Administration of Extracellular Vesicles From Donor Human Milk in Preterm Infants

NCT07402083 | Recruiting

• 1 other identifier: PI23/00202
• Study Type: observational
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

The AdVEMPrem study is exploring whether tiny particles called extracellular vesicles (EVs), which are naturally found in human milk, can help protect very premature babies from serious gut problems such as necrotizing enterocolitis (NEC). NEC is a dangerous condition that affects the intestines of preterm infants and can lead to long-term health issues. Human milk is the best nutrition for babies, but when a mother's own milk is not available, donor human milk (DHM) is used. EVs in milk carry proteins, fats, and genetic material that may support gut development, immunity, and brain growth. While laboratory studies suggest EVs are beneficial, their effects in premature babies have not yet been proven. In this study, 20 very preterm infants (\<32 weeks of gestation) will be enrolled during their stay in the Neonatal Intensive Care Unit (NICU). All babies in the study will receive oral supplementation with EVs isolated from donor human milk. Researchers will monitor feeding tolerance, growth, intestinal health, and early development. Blood and urine samples will also be collected to study how EVs affect metabolism and stress markers. The main goal is to see if EV supplementation is safe and well tolerated. Longer-term follow-up will explore whether EVs improve growth and neurodevelopment as the babies grow. This research could lead to new nutritional strategies to reduce NEC and improve outcomes for premature infants and their families.

Conditions

Very Preterm Infants (<32 Weeks of Gestation)

Keywords

Preterm birth (<32 weeks); Donor human milk (DHM); Extracellular vesicles (EVs); Feeding tolerance; Necrotizing enterocolitis (NEC); Neurodevelopment; Donor Human Milk Extracellular Vesicle (DHMEVs)

Outcome Measures

Primary Outcomes (2)

• Number of participants with treatment-related serious adverse events

  Safety will be evaluated by the number of participants experiencing one or more treatment-related serious adverse events, defined as any of the following: (i) necrotizing enterocolitis (Bell stage ≥ II); (ii) metabolic or renal complications requiring medical intervention, (iii) cholestasis, or (iv) culture-proven sepsis. Participants experiencing multiple events will be counted once.

  From enrollment until term-equivalent age (i.e., up to 40 weeks postmenstrual age)

• Tolerance of donor human milk EV supplementation

  Feeding tolerance is evaluated by the number of participants without clinical signs of gastrointestinal symptoms and successful progression of enteral feeding.

  From enrollment until term-equivalent age (i.e., up to 40 weeks postmenstrual age)

Secondary Outcomes (16)

• Infant weight

  From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age

• Infant length

  From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age

• Infant head circumference

  From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age

• Analysis of redox status biomarkers

  21 days of life

• Concentration of TFN alpha (inflammatory biomarker)

  21 days of life

Study Arms (1)

EV supplementation in very preterm infants

Infants born before 32 weeks of gestation will receive own mother's milk supplemented with extracellular vesicles isolated from donor human milk.

Dietary Supplement: Donor human milk extracellular vesicles (DHM-EVs)

Interventions

Donor human milk extracellular vesicles (DHM-EVs) DIETARY_SUPPLEMENT

Infants born before 32 weeks of gestation will receive supplementation with extracellular vesicles isolated from donor human milk, in addition to standard nutritional care.

EV supplementation in very preterm infants

Eligibility Criteria

• Age: 0 Days - 14 Days
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)
• Sampling Method: Non-Probability Sample

Study Population

Preterm infants at risk of developing necrotizing enterocolitis (NEC), recruited between 14 and 28 days of life during their stay in the Neonatal Intensive Care Unit (NICU). A total of 20 infants will be enrolled to receive oral administration of extracellular vesicles (EVs) isolated from donor human milk (DHM) as a dietary supplement.

