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Taskou C, Sarantaki A, Georgakopoulou VΕ, Spyratos GA, Drossos PV, Daskalakis G, Beloukas A, Lykeridou A. Assessing the Presence of IgG Antibodies against Influenza Viruses in Neonates after Maternal Vaccination and Factors That May Affect the Transplacental Transfer. Diseases 2023; 11:166. [PMID: 37987278 PMCID: PMC10660699 DOI: 10.3390/diseases11040166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
Special populations, particularly pregnant women, are uniquely susceptible to infectious diseases due to alterations in their immunological, respiratory, and cardiovascular systems during gestation. Influenza infections during the perinatal period have been associated with more severe maternal and perinatal outcomes, underscoring the critical importance of vaccination data for pregnant women. According to the World Health Organization (WHO), all pregnant women and those of childbearing age should receive the inactivated influenza vaccine, irrespective of their pregnancy stage. This study aimed to elucidate factors influencing neonatal antibody presence following maternal influenza vaccination. Conducted through convenience sampling in Athens, Greece, this study involved 78 pregnant women who received flu vaccinations. The participants completed questionnaires covering demographics, obstetric history, attitudes toward influenza vaccination, and knowledge about the influenza virus and pregnancy vaccination. Blood samples were collected from 83 neonates to assess IgG antibody presence. Five of the surveyed women had twin pregnancies. The statistical analysis employed IBM SPSS-Statistics version 26.0. This study revealed the presence of positive influenza A and B antibodies in neonates following maternal immunization. Furthermore, it identified factors such as the gestational week and timing of vaccination during pregnancy that influenced the transfer of antibodies from mother to fetus. These findings offer valuable insights for healthcare professionals to provide informed recommendations on influenza vaccination during pregnancy and empower expectant mothers to make informed decisions about the benefits of immunization.
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Affiliation(s)
- Chrysoula Taskou
- Midwifery Department, University of West Attica, 11521 Athens, Greece; (A.S.); (A.L.)
| | - Antigoni Sarantaki
- Midwifery Department, University of West Attica, 11521 Athens, Greece; (A.S.); (A.L.)
| | | | - Gerasimos A. Spyratos
- Biomedical Sciences Department, University of West Attica, 11521 Athens, Greece; (G.A.S.); (P.V.D.)
- Labogen S.A. Laboratories, 11143 Athens, Greece
| | - Panagiotis V. Drossos
- Biomedical Sciences Department, University of West Attica, 11521 Athens, Greece; (G.A.S.); (P.V.D.)
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Apostolos Beloukas
- Biomedical Sciences Department, University of West Attica, 11521 Athens, Greece; (G.A.S.); (P.V.D.)
- National AIDS Reference Centre of Southern Greece, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece
| | - Aikaterini Lykeridou
- Midwifery Department, University of West Attica, 11521 Athens, Greece; (A.S.); (A.L.)
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Sartoretti J, Eberhardt CS. The Potential Role of Nonhuman Primate Models to Better Comprehend Early Life Immunity and Maternal Antibody Transfer. Vaccines (Basel) 2021; 9:vaccines9040306. [PMID: 33804886 PMCID: PMC8063815 DOI: 10.3390/vaccines9040306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 02/04/2023] Open
Abstract
Early life immunity is a complex field of research and there are still gaps in knowledge regarding the detailed mechanism of maternal antibody transfer, the impact of maternal antibodies on infant vaccine responses and the ontogeny of human early life immunity. A comprehensive understanding is necessary to identify requirements for early life vaccines and to improve early childhood immunization. New immunological methods have facilitated performing research in the youngest, however, some questions can only be addressed in animal models. To date, mostly murine models are used to study neonatal and infant immunity since they are well-described, easy to use and cost effective. Given their limitations especially in the transfer biology of maternal antibodies and the lack of infectivity of numerous human pathogens, this opinion piece discusses the potential and prerequisites of the nonhuman primate model in studying early life immunity and maternal antibody transfer.
