Appearance of specific colostrum antibodies after clinical infection with Salmonella typhimurium

Combined HIV-1 Envelope Systemic and Mucosal Immunization of Lactating Rhesus Monkeys Induces a Robust Immunoglobulin A Isotype B Cell Response in Breast Milk

Maternal vaccination to induce anti-HIV immune factors in breast milk is a potential intervention to prevent postnatal HIV-1 mother-to-child transmission (MTCT). We previously demonstrated that immunization of lactating rhesus monkeys with a modified vaccinia Ankara (MVA) prime/intramuscular (i.m.) protein boost regimen induced functional IgG responses in milk, while MVA prime/intranasal (i.n.) boost induced robust milk Env-specific IgA responses. Yet, recent studies have suggested that prevention of postnatal MTCT may require both Env-specific IgA and functional IgG responses in milk. Thus, to investigate whether both responses could be elicited by a combined systemic/mucosal immunization strategy, animals previously immunized with the MVA prime/i.n. boost regimen received an i.n./i.m. combined C.1086 gp120 boost. Remarkably, high-magnitude Env-specific IgA responses were observed in milk, surpassing those in plasma. Furthermore, 29% of vaccine-elicited Env-specific B cells isolated from breast milk were IgA isotype, in stark contrast to the overwhelming predominance of IgG isotype Env-specific B cells in breast milk of chronically HIV-infected women. A clonal relationship was identified between Env-specific blood and breast milk B cells, suggesting trafficking of that cell population between the two compartments. Furthermore, IgA and IgG monoclonal antibodies isolated from Env-specific breast milk B cells demonstrated diverse Env epitope specificities and multiple effector functions, including tier 1 neutralization, antibody-dependent cellular cytotoxicity (ADCC), infected cell binding, and inhibition of viral attachment to epithelial cells. Thus, maternal i.n./i.m. combined immunization is a novel strategy to enhance protective Env-specific IgA in milk, which is subsequently transferred to the infant via breastfeeding.

IMPORTANCE

Efforts to increase the availability of antiretroviral therapy to pregnant and breastfeeding women in resource-limited areas have proven remarkably successful at reducing HIV vertical transmission rates. However, more than 200,000 children are infected annually due to failures in therapy implementation, monitoring, and adherence, nearly half by postnatal HIV exposure via maternal breast milk. Intriguingly, in the absence of antiretroviral therapy, only 10% of breastfed infants born to HIV-infected mothers acquire the virus, suggesting the existence of naturally protective immune factors in milk. Enhancement of these protective immune factors through maternal vaccination will be a critical strategy to reduce the global pediatric AIDS epidemic. We have previously demonstrated that a high magnitude of HIV Env-specific IgA in milk correlates with reduced risk of infant HIV acquisition. In this study, we describe a novel HIV vaccine regimen that induces potent IgA responses in milk and therefore could potentially protect against breast milk HIV MTCT.

The Mammary Gland in Mucosal and Regional Immunity

The mammary gland (MG) lacks a mucosa but is part of the mucosal immune system because of its role in passive mucosal immunity. The MG is not an inductive site for mucosal immunity. Rather, synthesis of immunoglobulin (Ig)A by plasma cells stimulated at distal inductive sites dominate in the milk of rodents, humans, and swine whereas IgG1 derived from serum predominates in ruminants. Despite the considerable biodiversity in the role of the MG, IgG passively transfers the maternal systemic immunological experience whereas IgA transfers the mucosal immunological experience. Although passive antibodies are protective, they and other lacteal constituents can be immunoregulatory. Immune protection of the MG largely depends on the innate immune system; the monocytes–macrophages group together with intraepithelial lymphocytes is dominant in the healthy gland. An increase in somatic cells (neutrophils) and various interleukins signal infection (mastitis) and a local immune response in the MG. The major role of the MG to mucosal immunity is the passive immunity supplied to the suckling neonate.

Multiple independent lineages of HIV-1 persist in breast milk and plasma

DESIGN

the origin and evolution of HIV-1 in breast milk is unclear, despite the continuing significance of this tissue as a transmitting compartment. To elucidate the evolutionary trajectory of viral populations in a transient mucosal compartment, longitudinal sequences of the envelope glycoprotein (gp120) region from plasma and breast milk spanning the first year after delivery were analyzed in six women infected by HIV-1 subtype C.

METHODS

multiple phylogenetic algorithms were used to elucidate the evolutionary history and spatial structure of virus populations between tissues.

RESULTS

overall persistent mixing of viral sequences between plasma and breast milk indicated that breast milk is not a distinct genetic viral compartment. Unexpectedly, longitudinal phylogenies showed multiple lineages defined by long branches that included virus from both the breast milk and the plasma. Plasma was unlikely the anatomical origin of the most recent common ancestor (MRCA) in at least three of the patients, although in other women, the temporal origin of the MRCA of the viral populations following delivery occurred well before the onset of breast milk production.

