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ZENODO
Article . 2026
License: CC BY
Data sources: ZENODO
ZENODO
Article . 2026
License: CC BY
Data sources: Datacite
ZENODO
Article . 2026
License: CC BY
Data sources: Datacite
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Nickel as a Catalytic Driver of Necrotizing Enterocolitis: Dietary Nickel, Microbial Metallomics, and the Activation of Nickel-Dependent Virulence Pathways in the Preterm Gut

Authors: Pendergrass, Karen;

Nickel as a Catalytic Driver of Necrotizing Enterocolitis: Dietary Nickel, Microbial Metallomics, and the Activation of Nickel-Dependent Virulence Pathways in the Preterm Gut

Abstract

Necrotizing enterocolitis (NEC) has long been framed as a disease of prematurity driven by “dysbiosis,” formula feeding, and opportunistic pathogens. Yet despite decades of research, a central mechanistic question has remained unanswered: why do the same microbial taxa repeatedly dominate in NEC, and what enables them to so effectively overwhelm the immature infant gut? This paper argues that the missing variable has been hiding in plain sight: nickel. By integrating microbiome data, microbial enzymology, nutritional immunology, and infant feeding practices, this work reframes NEC as a nickel-enabled disease state. The pathogens consistently enriched in NEC, particularly Escherichia coli and related Enterobacteriaceae, rely on nickel-dependent enzymes such as urease, [NiFe]-hydrogenases, and glyoxalase I to alkalinize their environment, detoxify metabolic stress, evade neutrophil killing, and thrive under inflammatory conditions. At the same time, host defenses such as lactoferrin and calprotectin explicitly function to withhold nickel as part of nutritional immunity. The paradox is dietary. Human breast milk is naturally nickel-poor. In contrast, infant formulas, especially soy-based formulations, contain orders of magnitude higher nickel concentrations, effectively delivering a bolus of the exact metal cofactor required to activate these microbial virulence pathways. When combined with formula-associated elevations in gut pH and reduced colonization by acidifying commensals, excess dietary nickel functionally licenses pathogenic metabolism while undermining host metal sequestration strategies. Viewed through this metallomic lens, the classic NEC findings suddenly align: reduced alpha diversity, Proteobacteria blooms, loss of protective taxa, epithelial injury, and inflammation are no longer isolated observations but predictable consequences of a nickel-replete gut ecosystem. The conclusion is difficult to ignore: the microbiology, the biochemistry, and the feeding data were already there. What was missing was the recognition that nickel is not a passive contaminant, but a catalytic driver. This work introduces a unifying framework with immediate implications for infant formula composition, NEC risk stratification, biomarker development, and the design of nickel-targeted preventative and therapeutic strategies. It invites neonatology, microbiome science, metallomic science, and nutrition to confront an uncomfortable possibility: that one of the most devastating diseases of prematurity has been unintentionally fueled by an overlooked trace metal all along.

Keywords

Nickel, Enterocolitis, Necrotizing, Escherichia coli, Nickel/pharmacokinetics, Glyoxalase I, nutritional immunity, metallomics, Urease, Infant Formula, Nickel/toxicity, [NiFe]-hydrogenase

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
Green