1. Introduction
Infants born prematurely (< 37 weeks gestation) and/or at a lower birth weight are at an increased risk of morbidities, acute and chronic neurodevelopmental and motor delays, and mortality [
1,
2,
3,
4,
5,
6]. Neurodevelopmental deficits may occur in preterm infants because they are born during a period of rapid neuronal and glial cell migration, growth, and maturation with changes in overall brain organization [
7,
8,
9,
10,
11,
12,
13]. Human milk (HM) consumption has been correlated with a reduced risk for these morbidities. Additionally, HM feedings in preterm and term infants are associated with increased feeding tolerance, greater cognitive development, and higher IQ scores up to seven years of age compared with infant formula (IF) feedings [
14,
15,
16,
17,
18,
19,
20,
21]. However, most of these studies are observational and include a number of confounding variables, such as caregiver education, maternal/paternal IQ and age, and socioeconomic status, that may impact the decision to, and duration of, feeding an infant HM [
22,
23,
24]. Randomized controlled feeding trials and the acquisition of tissue samples in non-diseased infants have obvious ethical limitations making animal models necessary to understand neurodevelopmental mechanisms in relation to feeding. The neonatal piglet model is ideally suited for developmental studies due to gastrointestinal (GI) and neurological developmental similarities and high genetic homology with human infants [
25,
26].
The protective effects of HM on the developing GI system are most pronounced in preterm infants. These infants are at high risk for neonatal inflammatory diseases, including necrotizing enterocolitis (NEC), sepsis, and chronic lung disease [
5,
15,
27,
28,
29]. These inflammatory disorders may lead to severe systemic inflammatory responses and blood-brain and blood-cerebrospinal fluid barrier disruptions, ultimately causing neuroinflammation and long-term cognitive impact [
30,
31,
32]. Neuroinflammation may result in white matter injury due to apoptosis and subarachnoid hemorrhage-associated blood-brain barrier disruption that may be related to changes in microglial phenotypes [
31,
32,
33]. This damage in early life may increase the risk of neurodevelopmental disorders, such as bipolar disorder, autism, cerebral palsy, and schizophrenia [
34,
35,
36,
37].
The primary neurodevelopmental processes in the early postnatal period of neurodevelopment are oligodendrocyte maturation and myelination of axons [
38,
39]. During development, microglia are closely associated with oligodendrocytes and phagocytose myelin sheaths [
40,
41]. However, microglia also eliminate cells and/or myelin in response to injury or disease [
42,
43]. These disease-related processes can be induced by inflammatory stimuli in the brain, which could disrupt normal developmental processes, including neurogenesis, oligodendrogenesis, neuronal migration, and myelination of axonal tracts due to aberrant pruning/phagocytosis [
44].
To assess neurodevelopment in a neonatal piglet model, a commonly used test is novel object recognition (NOR; [
45,
46]). The purpose of NOR testing is to utilize the innate exploratory nature of animals to assess memory of an object they have been previously exposed to (a familiar object; [
45]). If an animal can remember this familiar object, then introducing a novel object should result in the animal spending more time with the new object [
45].
The question remains whether the improved cognitive outcomes associated with early HM feeding exposure, compared with IF feeding, involve reducing chronic low-grade systemic inflammation and subsequently minimizing neuroinflammation. In this pilot study, we hypothesized that HM feedings would lead to neurodevelopmental and neurocognitive improvements through decreasing systemic inflammation, thus reducing neuroinflammation compared to bovine milk-derived infant formula (IF) feedings in a neonatal piglet model.
4. Discussion
This pilot study was conducted to assess the feasibility of using the neonatal piglet model to examine the effects of HM vs. IF on neurodevelopment. Due to the obvious ethical and tissue accessibility considerations involved in assigning specific feeding regimens in infant neurodevelopmental and neurocognitive studies, as well as potential neuroinflammation, a neonatal piglet model was used. This was the first study to compare HM vs. IF nutritional interventions utilizing different neurodevelopmental measures in term piglets from postnatal day (PD)2 to PD30.
For perspective, the serotonergic neurological system (an autonomic brainstem process that includes the regulation of cognition, mood, respiration, and the waking state) in a piglet at PD4 is approximately equivalent to about a one-month-old infant, PD12 to a four-month-old infant, and PD30 to a six-month-old infant [
69]. Moreover, one week of piglet total brain volume growth is equivalent to about one month of infant total brain volume growth [
70]. Utilization of a neonatal piglet model allows for shorter experimental feeding periods to examine the effect of early life feeding on brain development relevant to human infants.
