Human Nutrition and Metabolism

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1 Human Nutrition and Metabolism A Low-Molecular-Weight Factor in Human Milk Whey Promotes Iron Uptake by Caco-2 Cells 1 Paz Etcheverry, Dennis D. Miller and Raymond P. Glahn* 2 Department of Food Science and *U.S. Plant, Soil and Nutrition Laboratory, Cornell University, Ithaca, NY ABSTRACT The iron bioavailability of human milk (HM) is substantially greater than that of cow s milk (CM), but the factor responsible for this high bioavailability is unknown. This study evaluated the effects of various HM and CM fractions on iron bioavailability. Milk was separated into fat, casein and whey fractions by ultracentrifugation. Whey was further fractionated by ultrafiltration with a 10-kDa membrane to produce a 10-kDa retentate (10kR) and a 10-kDa filtrate (10kF). Samples were prepared by mixing various combinations of the fractions, bringing the samples to prefractionation weight with minimum essential medium (MEM), and adding iron (10 mol/l) as ferrous sulfate. Samples were divided into two aliquots: one was subjected to in vitro digestion, the other was not. Bioavailability was assessed by applying the samples to Caco-2 cell monolayers and incubating for 24 h. Ferritin formation in the cells was used as an index of iron uptake. Removing the fat from undigested HM samples doubled the ferritin formation, but removing the whey or casein had no effect. Results with digested HM samples were similar, except that removing the whey decreased ferritin formation by 48%. Removing the fat from digested CM samples had no effect, but removing the casein doubled the ferritin formation. Removing the 10kF from HM reduced ferritin formation by 60%, but removing the 10kR had no effect. These data suggest that a low-molecularweight factor ( 10 kda) in human milk enhances iron absorption. J. Nutr. 134: 93 98, KEY WORDS: iron bioavailability Caco-2 cells human milk cow s milk whey The bioavailability to human infants of iron from human milk (HM) 3 is greater than that from cow s milk (CM) on a fractional basis. The factors responsible for the greater Fe bioavailability of HM compared with CM have not been identified. However, HM contains lower concentrations of casein, phosphates and calcium, factors thought to inhibit Fe absorption, and higher concentrations of absorption-enhancing components such as lactoferrin, ascorbic acid, lactose, cysteine, taurine and inosine (1). Of these enhancing factors, HM lactoferrin has received the most attention. The interest in lactoferrin began in 1939 when it was first identified as a red protein in bovine milk. It was not until 20 y later that the purified protein was isolated from milk (2). Because Fe from HM is highly bioavailable and because HM contains high concentrations of lactoferrin, researchers speculated that this Fe-binding protein was responsible for making the metal readily absorbable. This was particularly interesting in the pediatric arena, because HM often represents the first and sole food for infants, at least for the first six months of life. It could be possible, researchers argued, that lactoferrin, with its bound Fe, was reaching the brush-border surface of the intestinal mucosal cells of 1 Presented in part at Experimental Biology 03, April 2003, San Diego, CA [Etcheverry, P., Miller, D. D. & Glahn, R. P. (2003) Human milk fractionation and its effect on iron uptake by Caco-2 cells. FASEB J. 17: LB365 (abstract)]. 2 To whom correspondence should be addressed. rpg3@cornell.edu. 3 Abbreviations used: CM, cow s milk; HM, human milk; MEM, minimum essential medium; 10kF, 10-kDa filtrate; 10kR, 10-kDa retentate. the infant intact, due to the very immature GI system in the infant (low levels of peptic enzymes, high gastric ph and low levels of intestinal enzymes), and that the iron-lactoferrin complex was absorbed intact. However, more recent reports began to cast doubt on the importance of lactoferin as a promoter of Fe absorption (3 5). Interest in lactoferrin and its effect on Fe absorption has waned in recent years. A literature search on lactoferrin documented increasing interest in its bacteriostatic, fungicidal, antioxidant and antiviral effects, some of which depend