This study demonstrates that progressive antenatal inflammation reduced the length, number and complexity (arborisation) of basal dendrites, and reduced the numbers of dendritic spines on pyramidal neurons within the somatosensory cortex in late gestation fetal sheep. The reduction in dendritic length and complexity was linked to an increased number of microglia and IL-1β positive staining but was not associated with changes in the number of cortical neurons or cortical area. Functionally, the inflammation-induced reduction in dendritic length and complexity were associated with transient increases in delta (slow wave) activity, reduced beta (fast wave) activity and an overall reduction in the spectral edge frequency of the EEG. Given the association between exposure to perinatal inflammation and reductions in cortical growth and connectivity [6, 7, 33], the novel data obtained in the present study provide critical insight into the deficits in neuronal structure and function arising from antenatal inflammation.
Clinically, gram negative infections, including E. coli, continue to be among the most common pathogens linked to perinatal infection/inflammation and increased risk of perinatal brain injury [34, 35]. We sought to reproduce features of gram-negative infection/inflammation using repeated progressive LPS infusions to promote a chronic fetal inflammatory response that is commonly associated with adverse neurodevelopmental outcomes [24, 36]. By contrast, most of the previous preclinical studies have focused on the pathophysiological consequences of single or repeated bolus doses of LPS or other infectious/inflammatory stimuli [37].
This study showed that inflammation induced by progressive systemic LPS infusion was associated with increased numbers of microglia and greater immunoreactivity of IL-1β in the somatosensory cortex but no significant increases in cortical IL-1β (p = 0.06), IL-6 (p = 0.09) or IL-1ɑ mRNA expression. Consistent with this observation, human post-mortem studies have reported increased microglial numbers and IL-1β immunoreactivity in areas of white and grey matter inflammation and injury [38–40]. Indeed, cerebral recognition of pathogen associated molecular patterns such as LPS by innate immune receptors, including toll like receptor 4, on microglia and other immune cells leads to glial cell activation and nuclear factor kappa B induced transcription of bioactive IL-1β [41]. Furthermore, circulating cytokines, including IL-1β, can penetrate the blood brain barrier [42–44] to recruit and activate microglia within the central nervous system [41]. Thus, the concomitant increase in numbers of microglia and IL-1β immunoreactivity observed in this study strongly supports sustained inflammation in the somatosensory cortex 4 days after beginning intravenous LPS infusions.
In this experimental model of antenatal inflammation, we have previously reported increased concentrations systemic pro and anti-inflammatory cytokines (IL-1β, tumour necrosis factor [TNF], IL-6 and IL-10), in addition to diffuse white matter gliosis and reduced numbers of precursor oligodendrocytes [24]. The present study shows that exposure to inflammation did not affect overall numbers of neurons (NeuN+) or neuronal density in the areas of the somatosensory cortex evaluated in this study, suggesting a lack of overt cortical injury. This is further confirmed by the similar numbers of TUNEL + cells between groups, suggesting no effect of LPS-exposure on numbers of apoptotic cells in the somatosensory cortex. This observation is consistent with neonatal experimental and clinical studies showing limited or no neuronal cell death in cases of perinatal encephalopathy, including after systemic inflammation [10, 45, 46]. By contrast, we observed increased numbers of caspase-3 + cells in LPS-exposed fetuses compared to controls. Indeed, increased numbers of caspsase-3 positive cells without increased cell death has been reported in the adult and perinatal brain [47–50] and is likely to be linked to other roles that caspases play, which include immune/microglial activation and cell differentiation [50–52].
We observed a reduction in neuronal dendritic complexity in LPS-exposed fetuses as shown by reduced dendritic length, numbers of dendritic terminals, dendritic arborisation, and numbers of dendritic spines. In humans, the marked cortical expansion that occurs during the last trimester is thought to reflect the prolific increase in neuronal dendritic growth and complexity that occurs during this stage of development [53, 54]. Our observations suggest that at this period in late gestation, neuronal development within the somatosensory cortex in the developing fetus is highly vulnerable to inflammation-induced impairments in dendritic arborisation and spine formation. These data are consistent with previous studies that reported reduced neuronal arborisation in the frontal cortex of fetal sheep after acute cerebral ischaemia at mid gestation, and reduced dendritic number and spine density in the retrosplenial cortex of newborn rabbits (P1) after a single bolus of intra-amniotic LPS (20µg/kg) [55]. Similarly, in separate rodent studies examining the long-term effects of prenatal and early postnatal LPS-induced inflammation, reduced dendritic arborisation was seen in the motor cortex and medial prefrontal cortex on postnatal days 21 and 60 [10, 56]. Furthermore, these data support a link between diffuse white matter injury, which we have previously reported in the same experimental paradigm [24], and impaired neuronal development. For example, human case series have shown reduced dendritic length in cases of both diffuse and necrotic white matter injury [57, 58]. Similarly, moderate LPS-induced inflammation in neonatal rodents (from P1-P3) was associated with reduced dendritic arborisation in the motor cortex, diffuse white matter injury, and impaired myelination and motor function on postnatal day 21 [10].
