O uso de fármacos durante a lactação é uma prática comum; porém, os tratamentos farmacológicos impõem grandes dúvidas tanto aos profissionais quanto às nutrizes sobre a segurança do uso destes durante este período. A amamentação é uma forma de vínculo entre mãe e bebê e está associada a diversos benefícios nutricionais, imunológicos, cognitivos, psicoafetivos, econômicos e sociais. A depressão é um problema clínico importante durante o período pós-parto, e a vulnerabilidade para o início ou recorrência de sintomas depressivos aumenta a possibilidade de uso de psicofármacos enquanto ocorre a lactação. Os antidepressivos inibidores seletivos da recaptação da serotonina são comumente prescritos para o tratamento destes quadros depressivos, entre eles fluoxetina, sertralina, citalopram e paroxetina, sendo que a maioria destes é excretada no leite materno e há grande variabilidade na quantidade de analitos que pode ser recebida pelo lactente. Bupropiona é um fármaco antidepressivo utilizado para o tratamento do tabagismo e quadros depressivos e tem sua excreção ao leite materno relatada em literatura. Métodos bioanalíticos para determinação da excreção de fármacos antidepressivos foram desenvolvidos e validados por cromatografia líquida acoplada a espectrômetro de massas e cromatografia líquida com detecção ultravioleta. Estes métodos demonstraram serem seletivos, lineares, precisos e exatos, com limites de quantificação de 5 ng/mL (fluoxetina, citalopram e bupropiona) e 20 ng/mL (sertralina e paroxetina) para método por LC-MS e de 200 ng/mL para todos os analitos no método por CLAE-UV. As amostras de leite materno foram coletadas em Banco de Leite de mães que declararam utilizar fluoxetina ou sertralina ou paroxetina e analisados. Os dados de concentração encontrados para os fármacos referidos estão dentro da faixa encontrada em literatura confirmando sua excreção no leite materno. Paroxetina apresentou valores abaixo do limite de quantificação. Das concentrações encontradas no leite materno, foram estimadas as doses absolutas e relativas no lactante, sendo que os resultados demonstraram baixos valores em relação a estas estimativas, podendo os fármacos analisados ser considerados seguros para manutenção do uso durante a lactação. Foi também detectada nas análises por LC-MS a presença de norfluoxetina, metabólito da fluoxetina, confirmando sua excreção nesta matriz. / The use of medications during lactation is a common practice; however pharmacological treatments impose serious doubts to both, professionals and nursing mothers, about the safety of drugs use during this period. Breastfeeding is a natural form of bonding between mother and baby and it is associated with many nutritional, immunological, cognitive, psychoemotional, social and economic benefits. Depression is a major clinical problem during the postpartum period and the vulnerability to onset or recurrence of depressive symptoms increases the possibility of psychotropic drug use during lactation. Selective inhibitors of serotonin reuptake are commonly prescribed for the treatment of depressive disorders, including fluoxetine, sertraline, citalopram and paroxetine. Most of these drugs are excreted in breast milk and there is great variability in the amount of analytes that can be received by the infant. Bupropion is an antidepressant used for tabagism treatment and for depression symptoms; it is also described in literature its excretion into breast milk. Bioanalytical methods for determining the excretion of antidepressants were developed and validated by liquid chromatography coupled to mass spectrometry and liquid chromatography with ultraviolet detection. These methods proved to be selective, linear, precise and accurate with quantification limits of 5 ng/mL (fluoxetine, citalopram e bupropion) and 20 ng/mL (sertraline e paroxetine) for LC-MS method and 200 ng/mL for all analytes in the CLAE-UV method. Human milk samples were collected in milk banks from mothers to which the antidepressants fluoxetine or sertraline or paroxetine were administered, and the concentrations in this matrix were verified. Found concentrations were within the range described in the literature confirming their excretion in the breast milk. Paroxetine presented values less than limit of quantification. From the found concentrations, the absolute and relative doses in nursing were estimated. The results showed low values for these estimates and so the analyzed drugs can be considered safe to continue use during lactation. The presence of norfluoxetine, a metabolite of fluoxetine, was also detected by LC-MS, confirming its excretion in this matrix.

