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Journal of Virology, October 2006, p. 10191-10200, Vol. 80, No. 20
0022-538X/06/$08.00+0 doi:10.1128/JVI.01095-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Institut de Génétique Moléculaire de Montpellier, UMR 5535-IFR 122, CNRS, 1919, Route de Mende, 34293 Montpellier Cedex 5, France
Received 29 May 2006/ Accepted 24 July 2006
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Using a lethal-retroviral-infection model of immunocompetent mice, we recently reported that short passive immunization with a neutralizing MAb, in addition to an expected immediate decrease in the viral load, may help the endogenous immune system mount a long-term protective immune response. In brief, when newborn animals under the age of 5 to 6 days are inoculated, the FrCasE simple retrovirus first propagates in the periphery and then penetrates into the central nervous system. There, it causes a rapid noninflammatory spongiform degenerative disease, leading to the death of all mice within 1 to 2 months. In contrast, mice infected at an older age do not develop a neurological illness, but splenomegaly and leukemia were observed in 80% of them within 3 to 6 months postinfection, due to periphery-restricted replication of FrCasE. When newborn viremic animals are briefly treated (<15 days) with the neutralizing MAb 667 (IgG2a/
), which recognizes the viral receptor-binding VRA domain of Env (7), shortly after infection (< 2 days), the animals survive and show no sign of any disease. This protection is due to both an immediate effect on the viral load and the development of a strong protective immune response capable of containing viral replication for more than 16 months (the duration of the experiments) following MAb clearance (13). Although the molecular and cellular bases underlying the immunomodulatory effect of MAb 667 have not yet been completely elucidated, a clear and essential contribution of the humoral response to antiviral protection has been demonstrated (13). If this is also the case in humans, this observation may have potentially important therapeutic consequences, as MAb treatments may help infected individuals develop their own antiviral immunity. The report that intensive treatment of juvenile simian immunodeficiency virus-infected macaques with anti-simian immunodeficiency virus hyperimmune serum immunoglobulins (Igs) accelerated the appearance of neutralizing antibodies, as assayed in vitro, in a fraction of the animals (14) suggests that this may be the case, at least in primates. However, although no virus challenge experiments were conducted to demonstrate that the antiviral response was actually protective in vivo, it is interesting that this immune response correlated with a delayed onset of the disease in some monkeys (14).
It is well established that humoral immunity can be passively transferred from mother to baby, prenatally across the placenta and postnatally through the colostrum and breast milk in rodents and humans, although the relative contributions of these two modes of transfer differ between the species (see Discussion for more details). Importantly, mother-to-baby transfer of immunity has been shown to confer protection against a variety of pathogens (4, 32). For example, in the specific case of viral infections, immunoglobulin transfer through milk has been shown to be beneficial against infections by respiratory syncytial virus in humans (8), feline immunodeficiency virus in kittens (3), and herpes simplex virus (HSV) in mice (35). In contrast to these relatively clear-cut situations, HIV represents a more complex system, as in addition to infections occurring in utero and upon delivery, breast milk constitutes another route of transmission of the virus (2, 16, 34). Nevertheless, broad neutralizing antibody responses in the mother's sera (28, 29) and antiviral secretory IgMs in the mother's milk during the lactation period seem to be associated with a lower risk of mother-to-infant virus transmission (34), although strict correlations between antibody levels, protection, and breast milk transmission have not yet been established (25, 26). Taken together with other data (31), these observations suggest that a challenge for neonatal antiviral therapy may not only be the development of efficient maternal-vaccination strategies (31), but also that of efficient passive immunotherapies during late gestation and/or early life.
A recent follow-up of neonates with perinatally acquired HIV type 1 infection suggested that the developing immune systems of children may exhibit greater plasticity than those of adults to contain escape variants appearing during continually evolving chronic infection (10, 11). This observation challenges the common idea that the mature adult immune system is systematically more efficient at counteracting infections and also indirectly lends support to the concept that passive immunotherapies during late gestation and/or early life might also help infected patients prime their own protective immune responses, in addition to exerting an immediate antiviral effect. As a first step toward testing this possibility, we resorted to the FrCasE neonatal-infection model and studied how immunoglobulins from mothers who either displayed natural anti-FrCasE humoral responses or were subjected to passive immunotherapy could affect both viremia and the immune systems of infected pups until adulthood following transplacental and/or breastfeeding immunity transfer.
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Virus titers and 667 MAb neutralization activity assay. Viral titers were determined using a focal immunofluorescence assay (FIA) (33). Dilutions of virus-containing samples were added to 25% confluent Mus dunni cell cultures in the presence of 8 µg/ml of Polybrene. Cell-to-cell spread of replication-competent retroviruses was allowed to proceed for 2 days, and focus-forming units (FFU) were visualized by indirect immunofluorescence using the 667 MAb and fluorescein isothiocyanate-conjugated rabbit anti-mouse Ig antiserum. For assaying the virus neutralization activities of mouse sera, 4 x 102 FrCasE FFU were diluted in a 1:1 ratio with serum samples previously diluted in phosphate-buffered saline (PBS) (0.15 M NaCl, 0.01 M Na phosphate, pH 7) and incubated at 37°C for 1 h. The mixtures were used to infect 2 x 104 cells cultured in 12-well plates overnight. The infection medium was replaced by fresh culture medium, and the cells were allowed to reach confluence, at which time FFU were scored as described above.
