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Greenfield KG, Harlow OS, Witt LT, Dziekan EM, Tamar CR, Meier J, Brumbaugh JE, Levy ER, Knoop KA. Neonatal intestinal colonization of Streptococcus agalactiae and the multiple modes of protection limiting translocation. Gut Microbes 2024; 16:2379862. [PMID: 39042143 PMCID: PMC11268251 DOI: 10.1080/19490976.2024.2379862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a predominant pathogen of neonatal sepsis, commonly associated with early-onset neonatal sepsis. GBS has also been associated with cases of late-onset sepsis potentially originating from the intestine. Previous findings have shown GBS can colonize the infant intestinal tract as part of the neonatal microbiota. To better understand GBS colonization dynamics in the neonatal intestine, we collected stool and milk samples from prematurely born neonates for identification of potential pathogens in the neonatal intestinal microbiota. GBS was present in approximately 10% of the cohort, and this colonization was not associated with maternal GBS status, delivery route, or gestational weight. Interestingly, we observed the relative abundance of GBS in the infant stool negatively correlated with maternal IgA concentration in matched maternal milk samples. Using a preclinical murine model of GBS infection, we report that both vertical transmission and direct oral introduction resulted in intestinal colonization of GBS; however, translocation beyond the intestine was limited. Finally, vaccination of dams prior to breeding induced strong immunoglobulin responses, including IgA responses, which were associated with reduced mortality and GBS intestinal colonization. Taken together, we show that maternal IgA may contribute to infant immunity by limiting the colonization of GBS in the intestine.
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Affiliation(s)
| | | | - Lila T Witt
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jane E Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emily R Levy
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kathryn A Knoop
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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2
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Yeo S, Yang L, Ong K, Yong TT. Breastfeeding With Infectious Diseases. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058221123395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims: Human breast milk remains an important source of protection against infection, inflammation, allergy and long-term metabolic disorders for the breastfed offspring. During cases of ongoing infection, the dilemma faced by both medical health professionals and mothers is the need to balance the risk of continuing versus temporarily or permanently ceasing to breastfeed. The aim of our article is to review existing literature regarding breastfeeding during acute infectious and non-infectious illnesses and to provide feasible evidence-based suggestions which can be implemented by medical practitioners during counselling of breastfeeding mothers. Method: A literature search was conducted on PubMed (US National Library of Medicine) using various combinations of keywords related to breastfeeding and the various infections. The citations from all selected articles were reviewed for additional studies. Results: Most ongoing infections are not contraindications for breastfeeding, with the exceptions of Human Immunodeficiency viruses (HIV), Human T-cell lymphotropic virus (HTLV) types 1 and 2. Even with HIV, there is increasing evidence to reassure that with adequate antiretroviral therapy, breastfeeding is likely to be safe. Of particular concern during the COVID-19 pandemic too, current evidence indicates that mothers with COVID-19 infection can safely breastfeed, and therefore initiation and continuation of breastfeeding should continue to protect the health of the babies and mothers. Conclusion: During this pandemic especially, there is a strong and urgent need to support mothers with acute infections who wish to breastfeed. With better awareness, physicians can play an important role in securing positive experiences for breastfeeding mothers and optimizing infant outcomes.
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Affiliation(s)
- Samantha Yeo
- Singapore Health Services, KK Women's and Children's Hospital, Singapore
| | - Liying Yang
- Singapore Health Services, Singapore General Hospital, Singapore
| | - Kirsten Ong
- Singapore Health Services, KK Women's and Children's Hospital, Singapore
| | - Tze Tein Yong
- Singapore Health Services, Singapore General Hospital, Singapore
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3
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Wiggins JB, Trotman R, Perks PH, Swanson JR. Enteral Nutrition: The Intricacies of Human Milk from the Immune System to the Microbiome. Clin Perinatol 2022; 49:427-445. [PMID: 35659095 DOI: 10.1016/j.clp.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2012, the American Academy of Pediatrics stated that all preterm infant diets should consist of human milk (mother's own milk or pasteurized donor human milk). The clinical reasons supporting this policy are many, including reducing infections and retinopathy of prematurity, decreased neonatal intensive care unit length of stay, subsequent readmissions, a decrease in mortality, and improved neurodevelopmental outcomes. This article focuses on human milk, its composition and bioactive factors, and how it affects the gut-brain axis through the microbiome. We examine how differences between mother's own milk and pasteurized donor human milk affect the premature infant.
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Affiliation(s)
- Jaclyn B Wiggins
- Division of Neonatology, Department of Pediatrics, University of Virginia, Box 800386, Charlottesville, VA 22908, USA.
| | - Rachael Trotman
- Neonatal Intensive Care Unit, PO Box 800673, Nutrition Services, Ground Floor, UVA Main Hospital, 1215 Lee Street, Charlottesville, VA 22908-0673, USA
| | - Patti H Perks
- Neonatal Intensive Care Unit, PO Box 800673, Nutrition Services, Ground Floor, UVA Main Hospital, 1215 Lee Street, Charlottesville, VA 22908-0673, USA
| | - Jonathan R Swanson
- Division of Neonatology, Department of Pediatrics, University of Virginia, Box 800386, Charlottesville, VA 22908, USA
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Fox A, Marino J, Amanat F, Krammer F, Hahn-Holbrook J, Zolla-Pazner S, Powell RL. Robust and Specific Secretory IgA Against SARS-CoV-2 Detected in Human Milk. iScience 2020; 23:101735. [PMID: 33134887 PMCID: PMC7586930 DOI: 10.1016/j.isci.2020.101735] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023] Open
Abstract
The SARS-CoV-2 immune response in human milk has not yet been examined, although protecting infants and young children from COVID-19 is critical for limiting community transmission and preventing serious illness and death. Here, milk samples from eight COVID-19-recovered and seven COVID-19-suspected donors were tested for antibody (Ab) binding to the SARS-CoV-2 Spike protein. All samples exhibited significant specific IgA reactivity to the full Spike, whereas 80% exhibited significant IgA and secretory (s)Ab binding to the Receptor-Binding Domain (RBD). Additionally, 67% samples exhibited IgG and/or IgM binding to RBD. IgA and sAb titers were highly correlated, indicating most IgA to be sIgA. Overall, these data indicate that a robust sIgA-dominant SARS-CoV-2 Ab response in human milk after infection should be expected in a significant majority of individuals. Further research is highly warranted to determine Ab functionality and the potential for exploiting extracted milk sIgA for therapeutic use.
