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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
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Poster Session 3

Category: Infectious Diseases

Poster Session 3

(847) Non-Invasive Diagnosis of Symptomatic Congenital CMV Infection: Biomarkers from the MFMU Trial of Hyperimmune Globulin

Thursday, February 12, 2026
10:30 AM - 12:00 PM  

    Submitting Author and Presenting Author(s)

  • Lierni Ugartemendia, PhD (she/her/hers)

    Postdoctoral Research Fellow
    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

    • Coauthor(s)

  • Brenna L. Hughes, MD (she/her/hers)

    Professor
    Department of Obstetrics and Gynecology, Duke University School of Medicine
    Duke, North Carolina, United States

  • RS

    Robert Suchting, PhD

    Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • GD

    Gail Demmler-Harrison, MD

    Department of Pediatrics and Pathology & Immunology, Baylor College of Medicine
    Houston, Texas, United States

  • LG

    Laura Goetzl, MD

    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

Objective:

Prenatal diagnosis of congenital cytomegalovirus (CMV) infection requires delaying amniocentesis following primary infection. We hypothesized that fetal neural-derived extracellular vesicles (fCNSEVs) may allow for earlier non-invasive diagnosis of fetal infection as well as additional prognostic information.


Study Design:

We purified fCNSEVs from the serum of pregnant women with primary CMV infection (GA< 28 weeks) enrolled in the MFMU-CMV trial. 51 women received hyperimmune globulin (IG) and 47 placebo. Neonates were categorized into 3 groups: uninfected (UNI, n=44), asymptomatic (ASY, n=25), symptomatic (SYM, n=29), and infection was confirmed after birth. We measured synaptopodin (SYNPO) and BCL2-associated transcription factor 1 (BCLAF1) from fCNSEVs at baseline (GA< 27 weeks), and 8.3±0.7 weeks later. Linear mixed-effects models fit each log-transformed biomarker as a function of time by symptom group interaction, adjusting for main effects. Interpretation relied on estimated marginal contrasts and slopes. Follow-up models evaluated the effect of IG treatment.


Results:

Baseline SYNPO levels were significantly higher in SYM relative to UNI (+24.7%, p< .001) and ASY (+15.8%, p= .043). But there were not differences between ASY and UNI (+7.7%, p= .354). Similarly, BCLAF1 were significantly higher in SYM relative to UNI (+20%, p= .025) and ASY (+27.2%, p= .012), without differences between ASY and UNI (+3.3%, p= .811). 8 weeks post enrollment, SYNPO decreased by -20.2% in SYM (p< .001, Fig 1A) but no changes in BCLAF1 were observed (p=.092, Fig 1B).


Conclusion:

fCNSEV biomarkers may allow non-invasive identification of those fetuses at highest risk for symptomatic infection, both for patient counseling and for potential novel anti-viral treatments. Serial biomarker measurements are associated with neonatal outcome and may prove useful tracking response to therapy and/or fetal rebound from initial infectious injury through neuroplasticity.