mimmunМедицинская иммунологияMedical Immunology (Russia)1563-06252313-741XSPb RAACI10.15789/1563-0625-IAR-2619mimmun-2619Research ArticleОБЗОРЫREVIEWSИммуномодулирующий и регенеративный потенциалы грудного молока, недоношенность и детское сердцеImmunomodulatory and regenerative potentials of breast milk, prematurity and children’s hearthttps://orcid.org/0000-0002-3081-9477ПавлюковаЕ. Н.PavlyukovaE. N.

зав отделением атеросклероза и хронической ИБС 

PhD, MD (Medicine), Professor, Head, Department of Atherosclerosis and Chronic Coronary Heart Disease

Address for correspondence:Elena N. Pavlyukova –Research Institute of Cardiology 111a Kiyevskaya StTomsk634012 Russian FederationPhone: +7 (960) 977-86-98.

pavluk@cardio-tomsk.ruhttps://orcid.org/0000-0002-5550-5925КолосоваМ. В.KolosovaM. V.

доктор медицинский наук, профессор кафедры  детских болезней

PhD, MD (Medicine), Professor, Department of Pediatric Diseases

Tomsk

kolosova_mv@inbox.ruhttps://orcid.org/0000-0002-7556-9379НеклюдоваГ. В.NeklyudovaG. V.

аспирант НИИ кардиологии Томского НИМЦ  

Postgraduate Student

Tomsk

lv-gal@mail.ruhttps://orcid.org/0000-0002-7011-4316КарповР. С.KarpovR. S.

академик РАН, научный руководитель НИИ кардиологии Томского НИМЦ

PhD, MD (Medicine), Full Member, Russian Academy of Sciences, Scientific Supervisor

Tomsk

carpov@cardio-tomsk.ruНаучно-исследовательский институт кардиологии ФГБНУ «Томский национальный исследовательский медицинский центр Российской академии наук»РоссияResearch Institute of Cardiology, Tomsk National Research Medical CenterRussian FederationФГБОУ ВО «Сибирский государственный медицинский университет» Министерства здравоохранения РФРоссияSiberian State Medical UniversityRussian Federation2024130920232613756Copyright © Павлюкова Е.Н., Колосова М.В., Неклюдова Г.В., Карпов Р.С., 20242024Павлюкова Е.Н., Колосова М.В., Неклюдова Г.В., Карпов Р.С.Pavlyukova E.N., Kolosova M.V., Neklyudova G.V., Karpov R.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mimmun.ru/mimmun/article/view/2619

 Расширение в современных условиях фундаментальных знаний по вопросам физиологии лактации, биологии стволовых клеток и экзосом грудного молока, нюансам взаимодействия организма матери и ребёнка, начиная от внутриутробного периода, заканчивая постнатальным развитием,  требует от научного сообщества и практикующих врачей прогрессивного, динамичного взгляда при анализе известных, общепринятых клинических явлений и закономерностей (развитие иммунной системы младенцев и детей раннего возраста, естественное и искусственное вскармливание, особенности постнатального развития и роста органов и тканей детей, рождённых недоношенными). Компоненты триады «мать - грудное молоко - младенец» тесно связаны друг с другом и влияют на траекторию развития младенца. Грудное молоко кормящей женщины по современным представлениям является «живой, метаболической/эндокринной сигнальной системой», может рассматриваться как «иммунный орган», значимый для постнатального роста и программирования организма недоношенного ребёнка. Не меньшую ценность для постнатального развития в период новорождённости и раннего детства имеет активно обсуждаемое в специальной литературе явление - «микрохимеризм», вызванный грудным вскармливанием и играющий по современным представлениям ключевую роль в развитии иммунной системы и организма в целом Течение постнатального онтогенеза сердечно-сосудистой системы при отсутствии протективного (иммуномодулирующего и регенеративного) эффекта грудного молока кормящей женщины на спонтанное, некорректируемое воздействие неблагоприятных факторов недоношенности приводит, с высокой вероятностью, к ремоделированию и дисфункции сердца у рождённых недоношенными детей, а в отдалённой перспективе - и у взрослых. Поскольку молодые люди, родившиеся недоношенными, демонстрируют уникальный кардиальный фенотип, характеризующийся уменьшенным бивентрикулярным объемом, относительно более низкой систолической и диастолической функциями, непропорциональным увеличением мышечной массы, клинически проявляющийся повышенным риском сердечно-сосудистых заболеваний, гипертонией и снижением толерантности к физической нагрузке, то целесообразно считать преждевременные роды хроническим заболеванием. Следовательно, именно естественное вскармливание, реализующее эволюционно целесообразный защитный механизм для детского сердца, следует относить к фундаментальным факторам, выполняющим жизненно важную роль в профилактике сердечно-сосудистых заболеваний у рождённых недоношенными детей и взрослых

Recent expansion of fundamental knowledge on the physiology of lactation, and breast milk exosomes, stem cell biology, mother-child interactions from prenatal period to postnatal development requires a progressive, dynamic view from the scientific community and practicing physicians when analyzing known, generally accepted clinical phenomena and patterns (development of the immune system of infants and young children, natural and artificial feeding, features of postnatal development and growth of organs and tissues in children born prematurely). The components of the mother-breast-milk-infant triad are closely related to each other and influence developmental trajectory of the infant. According to modern concepts, breast milk of a nursing woman is a “living, metabolic / endocrine signaling system”, which may be considered an “immune organ” significant for postnatal growth and body programming of a premature baby. A valuable phenomenon of early postnatal development is actively discussed in the special literature, i,e., “microchimerism” caused by breastfeeding which, according to modern concepts, may play a key role in development of immune system and the whole body. Absence of protective (immunomodulatory and regenerative) effects of breast milk from a nursing woman on the spontaneous, uncorrectable impact of adverse factors of prematurity is likely predispose for remodeling and dysfunction of heart in prematurely born children, and, at longer range, in adults. The young children born prematurely show a unique cardiac phenotype characterized by reduced biventricular volume, relatively lower systolic and diastolic function, disproportionate muscle mass gain, clinically manifesting by increased risk of cardiovascular disease, hypertension, and decreased exercise tolerance. Hence, the premature birth may be considered a chronic disease state. Therefore, the natural feeding which provides a natural evolutionarily protective mechanism for the child’s heart should be attributed to the fundamental factors that play a vital role in prevention of cardiovascular diseases in prematurely born children and at later life periods.

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The authors declare that there are no conflicts of interest present.