A Rede Brasileira de Bancos de Leite Humano - rBLH-BR é a primeira rede temática do Serviço Único de Saúde - SUS, decorrente da articulação entre política pública de saúde, integração interinstitucional e atendimento a demandas da sociedade por melhoria da saúde dos lactantes, sendo reconhecida como a maior rede de bancos de leite humano no mundo. A estratégia de bancos de leite no Brasil beneficiou mais de 1,8 milhões de recém-nascidos e teve apoio de 1,3 milhões de doadoras entre 2009 e 2016. Neste contexto, a pesquisa identificou as inovações organizacionais e mercadológicas na rBLH-BR, entre dezembro de 2010 e dezembro de 2015, conforme critérios do Manual de Oslo (2005) e, posteriormente, analisou-se o uso dos canais de difusão pelas inovações identificadas. Metodologicamente a pesquisa adotou estudo de caso como procedimento técnico por meio do uso do método misto numa estratégia incorporada concomitante, envolvendo uma abordagem qualitativa e quantitativa com objetivos exploratórios e descritivos. A pesquisa foi realizada junto ao Centro de Referência Nacional - CRN da rBLH-BR, que é o Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira − IFF/Fiocruz. O estudo foi composto por uma pesquisa documental e entrevistas com especialistas com a finalidade de caracterizar a estrutura da rBLH-BR, identificar as inovações e seus canais de difusão, como também, especificar suas relações. O resultado evidenciou que as inovações organizacionais e mercadológicas seguem padrões. As inovações da dimensão organizacional são caracterizadas por serem desenvolvidas pela própria rede ou em colaboração, por serem inovações no âmbito mundial com grau de impacto radical e com difusão total na rede, que iniciam no CRN, passando pelos Centros de Referência Estaduais - CRE e posteriormente os BLHs, utilizando os meios de comunicação interpessoal como canal de difusão com base em soluções de TIC e web. Outro padrão identificado está relacionado as inovações da dimensão de marketing como novidade no âmbito da organização e de impacto incremental, as quais são desenvolvidas na própria rBLH-BR ou em cooperação, com a difusão partindo do CRN para toda a rede, promovida por meios de comunicação de massa. Portanto, o CRN foi identificado como centro inovador/difusor da rBLH-BR e responsáveis pelas funções de padronização, normatização, planejamento, controle, credenciamento e de estabelecer acordos de cooperação internacional. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES / The Brazilian Network of Human Milk Banks (rBLH-BR) is the first thematic network of the Unified Health System – SUS. The network results from the co-ordination between the public health policy, interinstitutional integration and the need to meet the society`s demands for an improvement in the health of lactating women, and is recognized as the largest network of breast milk banks in the world. The strategy of network of Human milk banks in Brazil has benefited more than 1.8 million newborns and had support from 1.3 million donors between 2009 and 2016. In this context, the research has identified the organizational and marketing innovations at the rBLH-BR from December 2010 and December 2015, according to the criteria of the Oslo Manual (2005). An analysis of the use of the diffusion channels was then conducted through the innovations that have been identified. In the methodological aspect, the research used a case study as technical procedure by means of a mixed method, within a concomitant and integral strategy, developed by means of a qualitative and quantitative approach, the goals of which are exploratory and descriptive. The research was conducted at Centro de Referência Nacional – CRN (National Reference Center) of rBLH-BR, which is the National Institute of Women, Children and Adolescents Health Fernando Figueira – IFF/FioCruz. The study consists of a documental research and interviews with experts with the purpose of characterizing the structure of the rBLH-BR, identify innovations and their channels of diffusion, and specify their relations. The result has shown that organizational and marketing innovations follow patterns. Organizational innovations are developed by the network itself or in collaboration with, since they are innovations at a world level with a radical impact and total diffusion in the network, initiated at the CRN, passing through the State Reference Centers (CRE), and then through the BLHs using interpersonal communications means as a diffusion channel and based on ICT and web solutions. The other pattern – innovations in the marketing dimension as a novelty within the Organization and with an incremental impact - are developed at the rBLH itself or in cooperation with, the diffusion of which starts from the CRN and extends to the entire network, promoted by mass media. Therefore, the CRN has been identified as the innovating and diffusing center of rBLH, responsible for functions such as standardization, planning, control, accreditation and establishment of international cooperation agreements.

