Predicting neonatal health outcomes from placental and fetal brain extracellular vesicles in pregnant opioid users

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Project Summary We are submitting this proposal in response to RFA-HD-23-032 (HEAL initiative: Opioid Exposure and Effects on Placenta Function, Brain Development, and Neurodevelopmental Outcomes). The rate of newborns with neonatal opioid withdrawal syndrome (NOWS) increased dramatically over the past decade. NOWS has long-term health consequences including poor growth, seizures, and altered neurodevelopmental and cognitive function. However, not all neonates exposed to opioids during gestation develop NOWS or require treatment. It is impossible to predict which infants will experience NOWS and require pharmacotherapy. Maternal opioid dose is not a predictor for NOWS, and though genetics and co-exposure to other drugs have been associated with NOWS severity, no factors have been identified that predict NOWS risk. Further, the mechanisms by which some infants develop NOWS while others do not are not understood. Accessible biomarkers of changes induced by opioid use for the placental and fetal brain would be highly valuable for deciding which infants will need opioid therapy for NOWS and making personalized risk assessments for opioid exposed infants. They could also shed light on the biological pathways that lead to the worst effects of opioid exposure during gestation. Extracellular vesicles (EVs) derived from the Placenta (PEV) or Fetal brain and central Nervous system (FNEV) can cross the fetal/placental barrier and can be isolated from maternal blood. They represent a powerful accessible tool to provide insight on placental health and fetal neurodevelopment and damage. This project will characterize PEVs and FNEVs profiles in healthy pregnancies and from pregnancies complicated by opioid use disorder, stratified by need for NOWS pharmacotherapy. For PEVs, we will focus on a panel of placental stress and serotonin processing markers, and for FNEVs we will focus on markers reported to be altered in the brains following opioid exposure during gestation. Our studies will lead to assays that define NOWS risk pre-birth and will bring new insights into the molecular pathways impacted by opioid use.