Neonatal immune signatures differ by sex regardless of neurodevelopmental disorder status: macrophage migration inhibitory factor (MIF) alone reveals a sex by diagnosis interaction effect.

Immune dysregulation, including aberrant peripheral cytokine/chemokine levels, is implicated in neurodevelopmental disorders (NDD) such as autism spectrum disorder (ASD). While the diagnosis of ASD is more common in males compared to females, sex effects in immune dysregulation related to neurodevelopment remain understudied. The aim of this exploratory study was to determine whether there are sex-specific effects in neonatal immune dysregulation with respect to an ASD or delayed development (DD) diagnosis. We utilized the data from the Early Markers for Autism study, a population based case-control study of prenatal and neonatal biomarkers of ASD. The immune profile of newborns later diagnosed with ASD (n= 482, 91 females), DD (n= 140, 61 females) and sex-matched general population controls (GP; n= 378, 67 females) were analyzed using neonatal bloodspots (NBS) via 42-plex multiplex assay. Multiple linear regression analysis was performed to identify whether sex was associated with differences in cytokine/chemokine levels of children with ASD, DD, and GP. A sex by diagnosis interaction effect was observed only for the chemokine macrophage migration inhibitory factor (MIF), with males displaying higher levels of NBS MIF than females in the GP control group (p= 0.02), but not in ASD (p= 0.52) or DD (p= 0.29) groups. We found that regardless of child diagnosis, newborn blood spot eluates from females had a significantly higher concentration than males with the same diagnosis of the chemokines granulocyte chemotactic protein 2 (GCP-2; p< 0.0001), macrophage inflammatory protein 2-alpha (GROβ; p= 0.002), interferon-inducible t-cell alpha chemoattractant (I-TAC; p< 0.0001), stromal cell-derived factor 1 alpha and beta (SDF-1α-β; p= 0.03), innate inflammatory chemokines interferon-gamma induced protein 10 (IP-10; p= 0.02), macrophage inflammatory protein 1-alpha (MIP-1α; p= 0.02), and the Th1-related pro-inflammatory cytokine interleukin-12 active heterodimer (IL-12p70; p= 0.002). In contrast, males had a higher concentration than females of secondary lymphoid-tissue chemokine (6CKINE; p= 0.02), monocyte chemotactic protein 1 (MCP-1; p= 0.005) and myeloid progenitor inhibitory factor 1 (MPIF-1; p= 0.03). Results were similar when analyses were restricted to NBS from DD and ASD further classified as ASD with intellectual disability (ID), ASD without ID, and DD (GCP-2, p= 0.007; I-TAC, p= 0.001; IP-10, p= 0.005; IL-12p70, p= 0.03 higher in females; MPIF-1, p= 0.03 higher in male). This study is the first to examine sex differences in neonatal cytokine/chemokine concentrations, and whether these differences are associated with neurodevelopmental outcomes. Results highlight the importance of considering sex as a critical factor in understanding the immune system as it relates to child development.