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Affiliation(s)
- Alisa Fox
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
| | - Jessica Marino
- Health Sciences Research Institute, University of California, 5200 Lake Road, Merced, CA 95343, USA
- Department of Psychology, University of California Merced, 5200 Lake Road, Merced, CA 95343, USA
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
| | - Jennifer Hahn-Holbrook
- Health Sciences Research Institute, University of California, 5200 Lake Road, Merced, CA 95343, USA
- Department of Psychology, University of California Merced, 5200 Lake Road, Merced, CA 95343, USA
| | - Susan Zolla-Pazner
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
| | - Rebecca L. Powell
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY 10029, USA
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Meyer K, Volkmann A, Hufnagel M, Schachinger E, Klau S, Horstmann J, Berner R, Fischer M, Lehner A, Haas N, Ulrich S, Jakob A. Breastfeeding and vitamin D supplementation reduce the risk of Kawasaki disease in a German population-based case-control study. BMC Pediatr 2019; 19:66. [PMID: 30808315 PMCID: PMC6390341 DOI: 10.1186/s12887-019-1438-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/18/2019] [Indexed: 01/16/2023] Open
Abstract
Background In Kawasaki disease (KD), a vasculitis of unknown etiology, the most serious complication is the development of coronary artery aneurysm (CAA). To date, the exact pathomechanism of KD is unknown. Both environmental and genetic factors seem to be associated with the development of the disease. Methods Data on KD patients recruited from the population-based German Pediatric Surveillance Study during 2012–2014 were used to evaluate the impact of various factors from the perinatal and infancy period on the development of KD. The study design was a matched case-control study with respect to age, sex and place of residence (n = 308 KD cases, n = 326 controls). All KD patients were individually re-evaluated; all fulfilled the international diagnostic KD criteria. A standardized questionnaire was used to review breastfeeding practices, vitamin D supplementation and birth characteristics. Logistic regression analyses were performed to obtain odds ratios (OR) for various risk factors among the case-control pairs. Simple measures of association were used to assess the impact of these factors on the clinical course. Results There was no difference in lengths of gestation, birth weight or parturition between KD patients and controls, but independently from each other vitamin D supplementation and breastfeeding were negatively associated with KD, even when adjusted for age, place of residence and sex. The duration of vitamin D was significantly shorter among children with KD than among children without KD (p = 0.039, OR = 0.964, 95% CI: 0.931–0.998), as was the duration of breastfeeding (p = 0.013, OR = 0.471, 95% CI: 0.260–0.853). Comparing KD patients with and without breastfeeding and/or vitamin D supplementation, there were no differences regarding developing CAA, being refractory to intravenous immunoglobulin treatment, age at onset of the disease and levels of inflammatory laboratory values. Conclusion Our findings indicate breastfeeding and vitamin D supplementation to have protective effects in association with KD in our study population; however, these seem not to influence the natural course of the disease. Although the overall effects were relatively small, they nevertheless underline the overall benefit of both interventions. Trial registration Clinical Trial Registration: German clinical trial registration, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00010071. Date of registration was 26. February 2016. The trial was registered retrospectively. Electronic supplementary material The online version of this article (10.1186/s12887-019-1438-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Meyer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Mathildenstraße 1, D-79106, Freiburg, Germany.
| | - A Volkmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - M Hufnagel
- Division of Pediatric Infectious Disease and Rheumatology, Center for Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - E Schachinger
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Mathildenstraße 1, D-79106, Freiburg, Germany
| | - S Klau
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - J Horstmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Mathildenstraße 1, D-79106, Freiburg, Germany
| | - R Berner
- Department for Pediatrics, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - M Fischer
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - A Lehner
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - N Haas
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - S Ulrich
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - A Jakob
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Keim SA, Kulkarni MM, McNamara K, Geraghty SR, Billock RM, Ronau R, Hogan JS, Kwiek JJ. Cow's Milk Contamination of Human Milk Purchased via the Internet. Pediatrics 2015; 135:e1157-62. [PMID: 25847797 PMCID: PMC9923537 DOI: 10.1542/peds.2014-3554] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The US Food and Drug Administration recommends against feeding infants human milk from unscreened donors, but sharing milk via the Internet is growing in popularity. Recipient infants risk the possibility of consuming contaminated or adulterated milk. Our objective was to test milk advertised for sale online as human milk to verify its human origin and to rule out contamination with cow's milk. METHODS We anonymously purchased 102 samples advertised as human milk online. DNA was extracted from 200 μL of each sample. The presence of human or bovine mitochondrial DNA was assessed with a species-specific real-time polymerase chain reaction assay targeting the nicotinamide adenine dinucleotide (NADH) dehydrogenase subunit 5 gene. Four laboratory-created mixtures representing various dilutions of human milk with fluid cow's milk or reconstituted infant formula were compared with the Internet samples to semiquantitate the extent of contamination with cow's milk. RESULTS All Internet samples amplified human DNA. After 2 rounds of testing, 11 samples also contained bovine DNA. Ten of these samples had a level of bovine DNA consistent with human milk mixed with at least 10% fluid cow's milk. CONCLUSIONS Ten Internet samples had bovine DNA concentrations high enough to rule out minor contamination, suggesting a cow's milk product was added. Cow's milk can be problematic for infants with allergy or intolerance. Because buyers cannot verify the composition of milk they purchase, all should be aware that it might be adulterated with cow's milk. Pediatricians should be aware of the online market for human milk and the potential risks.
