This application is for a K08 Career Development Award investigating the novel anti-inflammatory properties of breast milk in necrotizing enterocolitis (NEC). NEC affects nearly 1 out of 10 premature infants weighing less than 1500 grams, with a mortality of up to 50%. It is characterized by intestinal barrier disruption and intestinal necrosis, multi-system organ failure and death. The specific molecular mechanisms responsible for the development of NEC remain unclear. Our laboratory has shown that activation of the bacterial lipopolysaccharide receptor, toll-like receptor 4 (TLR4) is required fo NEC development and that TLR4 activation leads to two key pathological features of NEC: NF-kB-mediated inflammatory response with associated intestinal injury and impaired mucosal healing. Breast milk is the only known protective agent against NEC, but the specific protective component and protective mechanism remain unknown. Our preliminary studies show breast milk decreases TLR4 signaling and a major factor mediating this protective effect is epidermal growth factor (EGF). The overall hypothesis is that activation of the EGF receptor ameliorates NEC by antagonizing at least two major deleterious aspects of TLR4 signaling: inflammation and impaired epithelial healing. The protection seen with EGFR activation likely involves the competitive interaction of several signal transduction pathways. Therefore, we further hypothesize that the EGF in breast milk promotes intestinal cell healing by enhancing Wnt and decreasing Notch activation. To test this hypothesis, we will use our experimental NEC model to pursue the following specific aims: 1. To determine the extent that breast milk inhibits TLR4-mediated inflammatory signaling in NEC. 2. To characterize the effects of breast milk on intestinal epithelial cell proliferation and mucosal healing. 3. To determine the mechanisms by which breast milk regulates intestinal epithelial cell differentiation via TLR4-mediated Notch activation in NEC pathogenesis. The candidate is a Neonatologist who has been working closely with her mentor for the past four years. She benefits from a well-established and successful mentor with a supportive academic environment. In addition, the candidate meets on a regular basis with her Scientific Advisory Committee, which is comprised of experts in Immunology, Cell Biology and Physiology, and her collaborator, Dr. Jennifer Grandis with expertise in EGFR signal transduction. The candidate's immediate goals are to gain increased knowledge in molecular biology, immunology and signal transduction. Her long-term career goals are to become a productive independent investigator who will significantly contribute to the field studying the pathogenesis of NEC. To achieve these goals, a structured career development plan was developed which includes: gaining knowledge through educational activities, course work, conferences, frequent mentor meetings with a gradual increase in independence and a Scientific Advisory Committee who is devoted to the candidate's success.

Public Health Relevance

Necrotizing enterocolitis (NEC) is associated with significant infant mortality and the etiology remains incompletely understood. Breast milk is known to protect against NEC, however the specific protective component and mechanism that mediates protection remain unclear. This proposal seeks to understand the anti-inflammatory properties of breast milk on the intestinal epithelium in the pathogenesis of NEC.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Clinical Investigator Award (CIA) (K08)
Project #
Application #
Study Section
Digestive Diseases and Nutrition C Subcommittee (DDK)
Program Officer
Podskalny, Judith M,
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pittsburgh
Schools of Medicine
United States
Zip Code
Sodhi, Chhinder P; Fulton, William B; Good, Misty et al. (2018) Fat composition in infant formula contributes to the severity of necrotising enterocolitis. Br J Nutr 120:665-680
Lanik, Wyatt E; Xu, Lily; Luke, Cliff J et al. (2018) Breast Milk Enhances Growth of Enteroids: An Ex Vivo Model of Cell Proliferation. J Vis Exp :
Hackam, David J; Sodhi, Chhinder P; Good, Misty (2018) New insights into necrotizing enterocolitis: From laboratory observation to personalized prevention and treatment. J Pediatr Surg :
Ralls, Matthew W; Gadepalli, Samir K; Sylvester, Karl G et al. (2018) Development of the necrotizing enterocolitis society registry and biorepository. Semin Pediatr Surg 27:25-28
Mara, Madison A; Good, Misty; Weitkamp, Joern-Hendrik (2018) Innate and adaptive immunity in necrotizing enterocolitis. Semin Fetal Neonatal Med 23:394-399
Good, Misty; McElroy, Steven J; Berger, Jennifer N et al. (2018) Limited achievement of NIH research independence by pediatric K award recipients. Pediatr Res 84:479-480
Lanik, Wyatt E; Mara, Madison A; Mihi, Belgacem et al. (2018) Stem Cell-Derived Models of Viral Infections in the Gastrointestinal Tract. Viruses 10:
Good, Misty; McElroy, Steven J; Berger, Jennifer N et al. (2018) Name and Characteristics of National Institutes of Health R01-Funded Pediatric Physician-Scientists: Hope and Challenges for the Vanishing Pediatric Physician-Scientists. JAMA Pediatr 172:297-299
Lueschow, Shiloh R; Stumphy, Jessica; Gong, Huiyu et al. (2018) Loss of murine Paneth cell function alters the immature intestinal microbiome and mimics changes seen in neonatal necrotizing enterocolitis. PLoS One 13:e0204967
Drummond, Coyne G; Bolock, Alexa M; Ma, Congrong et al. (2017) Enteroviruses infect human enteroids and induce antiviral signaling in a cell lineage-specific manner. Proc Natl Acad Sci U S A 114:1672-1677

Showing the most recent 10 out of 28 publications