CONCLUSIONS

these findings suggest that during pregnancy/lactation, a viral variant distinct from the plasma virus initially seeds the breast milk, followed by subsequent gene flow between the plasma and breast milk tissues. This study indicates the potential for reactivation or reintroduction of distinct lineages during major immunological disruptions during the course of natural infection.

Is there evidence that the gut contributes to mucosal immunity in humans?

BACKGROUND

Our understanding of the common mucosal immune system derives from animal studies. Antigen-sensitized lymphocytes in the gut-associated lymphoid tissue (GALT) migrate via the blood to mucosal tissues to generate the mucosal-associated lymphoid tissue (MALT). In these sites, B cells differentiate into plasma cells and produce antigen-specific secretory IgA, the principal specific immune antiviral and antibacterial defense of moist mucosal surfaces. Responses to oral intake seem necessary to actively maintain this system in health. Experimentally, lack of enteral stimulation with parenteral feeding alters GALT and MALT size and function. These alterations disturb intestinal and extraintestinal mucosal immunity.

METHODS

This review is an overview of current and classical studies demonstrating the human mucosal immune system and interactions with nutrition.

RESULTS

Human evidence of the mucosal immune system exists, although most data are indirect. Gut stimulation after oral intake induces a generalized immune response in the human MALT through a mucosal-immune network. Examples include neonatal development of GALT influenced by enteral feeding, the presence of antigen-specific IgA and antigen-specific IgA-secreting plasma cells in distant mucosal effector sites such as the breast after gut luminal antigen exposure, and isolation of IgA-producing cells from circulating blood.

CONCLUSIONS

It is unlikely that clinical studies will ever completely define the effect of route of feeding in all patient populations. This may be possible, however, if investigators understand, define and characterize nutrition-dependent immunologic mechanisms, allowing clinicians to examine clinical responses to nutrition in specific patient populations. This might allow generation of new approaches to protect mucosal immunity.

Evolution of infant nutrition

Homo sapiens has developed during the course of over two million years. The social and physical conditions of life, the availability of milk and infant foods as well as the presence of diseases have all undergone radical transformations from the Stone Age, at first without and then with fire, to the hunter–gatherer, farmer–herder, agricultural and, now, developed societies. These changes in the human environment may have induced modifications in the length of pregnancy, the development of the neonate at birth, the duration of lactation, the composition of breast milk and use of weaning foods and milk substitutes. Darwinian selection for the nutrient, anti-infective and other components of breast milk may have been determined by the effects of nutrition, through genetic variations in milk composition, on the survival of infants and perhaps also on fecundity and disease resistance in later adult life. Today Darwinian selection may no longer be effective in maintaining or modifying human mammary function, because modern hygienic environments, together with the availability of nutritionally adequate breast-milk substitutes, permit infant survival even under conditions of total lactational failure. National and international promulgations strictly control the composition of infant formulas offered as breast-milk substitutes or as weaning foods. These recommendations are modified as beliefs suggest, and research indicates, the effects of nutrients and other factors on the health and well-being of the child. Preliminary observations on child health have often proved valuable in furthering research. Unquestioning acceptance of apparently desirable, but untested, epidemiological associations have led to unexpected but dangerous iatrogenic problems. Recommendations for change cannot safely be made without proper comparisons with present products and procedures under practical conditions. Such tests are time consuming and require protocols of appropriate statistical design and power while still meeting the required sociological and ethical constraints, but are essential to identify possible harmful effects of any proposed change. It is suggested that no novel ingredients should be added, or major changes permitted in any component, until appropriate trials have established the value and safety of the proposed modifications. Breast-feeding is vital to maximize infant survival in developing countries. There are major difficulties in assessing any differences in morbidity and mortality of breast-fed v. artificially reared infants in the developed world. Carefully controlled studies with comparisons of health and well-being, not only in infancy but throughout life, are desirable if the effects of infant nutrition on adult well-being, suggested by epidemiological studies, are to be validated and ultimately applied. There are considerable variations in the composition of breast milk. This variance suggests that it may ultimately be possible to design formulas better able to meet the needs of individual infants than the milk available from the mother's breast.

Breast milk and HIV-1: vector of transmission or vehicle of protection?

Transmission of HIV-1 to the infant through breastfeeding is a major cause of new paediatric HIV-1 infections worldwide. Although extended breastfeeding accounts for approximately 40% of infant HIV infections worldwide, most breastfed infants remain uninfected, despite prolonged and repeated exposure to HIV-1. Mechanisms associated with transmission of HIV-1 through breastfeeding and factors related to protection from such transmission remain poorly understood. Here we focus on the cellular origin of HIV in breast milk and on immune factors within the milk that may offer protection from transmission of HIV infection. The presence of innate immunity and induction of adaptive immunity against HIV is explored: in particular, specific antibodies, cellular responses, and their significance. The role of mucosal immune activation and epithelial integrity in HIV transmission is also addressed. We are of the opinion that advances in laboratory methods that study specific aspects of immunity will help open new areas of understanding of HIV transmission through breastfeeding and mechanisms of protection, and contribute to the development of novel prevention strategies.