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Affiliation(s)
- Julie Sartoretti
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, 1211 Geneva 4, Switzerland;
- Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, 6 rue Willy-Donze, 1211 Geneve 4, Switzerland
| | - Christiane S. Eberhardt
- Center for Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, 1211 Geneva 4, Switzerland;
- Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, 6 rue Willy-Donze, 1211 Geneve 4, Switzerland
- Center for Vaccinology, University Hospitals of Geneva, 1205 Geneva, Switzerland
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Correspondence:
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Clements T, Rice TF, Vamvakas G, Barnett S, Barnes M, Donaldson B, Jones CE, Kampmann B, Holder B. Update on Transplacental Transfer of IgG Subclasses: Impact of Maternal and Fetal Factors. Front Immunol 2020; 11:1920. [PMID: 33013843 PMCID: PMC7516031 DOI: 10.3389/fimmu.2020.01920] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
Transplacental antibody transfer from mother to fetus provides protection from infection in the first weeks of life, and the four different subclasses of IgG (IgG1, IgG2, IgG3, and IgG4) have diverse roles in protection against infection. In this study, we evaluated concentrations and transplacental transfer ratios of the IgG subclasses in a healthy UK-based cohort of mother-cord pairs, and investigated associations with maternal, obstetric, and fetal factors. In agreement with previous studies, we found a strong association between maternal and cord IgG for all subclasses. We report a transfer efficiency hierarchy of IgG1>IgG3>IgG4=IgG2 in our study population, and our review of the literature demonstrates that there is no consensus in the hierarchy of subclass transfer, despite the commonly made statement that the order is IgG1>IgG4>IgG3>IgG2. We report additional data regarding negative associations between elevated maternal IgG concentrations and maternal/cord transfer ratios, finding an effect on IgG1, IgG2, and IgG3 subclasses. Levels of IgG subclasses were the same between venous and arterial blood samples from the umbilical cord, but there was a significantly higher level of total IgG in arterial blood. We found no correlation between placental FcRn protein levels and IgG transfer in our cohort, suggesting that IgG is the main determinant of observed differences in transplacental transfer ratios at term. Neonatal IgG1 and IgG4 levels were increased with later gestation at delivery, independent of any increase in transplacental transfer, indicating that the benefit of later gestation is through accumulation of these subclasses in the fetus. Neonatal IgG2 levels and transfer ratios were reduced in rhesus-negative pregnancies, suggesting that administered anti-D antibodies may compete for transplacental transfer of this subclass. Maternal influenza vaccination resulted in elevated maternal and neonatal levels of IgG4, whereas maternal Tdap vaccination had no impact on neonatal levels of the subclasses, nor transfer. However, within Tdap vaccinated pregnancies, later gestation at Tdap vaccination was associated with higher transplacental transfer. Our study provides information regarding levels and transfer of IgG subclasses in healthy term pregnancies and demonstrates the importance of recording detailed clinical information in studies of antibody transfer, including parity, ethnicity, and timing of maternal vaccine delivery.
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Affiliation(s)
- Toby Clements
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom
| | - Thomas F Rice
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom.,Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - George Vamvakas
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, United Kingdom
| | - Sara Barnett
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom.,Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - Megan Barnes
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom
| | - Beverly Donaldson
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Beate Kampmann
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom.,The Vaccine Center, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Vaccines and Immunity Theme, MRC Unit the Gambia at LSHTM, Banjul, Gambia
| | - Beth Holder
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College, London, United Kingdom.,Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College, London, United Kingdom
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Saso A, Kampmann B. Maternal Immunization: Nature Meets Nurture. Front Microbiol 2020; 11:1499. [PMID: 32849319 PMCID: PMC7396522 DOI: 10.3389/fmicb.2020.01499] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
Vaccinating women in pregnancy (i.e., maternal immunization) has emerged as a promising tool to tackle infant morbidity and mortality worldwide. This approach nurtures a 'gift of nature,' whereby antibody is transferred from mother to fetus transplacentally during pregnancy, or postnatally in breast milk, thereby providing passive, antigen-specific protection against infections in the first few months of life, a period of increased immune vulnerability for the infant. In this review, we briefly summarize the rationale for maternal immunization programs and the landscape of vaccines currently in use or in the pipeline. We then direct the focus to the underlying biological phenomena, including the main mechanisms by which maternally derived antibody is transferred efficiently to the infant, at the placental interface or in breast milk; important research models and methodological approaches to interrogate these processes, particularly in the context of recent advances in systems vaccinology; the potential biological and clinical impact of high maternal antibody titres on neonatal ontogeny and subsequent infant vaccine responses; and key vaccine- and host-related factors influencing the maternal-infant dyad across different environments. Finally, we outline important gaps in knowledge and suggest future avenues of research on this topic, proposing potential strategies to ensure optimal testing, delivery and implementation of maternal vaccination programs worldwide.
