Insulin-like growth factors (IGF) I and II and IGF binding proteins (IGFBPs) in human colostrum/transitory milk during the first week postpartum: comparison with neonatal and maternal serum

Hormonal regulation of mammary gland development and lactation

Lactation is critical to infant short-term and long-term health and protects mothers from breast cancer, ovarian cancer and type 2 diabetes mellitus. The mammary gland is a dynamic organ, regulated by the coordinated actions of reproductive and metabolic hormones. These hormones promote gland development from puberty onwards and induce the formation of a branched, epithelial, milk-secreting organ by the end of pregnancy. Progesterone withdrawal following placental delivery initiates lactation, which is maintained by increased pituitary secretion of prolactin and oxytocin, and stimulated by infant suckling. After weaning, local cytokine production and decreased prolactin secretion trigger large-scale mammary cell loss, leading to gland involution. Here, we review advances in the molecular endocrinology of mammary gland development and milk synthesis. We discuss the hormonal functions of the mammary gland, including parathyroid hormone-related peptide secretion that stimulates maternal calcium mobilization for milk synthesis. We also consider the hormonal composition of human milk and its associated effects on infant health and development. Finally, we highlight endocrine and metabolic diseases that cause lactation insufficiency, for example, monogenic disorders of prolactin and prolactin receptor mutations, maternal obesity and diabetes mellitus, interventions during labour and delivery, and exposure to endocrine-disrupting chemicals such as polyfluoroalkyl substances in consumer products and other oestrogenic compounds.

The Function and Alteration of Immunological Properties in Human Milk of Obese Mothers

Maternal obesity is associated with metabolic changes in mothers and higher risk of obesity in the offspring. Obesity in breastfeeding mothers appears to influence human milk production as well as the quality of human milk. Maternal obesity is associated with alteration of immunological factors concentrations in the human milk, such as C-reactive protein (CRP), leptin, IL-6, insulin, TNF-Alpha, ghrelin, adiponectin, and obestatin. Human milk is considered a first choice for infant nutrition due to the complete profile of macro nutrients, micro nutrients, and immunological properties. It is essential to understand how maternal obesity influences immunological properties of human milk because alterations could impact the nutrition status and health of the infant. This review summarizes the literature regarding the impact of maternal obesity on the concentration of particular immunological properties in the human milk.

Impact of early aggressive nutrition on retinal development in premature infants

The normal retinal development is interrupted by preterm birth and a retinopathy of prematurity (ROP) may develop as its consequence. ROP is characterized by aberrant vessel formation in the retina as a response to multiple risk factors influencing the process of retinal angiogenesis. Insulin-like growth factor I (IGF-1) and vascular endothelial growth factor (VEGF) play an important role in the process of normal retinal vascularization. Insufficient nutrition during the first 4 postnatal weeks results in low serum levels of IGF-1, which is essential for correct retinal vessels formation, ensuring survival of the newly formed endothelial cells. Low IGF-1 level results in stop of angiogenesis in the retina, leaving it avascular and prompting the onset of ROP. Keeping the newborns in a positive energetic balance by providing enough nutrients and energy has a beneficial impact on their growth, neurodevelopment and decreased incidence of ROP. The best way to achieve this is the early parenteral nutrition with the high content of nutrients combined with early enteral feeding by the own mother´s breast milk. Multiple studies confirmed the safety and efficacy of early aggressive nutrition but information about its long-term effects on the metabolism, growth and development is still needed.

Effect of human milk formula with bovine colostrum supplementation on bone mineral density in infant cynomolgus macaques

Insulin-like growth factor 1 (IGF1) is a regulator of human growth during infancy and childhood, known to promote bone and muscle growth as well as lipid accumulation. This study aimed to investigate the effects of formula milk with or without IGF1 supplementation (in the form of pure IGF1 or bovine colostrum) on growth and body composition in infant cynomolgus macaques during the first 6 months of life. Three groups of infants were nursery-reared and received formula milk with or without IGF1 or bovine colostrum supplementation for 4 months, and a fourth group consisting of breast-fed infants was included for comparison (n=6 for each group). Ranked-based analysis of covariance was used to detect differences between adjusted means for sex. No differences in weight, height, fat mass, and fat-free mass could be detected between groups. However, bone mineral density (BMD) was significantly different between groups at the end of formula feeding. Infants that received bovine colostrum supplementation displayed higher mean BMD than infants of all other groups, with no differences between the latter three groups. In conclusion, our results suggest that supplementation with bovine colostrum can enhance BMD in formula-fed infants, an effect that apparently does not depend on IGF1. Bovine colostrum supplementation could be beneficial for long-term bone health in infants with suboptimal bone growth.