Human immunodeficiency virus-specific CD8(+) T cells in human breast milk

Breast-feeding infants of human immunodeficiency virus (HIV)-infected women ingest large amounts of HIV, but most escape infection. While the factors affecting transmission risk are poorly understood, HIV-specific cytotoxic T-lymphocyte (CTL) responses play a critical role in controlling HIV levels in blood. We therefore investigated the ability of breast milk cells (BMC) from HIV-infected women from the United States and Zambia to respond to HIV-1 peptides in a gamma interferon enzyme-linked immunospot assay. All (n = 11) HIV-infected women had responses to pools of Gag peptide (range, 105 to 1,400 spot-forming cells/million; mean = 718), 8 of 11 reacted to Pol, 7 reacted to Nef, and 2 of 5 reacted to Env. Conversely, of four HIV-negative women, none responded to any of the tested HIV peptide pools. Depletion and tetramer staining studies demonstrated that CD8(+) T cells mediated these responses, and a chromium-release assay showed that these BMC were capable of lysing target cells in an HIV-specific manner. These data demonstrate the presence of HIV-specific major histocompatibility complex class I-restricted CD8(+) CTLs in breast milk. Their presence suggests a role in limiting transmission and provides a rationale for vaccine strategies to enhance these responses.

The conjunctival lymphoid follicle in mucosal immunology

The conjunctiva forms a continuous mucosal surface from the eyelid margin to the cornea, and makes contact with airborne antigens and those on the adjacent eyelid skin and preocular tear film. Conjunctival lymphoid follicles (CLF) undergo hyperplasia upon conjunctival infection by a specific array of pathogens; infection-associated enlargement of draining preauricular lymph nodes suggests that CLF participate in the afferent limb of acquired immune responses for the ocular surface. In this review, we examine the evidence for classification of CLF as part of the common mucosal immune system, and explore the possible therapeutic implications.

Presence of secretory IgA antibodies to an enteric bacterial pathogen in human milk and saliva

The concept of a common mucosal immune system in man was tested by examining the concurrent presence of specific-secretory IgA (SIgA) antibodies in human milk and saliva from three groups of subjects: 64 Sri Lankan women living in Sri Lanka; 20 immigrant Asian women living in Birmingham (median duration of residence in the United Kingdom five years); and 75 Caucasian women living in Birmingham (controls). Enzyme linked immunosorbent assays (ELISA) were developed to detect enterotoxigenic Escherichia coli (ETEC) colonisation factor/1 (CFA/1) specific SIgA antibodies in milk and saliva. ETEC CFA/1 specific SIgA antibody activity was detectable in milk (37.5% and 25%) and saliva (42.1% and 35%) of Sri Lankan and immigrant Asian women, respectively, but not in any of the Caucasian controls. Eighty five point two per cent of subjects who were positive had specific antibodies detectable in both milk and saliva; 5% of all Sri Lankan women and 10% of all immigrant Asian women had detectable antibody only in saliva. These observations lend further strong support to the idea that a common mucosal immune system exists in man. The continuing presence of specific SIgA antibodies in Asian immigrants to previously encountered antigens suggests that there may be an 'immunological memory' in the human secretory immune system.

IgA antibodies in human milk: epidemiological markers of previous infections?

The concept of an enteromammary link in secretory IgA (SIgA) antibody production was tested by hypothesising that specific SIgA antibody profiles in human milk might be an epidemiological marker for enteropathogens in a community. Milk from three subject groups was studied: 64 Sri Lankan women living in poor suburbs of Colombo, 20 Asian immigrant women domiciled in Birmingham, for a median period of five years (range 14 days-16 years), and 75 white women living in Birmingham. An enzyme linked immunosorbent assay (ELISA) was developed for the detection and measurement of SIgA antibodies to a panel of 14 crude O and 10 pure lipopolysaccharide antigens of diarrhoeagenic Escherichia coli strains well known to be endemic in the Indian subcontinent. The number of Sri Lankan and Asian immigrant women with SIgA antibodies to all 14 diarrhoeagenic E coli antigens (except O127 in Asian women) was significantly higher than in the white controls. The amount of E coli O antigen specific SIgA antibody activity as a percentage of total SIgA also gave significantly higher median values in Sri Lankan (6%) and in Asian immigrant (4%) women than in white controls (0.7%). SIgA antibodies were highly O serogroup specific and showed excellent concordance between crude O and the corresponding purified lipopolysaccharide antigens. These results suggest that milk antibody profiles represent an epidemiological marker of exposure to enteral pathogens. The continuing specific milk antibody response in Asian women who have been domiciled in the United Kingdom for many years may indicate 'memory' in the human secretory immune system.

