Early life medical intervention, such as occurs in the neonatal intensive care unit, saves infant lives, but also is
a significant risk factor for subsequent emotional, mood and sensory dysfunction, including chronic pain.
Critically, there is mounting evidence of significant sex differences in NICU outcomes, with greater mortality
and gross neurological dysfunction in males and greater risk of internalizing disorders in females. However,
the mechanisms underlying these sex differences are largely unknown, a key gap in the literature. Our long-
term goal is to understand the neurological substrates that underlie the different effects of neonatal pain and
stress on vulnerability to negative affect disorders, including chronic pain, during the juvenile period in male
and female rats. To accomplish this, we will expose neonatal rats to NICU-like treatment including a series of
repetitive paw pricks which results in a latent vulnerability. Our central hypothesis is that the underlying
neuro/endocrine mechanisms differ between the sexes. For example, we have previously demonstrated that
exposure to a subsequent “activating” stressor during the juvenile period unmasks alterations to negative
affective behavior and pain thresholds in both sexes following neonatal pain. However, the neurobiology
underlying these changes differ. For example, Corticotropin Releasing Factor (CRF)-containing cells within the
central nucleus of the amygdala (CeA) are particularly responsive during neonatal trauma and are reduced in
number later in life, but only in male rats. Females, although also affected by neonatal pain, do not appear to
undergo the same changes in the amygdalar CRF system. Importantly, however, intra-amygdala CRF1
antagonists can reverse the hypersensitivity in both sexes. Thus, while CRF-expressing cells in the CeA are
only involved in male rats, CRF receptors are involved in both sexes, suggesting involvement of a non-
amygdala source of CRF in females. Preliminary data point to the hypothalamus. To better understand these
differences, we propose a series of innovative experiments to identify the behavioral and brain changes
underlying the different effects of neonatal pain in male and female rats. Specific Aim 1 proposes hi-plex in
situ hybridization and florescent immunohistochemistry designed to assess changes in neuropeptide gene
expression and cellular phenotypes in the amygdala and hypothalamus to examine differences between male
and female rats exposed to NICU-like experiences. While the function of some individual genes and
biomarkers have been established, many cells co-express several neuropeptides and the various overlapping
expression patterns of these neuropeptides has not been studied. Specific Aim 2 looks for changes in
neuronal activation patterns in identified cell types in the amygdala and hypothalamus and correlates this with
changes in behavior, using immediate early gene signaling as a proxy for neuronal activation. Together, these
experiments will fill in critical gaps in our knowledge regarding sex differences in the lasting consequences of
neonatal pain.