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Affiliation(s)
- Sarah A. Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio;,Departments of Pediatrics, and,Division of Epidemiology, College of Public Health;,Address correspondence to Sarah A. Keim, PhD, MA, MS, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205. E-mail:
| | | | - Kelly McNamara
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Sheela R. Geraghty
- Cincinnati Children’s Center for Breastfeeding Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Rachel Ronau
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Joseph S. Hogan
- Department of Animal Sciences, College of Food, Agricultural, and Environmental Sciences; and
| | - Jesse J. Kwiek
- Microbial Infection and Immunity, College of Medicine;,Department of Microbiology, College of Arts and Sciences, The Ohio State University, Columbus, Ohio; and
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Neu J. Developmental aspects of maternal-fetal, and infant gut microbiota and implications for long-term health. Matern Health Neonatol Perinatol 2015; 1:6. [PMID: 27057323 PMCID: PMC4772751 DOI: 10.1186/s40748-015-0007-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/08/2015] [Indexed: 11/26/2022] Open
Abstract
Background Early life interactions between the human host and microbes set the stage for future health and disease. Findings In this review, some of the relationship of the human microbiome effects will be discussed as they relate to preterm delivery, early life diseases seen in prematurely delivered infants, and other childhood and adult maladies which include autoimmunity, allergic diseases, obesity or a healthy phenotype. Conclusion Although the data in these areas is just beginning to emerge, this review will provide a brief summary of some of the key research being done and will also speculate on emerging areas where major questions are being raised.
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Affiliation(s)
- Josef Neu
- College of Medicine, University of Florida, 1600 S.W. Archer Road, Gainesville, Florida 32610 USA
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8
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Abstract
Necrotizing enterocolitis (NEC) has largely been present in neonatal intensive care units for the past 60 years. NEC prevalence has corresponded with the continued development and sophistication of neonatal intensive care. Despite major efforts towards its eradication, NEC has persisted and appears to be increasing in some centers. The pathophysiology of this disease remains poorly understood. Several issues have hampered our quest to develop a better understanding of this disease. These include the fact that what we have historically termed 'NEC' appears to be several different diseases. Animal models that are commonly used to study NEC pathophysiology and treatment do not directly reflect the most common form of the disease seen in human infants. The pathophysiology appears to be multifactorial, reflecting several different pathways to intestinal necrosis with different inciting factors. Spontaneous intestinal perforations, ischemic bowel disease secondary to cardiac anomalies as well as other entities that are clearly different from the most common form of NEC seen in preterm infants have been put into the same database. Here I describe some of the different forms of what has been called NEC and make some comments on its pathophysiology, where available studies suggest involvement of genetic factors, intestinal immaturity, hemodynamic instability, inflammation and a dysbiotic microbial ecology. Currently utilized approaches for the diagnosis of NEC are presented and innovative technologies for the development of diagnostic and predictive biomarkers are described. Predictions for future strategies are also discussed.
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Affiliation(s)
- Josef Neu
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Fla., USA
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9
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Influence of prolonged storage process, pasteurization, and heat treatment on biologically-active human milk proteins. Pediatr Neonatol 2013; 54:360-6. [PMID: 23721828 DOI: 10.1016/j.pedneo.2013.03.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/09/2013] [Accepted: 04/16/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The bioactive proteins in human milk may be influenced by prolonged storage process, pasteurization, and heat treatment. This study was conducted to evaluate the effects of these procedures. MATERIALS AND METHODS Three forms of human milk - freshly expressed, frozen at -20°C for a prolonged duration, and pasteurized milk - were collected from 14 healthy lactating mothers and a milk bank. The concentrations of major bioactive proteins (secretory immunoglobulin A, lactoferrin, lysozyme, and leptin) were quantified using enzyme-linked immunosorbent assay kits. Changes in these proteins by heat treatment at 40°C or 60°C for 30 minutes were further evaluated. RESULTS The mean concentrations of lactoferrin and secretory immunoglobulin A were significantly reduced by 66% and 25.9%, respectively, in pasteurized milk compared with those in freshly-expressed milk. Heat treatment at 40°C or 60°C did not cause significant changes in lactoferrin and secretory immunoglobulin A, but there was an apparent increase in lysozyme (p = 0.016). There were no significant differences in leptin level among these three forms of milk prior to (p = 0.153) or after heat treatment (p = 0.053). CONCLUSION Various freezing/heating/pasteurization processes applied to human milk prior to delivery to neonates could affect the concentration of immunomodulatory proteins, especially lactoferrin, secretory immunoglobulin A, and lysozyme. Leptin was unaffected by the various handling processes tested. Fresh milk was found to be the best food for neonates. Further studies are warranted to evaluate the functional activity of these proteins and their effects on infants' immunological status.