You may qualify if:

• Preterm infants born at \<32 weeks gestational age
• Age between 0 and 14 days of life at enrollment
• At risk of developing necrotizing enterocolitis (NEC)
• Written informed consent obtained from parent(s) or legal guardian(s)

You may not qualify if:

• Major congenital anomalies or chromosomal abnormalities
• Severe gastrointestinal malformations (e.g., gastroschisis, intestinal atresia)
• Conditions incompatible with enteral feeding or EV supplementation
• Participation in another interventional clinical trial

Sponsors & Collaborators

• Instituto de Investigacion Sanitaria La Fe: lead
• Hospital Universitario La Fe: collaborator

Study Sites (1)

Hospital Universitario y Politécnico La Fe

Valencia, Valencia, 46026, Spain

RECRUITING

Related Publications (25)

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• Ramos-Garcia V, Ten-Doménech I, Moreno-Giménez A, Gormaz M, Parra-Llorca A, Shephard AP, et al. ATR-FTIR spectroscopy for the routine quality control of exosome isolations. Chemometrics and Intelligent Laboratory Systems 2021:104401. https://doi.org/10.1016/j.chemolab.2021.104401.

  BACKGROUND

• Buratta S, Urbanelli L, Tognoloni A, Latella R, Cerrotti G, Emiliani C, et al. Protein and Lipid Content of Milk Extracellular Vesicles: A Comparative Overview. Life 2023;13:401. https://doi.org/10.3390/life13020401.

  BACKGROUND

• Pisano C, Galley J, Elbahrawy M, Wang Y, Farrell A, Brigstock D, et al. Human Breast Milk-Derived Extracellular Vesicles in the Protection Against Experimental Necrotizing Enterocolitis. Journal of Pediatric Surgery 2020;55:54 -8. https://doi.org/10.1016/j. jpedsurg.2019.09.052.

  BACKGROUND

• Miyake H, Lee C, Chusilp S, Bhalla M, Li B, Pitino M, et al. Human breast milk exosomes attenuate intestinal damage. Pediatr

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  BACKGROUND

• Galley JD, Besner GE. The Therapeutic Potential of Breast Milk-Derived Extracellular Vesicles. Nutrients. 2020 Mar 11;12(3):745. doi: 10.3390/nu12030745.

  PMID: 32168961 BACKGROUND

• Chutipongtanate S, Morrow AL, Newburg DS. Human Milk Extracellular Vesicles: A Biological System with Clinical Implications. Cells. 2022 Jul 30;11(15):2345. doi: 10.3390/cells11152345.

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• Lonnerdal B. Human Milk MicroRNAs/Exosomes: Composition and Biological Effects. Nestle Nutr Inst Workshop Ser. 2019;90:83-92. doi: 10.1159/000490297. Epub 2019 Mar 13.

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• Chen W, Chen X, Qian Y, Wang X, Zhou Y, Yan X, et al. Lipidomic Profiling of Human Milk Derived Exosomes and Their Emerging Roles in the Prevention of Necrotizing Enterocolitis. Mol Nutr Food Res 2021;65:e2000845. https://doi.org/10.1002/ mnfr.202000845.

  BACKGROUND

• Zonneveld MI, Brisson AR, van Herwijnen MJC, Tan S, van de Lest CHA, Redegeld FA, et al. Recovery of extracellular vesicles from human breast milk is influenced by sample collection and vesicle isolation procedures. J Extracell Vesicles 2014;3. https://doi. org/10.3402/jev.v3.24215.

