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Mike JK, White Y, Hutchings RS, Vento C, Ha J, Manzoor H, Lee D, Losser C, Arellano K, Vanhatalo O, Seifert E, Gunewardena A, Wen B, Wang L, Wang A, Goudy BD, Vali P, Lakshminrusimha S, Gobburu JV, Long-Boyle J, Wu YW, Fineman JR, Ferriero DM, Maltepe E. Perinatal Azithromycin Provides Limited Neuroprotection in an Ovine Model of Neonatal Hypoxic-Ischemic Encephalopathy. Stroke 2023; 54:2864-2874. [PMID: 37846563 PMCID: PMC10589434 DOI: 10.1161/strokeaha.123.043040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Hypoxic-ischemic brain injury/encephalopathy affects about 1.15 million neonates per year, 96% of whom are born in low- and middle-income countries. Therapeutic hypothermia is not effective in this setting, possibly because injury occurs significantly before birth. Here, we studied the pharmacokinetics, safety, and efficacy of perinatal azithromycin administration in near-term lambs following global ischemic injury to support earlier treatment approaches. METHODS Ewes and their lambs of both sexes (n=34, 141-143 days) were randomly assigned to receive azithromycin or placebo before delivery as well as postnatally. Lambs were subjected to severe global hypoxia-ischemia utilizing an acute umbilical cord occlusion model. Outcomes were assessed over a 6-day period. RESULTS While maternal azithromycin exhibited relatively low placental transfer, azithromycin-treated lambs recovered spontaneous circulation faster following the initiation of cardiopulmonary resuscitation and were extubated sooner. Additionally, peri- and postnatal azithromycin administration was well tolerated, demonstrating a 77-hour plasma elimination half-life, as well as significant accumulation in the brain and other tissues. Azithromycin administration resulted in a systemic immunomodulatory effect, demonstrated by reductions in proinflammatory IL-6 (interleukin-6) levels. Treated lambs exhibited a trend toward improved neurodevelopmental outcomes while histological analysis revealed that azithromycin supported white matter preservation and attenuated inflammation in the cingulate and parasagittal cortex. CONCLUSIONS Perinatal azithromycin administration enhances neonatal resuscitation, attenuates neuroinflammation, and supports limited improvement of select histological outcomes in an ovine model of hypoxic-ischemic brain injury/encephalopathy.
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Affiliation(s)
- Jana Krystofova Mike
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Yasmine White
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Rachel S. Hutchings
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Christian Vento
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Janica Ha
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Hadiya Manzoor
- Department of Biomedical Engineering (H.M., A.W.), University of California Davis
| | - Donald Lee
- School of Pharmacy, University of Maryland, Baltimore (D.L., J.V.S.G.)
| | - Courtney Losser
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Kimberly Arellano
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Oona Vanhatalo
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
- Department of Pediatrics (B.D.G., P.V., B.D.G., P.V., S.L., J.-L.B., O.V.), University of California Davis
| | - Elena Seifert
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Anya Gunewardena
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
| | - Bo Wen
- College of Pharmacy, University of Michigan, Ann Arbor (B.W., L.W.)
| | - Lu Wang
- College of Pharmacy, University of Michigan, Ann Arbor (B.W., L.W.)
- Department of Biomedical Engineering (H.M., A.W.), University of California Davis
| | - Aijun Wang
- Department of Biomedical Engineering (H.M., A.W.), University of California Davis
| | - Brian D. Goudy
- Department of Pediatrics (B.D.G., P.V., B.D.G., P.V., S.L., J.-L.B., O.V.), University of California Davis
| | - Payam Vali
- Department of Pediatrics (B.D.G., P.V., B.D.G., P.V., S.L., J.-L.B., O.V.), University of California Davis
| | - Satyan Lakshminrusimha
- Department of Pediatrics (B.D.G., P.V., B.D.G., P.V., S.L., J.-L.B., O.V.), University of California Davis
| | - Jogarao V.S. Gobburu
- School of Pharmacy, University of Maryland, Baltimore (D.L., J.V.S.G.)
- Initiative for Pediatric Drug and Device Development, San Francisco, CA (J.V.S.G., J.R.F., E.M.)
| | - Janel Long-Boyle
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
- School of Pharmacy (J.L.-B.), University of California San Francisco
- Department of Pediatrics (B.D.G., P.V., B.D.G., P.V., S.L., J.-L.B., O.V.), University of California Davis
| | - Yvonne W. Wu
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
- Department of Neurology, Weill Institute for Neurosciences (Y.W.W., D.M.F.), University of California San Francisco
| | - Jeffrey R. Fineman
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
- Initiative for Pediatric Drug and Device Development, San Francisco, CA (J.V.S.G., J.R.F., E.M.)
| | - Donna M. Ferriero
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
- Department of Neurology, Weill Institute for Neurosciences (Y.W.W., D.M.F.), University of California San Francisco
| | - Emin Maltepe
- Department of Pediatrics (J.K.M., Y.W., R.S.H., C.V., J.H., C.L., K.A., O.V., E.S., A.G., J.L.-B., Y.W.W., J.R.F., D.M.F., E.M.), University of California San Francisco
- Department of Biomedical Sciences (E.M.), University of California San Francisco
- Initiative for Pediatric Drug and Device Development, San Francisco, CA (J.V.S.G., J.R.F., E.M.)
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