Esofagite Eosinofílica é uma doença inflamatória crônica restrita ao esôfago e imune mediada por antígenos. Sua prevalência descrita varia desde 0,4%, numa população geral, até 15% em pacientes com sintomas de disfagia. Já se conhece sua associação com doenças atópicas, anafilaxia e alergia alimentar, sendo o leite de vaca um dos principais alimentos envolvidos. Existem relatos recentes de casos em que pacientes foram diagnosticados com esofagite eosinofílica após serem submetidos à imunoterapia oral com o alimento causador de sua alergia alimentar mediada por IgE. Porém, em nenhum destes casos foi avaliado previamente se os mesmos pacientes já não apresentavam eosinofilia esofágica latente e/ou sintomas subjetivos sugestivos da doença. Considerando que, atualmente, um dos tratamentos mais promissores para alergia alimentar é a imunoterapia oral, justificou-se a necessidade de entender se esofagite eosinofílica seria de fato uma complicação do tratamento, ou se seria uma condição pré ou coexistente. Portanto, o objetivo deste trabalho foi avaliar a frequência de eosinofilia esofágica em pacientes com anafilaxia à proteína do leite de vaca. Foram analisados 89 pacientes matriculados no ambulatório de alergia alimentar do HC-FMUSP, com mediana de idade de 8 anos e que apresentavam anafilaxia ao leite de vaca. Todos foram submetidos à endoscopia digestiva alta com biópsias de esôfago, estomago e duodeno. Dados demográficos, comorbidades atópicas, uso de medicações e sintomas gastrointestinais foram analisados e comparados. A frequência de eosinofilia esofágica foi de 38,2% (34 de 89 pacientes). Em 15 dos 34 pacientes com eosinofilia esofágica, foi completada a investigação para esofagite eosinofílica com uso de inibidor de bomba de prótons em dose plena por 8 semanas antes de uma segunda endoscopia. Identificou-se, portanto, cinco pacientes (7,1%) com eosinofilia esofágica responsiva a inibidor de bomba de prótons e 10 pacientes com esofagite eosinofílica (14,2%). No grupo total de pacientes com eosinofilia esofágica (n=34) encontrou-se 29,4% de pacientes com quadro clínico gastrointestinal ausente; 23,5% oligossintomáticos, e apenas 47% com sintomas sugestivos de disfunção esofágica e, destes últimos, nem todos apresentavam sintomas esofágicos persistentes. Pode-se concluir que a frequência de esofagite eosinofílica descrita no grupo estudado foi significativamente superior à estimada na população geral e uma das mais altas descritas em grupos de pacientes com fatores de risco específicos. Também foi observada uma grande parcela de pacientes com eosinofilia esofágica, sendo muitos assintomáticos ou oligossintomáticos, surgindo o questionamento se esta não seria uma doença latente, de início precoce, insidioso e não relacionada diretamente como complicação de tratamentos atuais / Eosinophilic esophagitis is a chronic inflammatory disease, which occurs in the esophagus and is immune mediated by antigens. Its observed prevalence varies between 0.4% in the general population to 15% in patients with dysphagia. Its association with atopic diseases, anaphylaxis and food allergy has already been recognized. Cow\'s milk is one of the main food sources involved. There are recent reports of cases in which patients were diagnosed with eosinophilic esophagitis after being submitted to oral immunotherapy with the food that causes the IgE mediated allergy. However, in none of these cases was it previously determined if the same patients did not already present latent esophageal eosinophilia and/or subjective symptoms suggestive of the disease. Considering that, currently, one of the most promising treatment for food allergy is oral immunotherapy, the need to understand if eosinophilic esophagitis could be a treatment complication, or if it is a coexistent or preexistent condition, is justified. Therefore, the objective of this study was to evaluate esophageal eosinophilia frequency in patients with anaphylaxis to cow\'s milk protein. We analyzed eighty-nine patients registered in the Food Allergy Unit of the HCFMUSP, with a median age of 8 years, who