HIV-1 transmission via breastfeeding remains a major mode of infant HIV-1 acquisition in areas of high HIV prevalence, accounting for nearly half of the 350,000 new infant HIV-1 infections occurring annually. Maintaining the immunologic and nutritional benefits of breastfeeding, while protecting the infant against HIV-1 acquisition, is critical for HIV-free survival of infants in resource-poor regions of high HIV-1 prevalence. While antiretroviral drug prophylaxis administered to the infant and/or mother reduces postnatal HIV-1 transmission, concerns of toxicities and development of antiretroviral drug-resistant strains limit the success of this strategy. Therefore, novel strategies to prevent postnatal HIV-1 transmission via breastfeeding will be necessary to eliminate this mode of infant HIV-1 acquisition. Interestingly, in the absence of maternal/infant antiretroviral prophylaxis, only 10% of breastfeeding infants born to HIV-1-infected mothers will acquire HIV-1 via breastfeeding, despite chronic, daily HIV-1 exposure. This low rate of transmission suggests that innate factors in breast milk protect the majority of infants against virus acquisition. Through detailed fractionation and screening of proteins in breast milk for HIV-neutralizing activity, we have isolated a novel, potent HIV- neutralizing protein from breast milk. We hypothesize that this protein is responsible for protection of the overwhelming majority of HIV-exposed breastfeeding infants against HIV-1 acquisition. In this proposal, we will explore the interactions of this novel HIV-neutralizing protein with the HIV-1 Envelope, defining its active site and the neutralizing epitope of the HIV-1 Envelope that mediates the virus inhibition, potentially uncovering a unique target for HIV-1 neutralization. Furthermore, we will investigate the in vivo efficacy of this protin by investigating the association between the endogenous concentration in milk and protection against postnatal HIV-1 transmission in a large cohort of HIV-infected mother-infant pairs. This work will define the mechanism and efficacy of this newly-identified HIV-1-neutralizing protein isolated from breast milk, establishing a novel, safe prophylactic agent to protect infants against HIV-1 acquisition via breastfeeding. This proposal is being submitted in response to the NIAID Program Announcement PA-11-217 """"""""Mechanistic Studies of HIV-exposed Seronegative Individuals"""""""", specifically addressing innate factors that naturally protect the majority of highly HIV-exposed, breastfeeding infants against postnatal HIV-1 acquisition.

Public Health Relevance

HIV-1 transmission via breastfeeding accounts for nearly half of the 350,000 infant HIV infections occurring annually. Impeding postnatal HIV transmission, while maintaining the nutritional and immune benefits of breastfeeding, is critical to improving HIV-free survival of infants in regions of high HIV prevalence. We have isolated a novel HIV-1-neutralizing protein from breast milk which holds promise for use as infant prophylaxis against postnatal HIV-1 acquisition. In this proposal, we will define the interactions of this inhibitor wih the HIV-1 Envelope and determine its association with protection against postnatal HIV-1 transmission in a human cohort, work that is critical to its development as a novel strategy for protection against infant HIV-1 acquisition.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Exploratory/Developmental Grants (R21)
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AIDS Immunology and Pathogenesis Study Section (AIP)
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Stansell, Elizabeth H
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Duke University
Schools of Medicine
United States
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Kelly, Matthew S; Benjamin, Daniel K; Puopolo, Karen M et al. (2015) Postnatal Cytomegalovirus Infection and the Risk for Bronchopulmonary Dysplasia. JAMA Pediatr 169:e153785
Fouda, Genevieve G; Jaeger, Frederick H; Amos, Joshua D et al. (2013) Tenascin-C is an innate broad-spectrum, HIV-1-neutralizing protein in breast milk. Proc Natl Acad Sci U S A 110:18220-5