title: Human milk oligosaccharides differ between HIV-infected and HIV-uninfected mothers and are related to necrotizing enterocolitis incidence in their preterm very-low-birth-weight infants.
abstract: The heavy burden of maternal HIV infection has resulted in a high prevalence of premature birth and associated necrotizing enterocolitis (NEC). Human milk oligosaccharides (HMOs) were recently associated with HIV infection and transmission through breastfeeding and were also shown to reduce NEC in an animal model, particularly the HMO disialyllacto-N-tetraose (DSLNT). The primary aim of this study was to verify differences in HMO composition between HIV-infected and HIV-uninfected women. The secondary aim was to assess whether the HMO composition in the milk of mothers whose infants were diagnosed with NEC differs from that of mothers whose infants did not develop NEC. This study forms part of a larger clinical trial conducted at the Tygerberg Children's Hospital, Cape Town, South Africa, which recruited HIV-infected and HIV-uninfected mothers and their preterm infants (<34 wk gestation; ≥500 and ≤1250 g). Eighty-two mother-infant pairs were selected for the substudy. Mother-infant pairs were stratified according to the mother's HIV (infected/uninfected) and secretor status (secretor/nonsecretor). HMOs in 4- and 28-d postpartum milk samples were analyzed by HPLC and compared between groups. Our results confirm previous reports that HIV-infected mothers have higher relative abundances of 3'-sialyllactose in their milk compared with HIV-uninfected mothers (10.7% vs. 6.8%; P < 0.01). Most intriguingly, the data also indicated that low concentrations of DSLNT in the 4-d milk samples in the mother's milk increased the infant's risk of NEC (200 ± 126 vs. 345 ± 186 μg/mL; P < 0.05), which is in accordance with results from previously published animal studies and warrants further investigation. This trial was registered at clinicaltrials.gov as NCT01868737.
authors.affiliation: Division of Human Nutrition and evettev@sun.ac.za.
authors.forename: Evette
authors.initials: E
authors.lastname: Van Niekerk
authors.affiliation: Divisions of Neonatology and Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, San Diego, CA.
authors.forename: Chloe A
authors.initials: CA
authors.lastname: Autran
authors.affiliation: Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa; and.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Nel
authors.affiliation: Department of Pediatrics and Child Health, Division of Neonatology, Faculty of Medicine and Health Sciences, and.
authors.forename: Gert F
authors.initials: GF
authors.lastname: Kirsten
authors.affiliation: Division of Human Nutrition and.
authors.forename: Reneé
authors.initials: R
authors.lastname: Blaauw
authors.affiliation: Division of Human Nutrition and.
authors.forename: Lars
authors.initials: L
authors.lastname: Bode
mesh_terms: D000328:Adult; D001942:Breast Feeding; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D007234:Infant, Premature / Q000378:metabolism; D019102:Infant, Very Low Birth Weight / Q000378:metabolism; D008297:Male; D008895:Milk, Human / Q000737:chemistry*; D009035:Mothers; D009844:Oligosaccharides / Q000032:analysis*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D013019:South Africa; D055815:Young Adult
chemical_list: C421467:3'-sialyllactose; D009844:Oligosaccharides; C576246:disialyllacto-N-tetraose