presented cow\'s milk anaphylaxis. All of them were submitted to digestive endoscopy as well as esophagus, stomach, and duodenum biopsies. We also analyzed and compared demographic data, atopic comorbidities, use of medication, and gastrointestinal symptoms. The frequency of esophageal eosinophilia was 38.2% (34 of 89 patients). In 15 of the 34 patients with esophageal eosinophilia, full investigation for the disease was carried out using a proton pump inhibitor at full dose for eight weeks prior to a second endoscopy. From this, five patients (7.1%) had the proton pump inhibitor-responsive esophageal eosinophilia phenotype, and ten patients were diagnosed with eosinophilic esophagitis (14.2%). In the whole group of patients with esophageal eosinophilia (n = 34), it was found 29.4% of patients with an absent gastrointestinal clinical condition, 23.5% were oligosymptomatic, and only 47% had symptoms suggestive of esophagic dysfunction. Of these, not all presented persistent esophagic symptoms. It is possible to conclude that the frequency of eosinophilic esophagitis observed in this group was significantly higher than the estimated for the general population, and one of the highest observed in groups of patients with specific risk factors. A large portion of patients with esophageal eosinophilia were oligosymptomatic or asymptomatic, raising the question if this would not in fact be a latent disease, with a precocious beginning, insidious and not directly related to current treatments complications

Orientadores: Helena Teixeira Godoy, Fabio Augusto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-12T13:02:51Z (GMT). No. of bitstreams: 1 Kowalski_ClaudiaHoffmann_D.pdf: 1521730 bytes, checksum: 5077a83f5292bcd2dd1b651ce2fc229c (MD5) Previous issue date: 2008 / Resumo: Um estudo sobre a contaminação do leite materno com bifenilas policloradas (PCB) foi desenvolvido objetivando um conhecimento mais amplo dessa problemática no nosso país. Para isso, amostras de leite foram coletadas em nove estados brasileiros e questionários contendo perguntas sobre hábitos alimentares, condições sócio-econômicas, locais de habitação entre outras foram aplicados às mães doadoras. A determinação dos PCB foi feita por Microextração em Fase Sólida no modo headspace (HS-SPME) combinada com Cromatografia Gasosa e Detector de Captura de Elétrons (GC-ECD). As etapas da SPME foram otimizadas univariadamente e através de planejamento experimental Doehlert. A análise de variância mostrou que a temperatura de extração e a força iônica do meio (estudada através da adição de NaCl) foram as variáveis que mais influenciaram nas quantidades de PCB extraídas. Em seguida, refinaram-se as condições experimentais através de uma abordagem neuro-genética (rede neural Bayesiana aliada a algoritmos genéticos) que identificou como o ponto experimental ótimo a seguinte condição: concentração de NaCl de 0,36 g mL-1, temperatura de extração de 95,0 °C, tempo de extração de 60 minutos e adição de 210 µL de metanol. Após a otimização, o método foi validado através do estudo das figuras de mérito e apresentou-se linear na faixa estudada (1 a 16 µg L-1) com r > 0,9884, além de boa precisão (RSD < 12 %, n = 5), recuperação aceitável (71 a 127 %) e limites de quantificação entre 0,45 µg L-1 e 2,42 µg L-1. A fim de estabelecer correlações entre os resultados das amostras (expressos na forma de áreas cromatográficas) e os resultados obtidos nos questionários, fez-se uso da rede neural de Kohonen. Assim, foi possível verificar que nas cidades metropolitanas o acúmulo de PCB no leite é mais expressivo que em outras regiões. Por exemplo, em São Paulo 58 % das amostras estavam contaminadas com algum PCB, principalmente os congêneres 180 e 153. Outro resultado gerado pela rede foi que, em geral, as amostras de leite maduro (maior porcentagem de gordura) estavam mais contaminadas com PCB. O número de gestações também foi um fator importante a ser considerado, pois o estudo mostrou que o primeiro filho normalmente recebe uma dose maior de PCB do que os demais. Ainda, maior contaminação foi