Functional analysis of the IGF-system in milk

The development of milk during evolution is considered a more recent step to provide the neonate with adequate amounts of energy, nutrients, and specific hormonal signals thereby, granting a fast and efficient rate of postnatal growth and development. Since the insulin- or the insulin-like growth factor (IGF) systems were evolved much earlier, it can be assumed that the functionality of the IGF-system has been integrated into the novel matrix milk containing casein and whey proteins from the beginnings. In fact, IGFs and IGF-binding proteins (IGFBPs) are abundantly present in milk, which is particularly true for fore-milk or colostrum and the potential effects of milk-borne IGF-compounds on the consuming organisms have in fact been addressed by several studies. Those studies examined, if orally administered IGFs can be absorbed by the consumer's gastro-intestinal tract and thus contribute e.g. to the somatic growth of infants. A second line of studies assessed local effects of milk-borne IGFs on growth and development of the gastro-intestinal tract itself. Finally, distinct functions of isolated IGF-compounds for growth and involution of the mammary gland have also been provided in the past. While the consumption of milk seems not to represent a major source of endogenous IGFs, accumulating evidence indicates secondary effects of milk on the endogenous IGF-system, which may be mediated by micronutrients such as branched amino acids and metabolic programming. By contrast, direct effects on growth and development of oesophageal and intestinal cells have been observed if IGFs were administered orally.

Insulin-like growth factors in the gastrointestinal tract and liver

The liver is a major source of insulin-like growth factors (IGFs) and IGF binding proteins (IGFBPs) that are present in the circulation and have important endocrine activities relating to energy metabolism, body size, carcinogenesis, and various organ-specific functions. Although IGFs have only minor effects on the normal liver itself, production of IGFs and IGFBPs in a tissue-specific manner in the gastrointestinal tract exert important regulatory effects on cellular proliferation, survival, and apoptosis. IGFs and IGFBPs play important regulatory roles in the response of both the liver and the gastrointestinal tract to inflammation and in the development of neoplasia.

Vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor-I and platelet-derived growth factor levels in human milk of mothers with term and preterm neonates

Human milk is a complex biological fluid. It contains many nutrients, anti-infectious and biologically active substance. Human milk also contains many angiogenic polypeptides. We have determined four of these: Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), insulin-like growth factor- I (IGF-I) and platelet-derived growth factor (PDGF). The aim of this study was to compare the concentrations of VEGF, b-FGF, IGF-I and PDGF in human milk collected from mothers with preterm and term neonates. Human milk samples were collected from 29 mothers of preterm (<37 weeks) and from 29 mothers of term (38>weeks) infants at days 3, 7 and 28 postpartum. Milk samples were analyzed for VEGF, b-FGF and PDGF by enzyme-linked immunosorbent assay and IGF-I was measured by radioimmunoassay method. Human milk levels of VEGF, IGF-I and b-FGF were significantly higher (p<0.001). Furthermore, within-preterm group concentrations of VEGF, IGF-I and PDGF significantly differed during postpartum days 3-7-28 (p<0.001, p<0.05, p<0.001, respectively), but did not do so for b-FGF concentrations. In term groups, concentrations of IGF-I and VEGF significantly differed (p<0.05, p<0.001, respectively), but did not do so for concentrations of b-FGF and PDGF. This is the first report of simultaneous measurements of four major angiogenic factors in human milk collected from mothers with preterm and term. Our results suggest that three of four angiogenic factors, VEGF, b-FGF and IGF-I, are higher concentration in human milk which collected from preterm mothers than those of terms.

Temporal changes in insulin-like growth factors I and II and in insulin-like growth factor binding proteins 1, 2, and 3 in human milk

AIM

To evaluate the postpartum time course of changes in insulin-like growth factors (IGFs) and their binding proteins (IGFBPs).

