Persistent inflammation and white matter damage in the preterm brain: Insights from a novel ovine model of chronic inflammation.

Preterm brain injury involves persistent inflammation, making it a potential therapeutic target. Current large animal models focus on short-term outcomes, limiting understanding of long-term effects. We developed an ovine model of inflammation-induced preterm brain injury to assess long-term neuropathology at an age equivalent to early cerebral palsy diagnosis in human infants. Fetal sheep were instrumented at gestational day (d) 90-91 (term is 148d): one group received lipopolysaccharide (LPS 200 ng; n = 9) on 96d, 97d, and 98d (0.65 gestation, ∼25-26 weeks human brain development), and a control group received saline (n = 8). Birth was induced on 138d, and lambs were euthanised within 24 h of birth. Brains were evaluated for white matter injury, microglial/macrophage activation and astrogliosis in the subcortical (SCWM), periventricular (PVWM), and cortical (CWM) white matter, subventricular zone (SVZ), and corpus callosum (CC). Antenatal LPS administration was associated with significant persistent microglial/macrophage activation in the PVWM (P = 0.04), SCWM (P = 0.01), and CWM (P = 0.006). Furthermore, LPS exposure was associated with reduced oligodendrocyte cell number in the PVWM (P = 0.02), SCWM (P = 0.001), and CWM (P = 0.0001), and reduced myelination in CWM (CNPase, P < 0.0001 and MBP, P = 0.04) and SVZ (MBP, P = 0.05). No difference in astrogliosis or microhaemorrhages was observed. We demonstrated that in a large animal model of inflammation-induced intrauterine preterm brain injury, long-term persistent inflammation occurs, along with significant white matter injury, including loss of oligodendrocytes and reduced myelination in multiple white matter regions. This model paves the way for long-term evaluation of promising therapeutics and behavioral assessment in this clinically relevant model of persistent preterm brain injury.