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A developmental role for toll like receptor 4 in the neonatal intestine

Pediatric Research volume 98, pages 16–17 (2025)Cite this article

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One of the most challenging problems facing the newborn infant involves the need to adapt to the harsh world of postnatal life, characterized by an urgent need to absorb enteral nutrients while simultaneously handling the onslaught of environmental microbes. How the newborn handles the adaptation from in utero to postnatal life will have a great impact on her immediate development and long-term health.

In an elegant example of biological efficiency, the processes of bacterial colonization of the newborn gastrointestinal tract, and the ability to tolerate enteral feeds, are inextricably linked,1,2,3. The  mechanisms that link these fundamental biological processes together however remain largely unknown and of great interest. Normal gut development is characterized by an appropriate composition of intestinal epithelial cells that are inter-connected by tight junctions, resulting in relative barrier impermeability, which guards against bacterial translocation into the circulation. Likewise, normal bacterial colonization has been shown to play crucial roles in maintaining normal intestinal permeability4 and limiting the subsequent development of sepsis in neonates.5 A critical question in neonatal health therefore focuses on how bacterial colonization can regulate normal intestinal development and function, and vise versa.6

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  1. Division of Pediatric Surgery, Johns Hopkins University, Baltimore, USA

    David J. Hackam

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  1. David J. Hackam
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Correspondence to David J. Hackam.

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Hackam, D.J. A developmental role for toll like receptor 4 in the neonatal intestine. Pediatr Res 98, 16–17 (2025). https://doi.org/10.1038/s41390-025-03900-w

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