on the fact that the protein can sequester Fe from the environment. To date, the Fe uptake enhancing component in HM, the so-called milk factor, has not been found. In this study, we determined the Fe bioavailability of HM and CM using the Caco-2 cell model system. Both HM and CM were first fractionated into fat, casein, and whey. These fractions were subsequently replaced with media to obtain modified milks, i.e., milks lacking fat, casein, or whey. The Caco-2 cell uptake of Fe from these modified milks was compared to that from intact milk. An important and unique feature of this study design was that removing one specific fraction or component from the milk made it possible to identify which components inhibit or enhance Fe uptake. To our knowledge, there are no published studies that measure the Fe bioavailability of milk in this way. Therefore, the specific objectives of this study were to determine whether a milk factor indeed exists, and if so, to identify the HM fraction that contains the Fe uptake enhancing component /04 $ American Society for Nutritional Sciences. Manuscript received 29 July Initial review completed 26 August Revision accepted 30 September

2 94 ETCHEVERRY ET AL. MATERIALS AND METHODS FIGURE 1 Fractionation procedure for human milk (HM). The same procedure was applied to cow s milk (CM); MEM minimum essential medium. Ultrafiltration of the whey yielded a 10-kDa retentate (10kR; particles 10 kda) and filtrate (10kF; particles 10 kda). Glassware. All glassware was rinsed with 10% HCl and 18 M H 2 O before use in order to avoid mineral contamination. Cell cultures. The Caco-2 cells were purchased from the American Type Culture Collection (ATCC, Rockville, MD). Stock cultures were maintained in DMEM (GIBCO, Grand Island, NY), ph 7.4, supplemented with 10% (v/v) fetal bovine serum (GIBCO), 25 mmol/l HEPES and 1% antibiotic-antimycotic solution (GIBCO). Cells were cultured at 37 C in an incubator with an atmosphere of 5% CO 2 and 95% air at constant humidity. The medium was replaced every 2 d. For uptake experiments, cells (passages 30 to 35) were grown in collagen-treated 6-well or 24-well plates at an initial seeding of 50,000 cells/cm 2. Uptake experiments were conducted at 14 d postseeding. HM and CM fraction preparation. The HM was obtained from the USDA Agriculture Research Service (USDA/ARS) Children s Nutrition Research Center (CNRC; Houston, TX). The CNRC obtained informed written consent from each mother donating the milk. The HM was fractionated as described by Fransson and Lönnerdal (6). To obtain HM fat, HM casein and HM whey, HM was first ultracentrifuged at 150,000 g for1hat4 C in an Optima XL-100K ultracentrifuge (Beckman Instruments, Palo Alto, CA). The resulting components were an upper phase (fat), a supernatant consisting of whey (also known as the serum phase), and a pellet containing the casein. The fat was removed with a spatula into a sterile preweighed test tube and replaced with an equal weight of minimum essential medium (MEM; GIBCO). The resulting product was labeled HM fat. To prepare HM casein, the fat and whey components were transferred to a clean test tube. The casein pellet was saved in a preweighed tube. An amount of MEM equal to the weight of the casein was then added to the fat and whey components. To prepare HM whey, the casein and fat components were combined, and MEM was added to replace the whey (Fig. 1). To ensure that the HM fractions were well mixed, they were left overnight at room temperature on a platform rocker (Model RP-50, Elmeco Laboratory Instruments, Rockville, MD). They were then stored at 20 C until further use. The same fractionation method was used to prepare CM fat, CM casein and CM whey. The CM used was pasteurized, vitamin D fortified whole milk purchased at the local Cornell Dairy Store (Ithaca, NY). Ultrafiltration of whey. The HM and CM whey components obtained by ultracentrifugation were ultrafiltered using an Amicon 8200 stirred ultrafiltration cell with a 10-kDa membrane disc (Millipore, Bedford, MA) at an operating pressure of 276 kpa. This produced a 10-kDa retentate (10kR; components 10 kda) and filtrate (10kF; components 10 kda) (Fig. 1). To prepare HM 10kF, HM 10kR, CM 10kF and CM 10kR whey, intact