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Fulltext HIV transmission through breast milk: the science behind the understanding of current trends and future research

Prameela KK

Med J Malaysia, 2012 Dec;67(6):644-51.
PMID: 23770969 MyJurnal

Breastmilk protects the infant from many diseases and many short- term and long- term benefits accrue. At the same time it is also known that breastfeeding acts as a vehicle for some infective agents. It is now accepted that breastmilk transmission of Human Immunodeficiency Virus- 1 (HIV-1) is an important mode of paediatric infection . Despite this fact, many researchers have observed that corresponding to the volume of milk consumed by the infant, maternal transmission via breastmilk is still comparatively low. Some have noted the long latency period of breastmilk HIV transmission with evidence of numerous anti-HIV factors in breastmilk. Although there are accepted standard guidelines on infant feeding in mothers who are HIV positive in many countries, it maybe equally important to realize gaps in our knowledge of mother- to -child HIV transmission. From an evolutionary perspective, the role of the mammary epithelial cell (MEC) and of breastmilk , in contributing to and possibly in influencing HIV-1 transmission is intriguing. The presence of HIV-1 or of other viruses in maternal milk seem to be a requisite to spur immunological defenses to optimize necessary protection to the infant. This article reviews some aspects of the science of HIV transmission through breastmilk and reflects the concept -based understanding of current policies on HIV and breastfeeding. At the same time, it highlights uncertainties in this field and the urgency for future research in this direction. Accepting current notions of breastmilk HIV transmission, greater deliberation by research may throw more light on why breastfeeding with its abundant advantages is fraught with the hazards of transmission of a deadly disease.
Fulltext Breastfeeding--anti-viral potential and relevance to the influenza virus pandemic

Prameela KK

Med J Malaysia, 2011 Jun;66(2):166-9; quiz 170.
PMID: 22106709

Essential nutritive and immunological ingredients abundantly present in breastmilk make it the choice infant nutrition. The uniqueness of mother's milk, in contrast to most therapeutics and immunizations, lies in its potential to adapt itself to the requirements of the infant so that timely immune defenses are tapped from its constituents by immune regulation, modulation and immune acceleration to stimulate novel substances; these render it pertinent as defense when faced with challenging organisms. While it is appreciated that immunity can be transferred from mother to infant through breastmilk following maternal influenza vaccination, the immense benefits conferred by breastfeeding per se during influenza pandemics may not be fully valued. This is substantiated by debates and ambiguities for continued breastfeeding in the face of maternal influenza infections. This article emphasises the utmost importance of breastfeeding in viral pandemics in the light of the changing immunological strategies used by viruses at different times and the urgent need for such opportune defenses. The prolific interaction of its constituents is frequently understated as enormous advantages to the suckling infant.
Gut microbes - Early immunity and health

Prameela KK

Med J Malaysia, 2021 05;76(3):395-400.
PMID: 34031340

INTRODUCTION: Microbes in the human gut impact holistic health. Modifiable events can steer immunity through commensal microbial action. This protects from acute diseases and lays foundation for enduring health benefits. Timely modulation of immune development by correct feeding choices negate consequences of microbial dysequilibrium.
MATERIALS AND METHODS: Review and critical analysis of relevant literature integrated to the core understanding of facets of microbial existence in the gut , their roles in early immunity , and impact on health were done. Known deficiencies in newborn immunity integrated to the actions of microbes in human milk permitted some conclusions to be drawn through logical extrapolations.
RESULTS: Deficiencies in early immunity can, at least partially, be surmounted by an optimal gut microbial milieu provided for by human milk which also enhances gut immunity and holistic health.
LIMITATIONS: This is a narrative review and articles chosen were subjectively analysed for suitability according to relevance, however, analysis by statistical methods was not done.
CONCLUSIONS: There are clear pathways linking gut microbes, intestinal epithelia, microbial metabolites and early immune maturation. The immature immune system is guided towards proper development and maturation by breastmilk factors and milk microbes for immediate and enduring holistic health. Utilising this knowledge, research must be energised on possible mutualistic benefits of gut microbes to counter the current health challenges. The counselling of breastfeeding must not overlook the unique microbial environment endowed by the mother as a gift of health.
Breastfeeding during breast milk jaundice - a pathophysiological perspective