Indirect measurement of intestinal immune responses to an orally administered attenuated bacterial vaccine

Intestinal fluid, saliva, circulating peripheral blood lymphocytes (PBL), and serum samples obtained from 81 human adult subjects who had been orally vaccinated with either Salmonella typhi Ty21a or one of its recombinant derivatives were examined to determine the value of indirect measurements of an antigen-specific intestinal-immunoglobulin A (IgA) response. Salivary IgA failed to provide consistent or correlative responses, and no evidence of a significant relationship was apparent with the intestinal-IgA responses. No significant correlation between the specific increase in responses in serum IgA and intestinal IgA was evident. While the magnitude of the serum IgG response significantly correlated with the intestinal-IgA response (P = 0.00064), it failed to detect 14.8% of the intestinal-IgA responses. The observation that 16.6% of the subjects had delayed serum IgA responses, with a peak occurring after day 23 compared with days 12 to 14, may have contributed to the inadequacy of the serum IgA response as a correlative indicator. The serum IgG responses in these subjects were also of a diminished magnitude. Specific IgA production by circulating PBL was found to be the most sensitive (92.6% response rate) and correlative (P = 0.00071) indicator of a specific intestinal-IgA immune response. However, its value in predicting protective efficacy is untried. These studies confirm that for the assessment of an enteric bacterial vaccine, determination of in vitro specific IgA production by circulating PBL may offer a single measurement of specific immunity which is as useful as serum and intestinal measurements combined.

The anti-inflammatory activity of a low molecular weight component derived from the milk of hyperimmunized cows

"Immune" milk has been utilized as a source of biologically active compounds for many years. In the present study, a low molecular weight fraction, isolated from the milk of dairy cows hyperimmunized with a multivalent bacterial vaccine (HIMF), has been evaluated for anti-inflammatory activity. Analysis was carried out using the rat hind-paw oedema assay. HIMF was shown to have a marked anti-inflammatory effect in this model and carrageenin-induced oedema was suppressed by up to 80% in individual experiments. The agent was active following oral, subcutaneous, intramuscular, intraperitoneal or intravenous administration. Intravenous injection was particularly effective and amounts as small as 1 mg significantly reduced the inflammatory response to carrageenin. The experiments have established that milk from hyperimmunized cows contains a highly active anti-inflammatory compound and form a basis for further studies, which will attempt to isolate and further characterize the active moiety.

Specific immune response in humans following rectal delivery of live typhoid vaccine

The specific immune responses to the live vaccine Salmonella typhi Ty21a following rectal administration were determined in serum, peripheral blood lymphocytes, saliva and in jejunal fluid of adult human subjects. Following vaccination, all seven subjects had a detectable anti-typhoid IgA antibody response using their peripheral blood lymphocytes (p = 0.009). Significant rises in postvaccination anti-typhoid IgA antibody were observed in the jejunal fluid (p = 0.033), serum (p = 0.010) and saliva (p = 0.050) of these subjects. This study confirms that the normal rectal mucosa is an efficient route of entry to the systemic immune system for microbial agents, and therefore may provide a further possible route of immunization with attenuated bacterial vaccines.

Naturally occurring IgA antibodies to ocular and oral microorganisms in tears saliva and colostrum: evidence for a common mucosal immune system and local immune response

In this study, levels of naturally occurring secretory IgA (sIgA) antibodies to bacterial isolates representative of the microflora of the human eye (Staphylococcus epidermidis and a Corynebacterium species) and the oral cavity (Streptococcus mutans serotypes c and d) were assessed in three different human external secretions. Tears and parotid saliva samples collected at the same time from 22 healthy subjects and colostrum from 11 healthy women (1-14 days post partum) were assessed for sIgA anti-bacterial antibody levels by an enzyme-linked immunosorbent assay. Significantly higher levels (P less than 0.001) of IgA antibodies to Staphylococcus epidermidis and the Corynebacterium sp. were found in tears than in parotid saliva. Furthermore, higher levels of sIgA antibodies to Streptococcus mutans serotype d occurred in parotid saliva than in tears of these subjects. Although levels of salivary sIgA antibodies to S. mutans serotype c were lower than those seen to serotype d, they were not significantly different from those in tears. However, absolute sIgA anti-serotype c antibodies per mg IgA were higher in saliva than in tears. When sIgA antibody levels to the four bacterial strains were assessed in colostrum, the proportion of sIgA antibodies per mg IgA were much lower than seen in tears or saliva. These results suggest that natural sIgA antibodies which occur in human external secretions are induced by antigen ingestion and stimulation of the common mucosal immune system. However, the local presence of antigen at a mucosal site induces greater clonal expression and results in higher levels of sIgA antibodies than at mucosal sites not exposed to local antigenic stimulation.