  BACKGROUND

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  BACKGROUND

• Thery C, Witwer KW, Aikawa E, Alcaraz MJ, Anderson JD, Andriantsitohaina R, Antoniou A, Arab T, Archer F, Atkin-Smith GK, Ayre DC, Bach JM, Bachurski D, Baharvand H, Balaj L, Baldacchino S, Bauer NN, Baxter AA, Bebawy M, Beckham C, Bedina Zavec A, Benmoussa A, Berardi AC, Bergese P, Bielska E, Blenkiron C, Bobis-Wozowicz S, Boilard E, Boireau W, Bongiovanni A, Borras FE, Bosch S, Boulanger CM, Breakefield X, Breglio AM, Brennan MA, Brigstock DR, Brisson A, Broekman ML, Bromberg JF, Bryl-Gorecka P, Buch S, Buck AH, Burger D, Busatto S, Buschmann D, Bussolati B, Buzas EI, Byrd JB, Camussi G, Carter DR, Caruso S, Chamley LW, Chang YT, Chen C, Chen S, Cheng L, Chin AR, Clayton A, Clerici SP, Cocks A, Cocucci E, Coffey RJ, Cordeiro-da-Silva A, Couch Y, Coumans FA, Coyle B, Crescitelli R, Criado MF, D'Souza-Schorey C, Das S, Datta Chaudhuri A, de Candia P, De Santana EF, De Wever O, Del Portillo HA, Demaret T, Deville S, Devitt A, Dhondt B, Di Vizio D, Dieterich LC, Dolo V, Dominguez Rubio AP, Dominici M, Dourado MR, Driedonks TA, Duarte FV, Duncan HM, Eichenberger RM, Ekstrom K, El Andaloussi S, Elie-Caille C, Erdbrugger U, Falcon-Perez JM, Fatima F, Fish JE, Flores-Bellver M, Forsonits A, Frelet-Barrand A, Fricke F, Fuhrmann G, Gabrielsson S, Gamez-Valero A, Gardiner C, Gartner K, Gaudin R, Gho YS, Giebel B, Gilbert C, Gimona M, Giusti I, Goberdhan DC, Gorgens A, Gorski SM, Greening DW, Gross JC, Gualerzi A, Gupta GN, Gustafson D, Handberg A, Haraszti RA, Harrison P, Hegyesi H, Hendrix A, Hill AF, Hochberg FH, Hoffmann KF, Holder B, Holthofer H, Hosseinkhani B, Hu G, Huang Y, Huber V, Hunt S, Ibrahim AG, Ikezu T, Inal JM, Isin M, Ivanova A, Jackson HK, Jacobsen S, Jay SM, Jayachandran M, Jenster G, Jiang L, Johnson SM, Jones JC, Jong A, Jovanovic-Talisman T, Jung S, Kalluri R, Kano SI, Kaur S, Kawamura Y, Keller ET, Khamari D, Khomyakova E, Khvorova A, Kierulf P, Kim KP, Kislinger T, Klingeborn M, Klinke DJ 2nd, Kornek M, Kosanovic MM, Kovacs AF, Kramer-Albers EM, Krasemann S, Krause M, Kurochkin IV, Kusuma GD, Kuypers S, Laitinen S, Langevin SM, Languino LR, Lannigan J, Lasser C, Laurent LC, Lavieu G, Lazaro-Ibanez E, Le Lay S, Lee MS, Lee YXF, Lemos DS, Lenassi M, Leszczynska A, Li IT, Liao K, Libregts SF, Ligeti E, Lim R, Lim SK, Line A, Linnemannstons K, Llorente A, Lombard CA, Lorenowicz MJ, Lorincz