milk samples were ultracentrifuged as described above. Fat and casein were then transferred to a clean test tube. The whey components were ultrafiltered as described above, and the 10kF or 10kR whey fractions were added to the appropriate samples (i.e., the 10kR fraction was added to the HM or CM 10kF whey and the 10kF fraction was added to the HM or CM 10kR whey; Fig. 1). The weight of the component that was not included was replaced with MEM. Effect of the HM fractions on Caco-2 cell Fe uptake. To study the effects of HM, HM fat, HM casein and HM whey on Fe uptake, 1 ml of each sample was combined with 14 ml of MEM. This dilution was necessary because a more concentrated milk sample proved to be lethal to the cells. A 24-well plate was prepared with 0.5 ml of MEM. The following day, 0.75 ml of each prepared HM sample was transferred to a microcentrifuge tube. Iron (as ferrous sulfate) was added to some samples to bring the final concentration to 10 or 20 mol/l Fe. The MEM on top of the cells was aspirated. After vortexing the contents of each microcentrifuge tube, 0.5 ml of this solution was placed on top of the cells. Each sample was prepared in duplicate for each 24-well plate. Five plates were prepared, all on the same day. Each fractionation process was performed separately and independently. After incubating for 24 h to allow ferritin formation, the contents of each well were aspirated, and the cells were washed twice with saline. Cells were then sonicated for 15 min at 4 C in the presence of 0.5 ml of 18 M H 2 O in an Elma Transsonic Digital sonicator (Lab-Line Instruments, Melrose Park, IL). The wells were scraped with a pipette tip. The contents of the wells were transferred to microcentrifuge tubes and stored at 20 C until analysis for cell protein and ferritin. Effect of the 10kF and 10kR whey fractions on Fe uptake. The effects of the HM and CM 10kF and 10kR whey fractions on Fe uptake were compared. Approximately 1gofeach 10kF and 10kR whey fraction was dissolved in 14 ml of MEM, and 0.75 ml of each sample was then transferred to a microcentrifuge tube. Because the ferritin levels of cells treated with the HM fractions did not differ from those of the control cells, Fe (as ferrous sulfate) was added to the samples to achieve a final concentration of 10 mol/l Fe in each well. After 24 h the cells were rinsed, sonicated, transferred to microcentrifuge tubes and stored at 20 C until analysis for cell protein and ferritin. Each sample was prepared in duplicate for each 24-well plate, and there were five independent replications. Effect of the HM and CM fractions on Caco-2 cell Fe uptake after in vitro digestion. To study the effect of enzymatic digestion of the HM fractions on Fe uptake, all HM fractions (HM, HM fat, HM casein, HM whey, HM 10kF whey, HM 10kR whey) and the corresponding CM fractions were subjected to in vitro digestion. Details of the procedure were as previously described (7). To 2 ml of each sample, 3 ml of 140 mmol/l NaCl, 5 mmol/l KCl was added. After peptic digestion the volume of each sample was brought to 10 ml (instead of 15 ml) with 140 mmol/l NaCl, 5 mmol/l KCl. Iron (10 mol/l as ferrous sulfate) was added to each sample. Peptic digestion was carried out at ph 4 rather than ph 2 to simulate gastric ph conditions in infants. All samples were prepared on the same day, using cells grown on 6-well plates, and there were five independent replications. Chemical analyses. Cell and sample protein were assessed using a Bio-Rad DC protein assay kit (Bio-Rad, Hercules, CA), based on the Lowry assay. Mineral concentration was measured via inductively coupled argon plasma emission spectrometry (ICAP Model 61E Trace Analyzer; Thermo Jarrell Ash, Franklin, MA). Caco-2 cell ferritin was assessed using a one-stage sandwich immunoradiometric assay (FER-IRON II Ferritin Assay; RAMCO Laboratories, Houston, TX). Statistical analysis. Data were analyzed by one-way ANOVA after testing for normality and equal variance with Prism software (GraphPad Software, San Diego, CA). Samples with unequal variances were logarithmically transformed and analyzed by one-way ANOVA. Selected pairs of means were compared by Bonferroni posttest. Values of P 0.05 were considered significant.