encontrada no leite de mães que moram nas proximidades de indústrias e/ou rios poluídos, corroborando com o fato de que esses compostos chegam facilmente ao meio ambiente e em seguida aos seres humanos / Abstract: A study about the contamination of the breast milk with polychlorinated biphenyls (PCB) was developed aiming a wider knowledge of this problematic in our country. For that, breast milk samples were collected in nine Brazilian states and questionnaires with questions regarding to food habits, social and economic conditions, places of dwelling between others were applied to the donors. The determination of the PCB was done by headspace Solid-Phase Microextraction (HS-SPME) combined with Gas Chromatography and Electron Capture Detector (GC-ECD). The SPME steps were optimized through univariated procedures and Doehlert experimental design. The analysis of variance showed that the temperature of extraction and the ionic strength of the media (studied by the addition of NaCl) were the most significant variables in the quantities of extracted PCB. After that, the experimental conditions were refined considering a neurogenetic approach (Bayesian neural network and genetic algorithms) and it was identified as the optimum experimental point the following condition: concentration of NaCl of 0.36 g mL-1, temperature of extraction of 95.0 °C, time of extraction of 60 minutes and addition of 210 µL of methanol. After the optimization, the method was validated through the study of the figures of merit. It showed linear in the studied range (1 to 16 µg L-1) with r > 0.9884, besides good precision (RSD < 12 %, n = 5), acceptable recuperation (71 to 127 %) and limits of quantization between 0.45 µg L-1 and 2.42 µg L-1. In order to establish correlations between the results of the samples (expressed as chromatographic areas) and the results obtained in the questionnaires, Kohonen neural network had been used. Thus, it was possible to check that in the metropolitan cities the accumulation of PCB in the milk is more expressive than in other regions. For example, in Sao Paulo state, 58 % of the samples were contaminated by some PCB, mainly the congener 180 and 153. Another result produced by the net was that the samples of hindmilk (higher fat percentage) were the most contaminated. The number of gestations also was an important factor to be considered, since the study showed that the first son normally receives a higher dosage of PCB compared to the others. Also higher levels of contamination was found in the milk of mothers who lived in the proximities of industries and/or polluted rivers, corroborating with the fact that these compounds are easily spread in the environment and consequently in the human beings / Doutorado / Doutor em Ciência de Alimentos

This diploma thesis deals with the evaluation of clinical manifestations in infants with allergic colitis and their overall nutritional status, anthropometry, blood count and antibodies against cow's milk proteins. Allergic colitis is one of the most common manifestations of infant allergy to cow`s milk protein with gastrointestinal involvement. The theoretical part summarizes the anthropometric evaluation of growth and development, infant nutrition, the most important laboratory indicators of nutritional status. The part is generally devoted to food allergies, mainly allergy to cow's milk protein. The practical part deals with the evaluation of a sample of examined patients in gastroenterology outpatient clinics and nutritional outpatient clinic of the Department of Pediatrics and Adolescent Medicine of the 1st Faculty of Medicine, Charles University and General Hospital in Prague. The observed group of infants with allergic colitis includes infants exclusively breastfed, breastfed by a mother following a non-dairy diet, infants on an extensive hydrolyzate or on an amino acid formula. The main goal of the diploma thesis was to trace the most common clinical manifestations and whether there are any changes in their nutritional status during the disease and its treatment. A total of 45 randomly...