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Affiliation(s)
- Anja Saso
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Banjul, Gambia
| | - Beate Kampmann
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Banjul, Gambia
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Ranjan V, Mishra A, Kesarwani A, Mohan KV, Lal SN, Puliyel J, Upadhyay P. Mother-to-Child Transfer of Reactivated Varicella-Zoster Virus DNA and Varicella-Zoster IgG in Pregnancy. Viral Immunol 2019; 33:72-76. [PMID: 31834852 DOI: 10.1089/vim.2019.0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stress-induced subclinical reactivation of varicella-zoster virus (VZV) has been studied previously. However, subclinical reactivation of VZV induced by the stress of pregnancy has not been investigated. The objective was to study varicella DNA and varicella antibody levels in mothers and their newborn babies. VZV immunoglobulin G (IgG) levels in 350 mother-newborn dyads were studied using indirect enzyme-linked immunosorbent assay testing. A subset of 73 dyads was selected, DNA was isolated from the serum samples, and quantitative polymerase chain reaction (qPCR) was performed. Nearly 15% (14.6%) mothers tested were positive for varicella antibodies (>100 mIU/dL) and 16% were borderline (<100 and >50 mIU/dL). Approximately 16.9% of the babies were positive, and 18% were in borderline. Among those tested for VZV-DNA, 70% of mothers with low VZ-IgG (<100 mIU/dL) and 11.32% of those with high VZ-IgG (>100 mIU/dL) were positive for DNA. Among the newborns, 60% of those with low VZ-IgG and 15% of those with high VZ-IgG were positive for DNA. Mothers who have had VZV infection in the past can transmit VZV DNA to their babies.
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Affiliation(s)
- Vivek Ranjan
- Department of Pediatrics, St. Stephens Hospital, New Delhi, India
| | | | | | | | | | - Jacob Puliyel
- Department of Pediatrics, St. Stephens Hospital, New Delhi, India
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Frade J, Nunes C, Mesquita JR, São José Nascimento M, Gonçalves G. Rubella antibodies in cord blood sera in Portugal: association with maternal age and vaccination status. Epidemiol Infect 2018; 146:600-605. [PMID: 29458448 PMCID: PMC9134545 DOI: 10.1017/s0950268818000237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 01/04/2018] [Accepted: 01/21/2018] [Indexed: 11/06/2022] Open
Abstract
This study evaluated the impact of maternal vaccination against rubella on the levels of specific rubella IgG (rIgG) in 198 newborn cord sera samples. Detailed maternal vaccination data were available. Specific rIgG was measured using a commercial enzyme immunoassay. Most mothers (78.8%) had been vaccinated against rubella at least once in their lives. In 15 (7.6%) cord sera samples, the concentration of specific rIgG was below 11 IU/ml, which was classified as seronegative. Statistical analysis using multiple logistic regression (n = 198) showed that newborns of mothers born between 1986 and 1995, and those born to unvaccinated mothers, were more likely to be seronegative (odds ratio (ORs) 5.2 and 4.9, respectively, adjusted for sex and gestational age). For vaccinated mothers (n = 156), those born between 1986 and 1995 were more likely to have seronegative newborns (OR 11.5 adjusting for sex, gestational age and time since last vaccination). Mothers of the 15 (7.6%) seronegative newborns might have been susceptible to rubella during pregnancy. Checking the vaccination status therefore recommended.
