Milk is not just food but most likely a genetic transfection system activating mTORC1 signaling for postnatal growth

Milk provides substantial amounts of tryptophan easily hydrolyzed from α-lactalbumin in milk´s whey protein fraction. Tryptophan promotes pituitary serotonin synthesis [7], which increases growth hormone (GH) secretion [8]. GH stimulates hepatic IGF-1 synthesis. Both, GH and IGF-1 have been shown to increase by milk consumption [9]. Casein proteins are rich sources of tryptophan, too. Casein in comparison to whey protein has been shown to differentially increase hepatic IGF-1 synthesis [10]. There is substantial epidemiological evidence that milk consumption efficiently elevates IGF-1 plasma levels by 20 to 30% in comparison to non-dairy consumers [9‐14].

Water soluble, easily hydrolysable whey proteins in comparison to all other animal-derived structural muscle proteins provide highest amounts of the branched-chain amino acids (BCAAs) leucine, isoleucine and valine, which raise postprandial insulin plasma levels within minutes [15‐17]. Furthermore, whey proteins induce the secretion of the incretin glucose-dependent insulinotropic polypeptide (GIP), which in concert with insulinotropic BCAAs co-stimulates insulin secretion of pancreatic β-cells [15, 16]. Milk proteins, especially leucine, stimulate the release of the intestinal incretin glucagon-like peptide-1 (GLP-1) [18]. It has previously been shown that leucine stimulates insulin secretion by β-cells due to its metabolism by oxidative decarboxylation and the ability of leucine to allosterically activate glutamate dehydrogenase (GDH) by β-cell mitochondria [19‐21]. Xu et al. [22] demonstrated that leucine induced translation initiation by phosphorylation of 4E-BP-1 (formerly termed PHAS-I) and S6K, through the mTORC1-signaling pathway of pancreatic β-cells. In β-cells, leucine activates mTORC1 [19, 20] that regulates insulin secretion and β-cell mass expansion [23‐25]. Leucine not only increases insulin secretion but also enhances insulin signaling in insulin target tissues [26]. Chronic leucine supplementation elevated basal IRS-1 phosphorylation on tyrosine 632 and improved insulin-stimulated Akt and mTOR phosphorylation in liver, skeletal muscle and adipose tissue of rats fed a high fat diet [26]. In human skeletal muscle direct evidence has been provided that whey protein intake raised mTORC1 activity [27]. Thus, milk-derived BCAAs, especially leucine, appear to function as important messengers of mammalian lactation promoting insulin secretion and β-cell mass expansion required for appropriate mTORC1-driven postnatal growth.

Tryptophan deficiency has profound inhibitory effects on protein synthesis, RNA translation and growth [28]. Intragastric addition of tryptophan to early-weaned piglets increased intestinal GIP secretion [29]. Whey proteins and caseins are rich protein sources of tryptophan. Test meals of 16.7 g and 18.2 g whey protein to healthy young adults substantially increased GIP secretion and postprandial plasma GIP concentrations [15, 16], further supported by own data on postprandial plasma GIP levels of 10 healthy young adults (8 males, 2 females, mean age 25 yrs) after 30 g whey protein intake (Figure 1). Hydrolyzed peptides of whey protein competitively inhibit the GIP inactivating enzyme dipeptidyl peptidase IV, thereby extending GIP bioactivity [30]. GIP may not only signal via the entero-insular axis stimulating insulin secretion but also enhances GH secretion of the somatotroph cells of the pituitary, which express the GIP-receptor (GIPR) [31]. GIPR activation elevates cAMP, which drives GH-promoter activity [31]. Thus, GIP not only responds to dietary glucose but may function as a whey (tryptophan)-dependent GH-stimulating hormone that activates both pancreatic insulin as well as hepatic IGF-1 synthesis for mTORC1-dependent protein and lipid synthesis required for cell growth. Remarkably, deletion of tryptophan from a hepatocyte culture medium substantially decreased IGF-1 synthesis [32]. In accordance, Rich-Edwards et al. [9] demonstrated that milk consumption of children increased serum GH and IGF-1 levels and shifted the somatotropic axis to higher levels. Furthermore, it has been demonstrated in ovine hepatocyte cultures that IGF-1 synthesis clearly depends on amino acid availability in a dose dependent manner [33]. In a rat hepatocyte primary culture, IGF-1 mRNA expression was dependent on amino acid availability [34]. Furthermore, the essential amino acid content of the diet is critical for the optimal restoration of IGF-1 after fasting, when protein intake is reduced [35]. Recent evidence has been provided that post-exercise replenishment of essential amino acids plus carbohydrate significantly increased leucine and free IGF-1 serum levels of 8 young healthy males [36]. Insulin increases hepatic IGF-1 synthesis and enhances free IGF-1 bioactivity by inhibition of hepatic insulin-like growth factor-binding protein-1 (IGFBP-1) [37‐39]. IGFBP-2 may be subject to dual control, with GH and amino acid availability serving as the primary regulators [40, 41]. Thus, milk-derived amino acids provide a sophisticated regulatory network (GH, insulin and amino acids, especially leucine and tryptophan) that stimulates downstream IGF-1-signaling.