Duct-associated lymphoid tissue (DALT) of minor salivary glands and mucosal immunity

Minor salivary glands (MSG) play a substantial role in the secretory immunoglobulin A (sIgA)-mediated immunity of the oral cavity. There are two possibilities for the induction of this immunity: (i) an explicitly local antigenic stimulus, or (ii) a remote stimulus as part of the so-called 'common mucosal immune system'. This communication is an attempt to consolidate available evidence in support of both possibilities and to address the former in detail. Although there is strong circumstantial evidence supporting the feasibility of MSG functioning as a part of the common mucosal immune system, direct experimental evidence is yet to emerge. On the other hand, there is increasing structural and physiological evidence in support of MSG serving as a local immunological organ. The purely local response is attributed to the presence of MSG duct-associated lymphoid tissue (DALT), which is comparable to gut- or bronchial-associated lymphoid tissue (GALT or BALT) in origin, tissue organization and function. DALT is accessible to oral antigens by retrograde passage through MSG ducts. Repeated topical antigenic challenging via the oral mucosa may result in the appearance of interacinar plasma cells carrying specific homologous antibodies in MSG. Gut or enteric priming of the same antigen, by passing the oral mucosa by gastric intubation, need not evoke a remote immune response in MSG. Since DALT is more likely to occur in healthy, young growing individuals, who are less likely to undergo bioptic examination of MSG, it has not yet been documented in humans. The physiologically induced DALT is apt to be confused with focal accumulations of lymphoid tissue in pathologically altered MSG, as a consequence of local and some systemic autoimmune diseases. An attempt is made to demarcaate healthy and pathological MSG on the basis of currently available clinical, serological, immunological and genetic evidence.

Fluctuation of specific IgA antibodies in human milk

The concentration of secretory IgA and the levels of IgA specific antibodies against Escherichia coli labile-toxin, Shigella flexneri 6, and rotaviruses were determined in milk samples obtained serially from women during the first 16 weeks postpartum. The mean concentration of secretory IgA followed the expected pattern; the levels of specific antibodies fluctuated in an unpredictable manner and independently of milk secretory IgA content, becoming undetectable in many instances. Under some circumstances, continued breast-feeding may not guarantee continued intake of antibodies against intestinal pathogens by the breast-fed infant.

A factor present in human milk, but not colostrum, which is cytotoxic for human lymphocytes

This study reports the presence of a factor in human milk which is cytotoxic to both autologous and heterologous human peripheral blood mononuclear cells (PBMC). The cytotoxic effect was measured by the release of 51Cr from labelled cells or by the inability of PBMC to exclude trypan blue following exposure to milk. The cytotoxic factor was not dialysable or sensitive to heating at 56 degrees C for 30 min, and could not be adsorbed from milk by PBMC. It lysed lymphocytes harvested from colostrum and from autologous or heterologous milk. The cytotoxic factor in the milk was different from the factor found in colostrum which inhibits the proliferation of mitogen stimulated PBMC, but which is not cytotoxic. Testing of serial samples of milk from the same mother indicated that the factor could be detected in the milk after 3-4 days post partum. We conclude that factors cytotoxic for human PBMC appear in human milk early in lactation.

Antibodies to Escherichia coli O antigens and the in-vitro bacteriostatic properties of human milk and its IgA

Only a very small part of the iron-reversed bacteriostatic activity of milk against Escherichia coli, demonstrable in vitro, is due to its anti-O antibody. Most of its growth-inhibitory activity is due to another lactoferrin-dependent, non-specific system. IgA prepared from milk is bacteriostatic for E. coli in the presence of lactoferrin, if it contains O-antibody for the indicator strain and if the strain is susceptible. Susceptibility depends to some extent on virulence, since those inhibited by IgA antibody to their own O-antigens were enteropathogenic or enterotoxigenic, whereas the growth of commensal strains was inhibited only slightly or not at all.

Local immune response to repeated topical antigen application in the simian labial mucosa

Minor salivary glands of the oral mucosa in healthy monkeys (Macaca fascicularis and Macaca mulatta) contain organized structural units suitable for recognizing and processing antigens. A previous study of M. fascicularis monkeys provided experimental evidence of retrograde access of oral antigens deep into the minor salivary glands. The present study aimed at exploring the possible immune response of simian oral mucosa to repeated topical application of a chemically defined antigenic solution at the labial and gut mucosa. Ten female M. fascicularis animals were challenged topically at the lower lip mucosa at weekly intervals for a variable period of 4 to 8 weeks with a solution consisting of horseradish peroxidase, ferritin, and special India ink. Transmission electron microscopic examination of immunohistochemically treated sections of the labial glands revealed the presence of plasma cells containing specific anti-horseradish peroxidase antibody. These cells resided in the interacinar regions. Enteric and gut priming with the same antigen in four other monkeys, bypassing the oral mucosa, failed to reveal the presence of horseradish peroxidase-positive plasma cells in the labial mucosa of any of the four animals, although in one animal such cells could be identified in a mesenteric lymph node. This is suggestive of the existence, at least in primates, of a local immune response of the oral mucosa independent of systemic involvement.

