Immunology and Breastfeeding

Supporters

The Centre for Immunology and Breastfeeding is one of the five chairs endowed by the generous support from the Family Larsson Rosenquist Foundation. This donation provides financial independence in perpetuity, and enables us to pursue panoramic research with long horizons, in complete independence and freedom of research and teaching. 

We are also grateful to receive grant support from: 

• Western Australia Child Research Foundation
• Future Health Research and Innovation Focus Grant
• Channel 7 Telethon Trust
• The Kids Research Institute Australia collaborative award
• Westfarmer Centre of vaccines and Infectious Disease (WCVID) seed and partnership grant 

Collaborators

Global Human Milk Research Consortium (GHMRC)  

Our team is proud to be one of the five independent research centres that make up the prestigious Global Human Milk Research Consortium (GHMRC). Working together, we are committed to advancing the frontiers of human milk and breastfeeding research on a global scale, making a meaningful contribution to the UN Sustainable Development Goals and WHO Global Targets.

The ORIGINS project

The ORIGINS Project is the largest study of its kind in Australia, following 10,000 children, from their time in the womb, over a decade to improve child and adult health. Our Centre has two ongoing sub-projects using the ORIGINS cohort: the GAP study (Gateway for Allergy Prevention) and CEED study (Colostrum Exclusivity and Early Development)  

Our main Collaborators:

• Public health -  Prof. Pete Gething and Dr Susan Rumisha, Geospatial Health and Development team, The Kids; Sofa Rahmania, PhD, UWA, Prof. Rosalind Gibson and Prof. Lisa Houghton, New Zealand.
• Pediatricians including Prof. Suzan Prescott (School of Pediatrics and Child Health, University of Western Australia, Perth, Australia), Dr. Ravisha Srinivasjois ( Joondalup Health Campus) Prof. Desiree Silva ( The Kids Research Institute Australia and Joondalup Health Campus);, Prof George du Toit (Kings College London, UK), Dr Stéphanie De Smet (Hopital de l’Archet, France), 
• Dietician experts in child nutrition and allergy prevention: A/Prof Carina Venter (University of Colorado, USA); Dr Debbie Palmer (The Kids Research Institute Australia, Perth, Australia); Dr Therese O Sullivan (Edith Cowan University, Perth)
• Lactation consultants: Louisa Connoly, president of Lactation college (Perth, Australia) ; Kirsten Tannenbaum, Australian Breastfeeding Association (Australia)
• Infectious disease. Dr. Thomas Egwang (Kampala, Uganda) project on colostrum and helminth/ breast milk and malaria;  Dr Tim Barnett (The Kids Research Institute Australia, Perth, Australia),  Dr. Nelly Amenyogbe and Prof. Tobias Kollmann (Dalhousie University, Canada) colostrum and sepsis; Rick Maizels, Glasgow University, helminth infection; A/Prof. Lea- Ann Kirkham ear health among Aboriginal children (The Kids). Juan Rodriguez, Madrid University and Dr. Allison Imrie, UWA, Breast milk and COVID-19; Dr. Leshan Wannigama- Thailand. 
• Neurodevelopment, Prof. Giancarlo Natalucci ( Zurich University)
• Health economics, Prof. David Yanagizawa-Drott (Zurich University)
• Biochemistry, Dr. Lars Bode (UCSD) and Dr. Fadil Hannan (Oxford)
• Microbiota. Prof. David Lynn, (SAMHRI); Dr. Claus Christopherson (Curtin University, Perth, Australia) ; Remy Burcelin, Inserm, France
  Transcriptomic analysis, Dr. Tom Iosidifis and Dr. Patricia Agudelo, The Kids Research Institute Australia
• Epigenetics, Dr. David Martino, The Kids Research Institute Australia
• Skin, Mark Fear UWA, Prof Fiona Wood, UWA, and  Asha Bowen, The Kids Research Institute Australia Perth 

By learning from human milk, we can revolutionise how we care for newborns, offering interventions that are truly aligned with their developmental needs.

Currently, most treatments for newborns are adapted from adult treatments, primarily by adjusting the dosage. However, we are learning more every day about the key differences between newborns and adults, and breast milk has long understood these differences. Our research into the immunology of breastfeeding indicates that human milk may be the most effective way to promote mucosal immunity in infants (Macchiaverni et al., 2024; van den Elsen et al., 2022).

To provide advice to mothers and health professionals to maximise the chances of disease prevention through breastfeeding.

