The role of myeloid cells in the pathogenesis of necrotizing enterocolitis; a scoping review

TL;DR

This review explores how myeloid cells contribute to a severe gut disease in preterm infants and suggests immune-targeted therapies could help.

Contribution

The paper systematically reviews the role of specific myeloid cell types in NEC pathogenesis and highlights potential therapeutic strategies.

Findings

Reduced peripheral blood monocytes and increased intestinal proinflammatory monocytes and neutrophils correlate with NEC severity.

Immunoregulatory MDSCs may protect against NEC, but their function is impaired in affected preterm infants.

Therapies targeting TGF-β2 and lactoferrin show promise in preclinical models for reducing NEC inflammation.

Abstract

Necrotizing enterocolitis (NEC) is a severe gastrointestinal disorder that primarily affects preterm infants, resulting in significant morbidity and mortality. The exact cause of NEC remains unclear, but it is believed to involve a combination of immune dysregulation, intestinal injury, and microbiota imbalance.

This scoping review examines existing human and animal studies that explore the role of myeloid cells (neutrophils, monocytes, macrophages, and myeloid-derived suppressor cells (MDSCs) in NEC pathogenesis.

A reduction in peripheral blood monocytes, along with increased infiltration of proinflammatory monocytes and neutrophils into the intestine, are strongly associated with NEC severity. Immunoregulatory MDSCs may provide protective benefits; however, their activity appears impaired in preterm infants with NEC. Therapies targeting these immune pathways, including transforming growth factor-β2 (TGF-β2) and lactoferrin, show promise in preclinical models for mitigating inflammation and improving outcomes in infants with NEC.

Targeting myeloid cell immune responses represents a potential therapeutic strategy in NEC. Future research should focus on translating immune-modulating therapies to clinical practice, as such interventions may reduce NEC incidence and severity and offer new hope for vulnerable neonates.

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