01/27/2026
Primarily affecting premature infants, necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal condition. Many infants diagnosed with NEC die from the disease, and of those who survive, 40% go on to develop neurodevelopmental impairments.
Using MRI and an advanced technology that measures brain activity, the research team is investigating gut-brain axis signaling and the effects of chondroitin sulfate—a natural anti-inflammatory compound commonly used for osteoarthritis, in the prevention and treatment of NEC.
Often described as a “heart attack of the intestines,” necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal condition in which the blood supply is cut off to the intestines causing the tissue to die. NEC primarily affects very premature infants, and it is estimated that as many as 10% of premature babies globally will develop the disease. With very few treatments currently available, 40% to 50% of infants diagnosed with NEC die from the disease. Of those who survive, 40% of children go on to develop neurodevelopmental impairments such as cerebral palsy and autism.
Troy Markel, MD, a pediatric surgeon at Riley Children’s Health and professor of surgery at Indiana University School of Medicine, has studied NEC and its impact on premature infants for more than 12 years.
“There is a chain of nerves called the gut-brain axis that connects the gut to the brain,” explained Dr. Markel. “It’s believed that the neurodevelopmental impairment in survivors of NEC correlates to the amount of time the brain is exposed to the gut’s inflammatory and immune response to the disease.”
Most recently, Dr. Markel’s laboratory has focused on the benefits of chondroitin sulfate, a natural anti-inflammatory compound commonly used for osteoarthritis, in the prevention and treatment of NEC. In Dr. Markel’s research with both cell culture and other laboratory models, the chondroitin sulfate was effective in reducing the inflammation resulting from NEC.
In his Heartland-funded research, Dr. Markel is collaborating with brain imaging specialist Yunjie Tong, PhD, associate professor of biomedical engineering at Purdue University. Using MRI and an advanced technology called near-infrared spectroscopy that measures brain activity, Dr. Tong and Dr. Markel will further investigate gut-brain axis signaling and the effects of chondroitin sulfate.
“While chondroitin sulfate works locally in the gut and doesn’t travel through the bloodstream, our hope is that if it can be used to reduce the inflammation in the intestines, it will help decrease the signaling that’s sent to the brain and prevent neurological injury,” Dr. Markel explained. “And for the significant number of infants who die from NEC, I think ultimately it could be used as a lifesaving therapy in the earliest stages of NEC or as a preventive strategy for premature infants at higher risk of developing the disease.”
A Project of the Heartland Children’s Nutrition Collaborative
This work is made possible through a generous gift to the Riley Children’s Foundation from the Ricks Family Foundation, led by Riley physician Christina Ricks, MD, and her husband David A. Ricks. Their support fuels the Heartland Children’s Nutrition Collaborative—a joint effort between the IU School of Medicine Department of Pediatrics and Purdue’s Department of Food Science—to uncover how early‑life nutrition can influence lifelong health outcomes.