Prameela KK

Med J Malaysia, 2019 12;74(6):527-533.
PMID: 31929480

INTRODUCTION: Exclusive breastfeeding for the initial six months of life is crucial and it is recommended . Breast milk jaundice is an innocuous condition that occurs in some healthy, breastfed infants. However, the potential dangers of jaundice in the neonate such as bilirubin induced neuronal pathology, mandates a better understanding of the pathophysiology of breast milk jaundice and the impact of breastfeeding during jaundice. In this context , advice on continued breastfeeding must consider both the benefits of breastfeeding and the possible disadvantages of the jaundice.
METHODS: Reviewing literature and integrating relevant information facilitated the appraisal of this important topic. This article reviewed neonatal jaundice, the entry of bilirubin into the immature brain and how breastfeeding may impact jaundice in the neonate.
RESULTS: While some substances in breast milk may be responsible for jaundice on the one hand, there is an irrefutable spectrum of advantages conferred by continued breastfeeding, on the other. As the breastfed infant benefits from fewer infections, enhanced organ and physiological barrier maturity, as well as the prospect of genetic modification of certain diseases, these useful actions could also reduce risks of early jaundice and its complications.
DISCUSSION: An exciting field for further research, holistic integration of knowledge clarifies both the overall advantages of breastfeeding and wisdom of its continued counsel. In fact, breast milk jaundice may reflect a holistic expression of tissue protection and enhanced neonatal survival.
Fulltext The importance of breastfeeding in rotaviral diarrhoeas

Prameela KK, Vijaya LR

Malays J Nutr, 2012 Apr;18(1):103-11.
PMID: 23713234 MyJurnal

Globally, rotaviral vaccines in use today have contributed to the reduction of the incidence of rotaviral diarrhoeas. Despite the substantial protection conferred by the current vaccines against the rotaviral strains, it is only prudent to recognise that other protective factors, like breastfeeding, also provide some degree of protection against this disease. This article has attempted to review some important mechanisms of protection in breast milk against the rotaviruses and highlight the oft forgotten non-immunoglobulin fraction in breast milk as an additional tool of protection against rotavirus disease. The adaptive capacity of breast milk to environment is another compelling reason to continue breastfeeding as it can usefully complement and be significant in the use of many vaccines. Vital immunoprotective constituents in breast milk beneficially protect the infant by initiating and strengthening many immune responses and should be borne in mind as essential tools of defence even in an era where vaccines play a pivotal role in the combat against certain diseases. It is impressive that besides nutritive advantages, the suckling infant enjoys appreciable immunoprotection via exclusive breastfeeding.
Fulltext Breast milk immunoprotection and the common mucosal immune system: a review

Prameela KK, Mohamed AK

Malays J Nutr, 2010 Apr;16(1):1-11.
PMID: 22691850 MyJurnal

It is universally known that breastfeeding provides a broad spectrum of nutritional and non-nutritional advantages to the developing infant. Nonnutritive protecting potentials of breast milk towards different infections and non-infectious diseases are still attracting the attention of researchers in different specialties. The neonate, who is suddenly exposed to a wide variety of organisms, is in dire need of protection, enhancement and education of his immature immune system to encounter these organisms. The lactating mammary gland is an integral part of the common mucosal immune system which stands as a sentinel in combating pathogens that enter the body via the mucosal route. The common mucosal immune system also competently controls tolerance mechanisms to innocent proteins and is involved in surveillance of carcinogensis. The diverse roles of general mucosal immunity are nearly well established but the specialised functions of breast tissue and breast milk in boosting the immune responses need more emphasis and highlighting. The detailed understanding and evaluation of breast milk as an immunological tool is reviewed within the domain of the diverse activities of the common mucosal immune system.