As demonstrated above milk-derived amino acids up-regulate the secretory activity of the pituitary gland (GH secretion), the liver (IGF-1 secretion), the pancreatic β-cells (insulin secretion), the intestinal enteroendocrine K-cells (GIP secretion), and L-cells (GLP-1 secretion). Milk proteins in comparison to all other animal proteins provide the highest postprandial levels of the BCAAs leucine, isoleucine and valine [15, 16, 42]. Milk-driven insulin/IGF-1 signaling combined with leucine abundance provides optimal conditions for up-regulation of mTORC1 mediating accelerated growth and proliferation of peripheral cells of the milk recipient. Persistent milk consumption and dairy-enriched Western diet thus represents a fundamental stimulus for continued mTORC1 activation with all its adverse consequences in adolescence and adulthood [43].

Secreted microRNAs (miRs) represent a newly recognized most important layer of gene regulation in eukaryocytes, which plays a relevant role for intercellular communication [44, 45]. miRs bind through partial sequence homology to the 3′-untranslated region of target mRNAs and cause either translational block or less frequently mRNA degradation [46]. miRs that are enclosed by membranous microvesicles, so-called exosomes, play a pivotal role for horizontal miR transfer [47]. Intriguingly, breast milk contains the highest concentration of total RNAs (47,240 μg/L) in comparison to other body fluids like plasma (308 μg/L) [48]. There is accumulating evidence that bovine and human milk transfer substantial amounts of miRs for regulatory functions by exosomal transport [49‐51]. Chen et al. [50] have detected 245 miRs in cow’s milk. They reported relatively high and consistent expression of seven miRs in mature cow´s milk at various lactation periods listed from highest to lowest sequencing frequencies: miR-21 (24,137), miR-99a (24,097), miR-148a (16,597), miR-30d (14,089), miR-200c (11,010), miR-26b (6,595) and miR-26a (3,376), respectively [50]. In cow´s milk, whey and bovine colostrum, miR-containing exosomes of 50–100 nm have been identified [52‐54].

Milk exosomal miRs are of functional importance for the development and maturation of the neonate´s immune system [54‐56]. These findings implicate that exosomal miRs of milk may reach the systemic circulation and organ systems. The exosome lipid membrane protects milk-derived miRs against degradation. Remarkably, miRs of cow´s milk are resistant against acidic conditions (pH2) as well as heat exposure and external RNAse treatment [51], most likely withstanding the harsh degrading conditions in the gastrointestinal tract. Although, raw milk contains the highest amounts of total miRs, pasteurized commercial milk and milk powder still contain substantial and stable concentrations of miRs [50]. It has already been suggested that, milk-derived exosomes may pass the intestinal barrier and reach the systemic circulation [51]. Intestinal cells release exosomes of 30–90 nm in diameter from their apical and basolateral sides [57]. The tetraspanin CD63, a known exosome marker of cow´s milk exosomes [52], is present on intestinal epithelial-derived exosomes [57]. CD63- and CD81-containing tetraspanin molecules have been detected on exosomes in human plasma [58]. In fact, blood is regarded as a physiological fluid for exosome circulation in the body, pointing to the important role of exosomes as carriers for cell-cell or organ-organ communications [58‐60]. Furthermore, bovine milk´s predominant miR species, miR-21, is a major component of human plasma [61]. Thus, it is conceivable that milk´s exosomal miRs reach the plasma compartment to function as a messenger system promoting postnatal growth. In fact, it has already been demonstrated that a diet-derived miR, the plant MIR168a, reaches the plasma compartment of human subjects and affects LDLRAP1 metabolism in the liver [62]. Thus, there is good reason to assume that cow´s milk-derived miRs affect distant regulatory networks and organs of the milk recipient. A systemic transfer of milk-derived miRs to the neonate or the persistent milk consumer may augment mTORC1-mediated growth signaling, which is a physiologically required process for postnatal growth and development but not for humans after the lactation period.