At PD18 to PD22 (3-weeks-old) and PD25 to PD29 (4-weeks-old), the piglets in this study underwent NOR functional cognitive assessment. While the majority of significant results were not related to dietary exposure on its own, these results were useful to assess open field behavior in piglets. Previous studies in piglets have shown that when exhibiting anxiety, piglets move away from open spaces (center of an arena) and may seek the borders of the arena as a means of escape [
46,
71,
72]. Moreover, piglet stress is reflected in open arena movements: low mobility (freezing behaviors) or high mobility (as a means of finding a way out of the area; [
72,
73]). Therefore, a piglet experiencing stress would spend more time on the borders of the arena as a means of trying to escape instead of staying in the center.
The results of this study may indicate less anxiety in both HM-fed and IF-fed piglets at 4-weeks-old compared to 3-weeks old as shown by significantly less total distance traveled and less total time moving (
Figure 3a-b). This may be related to age (a more developed brain) and arena habituation over time. Furthermore, HM-fed piglets explored more at 4-weeks-old than 3-weeks-old as reflected by spending more time in the center of the area; whereas IF-fed piglets actually spent less time in the center of the arena at 4-weeks-old compared to 3-weeks-old (
Figure 3c). Previous studies on male piglet brain development have shown that total brain volume, cortex, diencephalon, cerebellum, and brainstem reach their max growth rate at around 4 to 5 weeks of age.
74 Our findings may reflect both increased brain maturation (4-weeks-old vs. 3-weeks-old) and/or impact of different feeding types, with HM-fed piglets at 4-weeks-old being less fearful of arena exploration than IF-fed piglets.
While we observed some interactions between dietary regimen and age, there were some dietary findings that may have clinical significance and contribute toward improving future studies. There was a significant dietary group difference between HM-fed piglets and IF-fed piglets during non-novel (center, border, and familiar object) revisits. During novel phase testing, both HM-fed and IF-fed piglets had fewer non-novel revisits at 4-weeks-old compared to 3-weeks-old, but HM-fed piglets had much higher revisits at both 3 and 4-weeks-old compared to IF-fed piglets (
Figure 4d). This may indicate more exploratory behavior overall in HM-fed piglets compared to IF-fed piglets. Moreover, although not statistically significant, HM-fed piglets showed overall more novel object visits and more time with novel objects at 4-weeks compared to 3-weeks-old in the novel phase. In contrast, IF-fed piglets exhibited less novel object visits and less time with novel objects at 4 and 3-weeks-old in comparison to HM-fed piglets (
Figure 4a,e). This may suggest a greater impact of a HM-fed diet on memory performance than age-related brain development alone. In a human observational study by Belfort et al., (2016), HM intake > 50% in the first 28 days of life in very preterm infants was associated with higher IQ, working memory, and motor function at 7 years of age and a larger volume of both deep nuclear gray matter and hippocampus at term equivalent age [
75]. Due to the Belfort et al. (2016) study being observational in nature, it was not possible to fully control confounding variables such as caregiver age, IQ, education, and socioeconomic status. However, our study supports their findings without these confounding variables.
Although HM-fed vs. IF-fed piglets at PD30 were not statistically different in body weight, there was a pattern towards HM-fed piglets having smaller body weights compared with IF-fed counterparts that may be clinically significant (
Figure 2b). Moreover, IF-fed piglets had a significantly higher daily percentage of weight gain throughout the study compared to the HM-fed piglets (
Figure 2c). This finding also aligns with clinical observations that HM-fed infants weigh less than IF-fed infants from at least three to eight months of age [
76,
77]. Despite HM-fed piglets having smaller body weights, they had greater normalized brain weights (brain volume per kg of body weight) than IF-fed piglets, which may also have clinical significance (
Figure S1). There is a similar pattern seen in infant MRI studies where HM-fed infants also have higher volumes of total white matter (including frontal and temporal regions), subcortical gray matter, and parietal lobe cortical thickness compared to formula-fed infants at two years old and even into adolescence [
78,
79,
80].
Moreover, we saw significant differences in prefrontal cortex microglia between HM-fed and IF-fed piglets (
Figure 5). HM-fed brains had microglia with characteristics indicative of a less activated phenotype - longer process lengths, more complex processes (more branch points and end points) - compared to microglia in IF-fed piglets (
Figure 5). Other features, such as cell volume, were not significantly different between feeding groups. One possible explanation for these findings is that if low-grade inflammation is present, it may not be sufficient to dramatically drive profound morphological shifts observable given the limited sample number. Of further consideration is the role of microglia during neurodevelopment, including phagocytosis, thus microglia in the developing brain may have a more activated phenotype and transcriptome than microglia in healthy adult brains [
81,
82,
83]. These subtle shifts in the piglets require a larger sample size to elucidate. Furthermore, while microglial morphology correlates well with activation state and function [
64,
84], there are other parameters that remain to be investigated such as transcriptomics that would provide more information on microglial responses in each feeding group. Future research is necessary to determine microglial proliferation and activation states as well as levels and types of inflammatory cytokines within the brain.