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Affiliation(s)
- J. Frade
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
- Health Research Unit of School of Health Sciences, Polytechnic Institute of Leiria, Campus 2 – Morro do Lena – Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
| | - C. Nunes
- Public Health Research Centre, National School of Public Health, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560 Lisboa, Portugal
| | - J. R. Mesquita
- Agrarian Superior School, Polytechnic Institute of Viseu, Quinta da Alagoa – Estrada de Nelas, Ranhados, 3500 – 606 Viseu, Portugal
| | - M. São José Nascimento
- Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy of University of Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - G. Gonçalves
- Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Decreased toll-like receptor-4/myeloid differentiation factor 88 response leads to defective interleukin-1β production in term low birth weight newborns. Pediatr Infect Dis J 2014; 33:1270-6. [PMID: 25389708 DOI: 10.1097/inf.0000000000000416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Morbidity and mortality rates are very high in low birth weight (LBW) newborns because of their increased susceptibility to infections compared with normal birth weight (NBW) newborns. A case and control study was designed to identify the status of toll-like receptor-4 (TLR-4) signaling and maternally derived immunoglobulin-G (IgG) subclasses in term LBW newborns compared with NBW newborns. METHODS To understand the basis of increased susceptibility to infections in LBW newborns, the levels of pro- and antiinflammatory cytokines interleukin-1β (IL-1β) and interleukin-10 (IL-10), respectively, released in response to lipopolysaccharide (LPS) stimulation of cord blood cells of LBW (n = 20) and NBW (n = 18) newborns, were quantified by enzyme-linked immunosorbent assay. Further, LPS-induced expression of TLR-4 and basal and LPS-induced expression of myeloid differentiation factor 88 (MyD88) were examined at mRNA levels in both groups. The levels of IgG subclasses in LBW (n = 20) and NBW (n = 18) newborns were quantified by enzyme-linked immunosorbent assay to explore the role of maternally derived immunity in LBW newborns. RESULTS LPS-mediated release of IL-1β was significantly diminished in LBW newborns when compared with NBW newborns, whereas there was no significant difference in IL-10. Decreased production of IL-1β in LBW newborns was correlated with reduced expression of TLR-4 and MyD88 mRNA. No significant differences were observed in the levels of all 4 IgG subclasses between LBW and NBW newborns. CONCLUSIONS Decreased production of IL-1β in LBW newborns was correlated with reduced expression of TLR-4 and MyD88 mRNA. This raises the possibility of increased susceptibility to infections in LBW when compared with the NBW newborns at term. Comparable levels of IgG subclasses in the 2 groups of newborns indicate that IgG is not a limiting factor in defense against infection in LBW newborns.
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Niewiesk S. Maternal antibodies: clinical significance, mechanism of interference with immune responses, and possible vaccination strategies. Front Immunol 2014; 5:446. [PMID: 25278941 PMCID: PMC4165321 DOI: 10.3389/fimmu.2014.00446] [Citation(s) in RCA: 317] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/01/2014] [Indexed: 01/28/2023] Open
Abstract
Neonates have an immature immune system, which cannot adequately protect against infectious diseases. Early in life, immune protection is accomplished by maternal antibodies transferred from mother to offspring. However, decaying maternal antibodies inhibit vaccination as is exemplified by the inhibition of seroconversion after measles vaccination. This phenomenon has been described in both human and veterinary medicine and is independent of the type of vaccine being used. This review will discuss the use of animal models for vaccine research. I will review clinical solutions for inhibition of vaccination by maternal antibodies, and the testing and development of potentially effective vaccines. These are based on new mechanistic insight about the inhibitory mechanism of maternal antibodies. Maternal antibodies inhibit the generation of antibodies whereas the T cell response is usually unaffected. B cell inhibition is mediated through a cross-link between B cell receptor (BCR) with the Fcγ-receptor IIB by a vaccine-antibody complex. In animal experiments, this inhibition can be partially overcome by injection of a vaccine-specific monoclonal IgM antibody. IgM stimulates the B cell directly through cross-linking the BCR via complement protein C3d and antigen to the complement receptor 2 (CR2) signaling complex. In addition, it was shown that interferon alpha binds to the CD21 chain of CR2 as well as the interferon receptor and that this dual receptor usage drives B cell responses in the presence of maternal antibodies. In lieu of immunizing the infant, the concept of maternal immunization as a strategy to protect neonates has been proposed. This approach would still not solve the question of how to immunize in the presence of maternal antibodies but would defer the time of infection to an age where infection might not have such a detrimental outcome as in neonates. I will review successful examples and potential challenges of implementing this concept.
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Affiliation(s)
- Stefan Niewiesk
- Department of Veterinary Biosciences, The Ohio State University , Columbus, OH , USA
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Gupta A, Mathad JS, Yang WT, Singh HK, Gupte N, Mave V, Bharadwaj R, Zaman K, Roy E, Bollinger RC, Bhosale R, Steinhoff MC. Maternal pneumococcal capsular IgG antibodies and transplacental transfer are low in South Asian HIV-infected mother-infant pairs. Vaccine 2014; 32:1466-72. [PMID: 24486350 PMCID: PMC3975143 DOI: 10.1016/j.vaccine.2014.01.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Our understanding of the mother-to-child transfer of serotype-specific pneumococcal antibodies is limited in non-immunized, HIV-positive women. METHODS We compared geometric mean antibody concentrations (GMCs), geometric mean transplacental cord:maternal ratios (GMRs) and proportions of samples with protective antibody concentration (≥0.35μg/ml) to serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F between 74 HIV-infected and 98 HIV-uninfected mother-infant pairs who had not received pneumococcal immunization in South Asia. Multivariable analysis was performed to assess the influence of HIV on protective antibody concentrations. RESULTS HIV-infected mothers and their infants exhibited lower GMCs and GMRs than their uninfected counterparts. This was significant for all serotypes except maternal GMC to serotype 1 and GMR for serotype 6B. In multivariate analysis, HIV was significantly associated with reduced odds of having protective pneumococcal IgG levels; 56-73% reduction for 3 maternal serotypes (4, 5, 23F) and 62-90% reduction for all cord samples except serotype 6B. CONCLUSIONS Maternal HIV infection is associated with lower levels of maternal pneumococcal antibodies and disproportionately lower cord antibodies, relative to maternal antibodies, suggesting that HIV infection compromises transplacental transfer. Reassessment of maternal and/or infant pneumococcal immunization strategies is needed in HIV-infected women and their infants.
