The immature intestinal epithelial cells in preterm infants play a role in the necrotizing enterocolitis pathogenesis: A review

Abstract

Intestinal stem cells (ISCs) possess the self-renewal capacity to produce progenitor cells that differentiate into Paneth cells, enterocytes, goblet cells, or enteroendocrine cells in the small intestine. The differences in functionality and population of intestinal epithelial cells (IECs) between neonates (including premature and term infants) and adults for both humans and rodents are discussed. The impact of gestational age and postnatal age on each IEC type's functionality is explored. The specific characteristics of Paneth cells, goblet cells, and enterocytes that make preterm infants more vulnerable to infectious diseases than term infants or adults are described. These characteristics in the preterm intestine include a reduced thickness of mucus, lower intestinal alkaline phosphatase secreted by enterocytes, and diminished secretion of lysozymes by Paneth cells compared to term infants, which increase their risk of inflammation, dysbiosis, and development of necrotizing enterocolitis (NEC). Further studies are needed to characterize the critical role of growth factors, antibodies, cytokines, and immune cells from breast milk to prevent NEC development in preterm infants by promoting their maturation of IECs.