Exosomal miR-21, a consistent component of cow´s milk and human breast milk [50, 56], appears to play a key role in mTORC1 signaling. Critical targets of miR-21 are mRNAs of important tumor suppressor proteins involved in upstream and downstream suppression of mTORC1 signaling, i.e., PTEN [63‐66], Sprouty1 and Sprouty2 [67‐69], PDCD4 [70‐72] (Figure 2). Furthermore, miR-21 has been shown to induce the cell cycle promoter cyclin D1 in an mTORC1-dependent manner [73]. Supposed that milk-derived miR-21 reaches distant cells of the milk recipient, PTEN suppression could increase insulin/IGF-1/PI3K/Akt signaling, which further augments mTORC1 activation. miR-21-induced inhibition of Sprouty1 and 2 would amplify Ras-Raf-MEK-ERK signaling, which additionally suppresses TSC2 and thus raises mTORC1 activity (Figure 2). Furthermore, miR-21 could stimulate the initiation of translation by repression of PDCD4, which is a suppressor of translation initiation that inhibits the RNA helicase eIF4A [74]. Both, 4E-BP-1 and PDCD4 are crucial regulatory inhibitors of translation initiation and thus of protein synthesis. Activation of the mTORC1 pathway and its substrate kinase S6K1 results in subsequent phosphorylation of 4E-BP-1 and PDCD4 that promote eIF4E-eIF4G complex assembly and stimulate mRNA translation [74]. miR-21-mediated suppression of PDCD4 expression may further amply translation initiation, a reasonable regulatory step of milk signaling to promote postnatal growth. In this regard, miR-21 signaling of milk appears to enhance upstream and downstream mTORC1 signaling.

Thus, milk appears to combine both amino acid- and miR-mediated pathways to optimize mTORC1 signaling for the promotion of postnatal growth. However, it is of critical concern that miR-21 is a well-known oncogene, which by suppressing various tumor suppressor genes plays a key role in resisting programmed cell death [75]. In comparison to amino acid signaling of milk, which primarily affects layers of posttranslational modifications, miR signaling of milk may represent an even more powerful archaic regulatory network, because it interferes with posttranscriptional regulation of numerous genes and gene networks. In fact, miR-21 has been shown to contribute to renal cancer cell proliferation and migration via activation of mTORC1 [76].

There is accumulating evidence that chronic diseases of civilization are associated with increased mTORC1 signaling [77, 78], like acne [79, 80], obesity [81, 82], type 2-diabetes [77, 83], arterial hypertension [84], Alzheimer´s disease [85], cancer [86], especially prostate cancer [87, 88]. Thus, cow´s milk is not just a simple food for humans, but a tremendously powerful evolutionary program of the faster growing species Bos taurus, which may permanently over-stimulate mTORC1 signaling in human milk consumers. In this regard the milk kinship hypothesis appears in a new light, which explains the increased risk for genetic disease in offspring of marriages of “milk siblings”, who were breastfed by the same woman (forbidden by the Qur´an in countries of the Middle East) [89]. Thus, we are at the beginning to ask for the metabolic consequences of bovine milk-derived miRs on human subjects during various phases of human growth and development.

Further research should investigate the precise trafficking of milk exosomes, which most likely reach the systemic circulation of the milk recipient. Continued mTORC1-activation by milk-derived exosomal transfer of miR-21 may represent a persistently adverse health effect of regular milk and dairy product intake, which may play an important role for the development and progression of mTORC1-driven diseases of civilization [77‐88]. In analogy to the postulated Trojan exosome hypothesis explaining the role of exosomes for the spread of RNA viruses [90], the milk exosome system too appears to function as a Trojan horse “transfecting” the neonate´s metabolism to ensure species-specific mTORC1-driven growth and anabolism.

There is accumulating evidence that milk consumption in children, adolescents and adults increases body mass index (BMI) [81‐83, 91‐93] and induces insulin resistance in children [17]. In Nordic countries, where women regularly consume milk during pregnancy, increased infant birthweights related to dairy protein intake during pregnancy have been reported [94, 95].

In comparison to all other structural animal proteins, whey proteins provide highest amounts of most easily hydrolysed BCAAs [42], which raise postprandial plasma BCAA levels within minutes [15, 16]. Thus, other high BCAA sources like muscle proteins of beef differ from soluble milk proteins, especially whey, by a more retarded release of BCAAs into the systemic circulation. In fact, beef has an insulinemic index of 51 [96], whereas insulin scores for milk and milk products range from 89 to 115 [96, 97]. Increased BCAA plasma levels in children and adolescents have recently been associated with increased risk for elevated BMI, insulin resistance and type 2 diabetes mellitus [98, 99]. However, the most striking difference between milk and muscle or plant proteins is the high amount of specific exosomal miRs, like miR-21 and miR-103 [50, 51], that may play an important role as an additional layer of metabolic regulation.