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Affiliation(s)
- Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, MD, United States; Bloomberg School of Public Health, Baltimore, MD, United States; Johns Hopkins University, Byramjee Jeejeebhoy Government Medical College HIV Clinical Trials Unit, Pune, India.
| | - Jyoti S Mathad
- Weill Cornell Medical College, New York, NY, United States
| | - Wei-Teng Yang
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Harjot K Singh
- Weill Cornell Medical College, New York, NY, United States
| | - Nikhil Gupte
- Johns Hopkins University School of Medicine, Baltimore, MD, United States; Johns Hopkins University, Byramjee Jeejeebhoy Government Medical College HIV Clinical Trials Unit, Pune, India
| | - Vidya Mave
- Johns Hopkins University School of Medicine, Baltimore, MD, United States; Johns Hopkins University, Byramjee Jeejeebhoy Government Medical College HIV Clinical Trials Unit, Pune, India
| | - Renu Bharadwaj
- Johns Hopkins University, Byramjee Jeejeebhoy Government Medical College HIV Clinical Trials Unit, Pune, India; Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune, India
| | - K Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Eliza Roy
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Robert C Bollinger
- Johns Hopkins University School of Medicine, Baltimore, MD, United States; Bloomberg School of Public Health, Baltimore, MD, United States; Johns Hopkins University, Byramjee Jeejeebhoy Government Medical College HIV Clinical Trials Unit, Pune, India
| | - Ramesh Bhosale
- Johns Hopkins University, Byramjee Jeejeebhoy Government Medical College HIV Clinical Trials Unit, Pune, India; Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospital, Pune, India
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IgG placental transfer in healthy and pathological pregnancies. Clin Dev Immunol 2011; 2012:985646. [PMID: 22235228 PMCID: PMC3251916 DOI: 10.1155/2012/985646] [Citation(s) in RCA: 579] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 07/24/2011] [Indexed: 12/13/2022]
Abstract
Placental transfer of maternal IgG antibodies to the fetus is an important mechanism that provides protection to the infant while his/her humoral response is inefficient. IgG is the only antibody class that significantly crosses the human placenta. This crossing is mediated by FcRn expressed on syncytiotrophoblast cells. There is evidence that IgG transfer depends on the following: (i) maternal levels of total IgG and specific antibodies, (ii) gestational age, (iii) placental integrity, (iv) IgG subclass, and (v) nature of antigen, being more intense for thymus-dependent ones. These features represent the basis for maternal immunization strategies aimed at protecting newborns against neonatal and infantile infectious diseases. In some situations, such as mothers with primary immunodeficiencies, exogenous IgG acquired by intravenous immunoglobulin therapy crosses the placenta in similar patterns to endogenous immunoglobulins and may also protect the offspring from infections in early life. Inversely, harmful autoantibodies may cross the placenta and cause transitory autoimmune disease in the neonate.
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van den Berg JP, Westerbeek EAM, van der Klis FRM, Berbers GAM, van Elburg RM. Transplacental transport of IgG antibodies to preterm infants: a review of the literature. Early Hum Dev 2011; 87:67-72. [PMID: 21123010 DOI: 10.1016/j.earlhumdev.2010.11.003] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
Newborn infants, especially preterm infants, have an immature immune system, which is not capable to actively protect against vaccine-preventable infections. Therefore, the newborn is dependent on transplacental transport of Immunoglobulin G (IgG), an active, FcRn receptor mediated process. Fetal IgG rises from approximately 10% of the maternal concentration at 17-22weeks of gestation to 50% at 28-32weeks of gestation. If transplacental acquired IgG is lower in preterm than in term infants, preterm infants are especially at risk for these vaccine-preventable diseases. The aim of this study was to review the transplacental transfer of IgG against vaccine-preventable diseases (measles, rubella, varicella-zoster, mumps, Haemophilus influenza type B, diphtheria, tetanus, pertussis and polio) to (pre)term infants and to identify factors that influence the transplacental transfer of these antigens. After selection, 18 studies on transplacental transport to preterm infants were included. In general, these studies showed for all antibodies that preterm infants have lower antibody concentrations compared with term infants. Maternal and infants antibody concentrations showed a strong correlation in 7 of the included studies. Infant antibody concentration was not associated with parity, maternal age, height or weight. Infants of vaccinated mothers had lower anti-measles antibody titers than infants of natural immunized mothers. IgG titers of preterm infants decrease earlier in life below protective antibody titers than term infants. Combined with their immature immune system, this puts preterm infants at increased risk for vaccine-preventable diseases.
