Mammary physiology and milk secretion

The presence of drugs or other potentially toxic materials in milk is an obvious public health risk, especially to infants and neonates. There is also increasing concern that human breast cancer is principally epigenetic in origin and results from environmentally produced lesions. Little is known about the mechanisms by which toxic substances enter milk or mammary tissue but knowledge of these processes is important to toxicologists and researchers involved in drug design and metabolism. Five general pathways have been described for transport of proteins, lipids, ions, nutrients and water into milk. Four of these pathways are transcellular, involving transport across at least two membrane barriers; the fifth is paracellular and allows direct exchange of interstitial and milk components. Solute transport by these pathways is mediated by a diverse, and complex array of transport and secretory processes that are regulated by hormonal, developmental, and physiological factors. Current research is beginning to define the mechanisms underlying some of these processes, however the regulation and coordination of solute transport mechanisms remains poorly understood. In this article we review our current understanding of the normal solute transport and secretory processes involved in milk production, and discuss potential regulatory mechanisms. (C) 2003 Elsevier Science B.V. All rights reserved.