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An increase in milk IgA correlates with both pIgR expression and IgA plasma cell accumulation in the lactating mammary gland of PRM/Alf mice. J Reprod Immunol 2012; 96:25-33. [DOI: 10.1016/j.jri.2012.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 07/25/2012] [Accepted: 08/13/2012] [Indexed: 12/24/2022]
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13
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Development Of The Gastrointestinal Mucosal Barrier. Nutr Rev 2009; 40:59-61. [DOI: 10.1111/j.1753-4887.1982.tb05265.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Salmon H, Berri M, Gerdts V, Meurens F. Humoral and cellular factors of maternal immunity in swine. DEVELOPMENTAL AND COMPARATIVE IMMUNOLOGY 2009; 33:384-93. [PMID: 18761034 DOI: 10.1016/j.dci.2008.07.007] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 07/07/2008] [Accepted: 07/07/2008] [Indexed: 05/10/2023]
Abstract
Immunoglobulins cannot cross the placenta in pregnant sows. Neonatal pigs are therefore agammaglobulinemic at birth and, although immunocompetent, they cannot mount rapid immune responses at systemic and mucosal sites. Their survival depends directly on the acquisition of maternal immunity via colostrum and milk. Protection by maternal immunity is mediated by a number of factors, including specific systemic humoral immunity, involving mostly maternal IgG transferred from blood to colostrum and typically absorbed within the first 36 h of life. Passive mucosal immunity involves local humoral immunity, including the production of secretory IgA (sIgA), which is transferred principally via milk until weaning. The mammary gland (MG) produces sIgA, which is, then secreted into the milk via the poly-Ig receptor (pIgR) of epithelial cells. These antibodies are produced in response to intestinal and respiratory antigens, including pathogens and commensal organisms. Protection is also mediated by cellular immunity, which is transferred via maternal cells present in mammary secretions. The mechanisms underlying the various immunological links between MG and the mucosal surfaces involve hormonally regulated addressins and chemokines specific to these compartments. The enhancement of colostrogenic immunity depends on the stimulation of systemic immunity, whereas the enhancement of lactogenic immunity depends on appropriate stimulation at induction sites, an increase in cell trafficking from the gut and upper respiratory tract to the MG and, possibly, enhanced immunoglobulin production at the effector site and secretion in milk. In addition, mammary secretions provide factors other than immunoglobulins that protect the neonate and regulate the development of mucosal immunity--a key element of postnatal adaptation to environmental antigens.
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MESH Headings
- Animals
- Cell Movement
- Colostrum/cytology
- Colostrum/immunology
- Colostrum/metabolism
- Cytokines/metabolism
- Female
- Histocompatibility Antigens Class I/immunology
- Hormones/immunology
- Immunity, Maternally-Acquired
- Immunity, Mucosal
- Immunoglobulin A, Secretory/immunology
- Immunoglobulin A, Secretory/metabolism
- Intercellular Signaling Peptides and Proteins/immunology
- Mammary Glands, Animal/cytology
- Mammary Glands, Animal/immunology
- Mammary Glands, Animal/metabolism
- Pregnancy
- Receptors, Fc/immunology
- Receptors, Polymeric Immunoglobulin/immunology
- Receptors, Polymeric Immunoglobulin/metabolism
- Swine/embryology
- Swine/immunology
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Affiliation(s)
- Henri Salmon
- Institut National de la Recherche Agronomique (INRA), Lymphocytes et Immunité des Muqueuses UR1282, Infectiologie Animale et Santé Publique F-37380, Nouzilly (Tours), France.
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Affiliation(s)
- Burris Duncan
- Department of Pediatrics and Public Health, Arizona Health Sciences Center, Mel and Enid Zuckerman, College of Public Health, 1295 N. Martin Ave., Tucson, AZ 85724, USA.
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Bourges D, Meurens F, Berri M, Chevaleyre C, Zanello G, Levast B, Melo S, Gerdts V, Salmon H. New insights into the dual recruitment of IgA+ B cells in the developing mammary gland. Mol Immunol 2008; 45:3354-62. [DOI: 10.1016/j.molimm.2008.04.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 04/18/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
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Abstract
The level of gastrointestinal (GI) maturity of an individual infant is a major determinant of whether the infant will be able to meet nutritional needs by sole use of the GI tract or if parenteral means will be necessary. The GI tract is not only an organ for digestion and absorption of nutrients; it also performs major endocrine, neural and immunologic functions. In this review, anatomic, functional and biochemical development will be described and related to means by which enteral nutrition can be used in the prematurely born infant to optimize health and prevent disease.
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Affiliation(s)
- Josef Neu
- Department of Pediatrics, Division of Neonatology, University of Florida, FL, USA.
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Neu J, Chen M, Beierle E. Intestinal innate immunity: how does it relate to the pathogenesis of necrotizing enterocolitis. Semin Pediatr Surg 2005; 14:137-44. [PMID: 16084400 DOI: 10.1053/j.sempedsurg.2005.05.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pathogenesis of necrotizing enterocolitis (NEC) is poorly understood, but appears to be multifactorial and highly associated with immaturity of the gastrointestinal tract, colonization of the intestinal microbiota, and immature innate immune system. The goal of this review is to provide an overview of some of these risk factors and how they might lead to the genesis of NEC. A better understanding of these factors should help us prevent and treat this devastating disease.
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Affiliation(s)
- Josef Neu
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida 32608, USA
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Callen J, Pinelli J. A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants. Adv Neonatal Care 2005; 5:72-88; quiz 89-92. [PMID: 15806448 DOI: 10.1016/j.adnc.2004.12.003] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Breastfeeding benefits preterm infants from a nutritional, gastrointestinal, immunological, developmental, and psychological perspective. Despite the benefits, the incidence and duration of breastfeeding preterm infants continues to be less than that of full-term infants. The lower incidence is probably related to breastfeeding challenges that preterm infants and parents face, including establishing and maintaining a milk supply and transitioning from gavage feeding to breastfeeding. In order to increase the incidence and duration of breastfeeding preterm infants, researchers must examine breastfeeding experiences longitudinally. This way, researchers and clinicians can begin to understand the barriers to breastfeeding at various time periods in the breastfeeding experience and begin implementing strategies to remove these barriers.
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Oddy WH. A review of the effects of breastfeeding on respiratory infections, atopy, and childhood asthma. J Asthma 2005; 41:605-21. [PMID: 15584310 DOI: 10.1081/jas-200026402] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The etiology of childhood asthma is not fully understood. Early exposure to certain respiratory infections may be protective for atopy and/or asthma whereas some infections have been suggested to exert the opposite effects. Wheezing lower respiratory illness (LRI) in the first year of life and atopy are independently associated with increased risk for current asthma in childhood and their effects are mediated via different causal pathways. These risk factors are multiplicative when they operate concommitantly within individual children. Exclusive breastfeeding protects against asthma via effects on both these pathways, as well as through other as yet undefined mechanisms. Furthermore, exclusive breastfeeding may protect against asthma and may reduce the incidence of lower respiratory illness, especially respiratory syncytial virus (RSV). We have previously demonstrated a protective effect of exclusive breastfeeding on asthmatic traits in children. The aim of this review was to clarify this protective association from intermediate associations with respiratory infections, atopy, or through other facets of breastfeeding. The bioactivity of breast milk and subsequent pathways that may act upon the development of asthma in children are explored.
