Breastfeeding Behaviors and the Innate Immune System of Human Milk: Working Together to Protect Infants against Inflammation, HIV-1, and Other Infections

Abstract

The majority of infants' breastfeeding from their HIV-infected mothers do not acquire HIV-1 infection despite exposure to cell-free virus and cell-associated virus in HIV-infected breast milk. Paradoxically, exclusive breastfeeding regardless of the HIV status of the mother has led to a significant decrease in mother-to-child transmission (MTCT) compared with non-exclusive breastfeeding. Although it remains unclear how these HIV-exposed infants remain uninfected despite repeated and prolonged exposure to HIV-1, the low rate of transmission is suggestive of a multitude of protective, short-lived bioactive innate immune factors in breast milk. Indeed, recent studies of soluble factors in breast milk shed new light on mechanisms of neonatal HIV-1 protection. This review highlights the role and significance of innate immune factors in HIV-1 susceptibility and infection. Prevention of MTCT of HIV-1 is likely due to multiple factors, including innate immune factors such as lactoferrin and elafin among many others. In pursuing this field, our lab was the first to show that soluble toll-like receptor 2 (sTLR2) directly inhibits HIV infection, integration, and inflammation. More recently, we demonstrated that sTLR2 directly binds to selective HIV-1 proteins, including p17, gp41, and p24, leading to significantly reduced NFκB activation, interleukin-8 production, CCR5 expression, and HIV infection in a dose-dependent manner. Thus, a clearer understanding of soluble milk-derived innate factors with known antiviral functions may provide new therapeutic insights to reduce vertical HIV-1 transmission and will have important implications for protection against HIV-1 infection at other mucosal sites. Furthermore, innate bioactive factors identified in human milk may serve not only in protecting infants against infections and inflammation but also the elderly; thus, opening the door for novel innate immune therapeutics to protect newborns, infants, adults, and the elderly.

Keywords: HIV-1; breast milk; breastfeeding behaviors; human breast milk stem cells; human milk oligosaccharides; innate immune bioactive factors; mother-to-child HIV transmission; soluble toll-like receptor 2.

Figure 1

Schematic representation of the protective components in breast milk. Breast milk innate factors that have anti-inflammatory and antimicrobial properties are likely to affect the passage of HIV through the breastfeeding infant’s intestine by modulating the integrity of the intestinal mucosa and directly inactivating the virus. In contrast to exclusively breastfed infants, non-exclusively breastfed infants may be exposed to contaminated water and/or food antigens without a protective threshold level of innate factors in breast milk, which may lead to increased intestinal permeability and microbial translocation. In addition, the foreign antigens likely increase inflammation and recruit increased target cells leading to increased HIV transmission.