3 HUMAN MILK ENHANCES FE UPTAKE BY CACO-2 CELLS 95 RESULTS Milk composition. According to Geigy Scientific Tables (8), mature HM contains 13 to 83 g fat/kg and 1.4 to 6.8 g casein/kg; CM contains 34 to 61 g fat/kg and 23 to 28 g casein/kg. The high CM casein concentration found in this study (Table 1) could be attributed to other components that precipitated with the casein following centrifugation, including enzymes, entrapped minerals, salts, cells, leukocytes, water and so forth. The Fe concentration of HM and CM was 8.8 and 4.5 mol/l, respectively. According to Geigy Scientific Tables (8), the Fe level of HM ranges from 3.6 to 26.0 mol/l, depending on whether the milk is mature or transitional, and in CM it ranges from 4.5 to 13.4 mol/l. Therefore, the Fe concentration of the CM used in this study was on the lower end of the range. Effect of the HM fractions on Caco-2 cell Fe uptake. The ferritin/cell protein ratios obtained with the fractions with no added Fe were very close to the basal ferritin/cell protein ratios obtained from Caco-2 cells that were not treated with any sample. This suggests that the endogenous Fe concentration of these fractions was too low to elicit any change in cell ferritin formation. Adding 10 and 20 mol/l Fe dramatically increased cell ferritin formation (Fig. 2). The (HM whey) 10 mol/l Fe and (HM casein) 10 mol/l Fe fractions had no effect on ferritin formation, compared with the HM 10 mol/l Fe control fraction. The (HM fat) 10 mol/l Fe fraction markedly increased cell ferritin formation, compared with the control fraction. The HM, HM fat, HM casein and HM whey fractions with 20 mol/l Fe produced the same results. Because the endogenous level of Fe in the HM samples was too low to elicit any cell ferritin response, 10 mol/l Fe was added to samples for the subsequent experiments. Effect of the 10kF and 10kR whey fractions on Fe uptake. Both the CM and HM 10kF whey fractions caused greater ferritin formation than the 10kR whey fractions (Fig. 3). Comparing the 10kF whey components, the CM whey caused markedly greater ferritin formation, whereas the HM whey caused greater ferritin formation among the 10kR whey components. The intrinsic or endogenous Fe concentration of the samples prior to dilution ranged from 0.72 to 1.8 mol/l for the 10kF whey fractions and 13.8 to 23.8 mol/l for the 10kR whey fractions (Table 2). After diluting 1:15 with MEM and adding iron (10 mol/l as ferrous sulfate), the total Fe levels among the fractions were very similar. Total Fe concentration of the final fractions ranged from to mol/l. Effect of the HM and CM fractions on Caco-2 cell Fe uptake after in vitro digestion. Iron (10 mol/l as ferrous sulfate) was added to all samples. The HM fat fraction elicited greater ferritin formation in the Caco-2 cells than the HM FIGURE 2 Ferritin levels of Caco-2 cells treated with human milk (HM) fractions with 0, 10 and 20 mol/l Fe added as FeSO 4. Bars are means SEM, n 5. Means for each iron concentration (0, 10 and 20 mol/l) without a common letter differ; P fraction. The ferritin/cell protein ratio was 95 ng/mg for the HM fraction and 179 ng/mg (an 88% increase) for the HM fat fraction. The HM whey fraction elicited significantly lower ( 48%) ferritin formation than the HM fraction.the HM casein fraction did not affect ferritin formation (Fig. 4). HM treatments elicited markedly greater ferritin formation than CM treatments. Removing casein from CM significantly TABLE 1 Concentration of fat, casein, whey and iron in human milk and cow s milk1 Component Human milk Cow s milk Fat, g/l Casein, g/l Whey (serum phase), g/l Iron, mol/l Values are means SD. Human milk, n 16; cow s milk, n 8. FIGURE 3 Ferritin levels of Caco-2 cells treated with human milk (HM) and cow s milk (CM) 10-kDa filtrate (10kF; components 10 kda) and retentate (10kR; components 10 kda) whey fractions with added iron (10 mol/l as FeSO 4 ). Bars are means SEM, n 5. Means without a common letter differ; P 0.05.