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Affiliation(s)
- Wendy H Oddy
- School of Public Health, Curtin University of Technology, Telethon Institute for Child Health Research, West Perth, Western Australia, Australia.
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Walker WA. The Dynamic Effects of Breastfeeding on Intestinal Development and Host Defense. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 554:155-70. [PMID: 15384575 DOI: 10.1007/978-1-4757-4242-8_15] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this review, evidence is provided to support the hypothesis that human milk provides a link between the mother and her newborn infant in the extrauterine environment in a manner similar to the placental link between mother and fetus in utero. In addition, breastfeeding helps prevent age-related diseases affecting the gastrointestinal tract during the newborn period. To provide evidence to support this hypothesis, anecdotal clinical studies are sited to suggest that human milk contains factors that may be missing in inherited diseases of inborn errors in metabolism and provide passive protective factors that lessen the expression of neonatal allergic and infectious diseases. In some instances, by providing the missing factor in an inherited disease, the newborn may be protected from serious damage to its developing brain. A second line of evidence to support this hypothesis is the observation that the composition of human milk varies with the infant's needs. To illustrate this principal, the composition of milk from mothers delivering prematurely and milk of mothers of full-term infants were compared, and the differences in trophic and protective factors in colostrum versus mature milk from mothers delivering full-term are cited. Finally, using observations from the laboratory that define the immaturities in neonatal and premature human intestinal defenses as the neonate's host defense deficiency, the specific effect that anti-inflammatory and maturational factors in human milk has on these immaturities is discussed. The active stimulus of maternal milk on the rapid development of host defenses is underscored. These cited examples of human milk effects in the newborn help support the stated hypothesis. Additional studies of human immature gut function along with translational and clinical studies are necessary to provide further objective evidence in support of breastfeeding for all neonates, particularly premature neonates.
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Affiliation(s)
- W Allan Walker
- Departments of Nutrition and Pediatrics, Harvard Medical School, Laboratory, Massachusetts General Hospital, Charlestown, MA 02129, USA.
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Bernt K, Walker WA. Human milk and the response of intestinal epithelium to infection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2002; 501:11-30. [PMID: 11787672 DOI: 10.1007/978-1-4615-1371-1_2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- K Bernt
- Developmental Gastroenterology Laboratory, Combined Program in Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital and The Children's Hospital, Boston 02129, USA
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Abstract
As survival rates for preterm infants improve, more attention is being focused on improving the quality of survival through optimal nutritional management. The benefits of human milk for term infants are well recognized, with current research suggesting that human milk may especially benefit the preterm infant. Some mothers are unable or unwilling to provide breastmilk for their infants. Although not as well studied as mother's own milk, pasteurized donor human milk can provide many of the components and benefits of human milk while eliminating the risk of transmission of infectious agents. Pasteurization does affect some of the nutritional and immunologic components of human milk, but many immunoglobulins, enzymes, hormones, and growth factors are unchanged or minimally decreased. In California donor human milk costs approximately $3.00 per ounce to purchase. A reduction in length of stay, necrotizing enterocolitis and sepsis may result in a relative saving of approximately $11 to the NICU or healthcare plan for each $1 spent for pasteurized donor milk.
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Affiliation(s)
- N E Wight
- Lactation Services, Sharp Mary Birch Hospital for Women, San Diego, CA 92123, USA
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Abstract
Various methods have been reported and used clinically to augment the nutrient supply for human milk-fed premature infants. These methods include specialized maltinutrient powdered mixtures (fortifiers), complete liquid formulas designed to be mixed with human milk, complete powdered formulas to be mixed with human milk, and alternate feeding of human milk and preterm formula. Although the optimum nutrition of premature infants is unknown, data are accumulating to suggest that human milk, fortified with additional nutrients, is appropriate for tube-fed infants. The use of fortified human milk typically provides premature infants adequate growth, nutrient retention, and biochemical indices of nutritional status when fed at approximately 180 mL/kg/d compared with unfortified human milk. Data are needed to determine the precise quantity of nutrients to be added as supplements. Nutrient interactions have not been explored in detail. Although large quantities of calcium seem to be needed, the exogenous calcium may affect fat absorption adversely. Manipulation of milk may affect the intrinsic host-defense properties of the milk. Compared with preterm formula, the feeding of fortified human milk may provide significant protection from infection and NEC. Lastly, the potential stimulation of an enteromammary pathway through skin-to-skin contact provides species-specific antimicrobial protection for premature infants. Several of these areas require additional exploration. Thus, for premature infants, neonatal centers should encourage the feeding of fortified human milk, together with skin-to-skin contact, as reasonable methods to enhance milk production while potentially facilitating the development of an enteromammary response.
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MESH Headings
- Brain/physiology
- Dietary Fats
- Dietary Supplements
- Enterocolitis, Necrotizing/prevention & control
- Humans
- Infant, Newborn
- Infant, Premature/physiology
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/prevention & control
- Milk, Human/immunology
- Milk, Human/physiology
- Nutritional Requirements
- Vision, Ocular/physiology
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Affiliation(s)
- R J Schanler
- Department of Pediatrics, Section of Neonatology, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA.
