Breast milk protects against the development of necrotizing enterocolitis through inhibition of Toll-like receptor 4 in the intestinal epithelium via activation of the epidermal growth factor receptor

Mucosal Immunol. 2015 Sep;8(5):1166-79. doi: 10.1038/mi.2015.30. Epub 2015 Apr 22.

Abstract

Breast milk is the most effective strategy to protect infants against necrotizing enterocolitis (NEC), a devastating disease that is characterized by severe intestinal necrosis. Previous studies have demonstrated that the lipopolysaccharide receptor Toll-like receptor 4 (TLR4) plays a critical role in NEC development via deleterious effects on mucosal injury and repair. We now hypothesize that breast milk protects against NEC by inhibiting TLR4 within the intestinal epithelium, and sought to determine the mechanisms involved. Breast milk protected against NEC and reduced TLR4 signaling in wild-type neonatal mice, but not in mice lacking the epidermal growth factor receptor (EGFR), whereas selective removal of EGF from breast milk reduced its protective properties, indicating that breast milk inhibits NEC and attenuates TLR4 signaling via EGF/EGFR activation. Overexpression of TLR4 in the intestinal epithelium reversed the protective effects of breast milk. The protective effects of breast milk occurred via inhibition of enterocyte apoptosis and restoration of enterocyte proliferation. Importantly, in IEC-6 enterocytes, breast milk inhibited TLR4 signaling via inhibition of glycogen synthase kinase-3β (GSK3β). Taken together, these findings offer mechanistic insights into the protective role for breast milk in NEC, and support a link between growth factor and innate immune receptors in NEC pathogenesis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Apoptosis / genetics
  • Apoptosis / immunology*
  • Cell Line
  • Enterocolitis, Necrotizing / genetics
  • Enterocolitis, Necrotizing / immunology
  • Enterocolitis, Necrotizing / pathology
  • Enterocolitis, Necrotizing / prevention & control*
  • Enterocytes / immunology*
  • Enterocytes / pathology
  • Epidermal Growth Factor / genetics
  • Epidermal Growth Factor / immunology
  • ErbB Receptors / genetics
  • ErbB Receptors / immunology
  • Female
  • Glycogen Synthase Kinase 3 / genetics
  • Glycogen Synthase Kinase 3 / immunology
  • Glycogen Synthase Kinase 3 beta
  • Mice
  • Milk / immunology*
  • Signal Transduction / genetics
  • Signal Transduction / immunology*
  • Toll-Like Receptor 4 / genetics
  • Toll-Like Receptor 4 / immunology*

Substances

  • Tlr4 protein, mouse
  • Toll-Like Receptor 4
  • Epidermal Growth Factor
  • EGFR protein, mouse
  • ErbB Receptors
  • Glycogen Synthase Kinase 3 beta
  • Gsk3b protein, mouse
  • Glycogen Synthase Kinase 3