4 96 ETCHEVERRY ET AL. TABLE 2 Protein and iron concentration in the 10-kDa filtrate (10kF) and 10-kDa retentate (10kR) whey fractions from human milk (HM) and cow s milk (CM)1 Whey fraction Protein2 Intrinsic Fe3 Total Fe4 g/l mol/l 10kF HM kR HM kF CM kR CM Values are expressed as means SD, n 3. 2 Protein concentration in the fractions before the 1:15 dilution with minimum essential medium (MEM). 3 Intrinsic Fe concentration in the fractions before the 1:15 dilution with MEM. 4 Total Fe is the intrinsic plus extrinsic Fe concentration after diluting the fractions with MEM and adding 10 mol/l Fe. increased ( 120%) ferritin formation, whereas removing fat had no effect (Fig. 4). The HM 10kF whey fraction elicited significantly lower ( 60%) ferritin formation than the HM fraction, but did not differ from the HM whey fraction (Fig. 5). The HM 10kR whey, CM whey and CM 10kF whey fractions did not affect cell ferritin formation (Fig. 5). DISCUSSION The fact that the digested HM whey fraction elicited the lowest cell ferritin formation (Figs. 4 and 5) suggests that the FIGURE 4 Ferritin levels of Caco-2 cells treated with digested human milk (HM) and cow s milk (CM) fractions. All test fractions were supplemented with iron (10 mol/l as FeSO 4 ) and subjected to in vitro digestion/caco-2 cell model. Bars are means SEM, n 5. Means without a common letter differ; P FIGURE 5 Ferritin levels of Caco-2 cells treated with digested human milk (HM) and cow s milk (CM) whey fractions, including 10-kDa filtrate (10kF; components 10 kda) and retentate (10kR; components 10 kda) fractions. All test fractions were supplemented with iron (10 mol/l as FeSO 4 ) and subjected to in vitro digestion/caco-2 cell model. Bars are means SEM, n 5. Means without a common letter differ; P whey component of HM contains a factor that enhances Fe uptake. This explains why ferritin formation in the cell drops considerably when the whey is removed from HM. Whey, the aqueous fraction of milk, is composed of whey proteins and low-molecular-weight components. The whey proteins include -lactalbumin, lactoferrin, immunoglobulins, lysozyme and serum albumin (9). The low-molecular-weight components may include carbohydrates, salts, peptides and vitamins. This study shows that it is the low-molecular-weight components of whey that enhance Fe uptake. Removing the 10kF whey fraction had the same effect as removing the total whey component from HM. Conversely, removing the 10kR whey fraction did not affect ferritin formation. Thus, the decrease in ferritin formation due to removing whey can be attributed to the low-molecular-weight whey components, not to the highmolecular-weight whey components. The decrease in ferritin formation when whey was removed was evident only when the samples were digested, i.e., when pepsin, pancreatin and bile were added to the samples before treating the cells. However, removing the whey from HM did not affect iron bioavailability when the samples were not digested (Fig. 2). The decrease in cell ferritin levels caused by digested HM whey but not undigested HM whey suggests that the Fe added to intact milk might form a complex with a whey component, rendering it unavailable to the cells without enzymatic digestion. The enzymatic digestion may also lead to the digestion of an Fe uptake inhibitor, thus increasing the bioavailability of Fe. Alternatively, it could also form a digestion product that promotes bioavailability by chelating Fe and keeping it soluble. The fact that the 10kF whey fraction ( 10 kda) had the greatest Fe uptake enhancing effect compared to the 10kR

5 HUMAN MILK ENHANCES FE UPTAKE BY CACO-2 CELLS 97 whey fraction ( 10 kda) rules out the possibility that lactoferrin, an 80-kDa glycoprotein (10), is the only or main Fe uptake enhancing component. After ultrafiltration, lactoferrin and the other whey proteins [ -lactalbumin (14.2 kda), serum albumin (68 kda) and immunoglobulins (150 to 900 kda)] would be retained in the 10kR fraction. The results of this study are in agreement with the observations of Hussain et al. (11) who found that it was the 10-kDa fraction of HM whey that led to higher iron transfer and uptake in Caco-2 cells grown in bicameral chambers. Likewise, Serfass and Reddy (12) recently found that low-molecular-weight fractions derived from a 10-kDa filtrate were as effective as ascorbate and nitrilotriacetate in solubilizing Fe at neutral ph. However, when