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Black KA, Hylander MA. Breastfeeding the high risk infant: implications for midwifery management. J Midwifery Womens Health 2000; 45:238-45. [PMID: 10907333 DOI: 10.1016/s1526-9523(00)00017-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The mother of a high risk infant is confronted with numerous parenting challenges, not the least of which is the decision about how to nourish her vulnerable newborn. Successful breastfeeding depends on overcoming obstacles posed by infant condition, maternal health, and the neonatal intensive care environment. These obstacles include maternal separation from the nursing infant during hospitalization, delayed initiation of the expression of breast milk due to maternal illness and/or surgery, the inability to suckle her infant or feed on demand, and the lack of sufficient maternal follow-up after discharge. This article reviews the benefits of providing breast milk to high risk infants, problems that may be encountered by mothers of high risk infants, and the interventions that may be used by the midwife to facilitate the breastfeeding process.
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Affiliation(s)
- K A Black
- Infant and Child Health Studies Branch, National Center for Health Statistics, Hyattsville, MD 20782, USA
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Tanneau GM, Hibrand-Saint Oyant L, Chevaleyre CC, Salmon HP. Differential recruitment of T- and IgA B-lymphocytes in the developing mammary gland in relation to homing receptors and vascular addressins. J Histochem Cytochem 1999; 47:1581-92. [PMID: 10567442 DOI: 10.1177/002215549904701210] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The mammary gland (MG) develops new vasculature and is colonized by lymphocytes, primarily T-cells, during pregnancy. In contrast, during lactation it is colonized primarily by IgA-containing B-cells (c-IgA cells). To explain this difference, we analyzed the spatiotemporal relationships between lymphocytes that expressed peripheral or mucosal homing receptors (HR) and the location of their vascular counterreceptors using quantitative immunohistochemical techniques. We observed that the density of beta(7+)/CD3(+) T-cells varied with the amount of the mucosal addressin cell adhesion molecule-1 (MAdCAM-1)-stained area. Both increased during pregnancy to peak at delivery, decreased rapidly in early lactation to a steady level in mid- and late lactation, and returned to resting values after weaning. Although 60% of these beta(7+)/CD3(+) T-cells scattered in the epithelium co-expressed alpha(E)beta(7), whereas the remaining 40% in association with blood vessels were alpha(4)beta(7), these results are consistent with a role of MAdCAM-1 in the localization of alpha(4)beta(7+) T-cells. In contrast to T-cells, beta(7+)/c-IgA(+) B plasmablasts (approximately 30% of total c-IgA cells) were located at the alveolar confluence, and their numbers increased in mid- and late lactation when MAdCAM-1 density plateaued. However, both T-and B-cells decreased after weaning. These results show an association between MAdCAM-1 expression level and recruitment of T-cells that does not hold for c-IgA B cells. Furthermore, the recruitment and accumulation of alpha(4)beta(7+) c-IgA cells are reminiscent of locally produced chemoattractants. (J Histochem Cytochem 47:1581-1592, 1999)
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Affiliation(s)
- G M Tanneau
- Laboratoire de Pathologie Infectieuse et Immunologie, Institut National de la Recherche Agronomique (INRA), Centre de Recherches de Tours, Nouzilly, France
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Bernt KM, Walker WA. Human milk as a carrier of biochemical messages. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1999; 88:27-41. [PMID: 10569221 DOI: 10.1111/j.1651-2227.1999.tb01298.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Not only does breast milk provides an ideal nutrient composition for the newborn, but it also contains a variety of substances that may actively influence growth and development of the infant and stimulate neonatal protection against gastrointestinal diseases. Hormones, growth factors, cytokines and even whole cells are present in breast milk and act to establish biochemical and immunological communication between mother and child. In addition, milk nutrients such as nucleotides, glutamine and lactoferrin have been shown to influence gastrointestinal development and host defense. The unique properties of milk as a mediator of biochemical messages will be presented and the clinical significance of breastfeeding in the prevention of neonatal gastrointestinal diseases will be discussed.
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Affiliation(s)
- K M Bernt
- Combined Program of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston 02115, USA
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Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103:1150-7. [PMID: 10353922 DOI: 10.1542/peds.103.6.1150] [Citation(s) in RCA: 449] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In a large-scale study of feeding strategies in premature infants (early vs later initiation of enteral feeding, continuous vs bolus tube-feeding, and human milk vs formula), the feeding of human milk had more effect on the outcomes measured than any other strategy studied. Therefore, this report describes the growth, nutritional status, feeding tolerance, and health of participating premature infants who were fed fortified human milk (FHM) in comparison with those who were fed exclusively preterm formula (PF). METHODS Premature infants were assigned randomly in a balanced two-way design to early (gastrointestinal priming for 10 days) versus late initiation of feeding (total parenteral nutrition only) and continuous infusion versus intermittent bolus tube-feeding groups. The type of milk was determined by parental choice and infants to receive their mother's milk were randomized separately from those to receive formula. The duration of the study spanned the entire hospitalization of the infant. To evaluate human milk versus formula feeding, we compared outcomes of infants fed >50 mL. kg-1. day-1 of any human milk (averaged throughout the hospitalization) with those of infants fed exclusively PF. Growth, feeding tolerance, and health status were measured daily. Serum indices of nutritional status were measured serially, and 72-hour nutrient balance studies were conducted at 6 and 9 weeks postnatally. RESULTS A total of 108 infants were fed either >50 mL. kg-1. day-1 human milk (FHM, n = 62) or exclusively PF (n = 46). Gestational age (28 +/- 1 weeks each), birth weight (1.07 +/- 0.17 vs 1.04 +/- 0.19 kg), birth length and head circumference, and distribution among feeding strategies were similar between groups. Infants fed FHM were discharged earlier (73 +/- 19 vs 88 +/- 47 days) despite significantly slower rates of weight gain (22 +/- 7 vs 26 +/- 6 g. kg-1. day-1), length increment (0.8 +/- 0.3 vs 1.0 +/- 0.3 cm. week-1), and increment in the sum of five skinfold measurements (0.86 +/- 0.40 vs 1.23 +/- 0.42 mm. week-1) than infants fed PF. The incidence of necrotizing enterocolitis and late-onset sepsis was less in the FHM group. Overall, there were no differences in any measure of feeding tolerance between groups. Milk intakes of infants fed FHM were significantly greater than those fed PF (180 +/- 13 vs 157 +/- 10 mL. kg-1. day-1). The intakes of nitrogen and copper were higher and magnesium and zinc were lower in group FHM versus PF. Fat and energy absorption were lower and phosphorus, zinc, and copper absorption were higher in group FHM versus PF. The postnatal retention (balance) surpassed the intrauterine accretion rate of nitrogen, phosphorus, magnesium, zinc, and copper in the FHM group, and of nitrogen, magnesium, and copper in the PF group. CONCLUSIONS Although the study does not allow a comparison of FHM with unfortified human milk, the data suggest that the unique properties of human milk promote an improved host defense and gastrointestinal function compared with the feeding of formula. The benefits of improved health (less sepsis and necrotizing enterocolitis) associated with the feeding of FHM outweighed the slower rate of growth observed, suggesting that the feeding of FHM should be promoted actively in premature infants.