Background: Managing medication during pregnancy and lactation in multiple sclerosis (MS) patients needs to balance potential risks to the newborn with the substantial risks of ongoing disease activity. Objective: To evaluate the potential transfer of natalizumab (NAT) into breast milk and into the serum of newborn babies in women who continued NAT treatment during pregnancy and lactation. Methods: Serum samples of 11 mother–infant pairs and mother milk samples of a further 4 women were analyzed for free NAT using a HL60 cell-based fluorescence-activated cell sorting (FACS) assay. Two mother–baby pairs were analyzed for cell-bound NAT, very-late-antigen (VLA)-4 expression, and saturation with NAT on immune cells by FACS analysis. Results: In the majority of the mother–infant serum pairs (6/11) and in all breast milk samples, free NAT was detectable. Cell-bound NAT was measurable in both mother–baby pairs with significant higher levels in babies. VLA-4 expression seems to be higher in newborns. Saturation with NAT was comparable between newborns and mothers. Conclusion: NAT can pass placental barrier before delivery and into breast milk. Measurable NAT on neonatal lymphocytes may have functional impact. Further investigations are needed to clarify safety and risk of NAT exposure during pregnancy and lactation.

The natural practice of breastfeeding has been strongly noted as one of the most cost-effective, health promoting, disease-prevention strategies of the 21st century. Although primary health organizations recommend exclusive breastfeeding for the first 6 months of life with added complementary foods and continued breastfeeding up to 2 years of age or longer, many mothers do not breastfeed their infants for the recommendation length of time. Applied policies and health practices, such as those described under the 10 Steps to Successful Breastfeeding and The International Code of Marketing of Breast Milk Substitutes, have been noted as contributing factors that can considerably impact the manner which women choose to feed their infants. A cross-sectional methodology assessed associations between maternity health practices and breastfeeding duration among women birthing in the United States. A secondary data analysis of the Infant Feeding Practice Study II and its Year 6 Follow-Up was conducted using IBM SPSS Statistics Version 24. Procedures for data analysis included frequencies, Ï?2 tests, and ordinal logistic regressions. Outcomes revealed that feeding infants any formula during their hospital stay drastically reduces the likelihood for prolonged breastfeeding duration. Study results also concluded that offering a pacifier to infants during their hospital stay reduced the length of breastfeeding duration. This study confirms many of the primary breastfeeding practices that are at the frontline of maternity patient care in the United States. Establishing well-grounded practices that aid in the long-term duration of breastfeeding could help save lives and improve child and maternal health outcomes within the United States.

Preterm birth is the number one cause of death in neonates, accounting for 35% of neonatal mortality. The preterm birth rate in the U.S. in 2021 was 10.5%, disproportionally affected by race and ethnicity. Obese women have an increased risk of preterm pregnancy, and if delivered before 37 weeks of gestation, the offspring have higher rates of complications that extend from the neonatal period into life-long metabolic and immune adverse outcomes. In the early months after delivery, preterm infants have higher rates of adverse health outcomes than term infants, including infections, extrauterine growth restrictions, respiratory, metabolic, and neurological complications, necrotizing enterocolitis (NEC), and bronchopulmonary dysplasia (BPD). Diet for the preterm infant is crucial for infection prevention, and maternal breast milk is most beneficial when given in the first few days after birth. Expectant and breastfeeding mothers should consume appropriate food and supplements to optimize their nutrition. In addition to nutrients, bioactive components, vitamins, and minerals found in breast milk (BM), there is evidence that microbes (microbiome) are a significant factor in infant development, contributing to protection against pathogens and playing a role in the development of the immune and nervous systems. Maternal BM composition and microbiome are affected by many factors, including maternal body mass index (BMI), maternal health, antibiotics use, mode of delivery, maternal parity, gestational age, and time and duration of lactation. Maternal body composition, however, and not maternal nutritional status, is associated with breast milk nutritional composition. Altogether, these maternal factors may modify the premature infant gut microbiome. We examined the role of maternal adiposity and how it impacts the composition of human breast milk, specifically hormones, nutrient composition, short and long chain fatty acids, and microbiome. We also examined the role of maternal adiposity and how it impacts the short-chain fatty acids and microbiome in infant fecal samples. We found that maternal adiposity affects breast milk hormones, potentially modulating infant metabolism. Additionally, we found that maternal adiposity does not alter the nutrient composition of breast milk; however, differences in both short and long chain fatty acids and maternal adiposity were detected. In our small cross-sectional cohort of preterm infants, we did not observe differences in short-chain fatty acids in the preterm infant stool samples compared to maternal adiposity. Concerning maternal adiposity and its impact on the microbiomes of breast milk and infants, we observed differences in phyla and genera between the maternal BMI groups on the outcome of breast milk and preterm infant microbiomes but no statistical significance in alpha and beta diversities between the groups. Thus, our results indicate that maternal adiposity impacts hormonal, microbial composition, and short-chain fatty acid profiles in breast milk, which tremendously influences infant growth and development.