Passive immunity to transmissible gastroenteritis virus: intramammary viral inoculation of sows

Sows were injected intramammarily with live-attenuated TGE virus, an enteric coronavirus--one sow during pregnancy and three sows during lactation. All sows were TGE antibody seronegative prior to inoculation except for one naturally infected sow inoculated during lactation. The animal injected during pregnancy had primarily IgG TGE antibodies in milk from all glands. By contrast, sows injected during lactation had IgA and IgM initially, and later IgA and IgG TGE antibodies in milk from injected and noninjected glands. The seropositive sow had elevated IgA TGE antibody titers in milk after IMm injection. Both seronegative sows inoculated intramammarily during lactation shed TGE virus in milk from injected glands, and their nursing piglets developed mild diarrhea and shed virus in their feces at three to nine DPE of the sows. Milk from IMm injected glands generally had higher TGE antibody titers than milk from noninjected glands. These results suggest that TGE virus replicates in lactating mammary gland tissue, thereby stimulating IgA immunocytes, leading to secretion of IgA antibodies in milk. Whether the intramammary route presents a natural route of enteric virus exposure in lactating animals (by way of infected nursing piglets), leading to IgA-antibody secretion in milk, requires further investigation.

Protective properties of anticholera antibodies in human colostrum

A comparative immunological study between two colostrum pools of Indian and Swedish mothers was carried out to evaluate their protective properties against Vibrio cholerae. Antibacterial and antitoxin titers were significantly higher in the Indian colostrum pool (ICP) than in the Swedish colostrum pool (SCP). Antilipopolysaccharide as well as antitoxin antibodies belonged to secretory immunoglobulin A (IgA) and IgM classes as determined by the enzyme-linked immunosorbent assay. ICP could significantly inhibit the adherence of V. cholerae to intestinal slices in vitro, whereas such activity was virtually absent in SCP. Moreover, ICP could induce significant protection against live vibrio challenge in rabbit ileal loops, whereas only a weak protective activity was observed with SCP. A secretory IgA fraction was obtained from ICP by using gel filtration and immunoadsorbent techniques. Human secretory IgA thus obtained exhibited antiadherence as well as protective activities against V. cholerae.

Antibody content of rabbit milk and serum following inhalation or ingestion of respiratory syncytial virus and bovine serum albumin

The contribution of bronchus-associated or gut-associated lymphoid tissues to the development of specific immunologic reactivity in lactating mammary glands was studied by evaluating the effect of the nature of the antigen and the route of immunization on milk antibody content. Groups of pregnant rabbits were immunized with respiratory syncytial virus (RSV) and bovine serum albumin (BSA) administered i.v., per oral (p.o.) or transtracheal (i.t.) routes. The response to RSV was characterized by the regular appearance of IgA anti-RSV in the colostrum, milk, bronchial, and intestinal secretions following p.o. or i.t. immunization, but not after i.v. immunization. RSV-specific IgG appeared in the colostrum, milk, and serum regardless of the route of immunization. On the other hand, the response to BSA by all three routes of immunization was characterized by the appearance of anti-BSA in serum, colostrum and milk which was solely associated with IgG. The anti-BSA isotype did not change during the 30-day nursing period and was not affected by BSA ingestion before or during pregnancy or during nursing. If BSA was reintroduced after 20 days of nursing, a sharp rise in the Ab content of milk occurred in p.o. but not i.v. immunized dams. This increased anti-BSA was also of the IgG isotype. These observations suggest that the isotypes of specific Ab responses in the lactating mammary gland of the rabbit may be determined by the physical and chemical nature of the antigens contacted on respiratory or intestinal mucosal surfaces.

Bronchomammary axis in the immune response to respiratory syncytial virus

The products of lactation from 26 nursing mothers were sequentially examined over several months for the presence or appearance of antibodies directed against respiratory syncytial virus. Antiviral IgM and IgG were rarely identified in either colostrum or milk. RSV-specific IgA was found in 75% (18/24) of specimens of colostrum; 40% (6/15) and 59% (4/7) of milk samples obtained at three and six months still contained specific IgA antibody. The latter increase was felt to represent boosting of exposed individuals when the virus was present in the community. Infection with the virus was documented in two mothers. Both had specific IgG, IgM, and IgA antibody responses in serum and nasopharyngeal secretions, but response in milk was limited to IgA. These data confirm that antibody to a specific respiratory tract pathogen is present in the products of lactation, that the specific activity is mainly of the IgA class, and that booster responses in milk are exclusively of the IgA class. Since RSV appears to replicate only in the respiratory tract, it is suggested that viral specific antibody activity observed in the mammary gland may be derived from the bronchopulmonary lymphoid tissue.