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Affiliation(s)
- R J Schanler
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
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Hylander MA, Strobino DM, Dhanireddy R. Human milk feedings and infection among very low birth weight infants. Pediatrics 1998; 102:E38. [PMID: 9724686 DOI: 10.1542/peds.102.3.e38] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm infants are immunologically immature at birth. Previous studies have demonstrated that human milk protects against infection in full-term infants, but there are few studies of its effect for preterm infants. OBJECTIVE To examine the effect of human milk feedings on infection incidence among very low birth weight (VLBW) infants during their initial hospitalization. STUDY DESIGN The sample consisted of 212 consecutive VLBW infants admitted to the Georgetown University Medical Center neonatal intensive care unit (NICU) during 1992-1993 and surviving to receive enteral feeding. Type of feeding (human milk vs formula), presence of infection and sepsis/meningitis (clinical signs and positive cultures for pathogenic organisms), and potential confounding variables were abstracted from medical records. Multiple logistic regression was used to control for confounders. RESULTS The incidence of infection (human milk [29.3%] vs formula [47.2%]) and sepsis/meningitis (human milk [19.5%] vs formula [32.6%]) differed significantly by type of feeding. Major risk factors for infection were similar in both groups. Human milk feeding was independently correlated with a reduced odds of infection (odds ratio [OR] = 0.43; 95% confidence interval [CI]: 0.23-0.81), controlling for gestational age, 5-minute Apgar score, mechanical ventilation days, and days without enteral feedings; and was independently correlated with a reduced odds of sepsis/meningitis (OR = 0.47, 95% CI:0.23-0. 95), controlling for gestational age, mechanical ventilation days, and days without enteral feedings. CONCLUSIONS The incidence of any infection and sepsis/meningitis are significantly reduced in human milk-fed VLBW infants compared with exclusively formula-fed VLBW infants.
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Affiliation(s)
- M A Hylander
- Georgetown University Medical Center, Department of Pediatrics, Washington, DC 20007-2197, USA
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Affiliation(s)
- R J Schanler
- Section of Neonatology, Baylor College of Medicine, Houston, Texas, USA
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Abstract
AIMS To measure the concentrations of total IgA in the milk secreted by both breasts, throughout the first year of lactation, in a cohort of Gambian mothers of infants at high risk of infection. SUBJECTS AND METHODS Sixty five women and their infants were studied monthly from the 4th to 52nd postpartum week. Samples of milk were obtained from each breast by manual expression immediately before the infant was suckled. Milk intakes were measured by test weighing the infants before and after feeds over 12 hour periods; IgA concentrations were determined by enzyme linked immunosorbent assay. RESULTS A total of 1590 milk samples was measured. The median (interquartile range) concentration of IgA for all samples was 0.708 (0.422-1.105) g/l; that in milk obtained from the left breast was 0.785 (0.458-1.247) g/l, and that in milk obtained from the right breast was 0.645 (0.388-1.011) g/l (p < 0.0001). There was no significant change in milk or IgA intakes with advancing infant age, but there was a close concordance of IgA concentrations between the two breasts, with "tracking" of the output of the left and right breasts. There was a significant (p < 0.01) negative correlation between maternal age and parity, and weight of milk ingested by infants. During the dry season (December to May) the median (interquartile range) IgA concentration was significantly higher at 0.853 (0.571-1.254) g/l than during the rainy season (June to November), when it was 0.518 (0.311-0.909) g/l (p < 0.0001). CONCLUSIONS Sustained IgA secretion is likely to protect suckling infants from microbial infection.
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Affiliation(s)
- L T Weaver
- Department of Child Health, University of Glasgow
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Wright LE. Intertooth patterns of hypoplasia expression: implications for childhood health in the classic Maya collapse. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1997; 102:233-47. [PMID: 9066902 DOI: 10.1002/(sici)1096-8644(199702)102:2<233::aid-ajpa6>3.0.co;2-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Enamel hypoplasias, which record interacting stresses of nutrition and illness during the period of tooth formation, are a key tool in the study of childhood health in prehistory. But interpretation of the age of peak morbidity is complicated by differences in susceptibility to stress both between tooth positions and within a single tooth. Here, hypoplasias are used to evaluate the prevailing ecological model for the collapse of Classic Period Lowland Maya civilization, circa AD 900. Hypoplasias were recorded in the full dentition of 160 adult skeletons from six archaeological sites in the Pasion River region of Guatemala. Instead of constructing a composite scale of stress experience, teeth are considered separately by position in the analysis. No statistical differences are found in the proportion of teeth affected by hypoplasia between "Early," Late Classic, and Terminal Classic Periods for anterior teeth considered to be most susceptible to stress, indicating stability in the overall stress loads affecting children of the three chronological periods. However, hypoplasia trends in posterior teeth may imply a change in the ontogenetic-timing of more severe stress episodes during the final occupation and perhaps herald a shift in child-care practices. These results provide little support for the ecological model of collapse but do call to attention the potential of posterior teeth to reveal subtle changes in childhood morbidity when consideredindividually.