Although the systemic cytokines (IL-6, IL-8, IL-10, IL-1
β, and TNF-
α) from piglet blood plasma did not result in statistically significant results, this study showed patterns in HM-fed piglets having higher concentrations of IL-1
β compared to IF-fed piglets (
Figure S2). It is important to note that while IL-1
β is typically released in response to infection and injury [
85,
86], it is also an immune cell mediator within the brain produced by glial cells and found in high abundance within the hippocampus [
87,
88,
89]. IL-1
β may be involved in synaptic plasticity with higher gene expression during long term potentiation processes involving learning and memory maintenance [
90,
91]. Long term potentiation is necessary for the strengthening of synaptic processes [
92]. It is possible that HM-fed piglets had higher levels of IL-1
β in this study due to more memory consolidation compared to IF-fed piglets.
There are also known sex differences in baseline inflammatory states. Males appear to have more activated microglia than females based on morphology [
93]. While this is necessary for brain masculation during development, it may result in a higher baseline state of inflammation than females. Therefore, if feeding interventions, such as HM, decrease systemic inflammation, then this may impact males more greatly than females.
Due to the pilot nature of this study, study design and results were used to determine the feasibility of a larger study and to generate preliminary data to further future research efforts that are adequately powered. Many potentially significant clinical trends were seen, and a larger sample size will help to determine whether these differences will become statistically significant. We conducted a power analysis using the NOR data which indicated a sample size of n = 15 to 20 per feeding group would provide adequate statistical power to detect statistically significant and biologically meaningful differences between groups. Other limitations of this study involved uncontrollable variables related to the acquisition of piglets, NOR procedure, and microglial morphology. Piglets were obtained on PD2; however, it was difficult to quantify the actual volume of sow colostrum consumed and the exact postnatal age (in hours) of the piglet. Only date of birth, but not hour of birth, was listed at purchase. Both colostrum intake and postnatal age may have influenced overall piglet immune status. Furthermore, the NOR functional cognitive procedure may have been too strenuous for the piglet subjects. Piglets appeared less interested in both familiar and novel objects when randomization of trials results in more than two trials in one day (i.e. familiarization trial, 5 minute delay, and 1 hour delay). This may have impacted how much they visited the novel object leading to less accurate results. However, this pilot study provided data for NOR procedure improvements in future studies.
Future studies can improve these findings by increasing the sample size, simplifying NOR procedure (minimizing the number of novel object delay trials and the number of different colored objects) and having more precise PD age and colostrum consumption. Moreover, future studies will include microglial morphological comparisons between feeding groups with particular emphasis between Iba1 and CD68 to quantify the number of phagocytic microglia present and Iba1 and Tmem119 to differentiate between peripheral macrophages (Iba1+/Tmem119-) and resident microglia [
94,
95,
96].
Author Contributions
Conceptualization, Y.C.; methodology, L.A.N., Y.C., B.D.F., and A.M.; software, L.A.N., J.P., B.D.F, Y.C., and A.M.; validation, L.A.N., J.P., B.D.F, Y.C., and A.M.; formal analysis, J.P., L.A.N., B.D.F., and A.M.; investigation, L.A.N., Y.C., and B.D.F.; resources, Y.C.; data curation, J.P., L.A.N., B.D.F., and A.M.; writing—original draft preparation, L.A.N., J.P., and A.M.; writing—review and editing, , L.A.N., J.P., B.D.F, Y.C., and A.M.; visualization, L.A.N., B.D.F., and A.M.; supervision, Y.C., B.D.F., and A.M.; project administration, Y.C.; funding acquisition, Y.C. All authors have read and agreed to the published version of the manuscript.
Figure 1.
Novel object recognition (NOR) testing of human milk (HM)-fed and bovine milk-derived infant formula (IF)-fed piglets at 3-weeks-old and 4-weeks-old to assess learning and memory. NOR neurocognitive testing involved four phases conducted in the following order: habituation, familiarization, novel testing, and control. (a) Flowchart of each NOR phase. The habituation phase had 2 trials, the familiarization phase had 1 trial, the novel testing phase had 3 trials (with randomized novel toy delay of 5 minutes, 1 hour, and 24 hours after the familiarization trial), and the control phase had 2 trials. All phase trials had a duration of 5 minutes, except for the habituation phase trials which were 10 minutes; (b) Objects used during NOR testing. Object pairs 1-2 were examined at week 3 and object pairs 3-4 at week 4 of familiar and novel testing phases. Control phase testing involved the opposite object pairs where both feeding groups were exposed to all novel object pairs: 3-4 at week 3 and 1-2 at week 4.
