It is well understood that hypoxic-ischemic (HI) brain injury during the highly vulnerable perinatal period can lead to cerebral palsy, the most prevalent cause of chronic disability in children. Recently, human clinical trials have reported safety and some efficacy following treatment of cerebral palsy using umbilical cord blood (UCB) cells. UCB is made up of many different cell types, including endothelial progenitor cells (EPCs), T regulatory cells (Tregs), and monocyte-derived suppressor cells (MDSCs). How each cell type contributes individually towards reducing neuroinflammation and/or repairing brain injury is not known. In this study, we examined whether human (h) UCB, or specific UCB cell types, could reduce peripheral and cerebral inflammation, and promote brain repair, when given early after perinatal HI brain injury. HI brain injury was induced in postnatal day (PND) 7 rat pups and cells were administered intraperitoneally on PND 8. Behavioral testing was performed 7 days post injury, and then, brains and spleens were collected for analysis. We found in vitro that all UCB cell types, except for EPCs, were immunomodulatory. Perinatal HI brain injury induced significant infiltration of CD4+ T cells into the injured cerebral hemisphere, and this was significantly reduced by all hUCB cell types tested. Compared to HI, UCB, Tregs, and EPCs were able to reduce motor deficits, reduce CD4+ T cell infiltration into the brain, and reduce microglial activation. In addition to the beneficial effects of UCB, EPCs also significantly reduced cortical cell death, returned CD4+ T cell infiltration to sham levels, and reduced the peripheral Th1-mediated pro-inflammatory shift. This study highlights that cells found in UCB is able to mediate neuroinflammation and is an effective neuroprotective therapy. Our study also shows that particular cells found in UCB, namely EPCs, may have an added advantage over using UCB alone. This work has the potential to progress towards tailored UCB therapies for the treatment of perinatal brain injury.

Cerebral palsy (CP) is a permanent motor disorder that results from brain injury and neuroinflammation during the perinatal period. Mesenchymal stromal cells (MSCs) have been explored as a therapy in multiple adult neuroinflammatory conditions. Our study examined the therapeutic benefits of intranasal delivery of human umbilical cord tissue (UC) derived-MSCs in a rat model of neonatal hypoxic–ischemic (HI) brain injury. To do this, HI was performed on postnatal day 10 Sprague-Dawley rat pups via permanent ligation of the left carotid artery, followed by a hypoxic challenge of 8% oxygen for 90 min. A total of 200,000 UC-MSCs (10 million/kg) were administered intranasally 24 h post-HI. Motor control was assessed after seven days, followed by post-mortem. Analysis included brain immunohistochemistry, gene analysis and serum cytokine measurement. Neonatal HI resulted in brain injury with significant loss of neurons, particularly in the hippocampus. Intranasal administration of UC-MSCs significantly reduced the loss of brain tissue and increased the number of hippocampal neurons. HI significantly upregulated brain inflammation and expression of pro-inflammatory cytokines, while intranasal UC-MSCs significantly reduced markers of neuroinflammation. This study demonstrated that a clinically relevant dose (10 million/kg) of UC-MSCs was neuroprotective following HI by restoring neuronal cell numbers and reducing brain inflammation. Therefore, intranasal delivery of UC-MSCs may be an effective therapy for neonatal brain injury.

Fetal growth restriction (FGR) is a common complication of pregnancy, resulting in a fetus that fails to reach its genetically determined growth potential. Whilst the fetal cardiovascular response to acute hypoxia is well established, the fetal defence to chronic hypoxia is not well understood due to experiment constraints. Growth restriction results primarily from reduced oxygen and nutrient supply to the developing fetus, resulting in chronic hypoxia. The fetus adapts to chronic hypoxia by redistributing cardiac output via brain sparing in an attempt to preserve function in the developing brain. This review highlights the impact of brain sparing on the developing fetal cardiovascular and cerebrovascular systems, as well as emerging long-term effects in offspring that were growth restricted at birth. Here, we explore the pathogenesis associated with brain sparing within the cerebrovascular system. An increased understanding of the mechanistic pathways will be critical to preventing neuropathological outcomes, including motor dysfunction such as cerebral palsy, or behaviour dysfunctions including autism and attention-deficit/hyperactivity disorder (ADHD).