METHODS

Breast milk IGF-I and IGF-II and IGFBP-1, IGFBP-2, and IGFBP-3 levels were determined in 23 women with babies born at term, from day 4 until up to 9 months after birth.

RESULTS

The IGFBP-3 levels were highest from day 4 to day 6 and then decreased by days 10-12. In contrast, IGF-I and IGF-II and IGFBP-1 and IGFBP-2 showed little change over the first 2 weeks after birth. Subsequently, all the IGF components showed a moderate decline over approximately the first 1-3 months and then stable levels up to 9 months after birth.

CONCLUSION

Although the possibility cannot be excluded that these changes in levels of IGFs and their binding proteins in human milk represent passive loss from the mammary gland, we speculate that higher early levels of the human milk IGF system contribute to maturation of the infant gut.

Effect of enteral IGF-1 supplementation on feeding tolerance, growth, and gut permeability in enterally fed premature neonates

OBJECTIVES

The gastrointestinal tract of the premature newborn functions suboptimally with regard to digestion, absorption, and feeding tolerance. Human milk contains trophic factors, such as insulin-like growth factor-1 (IGF-1), that are believed to stimulate gut growth and function. The objective of this double blind, randomized, controlled trial was to assess the effects of enteral IGF-1 supplementation on whole body growth measured by weight gain (in grams per kilogram per day), days to regain birth weight, and anthropometrical characteristics, and gut maturation and permeability (measured by sugar absorption tests).

PATIENTS AND METHODS

The study included 60 premature infants (birth weight 750-1250 g) during the first month of life. Patients received either standard infant formula or standard infant formula supplemented with IGF-1 in a concentration twice that of human colostrum (10 microg/100 mL of formula). Primary endpoints were days to full enteral feeding, days to regain birth weight, and growth rate. Sugar absorption tests were performed weekly to assess the secondary endpoints gut permeability and maturation.

RESULTS

None of the primary endpoints differed to statistical significance between groups at any point. However, gut permeability was significantly lower in the IGF-1 supplement group on day 14 compared with the control group. At day 21, lactulose/mannitol excretion ratios were (again) comparable between the groups.

CONCLUSIONS

Although gut permeability showed a faster decrease in the IGF-1 supplement group, our data do not support IGF-1 supplementation to infant formula.

Insulin-like growth factors and insulin-like growth factor binding proteins in mammary gland function

Insulin-like growth factor (IGF)-mediated proliferation and survival are essential for normal development in the mammary gland during puberty and pregnancy. IGFs interact with IGF-binding proteins and regulate their function. The present review focuses on the role of IGFs and IGF-binding proteins in the mammary gland and describes how modulation of their actions occurs by association with hormones, other growth factors and the extracellular matrix. The review will also highlight the involvement of the IGF axis in breast cancer.

Insulin-like growth factors and insulin-like growth factor binding proteins in mammary gland function

Insulin-like growth factor (IGF)-mediated proliferation and survival are essential for normal development in the mammary gland during puberty and pregnancy. IGFs interact with IGF-binding proteins and regulate their function. The present review focuses on the role of IGFs and IGF-binding proteins in the mammary gland and describes how modulation of their actions occurs by association with hormones, other growth factors and the extracellular matrix. The review will also highlight the involvement of the IGF axis in breast cancer.

Insulin-like growth factor binding protein-5 (IGFBP-5) potentially regulates programmed cell death and plasminogen activation in the mammary gland

This study aims to investigate the mechanism by which prolactin and GH interact to maintain mammary epithelial cell function in the rat. IGF-I is an important survival factor for the mammary gland and we have demonstrated that the effects of GH and prolactin involve IGF-I. GH acts by increasing IGF-I whilst prolactin acts by inhibiting the expression of IGFBP-5 from the mammary epithelium. During mammary involution, when serum prolactin levels decline, IGFBP-5 expression is dramatically upregulated and it binds with high affinity to IGF-I preventing IGF-I interaction with the IGF-receptor and thus leading to epithelial cell apoptosis. We have identified a specific interaction of IGFBP-5 with alpha s2-casein. This milk protein has also been shown to bind plasminogen and its activator tissue-type plasminogen activator (tPA) leading to enhanced conversion of plasminogen to plasmin. Plasmin is an important initiator of re-modelling of the extracellular matrix during mammary involution. A potential interaction between the cell death and extracellular matrix remodelling is evident from the observation that IGFBP-5 binds to plasminogen activator inhibitor-I (PAI-1). We thus hypothesized that IGFBP-5 could activate cell death by sequestration of IGF-I and activate plasminogen cleavage by sequestering PAI-1. In support of this hypothesis we have shown that both prolactin and GH inhibit tPA activity and plasminogen activation in the involuting mammary gland. Our results suggest that GH and prolactin inhibit cell death and ECM remodelling via the IGF-axis and also indicate a novel role for the milk protein alpha s2-casein in this process. We have now established lines of transgenic mice expressing IGFBP-5 on the beta-lactoglobulin promoter to explore its function in greater detail.