AM, Lotvall J, Lovett J, Lowry MC, Loyer X, Lu Q, Lukomska B, Lunavat TR, Maas SL, Malhi H, Marcilla A, Mariani J, Mariscal J, Martens-Uzunova ES, Martin-Jaular L, Martinez MC, Martins VR, Mathieu M, Mathivanan S, Maugeri M, McGinnis LK, McVey MJ, Meckes DG Jr, Meehan KL, Mertens I, Minciacchi VR, Moller A, Moller Jorgensen M, Morales-Kastresana A, Morhayim J, Mullier F, Muraca M, Musante L, Mussack V, Muth DC, Myburgh KH, Najrana T, Nawaz M, Nazarenko I, Nejsum P, Neri C, Neri T, Nieuwland R, Nimrichter L, Nolan JP, Nolte-'t Hoen EN, Noren Hooten N, O'Driscoll L, O'Grady T, O'Loghlen A, Ochiya T, Olivier M, Ortiz A, Ortiz LA, Osteikoetxea X, Ostergaard O, Ostrowski M, Park J, Pegtel DM, Peinado H, Perut F, Pfaffl MW, Phinney DG, Pieters BC, Pink RC, Pisetsky DS, Pogge von Strandmann E, Polakovicova I, Poon IK, Powell BH, Prada I, Pulliam L, Quesenberry P, Radeghieri A, Raffai RL, Raimondo S, Rak J, Ramirez MI, Raposo G, Rayyan MS, Regev-Rudzki N, Ricklefs FL, Robbins PD, Roberts DD, Rodrigues SC, Rohde E, Rome S, Rouschop KM, Rughetti A, Russell AE, Saa P, Sahoo S, Salas-Huenuleo E, Sanchez C, Saugstad JA, Saul MJ, Schiffelers RM, Schneider R, Schoyen TH, Scott A, Shahaj E, Sharma S, Shatnyeva O, Shekari F, Shelke GV, Shetty AK, Shiba K, Siljander PR, Silva AM, Skowronek A, Snyder OL 2nd, Soares RP, Sodar BW, Soekmadji C, Sotillo J, Stahl PD, Stoorvogel W, Stott SL, Strasser EF, Swift S, Tahara H, Tewari M, Timms K, Tiwari S, Tixeira R, Tkach M, Toh WS, Tomasini R, Torrecilhas AC, Tosar JP, Toxavidis V, Urbanelli L, Vader P, van Balkom BW, van der Grein SG, Van Deun J, van Herwijnen MJ, Van Keuren-Jensen K, van Niel G, van Royen ME, van Wijnen AJ, Vasconcelos MH, Vechetti IJ Jr, Veit TD, Vella LJ, Velot E, Verweij FJ, Vestad B, Vinas JL, Visnovitz T, Vukman KV, Wahlgren J, Watson DC, Wauben MH, Weaver A, Webber JP, Weber V, Wehman AM, Weiss DJ, Welsh JA, Wendt S, Wheelock AM, Wiener Z, Witte L, Wolfram J, Xagorari A, Xander P, Xu J, Yan X, Yanez-Mo M, Yin H, Yuana Y, Zappulli V, Zarubova J, Zekas V, Zhang JY, Zhao Z, Zheng L, Zheutlin AR, Zickler AM, Zimmermann P, Zivkovic AM, Zocco D, Zuba-Surma EK. Minimal information for studies of extracellular vesicles 2018 (MISEV2018): a position statement of the International Society for Extracellular Vesicles and update of the MISEV2014 guidelines. J Extracell Vesicles. 2018 Nov 23;7(1):1535750. doi: 10.1080/20013078.2018.1535750. eCollection 2018.