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Affiliation(s)
- L E Wright
- Texas A&M University, College Station 77843-4352, USA
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Hoshower LM. Brief communication: immunologic aspects of human colostrum and milk--a misinterpretation. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 1994; 94:421-5. [PMID: 7943195 DOI: 10.1002/ajpa.1330940310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Interpretations of the demographic impact of Western diseases are frequently clouded by a failure to appreciate the complex nature of immune responses. It is commonly assumed that epidemic diseases are generally characterized by both transplacental and lacteal transmission of maternal antibodies. This is not, however, the case for viral diseases, such as measles, smallpox, and influenza--all of which reached epidemic proportions during the post-Columbian era. In this paper I review the nature of the immune response for viral diseases, with emphasis upon measles, a disease that contributed heavily to the demise of native peoples.
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Weaver LT. Breast and gut: the relationship between lactating mammary function and neonatal gastrointestinal function. Proc Nutr Soc 1992; 51:155-63. [PMID: 1438323 DOI: 10.1079/pns19920025] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Sampson HA. Immunologic Mechanisms in Adverse Reactions to Foods. Immunol Allergy Clin North Am 1991. [DOI: 10.1016/s0889-8561(22)00070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Le Deist F, de Saint-Basile G, Angeles-Cano E, Griscelli C. Prostaglandin E2 and plasminogen activators in human milk and their secretion by milk macrophages. AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY AND MICROBIOLOGY : AJRIM 1986; 11:6-10. [PMID: 3461715 DOI: 10.1111/j.1600-0897.1986.tb00020.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Human milk was shown to contain prostaglandin E2 (PGE2) and plasminogen activator (PA) at variable concentrations depending on the time of lactation after delivery. Milk PA was functionally and immunologically identical to urokinase. A follow-up study showed that the maximum PGE2 concentrations occurred during the second week while the maximum PA concentration was observed at the end of the first week of lactation. Milk macrophages cultured in vitro were able to secrete both PGE2 and PA. When cells were activated by concanavalin A (ConA) or E. coli lipopolysaccharide (LPS), PGE2 secretion increased dramatically while PA secretion did not. The ability of activated macrophages to secrete PGE2 was at its highest shortly after delivery. It then progressively decreased during lactation. The possible physiological role of PGE2 and PA on the gastrointestinal tract of breast fed infants is discussed.
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Marsh MN. Functional and structural aspects of the epithelial lymphocyte, with implications for coeliac disease and tropical sprue. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1985; 114:55-75. [PMID: 2935927 DOI: 10.3109/00365528509093768] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epithelial lymphocytes comprise a compartmentalised and specialised population of presumed effector cells which, in general, express the surface phenotypes (Lyt-2+; OX2+; OKT8+) of suppressor/cytolytic (Ts/c) cells. Granular cells within this population (gEL) morphologically resemble the circulating large granular lymphocytes (LGL) which subserve spontaneous (NK) cytolytic activity. Recent in vitro results indicate that gEL can develop this function after prolonged in vitro culture; the relevance of this, in vivo, remains to be decided. EL also appear to be able to mediate ADCC with sIgA against enteric micro-organisms. This is the kind of integrated activity that might be anticipated from local immunocytes within the intestinal mucosa. Other recent work suggests that gEL are not precursors of mucosal mast cells. EL also appear to be capable of inducing Ia-like expression in surface and crypt enterocytes, a property enjoyed both by highly purified Th, but also Ts/c, cells as well. This raises the interesting prospect that enterocytes may display antigen in macrophage-like fashion to other adjacent cells within the inter-epithelial cell spaces. These latter observations might be more consistent with the presence of 'activated' and 'blast-transformed' lymphocytes in such conditions as coeliac disease and tropical sprue. Another emergent view that demands appropriate attention is that the infiltrate of Ts/c cells into surface, and crypt, epithelium of coeliac mucosa does not necessarily cause injury or damage to the jejunal tissues. Nevertheless the role, either primary or secondary, that EL play either in coeliac disease or tropical sprue still remains obscure.
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Cates KL, Rowe JC, Ballow M. The premature infant as a compromised host. CURRENT PROBLEMS IN PEDIATRICS 1983; 13:1-63. [PMID: 6360551 DOI: 10.1016/0045-9380(83)90008-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Arnon SS, Damus K, Thompson B, Midura TF, Chin J. Protective role of human milk against sudden death from infant botulism. J Pediatr 1982; 100:568-73. [PMID: 7038077 DOI: 10.1016/s0022-3476(82)80754-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We examined the possibility that human milk and formula milk might differentially affect the severity of the infant botulism because they differ in immunologic composition and in influence on the normal intestinal microflora against which Clostridium botulinum must compete. A beneficial effect of human milk was suggested by the different feeding experiences of the moderate, hospitalized patients and the sudden death cases. Of patients hospitalized in California, 66% (33/50) were still being nursed at onset of illness, a percentage significantly greater than that of matched controls (P less than 0.01). In contrast, all ten California cases of sudden infant death attributable to C. botulinum infection were being fed iron-supplemented formula milk at death) unlike their controls, P less than 0.02) and had received no human milk within ten weeks of death. A beneficial effect of human milk was also observed in differences in mean age at onset; hospitalized breast-fed patients were almost twice as old (13.8 +/- 6.7 weeks) as were hospitalized formula-fed patients (7.6 +/- 2.9 weeks) (P less than 0.01). Human milk (or possibly other factors associated with breast-feeding) appeared to have moderated the severity at onset of infant botulism, allowing time for hospital admission, whereas for some infants with this illness, formula milk (or possibly other factors associated with formula feeding) was linked to sudden unexpected death.
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