Bridging Stem Cell Models and Medicine: Integrated 3D Human Cerebral Organoids and Pediatric Serum Reveal Mechanisms and Biomarkers of Anesthetic-Induced Neurotoxicity

Abstract

BackgroundGeneral anesthetics have been shown to cause acute pathological changes in the developing brain, including neuronal cell death. These effects contribute to long-term cognitive and behavioral impairments observed in animal models. Epidemiological and prospective clinical studies have also reported associations between early-life exposure to anesthesia and neurodevelopmental deficits in children, raising significant concerns about pediatric anesthesia and highlighting the urgent need to understand the molecular mechanisms and biomarkers of anesthetic-induced developmental neurotoxicity (AIDN) using human-relevant models. MethodsThis study employed human induced pluripotent stem cell-derived cerebral organoids that were exposed to varying doses of anesthetic propofol for 1 to 6 hours, including single and repeated exposures. In parallel, serum samples were collected pre- and post-surgery from pediatric patients under 4 years old (n = 10 per group) who underwent either short (<1 hour) or prolonged anesthesia (>3 hours) at the Childrens Hospital of Wisconsin between September 2018 and October 2019. Pathological changes in organoids were assessed using chemical assays, electron microscopy, and western blotting. Brain injury-related proteins in patient serum were quantified via ELISA. Genome-wide expression profiling was conducted on 18,855 mRNAs and 27,427 lncRNAs in organoids and serum using microarray and bioinformatics. ResultsHigher doses, longer duration, and repeated exposures to propofol led to increased apoptosis in organoids. Six-hour exposure induced autophagy as evidenced by LC3-II elevation and led to dysregulation of 553 mRNAs and 792 lncRNAs in organoids, along with their co-expressed signaling networks, affecting pathways related to synaptic integrity, mitochondrial function, and inflammation. ELISA and serum analysis of pediatric patients (<4 years old) exposed to anesthesia (>3 hours) demonstrated elevated brain cell injury-associated proteins (e.g., increased NSE) and brain cell type-specific gene expression changes. Serum findings corroborated organoid data, identifying 21 mRNAs and 12 lncRNAs that were dysregulated in both models and associated with cell injury, neuronal development, inflammation, and learning deficits. ConclusionsThis study represents the first integrative transcriptomic analysis of AIDN using both 3D human cerebral organoids and pediatric patient serum--two complementary, human-relevant models. By identifying consistently dysregulated coding and non-coding RNAs across both platforms, we provide compelling evidence of shared molecular signatures linked to neuronal injury, inflammation, and neurodevelopmental disruption. These findings offer not only mechanistic insights but also lay the groundwork for the development of minimally invasive biomarkers and future therapeutic strategies. This dual-model approach bridges experimental discovery with clinical relevance, advancing the translational understanding of pediatric anesthetic neurotoxicity and supporting efforts to improve long-term neurological outcomes in vulnerable patient populations.