Insulin-like growth factor binding proteins: IGF-dependent and -independent effects in the mammary gland

The insulin-like growth factor binding proteins (IGFBPs) are a family of proteins which bind to the IGFs with high affinity. Their expression within the mammary gland is species specific; it has thus been difficult to determine the biological roles of these binding proteins during lactation. In this article we propose a role for IGFBP-5 in the mammary gland involving the initiation of apoptosis induced by sequestration of IGF-1, an important survival factor for the mammary gland. We have shown that this binding protein retains its high affinity for IGF-1 and that it is present in extremely high concentrations compared with the growth factor. These observations make it likely that IGFBP-5 is capable of preventing interaction of IGF-1 with its receptor on the epithelial cells synthesizing milk. We have also demonstrated that IGFBP-5 interacts with alpha(s2)-casein and that this interaction implicates it in the regulation of plasminogen activation in the mammary gland. The generation of plasmin is a key initiating event in the remodeling of the extracellular matrix during mammary involution. As such, IGFBP-5 may play a key role in coordinating cell death and tissue remodeling processes. Many of the molecules involved in embryological development are also expressed in the developing and involuting mammary gland. We believe that our studies may offer mechanistic explanations for apoptotic events in a wide variety of tissues. We have recently shown that IGFBP-5 is apoptotic in the chick embryonic limb bud, adding further support to our belief that IGFBP-5 serves this function in the mammary gland. We hope to be able to explore the role of this binding protein in the mammary gland with a transgenic mouse model expressing IGFBP-5 on the beta-lactoglobulin promoter.

-Bioactive factors in milk-

Human milk as well as the milk of several mammalian species contains, beside major nutrients and anti-infectious and immunocompetent substances, a group of biologically active substances called "milk-borne trophic factors" or "growth modulators". Milk-borne trophic can be classified into three groups: hormones and trophic peptides; nucleotides, nucleosides and derived substances; and polyamines, especially spermine and spermidine. Certain hormones and peptides such as growth hormone, insulin, insulin like-growth factor I (IGF-I), epidermal growth factor (EGF), prolactin and growth hormone releasing factor (GHRF) can influence directly newborn's metabolism after intestinal absorption and promote growth and differentiation of several organs and target tissues. They could exert a cytoprotective effect against toxins and toxic substances and reduce the potential risk of necrotizing enterocolitis. Nucleotides are present in human milk at high levels, and are precursors of nucleic acids, which implies that they can enhance growth and differentiation of several organs and tissues, especially the liver. Nucleotides from milk enhance lipid metabolism, lipoprotein synthesis and liver cell function and regeneration. In addition, they have a determinant action on the development of the gut associated lymphoid tissue (GALT). Lastly, polyamines, mainly spermine and spermidine, are polycationic substances virtually present in all cells, whose concentration in human milk is about ten times higher than in infant formulae. In addition, spermine and spermidine levels increase markedly during the first 3 days of lactation reaching, after 1 week, plateau levels which are respectively 12 and eight times higher than the levels measured at day 0. Although several experimental studies have shown that polyamines from the milk of lactating mammals determine important mitogenic, metabolic and immunological effects promoting growth and differentiation of the immature gastrointestinal tract of the offspring, their beneficial effects on growth and differentiation of the gastrointestinal tract in humans remain hypothetical. As a consequence, enrichment of milk formulae in one or in several trophic factors is an important but complex goal. Its practical realization is not realistic today because of a too great number of incertitudes. The most important is related to potential beneficial or adverse effects emerging at short or at long term and to the individual interactions of these substances which could be agonist and antagonist because they are naturally present in milk as a "complex cocktail" whose composition changes during the lactation period.

