Maternal milk is a complex fluid with multifunctional roles within the developing gastrointestinal tract. Epidermal growth factor (EGF) and heparin-binding EGF-like growth factor (HB-EGF) are members of the family of EGF-related peptides. Biological actions of these growth factors are mediated via interaction with the EGF-receptor (EGF-R). In the early postnatal period, breast milk is the major source of EGF for the developing intestinal mucosa. HB-EGF is also detected in breast milk, but in concentrations 2 to 3 times lower than EGF. Under normal physiological conditions, the intestinal epithelium undergoes a continuing process of cell proliferation, differentiation and maturation. EGF plays an important role in these processes. In pathophysiologic situations, EGF contributes to epithelial protection from injury and post-injury mucosal repair. Necrotizing enterocolitis (NEC) is a devastating disease affecting prematurely born infants. The pathogenesis of NEC is not known and there is no effective treatment for this disease. In an experimental NEC model, oral administration of a physiological dose of EGF significantly reduces the incidence and severity of NEC. HB-EGF provides similar protection against NEC, but only when pharmacological doses are used. Further studies are necessary before EGF can be introduced as an efficient therapeutic approach of intestinal injury.
Maternal milk and developing gutMaternal milk is an important and well-balanced source of nutrition for the newborn (1). Milk provides not only major nutrients, vitamins and minerals, but also a plethora of biologically active substances, such as hormones, cytokines, and growth factors (2-6). These biological active factors not only facilitate the development of essential digestive functions, but also regulate the maturation of the intestinal mucosal barrier (7). In addition to their normal physiological functions, many of these factors have the capacity to stimulate the healing and repair processes in injured intestinal epithelium.The gastrointestinal (GI) tract is a complex organ which undergoes substantial changes during the early stages of development. Profound growth, morphological and functional changes are observed during the late gestation and early postnatal period (8). Birth is possibly the most critical period in gastrointestinal development, when placental supply is replaced by enteral nutrition. Enteral nutrition initiates changes in intestinal mucosal structure and function required for utilization of milk feedings. However, intestinal maturation begins long before birth and amniotic fluid plays an important role in this process (7). In addition to its digestive