The role of intestinal alkaline phosphatase in the development of necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a devastating neonatal disease that affects neonates worldwide and often leads to high morbidity and mortality rates. Despite extensive research, the cause of NEC remains unclear, and current treatment options are limited. An important novel finding is the potential role of intestinal Alkaline Phosphatase (IAP) in both pathogenesis and treatment of NEC. IAP can play a vital role in detoxifying liposaccharides (LPS), a key mediator of many pathological processes, thereby reducing the inflammatory response associated with NEC. Furthermore, IAP can help prevent dysbiosis, improve intestinal perfusion, and promote autophagy. In this comprehensive review, we present evidence of the possible connection between IAP and the LPS/Toll-like receptor 4 (TLR4) pathway, impaired gut immunity, and dysbiosis in the preterm gut. Based on these findings, the administration of exogenous IAP might provide promising preventive and therapeutic avenues for the management of NEC. •Intestinal Alkaline Phosphatase (IAP), found in the intestine, may hold the key to prevent and treat necrotizing enterocolitis (NEC).•IAP's role in inflammation reduction, autophagy regulation, and improved intestinal perfusion impacts NEC's pathophysiology.•Evidence suggests exogenous IAP administration holds promise for preventing and treating NEC.