Breast milk reflects the maternal environment, from pollutants and infections to dietary habits, providing infants with an early glimpse into the world they will grow into. By examining how the composition of human milk affects immune development, we are paving the way for tailored advice that can help mothers enhance disease prevention through breastfeeding. Our research suggests that consuming allergens while breastfeeding might be the best way to prevent allergies in children. Ongoing clinical trials led by our collaborator, A/Prof Debbie Palmer, will soon reveal whether this approach can be recommended.

Building strong evidence to support breastfeeding initiatives.

Despite the World Health Organization’s (WHO) guidelines advocating for early initiation and exclusive breastfeeding, at least one-third of newborns worldwide miss out on these optimal practices due to delayed breastfeeding initiation or the introduction of formula supplements that replace colostrum. We already know that colostrum is crucial for reducing neonatal mortality in low-resource settings. Our ongoing research will highlight the role of colostrum in preventing allergies, parasitic infections, stunted growth, and much more.

The benefits of colostrum on long-term health 

Colostrum is required for gut immune development and successful anti-helminth defences (Rekima et al., 2024)

Globally, over 1.5 billion people, or 25% of the world's population, are affected by soil-transmitted helminths. Infected children suffer from both nutritional and physical impairments, leading to significant societal and economic impacts.

Using a unique preclinical model of colostrum deprivation, we demonstrated that colostrum is crucial for the expansion of key immune cells in the gut that are involved in controlling helminth infections (type 2 innate lymphoid immune cells). Interestingly, the microbiota was not required for this process. Additionally, in a proof-of-concept birth cohort study in Uganda, we found that providing the initial drops of colostrum to newborns was linked to a significant reduction in childhood helminth infections.

In conclusion, our study offers new evidence on how to reduce the burden of helminth infections: promote colostrum feeding! This research highlights that we can learn from colostrum to design interventions specifically tailored to neonates that support health, extending beyond just microbiota-based approaches.

Target breastmilk composition to maximize child health through breastfeeding.

a) The milky way to promote immunity 

Colostrum and IgA are particularly effective in protecting against COVID-19 infection (Macchiaverni et al., 2024). As long as SARS-CoV-2 continues to circulate, newborns will remain the only immunologically naïve and vulnerable group, potentially for a long period. Therefore, a targeted approach to COVID-19 prevention in newborns is necessary. In a birth cohort study from Spain, we found that the highest level of protective activity of human milk against COVID-19 was present in the colostrum of infected mothers, and this protection depended on anti-SARS-CoV-2-specific IgA. Our findings suggest that maternal mucosal COVID-19 vaccination should be evaluated to promote IgA secretion at mucosal sites, including in breast milk, for optimal protection of the infant. This underscores the importance of supporting successful breastfeeding initiation. Despite WHO recommendations, many newborns still do not receive adequate colostrum, especially when their mothers are infected with COVID-19.

Pathogen antigen shedding in breast milk to vaccinate Infants

Based on our observation that certain antigens in maternal milk stimulate a long-term immune response in infants (Baiz et al., 2017; Macchiaverni et al., 2014; Rekima et al., 2020), we proposed that the transfer of microbial antigens through breast milk could be the most effective way to vaccinate infants (Marchant et al., 2017; van den Elsen et al., 2022; Verhasselt, 2015). Pathogens present in breast milk could serve as ideal attenuated vaccines, with antigens enclosed in adjuvants designed for the developing infant mucosa. We validated this hypothesis in the context of malaria, showing that malaria antigens are present in human milk (van den Elsen et al., 2022).

b) The milky way to promote immune tolerance 

Educating the immune system through breast milk for allergy prevention.

In 2008, we challenged the conventional belief in allergen avoidance for preventing allergies, showing that egg allergens in maternal milk could help educate the infant immune system and reduce the likelihood of egg allergies (Verhasselt et al., 2008). This was confirmed in a birth cohort study (Verhasselt et al., 2020). We further identified factors that enhance allergy prevention through allergen shedding in breast milk, such as Vitamin A (Turfkruyer et al., 2016), TGF-beta (Rekima et al., 2016), and maternal immunization (Adel-Patient et al., 2020; Mosconi et al., 2010). Recently, we discovered an unexpected risk factor for both respiratory and food allergies: respiratory house dust mite allergens in breast milk (Baiz et al., 2017; Macchiaverni et al., 2014; Rekima et al., 2020). Our recent review in the top-ranked journal Journal of Allergy and Clinical Immunology (JACI) emphasises the importance of allergens in breast milk for immune system education (Macchiaverni et al., 2021). This knowledge will inform infant-focused preventive strategies to effectively reduce the burden of allergies (Macchiaverni et al., 2021).