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• Colombo M, Raposo G, Thery C. Biogenesis, secretion, and intercellular interactions of exosomes and other extracellular vesicles. Annu Rev Cell Dev Biol. 2014;30:255-89. doi: 10.1146/annurev-cellbio-101512-122326. Epub 2014 Aug 21.

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• Ascanius SR, Hansen MS, Ostenfeld MS, Rasmussen JT. Milk-Derived Extracellular Vesicles Suppress Inflammatory Cytokine Expression and Nuclear Factor-κB Activation in Lipopolysaccharide-Stimulated Macrophages. Dairy 2021;2:165 -78. https://doi. org/10.3390/dairy2020015.

  BACKGROUND

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  BACKGROUND

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  PMID: 31955884 BACKGROUND

• Poulimeneas D, Bathrellou E, Antonogeorgos G, Mamalaki E, Kouvari M, Kuligowski J, et al. Feeding the preterm infant: an overview of the evidence. Int J Food Sci Nutr 2021;72:4 -13. https://doi.org/10.1080/09637486.2020.1754352.

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  BACKGROUND

• Method for Mid-IR Spectroscopy of Extracellular Vesicles at the Subvesicle Level, Nikolaus Hondl, Lena Neubauer, Victoria Ramos-Garcia, Julia Kuligowski, Marina Bishara, Eva Sevcsik, Bernhard Lendl, Georg Ramer, ACS Measurement Science Au, DOI: 10.1021/acsmeasuresciau.5c00001

  RESULT

• Simultaneous Screening and Quantitation of Human Milk Oligosaccharides by Liquid Chromatography - Mass Spectrometry, Víctor Navarro-Esteve, Anna Zöchner, Marta Roca, Anna Parra-Llorca, Alba Moreno-Giménez, Laura Campos-Berga, María Jesús Vaya, Máximo Vento, Pilar Sáenz-González, María Gormaz, Isabel Ten-Domenech, Julia Kuligowski, Guillermo Quintás, Carbohydrate Polymer Technologies and Applications 9 (2024) 100644. doi: 10.1016/j.carpta.2024.100644

  RESULT

• Normalization approaches for extracellular vesicle-derived lipidomic fingerprints - A human milk case study, Isabel Ten-Doménech, Victoria Ramos-Garcia, Abel Albiach- Delgado, Jose Luis Moreno-Casillas, Alba Moreno-Giménez, María Gormaz, Marta Gómez-Ferrer, Pilar Sepúlveda, Máximo Vento, Guillermo Quintás, Julia Kuligowski, Chemometrics and Intelligent Laboratory Systems 246 (2024) 105070. doi: https://doi.org/10.1016/j.chemolab.2024.105070

  RESULT

• Ten-Domenech I, Moreno-Gimenez A, Campos-Berga L, Zapata de Miguel C, Lopez-Nogueroles M, Parra-Llorca A, Quintas G, Garcia-Blanco A, Gormaz M, Kuligowski J. Impact of maternal health and stress on steroid hormone profiles in human milk: Implications for infant development. J Lipid Res. 2024 Dec;65(12):100688. doi: 10.1016/j.jlr.2024.100688. Epub 2024 Oct 26.

  PMID: 39490927 RESULT

• Kuligowski J, Moreno-Torres M, Quintas G. Improving insights from metabolomic functional analysis combining multivariate tools. Anal Chim Acta. 2024 Sep 22;1323:343062. doi: 10.1016/j.aca.2024.343062. Epub 2024 Aug 5.

  PMID: 39182979 RESULT

• Albiach-Delgado A, Moreno-Casillas JL, Ten-Domenech I, Cascant-Vilaplana MM, Moreno-Gimenez A, Gomez-Ferrer M, Sepulveda P, Kuligowski J, Quintas G. Oxylipin profile of human milk and human milk-derived extracellular vesicles. Anal Chim Acta. 2024 Jul 18;1313:342759. doi: 10.1016/j.aca.2024.342759. Epub 2024 May 21.

  PMID: 38862207 RESULT

Biospecimen

Retention: SAMPLES WITH DNA

The study will retain biological samples collected from preterm infants, own mother's milk (OMM), and donor human milk (DHM) to support biochemical and functional analyses. Specifically: 1. OMM/DHM samples: isolation of extracellular vesicles (EVs), lipid profiling, and compositional characterization, and functional assays. 2. Infant urine samples: redox status and oxidative/nitrosative stress biomarkers. 3. Maternal urine samples: food intake biomarkers. 4. Infant blood samples (minimally invasive micro-sampling, e.g., dried blood spots and plasma samples): redox status (oxidized/reduced glutathione) and inflammation biomarker determination.

MeSH Terms

Conditions

Premature Birth; Enterocolitis, Necrotizing

Condition Hierarchy (Ancestors)

Obstetric Labor, Premature; Obstetric Labor Complications; Pregnancy Complications; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Enterocolitis; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases

Central Study Contacts

Julia Kuligowski, PhD

CONTACT

+34961246661; julia.kuligowski@uv.es

María Gormaz, PhD, MD

CONTACT

+34/961245686; gormaz_mar@gva.es

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 9, 2025
• First Posted: February 11, 2026
• Study Start: February 5, 2026
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2029
• Last Updated: February 11, 2026

Record last verified: 2026-02

Locations

ES (1)