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Affiliation(s)
- J P van den Berg
- Department of Paediatrics, Division of Neonatology, VU University Medical Center Amsterdam, The Netherlands
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12
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Samsami Dehaghani A, Doroudchi M, Ghaderi A. Placental transfer of tetanus-specific immunoglobulin G in Iranian mothers. J Matern Fetal Neonatal Med 2009; 14:147-50. [PMID: 14694968 DOI: 10.1080/jmf.14.3.147.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate placental transfer of anti-tetanus immunoglobulin (Ig)G antibodies in Iranian mothers. METHODS Sera collected from 209 pregnant women and their paired infants were evaluated for tetanus-specific antibodies by a commercial enzyme-linked immunosorbent assay. RESULTS In total, 15 (7.2%) out of 209 mothers and 12 (5.7%) out of 209 newborns were negative for anti-tetanus IgG. A highly significant correlation was observed between maternal and fetal anti-tetanus IgG (r = 0.80). The mean cord/maternal blood ratio of anti-tetanus IgG was 1.22 +/- 0.97. The mean cord/maternal blood ratio of anti-tetanus IgG in mothers with blood groups B+ and AB+ was lower than in mothers with other blood groups (p = 0.027). In addition, among mothers who had more than 0.5 IU/ml anti-tetanus IgG, a higher percentage of cases with cord/maternal blood ratio of < 1 was observed in carriers of blood groups B+ and AB+ compared to those with other blood groups (45.2% vs. 41.8%). Parity of more than 4 had a significant negative effect on both frequency of high positive sera and the mean of anti-tetanus IgG level in maternal and neonatal sera. CONCLUSIONS A relatively high percentage of pregnant women were not immune against tetanus. It was also found that the main factors that affect infants' tetanus-specific IgG are maternal concentration of this immunoglobulin, parity and maternal blood group.
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Affiliation(s)
- A Samsami Dehaghani
- Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Gonçalves G, Nascimento MSJ, Réu C, Cutts FT. Levels of rubella antibody among vaccinated and unvaccinated Portuguese mothers and their newborns. Vaccine 2006; 24:7142-7. [PMID: 16889877 DOI: 10.1016/j.vaccine.2006.06.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 06/25/2006] [Accepted: 06/26/2006] [Indexed: 11/24/2022]
Abstract
Maternal and cord sera (231 pairs) were tested to measure rubella IgG levels, using a commercial immunoassay method with final fluorescent detection (ELFA). One hundred and twenty-two women had been vaccinated against rubella. Geometric mean concentrations (GMC) were not associated with time since vaccination. GMC of rubella IgG among vaccinated and unvaccinated mothers were respectively 66.6 and 80.9IU/ml (p=0.29). The corresponding values for cord sera GMC were 140.6 and 140.2IU/ml (p=0.99). These GMC values seem to have been influenced by increased transplacental transport efficiency (TTE) among vaccinated mothers. This was observed if TTE was measured as difference or ratio of cord-maternal concentration of rubella IgG, but was only statistically significantly (p=0.02) for ratio. TTE also seemed to be higher when antibody levels in mothers were below <15IU/ml. There seemed to be some interaction between susceptibility and vaccination status, but these results should be seen with caution. We do not know of a proven biological reason to support differential TTE in vaccinated and unvaccinated mothers. The sensitivity of the lab assay might have influenced the results, such that very low antibody levels in some vaccinated mothers were underestimates of true concentrations. Our finding that 38 mothers had antibody levels considered to be below the threshold for protection highlights the importance of implementing policies to vaccinate susceptible women of childbearing age.
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Affiliation(s)
- Guilherme Gonçalves
- Instituto Gulbenkian de Ciência, Rua da Quinta Grande 6, Apartado 14, 2781-901 Oeiras, Portugal.
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