Anti-inflammatory mechanisms of breast milk exosomes in neonatal immune development

Breast milk exosomes (ΒΜΕs) are extracellular vesicles of 30-150 nm that have currently attracted research attention due to their protective role in neonatal immune development. Their bioactive cargos, including miRNAs, proteins and lipids, have been shown to facilitate cellular communication and regulate various physiological processes. In the present article, we explore known molecular mechanisms through which ΒΜΕs affect innate and adaptive immunity as well as the integrity of the intestinal epithelial barrier. BMEs can reduce symptoms of inflammatory intestinal diseases, such as necrotizing enterocolitis (NEC) by regulating key signaling pathways, including TLR4/MyD88/NF-κB, MAPK and PI3K/AKT. Their unique characteristics highlight the potential to serve as drug nanocarriers for therapeutic interventions especially in high-risk neonatal inflammatory diseases. Although the clinical application of ΒΜΕs needs to overcome several challenges such as heterogeneity, large-scale isolation and processing of ΒΜΕs, their anti-inflammatory effects are consistent and significant. Future multi-omics analyses for the comprehensive understanding of the molecular mechanisms through which exosomes exert immunomodulation are expected to reveal new opportunities to improve the health of vulnerable neonates.