Figure 1.
Novel object recognition (NOR) testing of human milk (HM)-fed and bovine milk-derived infant formula (IF)-fed piglets at 3-weeks-old and 4-weeks-old to assess learning and memory. NOR neurocognitive testing involved four phases conducted in the following order: habituation, familiarization, novel testing, and control. (a) Flowchart of each NOR phase. The habituation phase had 2 trials, the familiarization phase had 1 trial, the novel testing phase had 3 trials (with randomized novel toy delay of 5 minutes, 1 hour, and 24 hours after the familiarization trial), and the control phase had 2 trials. All phase trials had a duration of 5 minutes, except for the habituation phase trials which were 10 minutes; (b) Objects used during NOR testing. Object pairs 1-2 were examined at week 3 and object pairs 3-4 at week 4 of familiar and novel testing phases. Control phase testing involved the opposite object pairs where both feeding groups were exposed to all novel object pairs: 3-4 at week 3 and 1-2 at week 4.

Figure 2.
Piglet weight examined by feeding group (HM-fed vs. IF-fed) throughout the 28-day feeding regimen: (a) piglet weight at the beginning of the study (PD2); (b) piglet weight at the end of the study (PD30); and (c) average daily percentage of piglet weight gain throughout the study. HM-fed (n = 3); IF-fed (n = 3). Significance was determined by independent samples t-tests and is indicated by †p < 0.10, **p < 0.01. HM = human milk; IF = bovine milk-derived infant formula; PD = postnatal day.
Figure 2.
Piglet weight examined by feeding group (HM-fed vs. IF-fed) throughout the 28-day feeding regimen: (a) piglet weight at the beginning of the study (PD2); (b) piglet weight at the end of the study (PD30); and (c) average daily percentage of piglet weight gain throughout the study. HM-fed (n = 3); IF-fed (n = 3). Significance was determined by independent samples t-tests and is indicated by †p < 0.10, **p < 0.01. HM = human milk; IF = bovine milk-derived infant formula; PD = postnatal day.
Figure 3.
Novel Object Recognition (NOR) habituation phase trials of piglet exploration examined by feeding group (human milk vs. infant formula) and age (3-weeks-old vs.4-weeks-old): (a) the total distance traveled (cm); (b) total time spent moving (s); (c) total time spent in the center of the arena (s); (d) Total time spent at the borders of the arena (s); and (e) the number of border visits (count). All values are expressed in means ± SE bars. Significance was determined by ANOVA and is indicated by †p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001. Uppercase letters indicate nutritional group-by-age interaction significance. HM-fed (n = 3); IF-fed (n = 3); HM = human milk; IF = bovine milk-derived infant formula; s = seconds; cm = centimeter. .
Figure 3.
Novel Object Recognition (NOR) habituation phase trials of piglet exploration examined by feeding group (human milk vs. infant formula) and age (3-weeks-old vs.4-weeks-old): (a) the total distance traveled (cm); (b) total time spent moving (s); (c) total time spent in the center of the arena (s); (d) Total time spent at the borders of the arena (s); and (e) the number of border visits (count). All values are expressed in means ± SE bars. Significance was determined by ANOVA and is indicated by †p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001. Uppercase letters indicate nutritional group-by-age interaction significance. HM-fed (n = 3); IF-fed (n = 3); HM = human milk; IF = bovine milk-derived infant formula; s = seconds; cm = centimeter. .
Figure 4.
Novel object recognition (NOR) novel (a-g) and control (h-n) testing phase trials of piglet object interaction examined by feeding group (human milk vs. infant formula) and age (3-weeks-old vs. 4-weeks-old): (a,h) the number of novel object visits (count); (b,i) the number of familiar object visits (count); (c,j) the number of novel object revisits (count); (d,k) the number of non-novel (center, border, and familiar sample object) visits; (e,l) total time spent with the novel object (s); (f,m) total time spent with the familiar sample object (s); and (g,n) the discrimination index (DI; positive values indicate more time with the novel object vs. negative values indicate more time with the familiar sample object). All values are Means ± SE. Significance was determined by ANOVA and is indicated by †p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001. Superscript letters indicate nutritional group-by-age interaction significance. HM-fed (n = 3); IF-fed (n = 3); HM = human milk; IF = bovine milk-derived infant formula; s = seconds; cm = centimeter. .
