Chapter 2 - The Immunological Components of Human Milk

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Abstract

Breast‐feeding is generally accepted as the optimal method of feeding infants. However, we have yet to fully understand the complex mixture of bioactive compounds contained in human milk. Epidemiological studies have indicated that breast‐feeding is associated with health benefits in the infant for many immune‐related conditions. Breast milk contains various antimicrobial substances, factors that promote immune development, constituents that promote tolerance/priming of the infant immune system, as well as anti‐inflammatory components. This chapter identifies and discusses the immunological compounds in human milk and the available evidence for their effect on the immune system of the infant. Current feeding regimens recommended for infants are based primarily on the current understanding of the nutritional requirements of the neonate, but perhaps will be modified to reflect the consequences on immune function both immediate and later in life.

Section snippets

INTRODUCTION

In the nineteenth century, the first immunological molecules isolated from human milk were antibodies, giving rise to the notion that breast milk could have a positive influence on the infant's immunity (Bernt and Walker, 1999). One of the earliest studies reporting an association between breast‐feeding and a lower incidence of morbidity and mortality during the first year of life involved 20,000 healthy infants born in the Massachusetts General Hospital in 1932 (Grulee et al., 1935). Since

Evidence for benefits on infectious diseases

Young infants, in both developed (Brandtzaeg, 2003) and developing countries (Bernt and Walker, 1999), are at high risk for gastrointestinal infections (especially diarrhea). Diarrheal diseases are a leading cause of morbidity and mortality in developing countries (Bernt and Walker, 1999, Morrow and Rangel, 2004). It accounts for 22% of all deaths in children under 5 years (Morrow and Rangel, 2004, Morrow et al., 2005) and claims five million children per year or ∼500 deaths per hour (

Immune development in the infant

The neonatal period is particularly critical as the newborn is exposed to a large number of microorganisms, proteins, and chemicals that they have not previously encountered. Ultimately, resistance to infection relies on a balance between innate and adaptive (antigen driven) immunity. At birth, the cellular components of the immune system are in place, both mucosal and systemic antibody responses can be detected, and most infants can respond appropriately to immunization (Kelly and Coutts, 2000

TOLERANCE

Infancy is a time where there is a fine balance between an antigen response that results in tolerance (suppression) and one that results in sensitization (priming). The direction of the response is influenced by the nature, dose, and frequency of exposure of the antigen, all of which can be influenced by the maternal diet, as well as the age, genetic polymorphisms, and immunological status of the infant (Mayer and Shao, 2004). Breast‐feeding is thought to promote oral tolerance in the infant (

ANTI-INFLAMMATORY FACTORS IN HUMAN MILK

Inflammation is a necessary part of the immune response that helps protect the infant from infection (reviewed by Calder, 2006). The inflammatory response traps pathogens and signals the arrival of immune cells to destroy the antigen. However, this process results in a great deal of “collateral” damage of healthy tissue if it is not controlled. Gastrointestinal infections like necrotizing enterocolitis or those caused by Rotavirus can result in severe damage to intestinal tissue due to an over

CONCLUSIONS

Human milk is a complex mixture of interacting compounds, of which the composition differs not only between women but also within the lactation period. Although it is well documented that breast milk provides antimicrobial defense to the infant, research is still in its infancy in our understanding of the importance of the many minor components in this complex nutritional supplement on neonatal immune development, tolerance, and prevention of the inflammatory response. These gaps in our

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