The induction and expression of IgA anti-DNP antibodies in rat bile and secretions

Pregnant rats were immunized with dinitrophenylated type III-pneumococcal vaccine by the intravenous, gastric, or intramammary routes. Anti-DNP antibody responses in the IgA, IgG and IgM isotypes were measured in serum, secretions and bile. Gastric intubation was most effective at eliciting IgA antibody responses in bile and secretions, whereas the other routes were more effective at inducing IgG responses in serum and bile. IgM antibody responses were infrequent and were found in fluids most closely associated with the immunization route. Isoelectric focusing studies of IgA antibodies appearing in secretions and bile revealed that the gastric route consistently elicited antibody spectrotypes with shared components. Intravenous and intramammary immunization resulted in IgA spectrotypes possessing less homology, suggesting that these protocols lead to independent antibody responses triggered in spleen, draining lymph nodes, or secretory sites. After gastric stimulation, the appearance of IgA antibodies with identical spectral components in secretions and bile favours the concept that IgA precursor cells with identical clonotype potential migrate from the gastrointestinal area to secretory sites. Antibody expression in bile appears to result from the selective transfer of IgA populations gaining access to serum after synthesis at a secretory site.

Antibacterial and antitoxin responses in the serum and milk of cholera patients

Antibacterial and antitoxin responses in the acute and convalescent (7 to 10 days) sera of 14 cholera patients were determined by various serological techniques. Similar studies were also carried out with corresponding milk samples of six of these patients who were lactating women. A significant rise in antibacterial titers was observed in all convalescent serum and milk samples. A similar rise in antitoxin titers was observable in all serum and four milk samples. Specificity of the antibacterial titers was further evaluated by the indirect hemagglutination test using lipopolysaccharide antigen, and close correlations were noted between these titers and vibrio agglutination (P<0.001) and vibriocidal (P<0.001) titers of sera. Serum and milk convalescent cholera patients could effectively neutralize cholera toxin action in vivo, although the neutralizing activity of serum was higher than that of milk. Determination of antibody titers by the enzyme-linked immunosorbent assay demonstrated that anti-lipopolysaccharide activity in sera belonged predominantly to immunoglobulin M (IgM) and, to a lesser extent, to IgG and IgA, whereas such activity in milk was mostly contributed by secretory IgA, although some IgM antibodies also could be detected. On the other hand, antitoxic activity in convalescent sera primarily belonged to IgG, whereas such activity in milk was almost exclusively contributed by secretory IgA. These results demonstrate that an antibody response in the mammary gland was stimulated due to the antigen exposure in the gut and are consistent with the idea of a common homing pattern of immunocytes within the secretory immune system. Moreover, some differences in the antibody production mechanism between the systemic and secretory immune systems are indicated.

The antibody response to bacterial gastroenteritis in serum and secretions

The antibody responses to bacterial gastroenteritis in jejunal aspirates and sera from sixteen adults and nine children were examined using a radioimmunoassay. Twelve adults served as controls. A clear antibody response was apparent in both intestinal aspirates and sera. While the absolute concentrations of antibody were much higher in sera, the proportion of immunoglobulin committed to specific antibodies was similar in both the intestinal fluids and sera. The antibody responses in the intestine and in the serum were very similar in the group as a whole, but they varied widely in individual subjects. Over a period of 1 month intestinal antibody levels in adults remained constant but in children they showed a decrease. In two subjects high levels of intestinal antibody were still apparent after 1 year. The organism responsible for the infection was still present in the gut of five subjects 1 month after clinical recovery from infection in the presence of local antibody. The relevance of these results and their implications for further study of the immune response to bacterial gastroenteritis are discussed.

Antimicrobial activity of colostrum after administering killed Escherichia coli O111 vaccine orally to expectant mothers

An attempt was made to see if it was possible to produce antimicrobial activity in colostrum after killed Escherichia coli O111 vaccine had been given orally to expectant mothers. The colostral samples were used in vitro for the inhibition test immediately after the start of lactation. The colostrum from 7 of the 47 vaccine-treated mothers inhibited the growth of E. coli O111 compared with only one colostrum from 101 controls. No complication has occurred either in the vaccine-treated mothers or their suckling babies. The association between the presence of antimicrobial activity in the colostrum and the time of vaccine application was insignificant.

Antibody response of the lactating sow to oral immunization with Escherichia coli

Oral immunization of the lactating sow with live Escherichia coli (O8:K88) stimulated an IgA anti-K88 antibody response in mammary secretions and significantly enhanced the capacity of whey to inhibit adhesion of the inoculum E. coli strain to isolate pig enterocytes. An increase in agglutinating anti-O8 activity was also evident in jilk and was associated with both the IgA and IgM immunoglobulin classes. These results are consistent with the concept of a gut-mammary link, although measurement of specific antibody in the intestinal secretions of these animals suggested that there may be a difference in response duration at the two secretory sites. Prolonged oral administration of heat-killed organisms also stimulated specific antibody synthesis within the mammary gland, although the response, particularly to the O antigen, was both reduced and delayed in its appearance.