Figure 4.
Novel object recognition (NOR) novel (a-g) and control (h-n) testing phase trials of piglet object interaction examined by feeding group (human milk vs. infant formula) and age (3-weeks-old vs. 4-weeks-old): (a,h) the number of novel object visits (count); (b,i) the number of familiar object visits (count); (c,j) the number of novel object revisits (count); (d,k) the number of non-novel (center, border, and familiar sample object) visits; (e,l) total time spent with the novel object (s); (f,m) total time spent with the familiar sample object (s); and (g,n) the discrimination index (DI; positive values indicate more time with the novel object vs. negative values indicate more time with the familiar sample object). All values are Means ± SE. Significance was determined by ANOVA and is indicated by †p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001. Superscript letters indicate nutritional group-by-age interaction significance. HM-fed (n = 3); IF-fed (n = 3); HM = human milk; IF = bovine milk-derived infant formula; s = seconds; cm = centimeter. .

Figure 5.
Microglial morphology in the right prefrontal cortex of HM-fed (n = 3) vs. IF-fed piglets (n = 3) at PD30 as determined using immunofluorescence and quantified using 3DMorph: (a) average branch length (µm); (b) number of branch points (count); (c) number of end points (count); (d) cell complexity index (complexity score); (e) cell volume (µm3); (f) territorial volume (µm3); (g) representative images of HM-fed microglia and (h) IF-fed microglia; Iba1-green; DAPI-blue; scale bar = 50 um. **p < 0.01, ****p < 0.0001. µm =micrometer or micron; µm^3 = micrometer or micron cubed; HM = Human milk; IF = bovine milk-derived infant formula; PD = postnatal day.
Figure 5.
Microglial morphology in the right prefrontal cortex of HM-fed (n = 3) vs. IF-fed piglets (n = 3) at PD30 as determined using immunofluorescence and quantified using 3DMorph: (a) average branch length (µm); (b) number of branch points (count); (c) number of end points (count); (d) cell complexity index (complexity score); (e) cell volume (µm3); (f) territorial volume (µm3); (g) representative images of HM-fed microglia and (h) IF-fed microglia; Iba1-green; DAPI-blue; scale bar = 50 um. **p < 0.01, ****p < 0.0001. µm =micrometer or micron; µm^3 = micrometer or micron cubed; HM = Human milk; IF = bovine milk-derived infant formula; PD = postnatal day.
Table 1.
Novel object recognition (NOR) p-value results from ANOVA for all models and variables: Variables were divided based upon NOR phase (habituation, novel or control). Comparisons were by dietary nutrition group (HM-fed [n=3] vs. IF-fed [n=3]), piglet age (3-weeks-old vs. 4-weeks-old), and potential interactions (nutrition-by-age). .
Table 1.
Novel object recognition (NOR) p-value results from ANOVA for all models and variables: Variables were divided based upon NOR phase (habituation, novel or control). Comparisons were by dietary nutrition group (HM-fed [n=3] vs. IF-fed [n=3]), piglet age (3-weeks-old vs. 4-weeks-old), and potential interactions (nutrition-by-age). .
Variable |
Nutritional Group |
Age |
Nutrition-by-age |
Habituation Variables Distance Traveled Total Time Moving Total Center Time Total Border Time Border Visits |
|
|
|
0.176 |
8.77 x 10-4*** |
0.347 |
0.169 |
0.037* |
0.485 |
0.224 |
0.003** |
9.75 x 10-6**** |
0.231 |
0.002** |
1.00 x 10-5**** |
0.369 |
0.015* |
1.94 x 10-5**** |
Novel Variables Novel Object Visits Familiar Object Visits Novel Object Revisits Non-novel Object Revisits Time with Novel Object Time with Familiar Object DI |
|
|
|
0.356 |
0.001** |
0.603 |
0.036* |
1.87 x 10-7**** |
0.002** |
0.102 |
0.283 |
0.853 |
0.033* |
0.023* |
0.123 |
0.442 |
0.373 |
0.760 |
0.582 |
0.918 |
0.893 |
0.371 |
0.224 |
0.839 |
Control Variables Novel Object Visits Familiar Object Visits Novel Object Revisits Non-novel Object Revisits Time with Novel Object Time with Familiar Object DI |
|
|
|
0.847 |
0.321 |
1.28 x 10-4*** |
0.649 |
0.107 |
0.579 |
0.847 |
0.919 |
0.121 |
0.001** |
0.010* |
0.005** |
0.428 |
0.935 |
0.312 |
0.599 |
0.424 |
0.169 |
0.666 |
0.072† |
0.193 |