Blood–brain barrier (BBB) dysfunction and neuroinflammation are key mechanisms of brain injury. We performed a time-course study following neonatal hypoxia–ischemia (HI) to characterize these events. HI brain injury was induced in postnatal day 10 rats by single carotid artery ligation followed by hypoxia (8% oxygen, 90 min). At 6, 12, 24, and 72 h (h) post-HI, brains were collected to assess neuropathology and BBB dysfunction. A significant breakdown of the BBB was observed in the HI injury group compared to the sham group from 6 h in the cortex and hippocampus (p < 0.001), including a significant increase in albumin extravasation (p < 0.0033) and decrease in basal lamina integrity and tight-junction proteins. There was a decrease in resting microglia (p < 0.0001) transitioning to an intermediate state from as early as 6 h post-HI, with the intermediate microglia peaking at 12 h (p < 0.0001), which significantly correlated to the peak of microbleeds. Neonatal HI insult leads to significant brain injury over the first 72 h that is mediated by BBB disruption within 6 h and a transitioning state of the resident microglia. Key BBB events coincide with the appearance of the intermediate microglial state and this relationship warrants further research and may be a key target for therapeutic intervention.

Fetal growth restriction (FGR) increases the risk of cardiovascular disease. FGR is linked to placental insufficiency and fetal hypoxemia, leading to oxidative stress and inflammation, which collectively influence the developmental programming of cardiovascular disease. This study assessed whether melatonin (MLT), a potent antioxidant and anti‐inflammatory agent, could prevent cardiovascular deficits associated with FGR. Placental insufficiency was induced in ewes at 89 days of gestational age (dGA, term 148 dGA). Ewes were randomly allocated to control, FGR or FGR+MLT ( i.v. , 15 mg day ⁻¹ , from 95 dGA to birth) groups. Lambs were delivered preterm at 136 dGA and assessed as newborn (24 h) and 4‐week‐old lambs. Vascular function was determined in femoral arteries using in vitro wire myography and vascular morphology as assessed in carotid and femoral arteries. Newborn FGR lambs were ∼30% smaller than control lambs with an increased brain‐to‐body weight ratio, indicative of brain sparing. Femoral endothelial function declined between ∼24 h after birth and 4 weeks in FGR lambs. By contrast, femoral arteries from newborn FGR+MLT lambs displayed transient endothelial dysfunction that improved by 4 weeks. However, these arteries showed elevated levels of oxidative stress and inflammation. Despite improving endothelial function, melatonin also disrupted the brain‐sparing response in FGR lambs. Furthermore, by 4 weeks of age, melatonin treatment led to heightened oxidative stress and inflammatory markers in the peripheral vasculature, suggesting a potential trade‐off between vascular benefits and systemic maladaptation. These findings highlight the complexity of melatonin's effects on the cardiovascular system and underscore the need for careful evaluation of its long‐term safety and efficacy before clinical translation. image Key points: Fetal growth restriction (FGR) significantly increases the lifelong risk of cardiovascular disease, and there are currently no targeted treatments to mitigate these risks. This study follows growth‐restricted lambs from birth to 4 weeks of age (comparable to a 1‐year‐old human in terms of cardiovascular function) to characterise how FGR affects vascular development over time. FGR lambs exhibited progressive endothelial dysfunction in the femoral artery, but antenatal melatonin treatment restored endothelial function long‐term despite the presence of vascular oxidative stress and inflammation. The brain‐sparing response is a key adaptive mechanism for fetal survival, yet melatonin appears to dampen this response, highlighting the need for further investigation into its broader physiological effects.