they pretreated the low-molecular-weight whey component with pepsin, pancreatin and bile extract and added extrinsic Fe, the amount of soluble Fe did not differ from that found with nondigested low-molecular-weight whey (12). The HM fat fraction elicited the greatest cell ferritin formation, suggesting that it is the fat component of HM that inhibits Fe uptake (Figs. 2 and 4). It is possible that Fe added to intact HM is adsorbed to the fat globule membranes (composed of proteins and phospholipids). It is also possible that Fe binds to free fatty acids or fatty acids released from lipolysis of triacylglycerols (by human milk lipase) or to phospholipids, forming insoluble Fe soaps. Iron bound to the fat globule membranes or to fatty acids is not likely to be absorbed by the cells. The present study shows that HM fat reduces available iron whether digested (Fig. 4) or undigested (Fig. 2). Removing the casein from HM did not affect cell ferritin formation regardless of whether the samples were digested. Thus, HM casein did not affect iron uptake. Human milk casein, which is composed largely of -casein with small amounts of -casein and very little to no -casein (9,13), represents a small fraction of the total protein component of HM. The casein fraction of HM total protein can be as low as 20% in early milk to 40% in more mature milk (9), and the percentage of casein in HM ranges from 0.14 to 0.68% by weight (8). In the present study, the calculated percentage of casein in HM was 0.7% (Table 1). Because this is such a small fraction, the amount of Fe binding to casein is probably low, which could partly explain the lack of effect on Fe uptake. It is also possible that the casein is already saturated with other minerals, such as calcium, phosphorus, zinc, iron, magnesium and copper, preventing the added Fe from binding. Results for the CM casein, CM fat and CM whey fractions differed from those obtained with the HM fractions. The CM casein fraction elicited the greatest ferritin formation in the cells, which suggests that it is the casein component in CM that acts as an Fe uptake inhibitor, as opposed to the fat component in HM. Bovine casein, which is composed of, and caseins, has been shown to be an Fe uptake inhibitor, both in vivo (14) and in vitro (15,16). The low bioavailability of Fe from CM casein might be explained by 1) low dialyzability of Fe, as observed in infant formulas that contain casein as the main protein fraction (17) and in commercial casein (16); 2) very slow enzymatic digestion by the brush-border enzyme alkaline phosphatase, which liberates the phosphorus-fe complex from the casein (18) and 3) very strong affinity of the casein for Fe, which prevents it from interacting with the intestinal cell receptor. However, removing fat from CM did not affect ferritin formation. King et al. (19) studied the distribution of natural versus added 59 Fe isotopes in whole, unpasteurized and unhomogenized CM. Natural 59 Fe was incorporated into milk by administering the isotope via the subgular vein of the cow (intrinsic labeling), whereas the added 59 Fe was added directly to freshly drawn milk (extrinsic labeling). The milk was then fractionated. The researchers found that most of the added 59 Fe radioactivity (98%) was associated with the skim milk protein (i.e., devoid of fat). However, natural 59 Fe was highly concentrated at the fat globule membrane. Although the authors failed to explain the differences in distribution between the intrinsic and extrinsic isotope, this type of study might explain why removing fat from whole CM milk has no effect on Fe uptake. When Fe was added to whole CM, it did not bind to the fat. Removing whey from CM did not affect ferritin formation in the present study, nor did removing the 10kF whey. Although -lactalbumin and lactoferrin are the main whey proteins in HM, -lactoglobulin is the main whey protein in CM, followed by -lactalbumin and proteose-peptones, immunoglobulins and serum albumin (20). The 10kF CM whey fraction ( 10 kda) elicited the greatest Fe uptake in Caco-2 cells (Fig. 3). It is important to note that the whey fractions presented here were added to the cells on an equal-weight basis and that the samples were not digested. The weights in no way reflect the proportions found in either HM or CM. On an equal-weight basis, the 10kF CM whey elicited the greatest ferritin formation, whereas the higher molecular