Characterization of truncated insulin-like growth factor-binding protein-2 in human milk

Truncated forms of insulin-like growth factor (IGF)-binding protein-2 (IGFBP-2) have been purified from human milk and shown to retain partial IGF-binding activity. By affinity chromatography on agarose-IGF-I and HPLC, truncated IGFBP-2 of apparent Mr 14,000-16,000 resolved into two peaks. Both peaks bound radioiodinated IGF-II on ligand blotting. Within both peaks, two sequences were identified, starting at Gly169 and Lys181 of hIGFBP-2 (predicted Mr, 13,786 and 12,502, respectively, if both extend to Gln289). Mass spectrometry of a fraction predominantly containing Gly169 peptides yielded two major species, 13,840 and 13,425 Mr. Prolonged incubation of radioiodinated recombinant human (rh) IGFBP-2 with human milk failed to reveal any degradation, suggesting the formation of the fragments within the mammary gland. By solution binding assay, truncated IGFBP-2 showed less than 10% binding of [125I]IGF-I and 25% binding of [125I]IGF-II at pH 7.0 compared with rhIGFBP-2. No binding activity was seen at pH 4.0, in contrast to intact IGFBP-2, which showed peak binding from pH 4.0 to at least pH 9.0. The IGF-II association constant for truncated IGFBP-2 (6.5 nM(-1)) was 10-fold lower than that for intact IGFBP-2 (58 nM(-1)). Des(1-6)-IGF-II was totally inactive in displacing IGF-II tracer from the IGFBP-2 fragment, but displaced tracer from rhIGFBP-2 with 10% the activity of IGF-II. Thus, the amino-terminal hexapeptide of IGF-II is required for interaction with the carboxy-terminal domain of IGFBP-2. The presence of active IGFBP-2 fragments in milk suggests a role for milk IGFBP-2 in modifying IGF activity in the neonatal gut.

Breast-feeding and growth factors in preterm newborn infants

BACKGROUND

We analyzed the role that nutrition and the insulin-like growth factors IGF-I and IGFBP-3 play on neonatal growth.

METHODS

Full-term and preterm infants with 1 and 3 weeks of postnatal life (n = 54 and n = 33, respectively) were studied. Anthropmetric variables, daily intake of energy and nutrients, and serum levels of IGF-I and IGFBP-3 were measured.

RESULTS

At the first week after birth, preterm infants had lower IGF-I levels than did those in the control group. At the third week of postnatal life, serum IGF-I and IGFBP-3 levels showed a significant increase. Preterm infants born before 33 gestational weeks showed lower IGF-I (p < 0.02) and IGFBP-3 (p < 0.02) levels than those born between 33 and 37 gestational weeks. Preterm infants fed with human milk supplemented with a formula showed higher serum IGF-I levels than those fed exclusively with a milk formula (mean +/- SEM 48.2 +/- 9.5 micrograms/L vs. 25.4 +/- 4.4 micrograms/L, p < 0.05). IGF-I and IGFBP-3 were correlated between themselves and with energy and protein intake. Multiple regression analysis confirmed that energy intake and serum IGFBP-3 levels were the most predictable variables with regard to IGF-I levels at neonatal period.

CONCLUSIONS

These feedings suggest that IGF-I levels during the neonatal periods are influenced by the maturity stage of the newborn, energy intake, and the type of lactation.

Insulin-like growth factors in milk and mammary gland

Milk contains insulin-like growth factor I and II (IGF-I and IGF-II) and four IGF binding proteins (IGFBP). Their concentrations are highest prepartum and early postpartum, coinciding with maximal proliferation of mammary cells and the time when the infant gut is the least developed. This has lead to the suggestion that IGFs may be important for the growth and development of the mammary gland and that IGFs in milk play a role in promoting development of the gastrointestinal tract of the newborn. IGF-I and, to a lesser extent, IGF-II can stimulate milk yield and blood flow in goats when infused directly into the mammary gland, suggesting they may also be important in supporting established lactation. Thus IGFs may have a dual function in the mammary gland, establishing and maintaining the maternal mammary system and, once secreted into milk, supporting gastrointestinal development in the newborn.