Infant formula (IF) is a commonly used replacement whenever mother’s own milk is not available. Most IFs are based on cow milk (powders, liquids). Alternatives, based on other sources such as goat milk or plants, exist. Independent of the source, IF production and composition are strictly regulated. Besides proteins, minerals, and lipids, milk contains a variety of endogenous peptides. Whereas the human milk peptidome has been studied intensively, the peptidomes of IFs have been mostly neglected. This study investigated the peptidomes of different types of first stage IF, including cow milk-based powders and liquids, and powdered goat milk-based IF, highlighting major similarities and differences to human milk. Extracted native peptidomes were analyzed by nanoRPC-ESI-MS/MS using two different fragmentation techniques allowing the confident identification of 1587 peptides. β-Casein peptides dominated in all samples. Interestingly, powdered and liquid cow milk-based IFs differed in the numbers of β- and αS1-casein peptides, indicating processing-derived variations. However, the peptidomes of cow and goat milk-based IF appeared to be more comparable to each other than to human milk. Despite an overlap in the major source proteins, many peptide sequences were different, i.e., species-specific. Remarkably, the data indicate that the human milk peptidome might be donor-specific as well.

<p>Breastfeeding from HIV-infected mothers is one of the major sources of pediatric HIV-1 infection; however, an intervention that promotes exclusive breastfeeding has significantly reduced vertical HIV transmission rates and infant mortality. The mechanisms underlying this phenomenon remain unknown; however, have been closely linked to high levels of innate immune factors in breast milk. Indeed, the level of several innate factors in breast milk correlate with protection and/or have direct anti-viral properties <em>in vitro.</em> The innate immune factor, soluble TLR2 (sTLR2) is found in high concentration in breast milk and has previously been investigated for its anti-bacterial properties; however, its anti-viral properties remain poorly understood. Thus, the research presented in this thesis extended our understanding of sTLR2 by characterizing the mechanisms by which sTLR2 inhibited HIV-induced inflammation and infection. Chapter 2 examined the predominant forms of sTLR2 in breast milk from different women, its cellular source, bioavailability and kinetics postpartum. Functionally, we confirmed sTLR2’s anti-bacterial properties and extended to show, for the first time, that sTLR2 directly inhibited HIV infection <em>in vitro.</em> Chapter 3 documented a potential mechanism of sTLR2’s direct inhibition of HIV infection <em>in vitro</em> and, investigated sTLR2 and TLR2 expression in HIV uninfected compared to HIV infected breast milk and breast milk cells, respectively. Chapter 4 investigated the role of TLR2’s recognition of novel HIV pathogen associated molecular patterns (PAMPs), and whether TLR2 expression increased HIV infection and integration. Taken together, we present novel anti-viral functions of sTLR2 by demonstrating that sTLR2 bound to specific HIV PAMPs, which led to significantly decreased HIV-induced inflammation, co-receptor expression, and HIV infection. Furthermore, we demonstrated, for the first time, that TLR2 recognizes specific HIV PAMPs, which led to significantly increased pro-inflammatory cytokine production, co-receptor expression and HIV infection. Thus, sTLR2 and TLR2 represent innate immune factors that might have preventative and therapeutic applications for both infants and adults in the future.<strong><br /> </strong></p> / Doctor of Philosophy (Medical Science)