Milk-derived exosomes as a potential therapy for necrotizing enterocolitis: a scoping review

Introduction: Necrotizing enterocolitis (NEC), a devastating gut disease primarily affecting premature infants, currently lacks effective treatment options. Human milk, known for its protective benefits against NEC, contains compositions that hold promises for addressing this urgent medical need. Thus, this study aimed to provide an overview of the therapeutic potential of milk-derived exosomes, offering valuable insights that could pave the way for future clinical interventions and advancements in NEC treatment strategies. Methods: Keywords such as “human milk”, “exosomes”, “human milk exosomes”, “necrotizing enterocolitis”, “therapy”, and “treatment” were employed during the search strategy in Scopus, PubMed, and ScienceDirect.The articles were chosen in accordance with PRISMA-ScR, where a total of 125 articles were further screened based on the inclusion and exclusion criteria, resulting in five selected articles reviewed in this study.Results: Milk-derived exosomes have the ability to enhance epithelial integrity by increasing the expression of tight-junctions namely ZO-1, claudin-1, and occludin. These vesicles give protection to intestinal epithelial cell by improving the expression of goblet cells and increase mucin production and also able to reduce inflammation and stimulate cell growth and regeneration by increasing the number of ileum crypts and Lgr5 expression. In addition, milk-derived exosomes protect against cell damage by enhancing the expression of genes in the Wnt/?-catenin signalling pathway which are Axin2, c-Myc, and Cyclin D1. Conclusion: These findings conclude that milk-derived exosomes are beneficial to protect the intestinal epithelial cells. Various pathways can be explored and targeted in relations to creating new drugs that can effectively control the occurrence and development of NEC, including improving the prognosis of infants with NEC.