidSP) and EMBASE databases. Studies were assessed for risk of bias using the SYRCLE risk of bias assessment tool (PROSPERO; registration number CRD42023395690).
Results:
Forty preclinical publications using 12 models of perinatal neuroinflammation were identified and divided into 59 individual studies. Twenty-seven anti-inflammatory agents in 19 categories were investigated. Forty-five (76%) of 59 studies reported neuroprotection, from all 19 categories of therapeutics. Notably, 10/10 (100%) studies investigating anti-interleukin (IL)-1 therapies reported improved outcome, whereas half of the studies using corticosteroids (5/10; 50%) reported no improvement or worse outcomes with treatment. Most studies (49/59, 83%) did not control core body temperature (a known potential confounder), and 25 of 59 studies (42%) did not report the sex of subjects. Many studies did not clearly state whether they controlled for potential study bias.
Conclusion:
Anti-inflammatory therapies are promising candidates for treatment or even prevention of perinatal brain injury. Our analysis highlights key knowledge gaps and opportunities to improve preclinical study design that must be addressed to support clinical translation.
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