The somatosensory cortex has been shown to synapse with cervical excitatory neurons and modulate locomotion independently of the motor cortex [59]. Consistent with this observation, we have previously reported reduced fetal movements in the same fetal sheep paradigm, as shown by reduced nuchal electromyographic activity from 3 days after starting LPS infusions until the time of post-mortem [24]. Although we did not evaluate neuronal complexity within the motor cortex in this study, our data raise the possibility that impaired neuronal development in the somatosensory cortex may contribute to the inflammation-induced reduction in fetal body movements observed in this preclinical model of antenatal infection/inflammation. Taken together, these data further support a close link between impaired neuronal development in the somatosensory cortex and inhibition of motor function.
Whilst the precise mechanism/s underpinning the inflammation-induced impairment in neuronal development are yet to be identified, it is likely to include a direct effect of inflammation on the central nervous system. Indeed, in vitro studies have shown that cortical neurons exposed to inflammatory cytokines, including IL-1β, IL-6, TNF, and interferon gamma, show reductions in dendritic branching and synapse formation [60, 61]. This is supported by our findings of increased numbers of cortical microglia, which are known to secrete proinflammatory cytokines, along with increased IL-1β immunoreactivity observed in LPS exposed fetuses. Microglial processes have also been shown to interact with synapses to eliminate spines, suggesting a direct effect of microglial activation on spine density [62, 63]. Furthermore, reduced circulating concentrations of neural growth factors, including nerve growth factor and brain derived neurotrophic factor, have been reported in human and animal studies of perinatal infection/inflammation [55, 64, 65].
Consistent with the inflammation-induced reduction in neuronal complexity in the present study, neuronal activity in LPS-exposed fetuses was impaired, as shown by an overall reduction in the frequency of EEG activity along with a greater proportion of EEG activity in the delta band and a reduced proportion of activity in the beta band. Collectively, these data indicate loss of high frequency activity after LPS-exposure with a shift to lower frequency activity. As we have previously reported no differences in myelin density or numbers of mature myelinating oligodendrocytes at this timepoint in this cohort of LPS-exposed fetuses [24], the inflammation-induced reduction in high frequency activity may reflect inhibition of synaptic activity. This could be due to reductions in neuronal arborisation and numbers of dendritic spines on cortical neurons directly underlying the EEG electrodes (i.e., a direct functional consequence of inflammation-induced changes in neuronal pathology). Alternatively, elevated central levels of IL-1β were shown to induce NMDA mediated suppression of synaptic function [66]. Similarly, TNF inhibition using the soluble TNF receptor Etanercept reduced the magnitude of EEG suppression in fetal sheep exposed to LPS [67], possibly due to reduced NMDA receptor activation [68]. Furthermore, in vivo, and in vitro studies have shown that both LPS-and IL-1β-induced central inflammation actively mediate EEG suppression through the release of inhibitory neuromodulators such as allopregnanolone and adenosine [69, 70]. Taken together, these data suggest that inflammation-induced suppression of EEG activity is mediated by both the activation of anti-excitotoxic mediators as well as reduced complexity of the neuronal microstructure.
Clinical studies have shown that reduced EEG frequency is strongly predictive of subsequent brain injury and neurodevelopmental impairment in preterm and term infants. For example, in a cohort study, reduced EEG frequency was associated with the severity of neonatal white matter injury [71]. Similarly, depression of the EEG background pattern was associated with both motor and cognitive impairment in preterm and term infants with evidence of central inflammation [72, 73]. Furthermore, increased latency of somatosensory evoked potentials was reported in children with bilateral spastic cerebral palsy. Notably, the latency of somatosensory evoked potentials correlated with a history of exposure to perinatal infection/inflammation [74]. Functional MRI studies have shown reductions in cortical functional connectivity in fetuses exposed to inflammation before birth [33]. Similarly, reduced cortical functional connectivity was observed in preterm infants without evidence of overt cortical injury [75]. Subsequent investigation of infants with moderate to severe white matter injury, but without overt cortical injury, showed a reduction in cortical functional connectivity that correlated with the severity of white matter injury [76]. Our data suggest that in the absence of overt neuronal injury or white matter loss, reduced neuronal complexity and synaptic density may contribute to reduced functional connectivity within and between major grey matter structures after exposure to perinatal inflammation.
In conclusion, this study demonstrates that the inflammation-induced reduction in high frequency spectral band power is associated with reduced cortical neuronal arborisation and dendritic spine density. Collectively, these data support the concept that inflammation-induced impairments in neuronal maturation and function, rather than overt neuronal loss, are key components of the pathophysiological events that contribute to disturbed cortical neuronal growth and connectivity, and subsequently impaired neurodevelopmental outcomes, in infants exposed to perinatal inflammation. We propose that early EEG monitoring combined with neuroimaging modalities that enable more sensitive assessment of brain microstructure [10, 77] and therapeutics designed to mitigate systemic and central inflammation, could provide an effective approach for early detection and faster more effective therapeutic intervention.