Mechanisms of gut barrier failure in the pathogenesis of necrotizing enterocolitis: Toll-like receptors throw the switch.

Abstract:

:Necrotizing enterocolitis (NEC) is the leading cause of death from gastrointestinal causes in premature infants, and its overall survival has not improved in the past three decades. While the precise cause of NEC remains incompletely understood, we and others have shown that a major predisposing factor in the development and propagation of NEC is a breakdown of the intestinal barrier which leads to bacterial translocation and systemic sepsis. In seeking to identify the causes involved, we and others have also determined that activation of the receptor for bacterial endotoxin, namely toll-like receptor 4 (TLR4), is required for the development of intestinal barrier failure leading to NEC. We have also shown that the premature infant is endowed with strategies that can either limit or promote the extent of TLR4 signaling within the gut, which together determine the relative propensity with which NEC develops. In this review, we highlight the evidence for TLR4 signaling in the pathogenesis of NEC through a survey of its effects on gut barrier failure. We identify how TLR4 regulation within the gut can explain the unique susceptibility of the premature infant to the development of NEC, and highlight how strategies to limit the degree of TLR4 signaling can serve as novel therapeutic approaches for this devastating disease.

journal_name

Semin Pediatr Surg

authors

Hackam DJ,Good M,Sodhi CP

doi

10.1053/j.sempedsurg.2013.01.003

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

76-82

issue

2

eissn

1055-8586

issn

1532-9453

pii

S1055-8586(13)00004-8

journal_volume

22

pub_type

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