Breast milk lymphocyte response to K1 antigen of Escherichia coli

Comparison milk and blood lymphocyte blastogenic responses to the K1 antigen of Escherichia coli and lipopolysaccharide (LPS) from E. coli O127,B8 were examined in 16 postpartum women by [3H]thymidine uptake. Rabbit hemolysincoated sheep erythrocyte monolayers were used to deplete macrophages from milk lymphocyte preparations and to enrich for T lymphocytes in order to make milk preparations more comparable to blood preparations. Response was defined as a stimulation index of greater than or equal to 2.0. There was no evidence of selective response to K1 antigen by milk lymphocytes, since both blood and milk lymphocytes responded in four women and neither blood nor milk lymphocytes responded in nine. Milk lymphocytes alone responded to K1 in one woman, whereas blood lymphocytes alone responded in two women. Additional nonpaired milk or blood cultures were available from three women. None of these responded to K1 antigen. Corresponding lymphocyte cultures were stimulated with LPS. A positive K1 response was always accompanied by an LPS response, and the LPS response correlated with the K1 response in 17 of 19 women. Stool cultures examined with an antiserum agar showed no correlation between the presence of K1 E. coli in the stool and milk or blood lymphocyte response to K1 antigen. In the system used here, no selectivity of response of breast milk lymphocytes to K1 antigen was noted.

A common mucosal immune system. Antibody expression in secretions following gastrointestinal stimulation

Isoelectric focusing was used to probe the expression of IgA anti-DNP antibodies in secretions of rats receiving gastrointestinal immunization. The identity of the IgA antibody spectrotypes suggest that cells with identical clonotype potential seed various secretory surfaces following gastrointestinal stimulation. The data are discussed in terms of a common mucosal immune system linked by migrating populations of IgA precursor cells.

Bacteriostasis of Escherichia coli by milk. IV. The bacteriostatic antibody of human milk

Bacteriostatic activity for milk-sensitive and milk-resistant strains of Escherichia coli is reduced when IgA is removed from milk by precipitation. Lysozyme is not involved in bacteriostasis and can be removed without loss of activity; heavy bentonite absorption however removes some lactoferrin causing partial loss of activity. The heat-labile antigen eliciting bacteriostatic antibody for E. coli is present in milk-sensitive and milk-resistant strains and in some other Enterobacteriaceae, e.g. salmonella; it cross reacts with the antigen in others, e.g. proteus and enterobacter. The antibody is therefore likely to be present in all human milk as a result of the normal commensal gut flora and with widespread activity.

New knowledge in human milk immunoglobulin

One of the anti-infection principles of maternal milk is the predominant milk immunoglobulin, secretory IgA. This immunoglobulin contains antibodies against many pathogens and potential pathogens, viruses as well as bacteria, including several members of Enterobacteriacae. The antigenic stimuli for these milk antibodies seem to take place in the Peyer's patches of the intestine. Lymphoid cells leaving the patches after antigenic exposure seem to home to the mammary glands via the lymph and blood circulation. As a result, the milk contains secretory IgA antibodies against, among other things, the intestinal bacteria of the mother. These milk antibodies might reflect the spectrum of bacteria and viruses in the community and may be important for the protection of the breast-fed baby. Via the same homing mechanism the maternal milk obtains antibodies against dietary antigens, including cow's milk proteins. Studies of infants on mixed feeding suggest that the secretory IgA antibodies against the bovine proteins diminish the antigenic exposure, indicating the possibility of an anti-allergic mechanism.

Concept of the local and common mucosal immune response

The available information concerning the origin of IgA-producing plasma cells and the spectrum of IgA-associated antibodies found in external secretions provide arguments that support two pathways of stimulation for a secretory humoral immune response. In addition to an explicitly local immune response induced by a topical antigen application, a second mechanism of induction operating through the sensitization of GALT, and possibly BALT, emerges. The latter pathway of stimulation leads to the appearance of specific IgA-associated antibodies in secretions of mammary, salivary, and lacrymal glands (and perhaps other sites), all of which suggests the existence of a common mucosal secretory system. Not yet explained are the mechanisms involved in the homing to secretory glands of cells sensitized in the remote lymphoid tissues (GALT and BALT), the differentiation patterns of these cells, and the regulation of selective IgA expression.

Origin of IgA-secreting plasma cells in the mammary gland

Lymphoblasts from the mesenteric lymph nodes (MN) of mice home to the mammary glands of syngeneic recipients late in pregnancy and during lactation, and within hours of transfer most can be shown to contain IgA. Homing does not occur in virgins, in early pregnancy, or after weaning. Homing MN lymphoblasts are sensitive to antiserum to IgA plus complement, but not to other class-specific antisera. Thus, lymphoblasts in MN with the potential to home to the mammary gland are already committed to IgA synthesis and bear surface IgA before reaching their destination. These results explain observations, made by others, of specific IgA antibodies and IgA plasma cells in milk and colostrum after oral immunization. Under natural conditions it is likely that IgA precursor cells, after stimulation in the gut-associated lymphoid tissue by intestinal antigens, migrate to the mammary gland where they secrete antibodies which constitute an important defense mechanism of the newborn. In the absence of lactation, these cells probably form part of the normal traffic to the lamina propria of the small intestine.