Administration of Extracellular Vesicles From Donor Human Milk in Preterm Infants (AdVEMPrem)

February 9, 2026 updated by: Instituto de Investigacion Sanitaria La Fe

Administration of Extracellular Vesicles Isolated From Donor Human Milk as a Dietary Supplement for the Prevention of Necrotizing Enterocolitis in Preterm Infants

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.

Study Overview

Detailed Description

Human milk is the optimal source of nutrition for infants, providing essential nutrients and bioactive components that promote growth and development. Very preterm infants (<32 weeks gestation) are particularly vulnerable to feeding intolerance, impaired growth, and severe complications such as necrotizing enterocolitis (NEC). When a mother's own milk is insufficient or unavailable, pasteurized donor human milk (DHM) is the recommended alternative.

Extracellular vesicles (EVs) are nanosized particles naturally present in human milk that carry proteins, lipids, and nucleic acids involved in cell signaling, intestinal maturation, immune regulation, and neurodevelopment. Preclinical studies suggest that milk-derived EVs may reduce inflammation and support gut and brain development, but their role in clinical outcomes for very preterm infants has not yet been established.

The AdVEMPrem study (PI23/00202, ISCIII) is a prospective, single-arm pilot trial designed to evaluate the tolerance and safety of DHM-derived EV supplementation in very preterm infants. All enrolled infants will receive oral EV supplementation during hospitalization in the Neonatal Intensive Care Unit. Protocols for isolation and quality control of DHM-EVs will be established to ensure reproducible yields. The biochemical composition of milk and EVs will be characterized for product characterization and exploratory analyses, with emphasis on lipid profiles and functional properties. These analyses are not participant-level outcome measures. Clinical, nutritional, and developmental parameters will be monitored during the neonatal period, alongside biomarkers of redox balance and oxidative/nitrosative stress. Long-term follow-up will assess sustained effects on growth and neurodevelopmental trajectories.

Findings from this pilot study will provide foundational evidence for the potential of milk-derived EVs as a safe nutritional strategy to prevent NEC and improve outcomes in preterm infants. Results will inform the design of larger multicenter trials and may contribute to the development of standardized EV-based supplements or analogues from alternative sources, thereby addressing variability in donor milk composition. Ultimately, access to an efficient and safe nutritional supplement could reduce the incidence of NEC, improve infant and family outcomes, and deliver socio-economic and ecological benefits.

Study Type

Observational

Enrollment (Estimated)

20

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

    • Valencia
      • Valencia, Valencia, Spain, 46026
        • Recruiting
        • Hospital Universitario y Politécnico La Fe
        • Contact:
        • Principal Investigator:
          • Julia Kuligowski, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

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.

Description

Inclusion Criteria:

  • 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)

Exclusion Criteria:

  • 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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

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

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants with treatment-related serious adverse events
Time Frame: From enrollment until term-equivalent age (i.e., up to 40 weeks postmenstrual age)
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
Time Frame: From enrollment until term-equivalent age (i.e., up to 40 weeks postmenstrual age)
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 Outcome Measures

Outcome Measure
Measure Description
Time Frame
Infant weight
Time Frame: From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age
Measurements of weight (grams)
From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age
Infant length
Time Frame: From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age
Measurements of length (cm)
From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age
Infant head circumference
Time Frame: From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age
Measurement of head circumference (cm)
From enrollment until term-equivalent age (weekly) and at 3, 6, 12, 18, and 24 months of corrected age
Analysis of redox status biomarkers
Time Frame: 21 days of life
Evaluation of the ratio reduced/oxidized glutathione
21 days of life
Concentration of TFN alpha (inflammatory biomarker)
Time Frame: 21 days of life
Evaluation of TFN alpha in plasma employing an Enzyme-Linked Immunosorbent Assay (ELISA) kit (nM)
21 days of life
Concentration of IL-6 (inflammatory biomarker)
Time Frame: 21 days of life
Evaluation of IL-6 in plasma employing an ELISA kit (nM)
21 days of life
Concentration of calprotectin (inflammation biomarker)
Time Frame: 21 days of life
Evaluation of calprotectin in plasma employing an ELISA kit (nM)
21 days of life
Ratio of meta-tyrosine/phenylalanine
Time Frame: 14, 21, and 28 days of life
Evaluation of the ratio of meta-tyrosine/phenylalanine in urine samples by Liquid Chromatography coupled to tandem Mass Spectrometry (LC-MS/MS) as an indicator of oxidative damage to proteins
14, 21, and 28 days of life
Ratio of ortho-tyrosine/phenylalanine
Time Frame: 14, 21, and 28 days of life
Evaluation of the ratio of ortho-tyrosine/phenylalanine in urine samples by LC-MS/MS as an indicator of oxidative damage to proteins
14, 21, and 28 days of life
Ratio of 8-hydroxy-2'-deoxyguanosine/2'-deoxyguanosine
Time Frame: 14, 21, and 28 days of life
Evaluation of the ratio of 8-hydroxy-2'-deoxyguanosine/2'-deoxyguanosine in urine samples by LC-MS/MS as an indicator of oxidative damage to DNA
14, 21, and 28 days of life
Concentrations of 2,3-dinor-iPF2α-III
Time Frame: 14, 21, and 28 days of life
Evaluation of 2,3-dinor-iPF2α-III in urine samples by LC-MS/MS as an indicator of oxidative damage to lipids (n mol/g creatinine)
14, 21, and 28 days of life
Concentrations of 5-iPF2α-VI
Time Frame: 14, 21, and 28 days of life
Evaluation of 5-iPF2α-VI in urine samples by LC-MS/MS as an indicator of oxidative damage to lipids (n mol/g creatinine)
14, 21, and 28 days of life
Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-IV) - Motor Composite Score
Time Frame: 6 and 24 months corrected age
Motor development will be assessed using the Motor Composite Score of the Bayley-IV. Higher scores indicate better motor development.
6 and 24 months corrected age
Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-IV) Language Composite Score
Time Frame: 6 and 24 months corrected age
Language development will be assessed using the Language Composite Score of the Bayley-IV. Higher scores indicate better language development.
6 and 24 months corrected age
Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-IV) - Cognitive Composite Score
Time Frame: 6 and 24 months of corrected age
Neurodevelopment will be assessed using the Cognitive Composite Score of the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-IV). Higher scores indicate better cognitive development.
6 and 24 months of corrected age
Ages and Stages Questionnaire, Third Edition (ASQ-3) Total Score
Time Frame: 6 and 24 months of corrected age
Developmental screening will be assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3). The ASQ-3 is a parent-completed developmental screening tool consisting of five domains (communication, gross motor, fine motor, problem solving, and personal-social skills). Higher scores indicating better overall development.
6 and 24 months of corrected age

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 5, 2026

Primary Completion (Estimated)

December 31, 2027

Study Completion (Estimated)

December 31, 2029

Study Registration Dates

First Submitted

December 9, 2025

First Submitted That Met QC Criteria

February 9, 2026

First Posted (Actual)

February 11, 2026

Study Record Updates

Last Update Posted (Actual)

February 11, 2026

Last Update Submitted That Met QC Criteria

February 9, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Very Preterm Infants (<32 Weeks of Gestation)

Clinical Trials on Donor human milk extracellular vesicles (DHM-EVs)

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