weight CM whey elicited the least ferritin formation (Fig. 3). Also, the 10kF whey fractions that contained the lowest concentrations of protein (0.4 and 4.5 g/l) elicited the greatest Fe uptake, and the 10kR whey fractions that contained the highest concentrations of protein (98.3 and 40.3 g/l) elicited the least Fe uptake. The lower Fe uptake elicited by the 10kR whey could be due to protein aggregation that makes the Fe unavailable for cell uptake. The lower protein concentration of the 10kF whey suggests that the Fe uptake enhancing component in this fraction might be a nonprotein component. However, it could be a compound bound to a peptide or protein that can enhance Fe uptake when pepsin, pancreatin and bile are added, as previously shown. In conclusion, there seems to be an Fe uptake enhancing milk factor in HM, which is found in the whey. More specifically, it is the low-molecular-weight fraction ( 10 kda) that promotes Fe uptake. The high-molecular-weight fraction of whey, which includes lactoferrin among other whey proteins and components, is not the Fe uptake enhancing fraction. LITERATURE CITED 1. Jackson, L. S. & Lee, K. (1992) The effect of dairy products on iron availability. Crit. Rev. Food Sci. Nutr. 31: Baker, H. M., Anderson, B. F., Kidd, R. D., Shewry, S. C. & Baker, E. D. (2000) Lactoferrin three-dimensional structure: a framework for interpreting function. In Lactoferrin: Structure, Function and Applications. Proceedings of the 4th International Conference on Lactoferrin: Structure, Function and Applications, pp Elsevier Science B.V., Amsterdam, The Netherlands. 3. Davidsson, L., Kastenmayer, P., Yuen, M., Lönnerdal, B. & Hurrell, R. F. (1994) Influence of lactoferrin on iron absorption from human milk in infants. Pediatr. Res. 35: Fransson, G. B. & Lönnerdal, B. (1980) Iron in human milk. J. Pediatr. 3: Fairweather-Tait, S. J., Balmer, S. E., Scott, P. H. & Minski, M. J. (1987) Lactoferrin and iron absorption in newborn infants. Pediatr. Res. 22: Fransson, G. B. & Lönnerdal, B. (1983) Distribution of trace elements and minerals in human and cow s milk. Pediatr. Res. 17: Glahn, R. P., Lee, O. A., Yeung, A., Goldman, M. I. & Miller, D. D. (1998) Caco-2 cell ferritin formation predicts nonradiolabeled food iron availability in an in vitro digestion/caco-2 cell culture model. J. Nutr. 128: Ciba-Geigy (1981) Geigy Scientific Tables, Vol. 1: Units of Measurement, Body Fluids, Composition of the Body, Nutrition, pp Ciba-Geigy, West Caldwell, NJ.

6 98 ETCHEVERRY ET AL. 9. Lönnerdal, B. (1997) Effects of milk and milk components on calcium, magnesium, and trace element absorption during infancy. Physiol. Rev. 77: Brock, J. H. (2002) The physiology of lactoferrin. Biochem. Cell Biol. 80: Hussain, M. S., Serfass, R. E. & Reddy, M. B. (1999) Low molecular weight fraction from human milk enhances Fe bioavailability in Caco-2 cells. FASEB J. 13: A Serfass, R. E. & Reddy, M. B. (2003) Breast milk fractions solubilize Fe(III) and enhance iron flux across Caco-2 cells. J. Nutr. 133: Picciano, M. F. (2001) Nutrient composition of human milk. Pediatr. Clin. North Am. 48: Hurrell, R. F., Lynch, S. R., Trinidad, T. P., Dassenko, S. A. & Cook, J. D. (1989) Iron absorption in humans as influenced by bovine milk proteins. Am. J. Clin. Nutr. 49: Glahn, R. P., Wien, E. M., VanCampen, D. R. & Miller, D. D. (1996) Caco-2 cell iron uptake from meat and casein digests parallels in vivo studies: use of a novel in vitro method for rapid estimation of iron bioavailability. J. Nutr. 126: Kane, A. P. & Miller, D. D. (1984) In vitro estimation of the effects of selected proteins on Fe bioavailability. Am. J. Clin. Nutr. 39: García, R., Alegría, A., Barberá, R., Farré, R. & Lagarda, M. J. (1998) Dialyzability of iron, zinc and copper of different types of infant formulas marketed in Spain. Biol. Trace Elem. Res. 65: Yeung, A. C., Glahn, R. P. & Miller, D. D. (2001) Dephosphorylation of sodium caseinate, enzymatically hydrolyzed casein and casein phosphopeptides by intestinal alkaline phosphatase: implications for iron bioavailability. J. Nutr. Biochem. 12: King, R. L., Luick, J. R., Litman, I. I., Jennings, W. G. & Dunkley, W. L. (1959) Distribution of natural and added copper and iron in milk. J. Dairy Sci. 42: Swaisgood, H. E. (1996) Characteristics of milk. In: Food Chemistry, 3rd ed, pp Marcel Dekker, New York, NY.

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