Virus infection and follow-up of mice. Outbred Swiss mice were used in this study. Newborns were infected on day 3 using 100 µl of virus suspension containing 5 x 105 FFU/ml as previously described (13, 22). The mice were then examined for clinical signs of neurodegeneration daily until day 30 and weekly from then on. Blood was withdrawn from the retro-orbital sinus for viremia and anti-FrCasE serum immunoglobulin concentration assays. After clotting at room temperature for 15 min, blood samples were centrifuged at 6,000 x g for 15 min, and serum aliquots were stored at 20°C until required. For the virus challenge experiments, mice were injected intravenously with 300 µl of a FrCasE suspension containing 5 x 104 FFU/ml 30 weeks after the first infection. Blood samples were collected every 2 days during the first 2 weeks postchallenge to assay viremia and endogenous anti-FrCasE IgG concentrations. On day 18, the mice were sacrificed and the spleens were removed.
RNA purification, synthesis of cDNA, and reverse transcription (RT)-PCR analysis. Total RNA from splenocytes was prepared using RNAzol as specified by the supplier (Eurobio), and cDNA synthesis was performed as previously described (13). The env cDNA was amplified by PCR using the following oligonucleotides: 5'-TCT TAT TCG TGA CAG GAG GGT T-3' (sense) and 5'-ATA TGG AGG GTG GTT GTC TA-3' (antisense). PCR amplification was carried out using a hot-start protocol (3 min at 94°C) in a final volume of 50 µl containing 2 µl of each cDNA, 50 pmol of each primer, 1.5 mM MgCl2, and 2.5 units of Taq I polymerase (Eurobio, Paris, France). Forty-five cycles (94°C for 3 min, 65°C for 45 s, and 72°C for 45 s) for Env and 25 for ß-actin were followed by an elongation period of 10 min at 72°C. The nucleotide sequences of the amplification primers are available on request.
Flow cytometry analysis of infected splenocytes. Two sets of flow cytometry experiments were always conducted in parallel using either 667 or the rat 83A25 MAb, which recognize different Env epitopes with no difference in the final outcomes (9). The spleens were dissociated in cell culture medium and washed once by centrifugation and resuspension in PBS. Red blood cells were eliminated by adding the ACK lysis buffer (Biowhittaker). White blood cells were recovered by centrifugation, washed twice in PBS, and resuspended in Dulbecco's modified Eagle's medium containing 10% fetal calf serum. Samples of 5 x 105 cells were collected at room temperature for 1 h in the presence of 5 µg/ml of anti-Env MAb in 0.2% bovine serum albumin (BSA)-PBS, washed twice in 0.2% BSA-PBS, and incubated at room temperature with a secondary fluorescein isothiocyanate-conjugated rabbit anti-mouse IgG antibody for 1 h. The cells were washed twice in 0.2% BSA-PBS, resuspended in 500 µl of PBS, and analyzed using a FACScalibur flow cytometer (Becton Dickinson).
ELISA of anti-FrCasE antibodies. The 667 MAb and anti-FrCasE serum antibodies were assayed as described previously (13). Whereas animals of sufficient size were bled at the retro-orbital sinus, the blood of pups was collected following sacrifice. Milk samples were directly withdrawn from the stomachs of sacrificed pups. After resuspension in PBS plus 0.1% Tween 40, the samples were first sonicated to fully solubilize the proteins and then used for enzyme-linked immunosorbent assay (ELISA). The 667 and 678 MAbs used as standards for anti-FrCasE IgG2a and IgG1 assays, respectively, were diluted in PBS plus 0.1% Tween 40 containing 1% BSA. Peroxidase-conjugated anti-mouse IgG2a and IgG1 rabbit antisera (Serotec) were used as secondary antibodies.
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neutralizing MAb 667 for a few days (infected/treated animals) develop a sustained long-term protective immunity. This permits them to resist viral challenge, which is followed by the induction of a secondary immune response. Most often, the humoral arm of this response is predominantly of the IgG2a isotype, but it can occasionally be dominated by IgG1s (13). Here, as a first step, we followed anti-FrCasE antibody levels in both the sera and the milk of infected/treated mothers. Four-month-old infected/treated Swiss mice were mated, and their antiviral immune response was boosted upon intravenous reinoculation of FrCasE at midgestation (day 10 before birth). As our aforementioned passive immunotherapies were solely performed using a IgG2a/
MAb (13), we resorted here to animals displaying a predominantly IgG1 antiviral response as a means to address the abilities of other isotypes to induce a protective immune response in infected pups. The data presented in Fig. 1A indicate that, upon FrCasE recall, the humoral response was rapidly stimulated with a serum level of FrCasE-specific total IgGs (IgGt) shifting from approximately 1 to 3 mg/ml on the day of delivery. Importantly, it was predominantly of the IgG1 isotype and persisted for at least 14 days, (i.e., during the whole breastfeeding period), at which point weaning began. Consistently, milk anti-FrCasE antibodies, which reached their maximal level (approximately 250 µg/ml) within 1 week postpartum, were of the IgG1 isotype (Fig. 1B).
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FIG. 1. Anti-FrCasE immunoglobulins in the sera and milk of infected/treated mothers. (A) Anti-FrCasE IgG concentrations in sera during gestation and breastfeeding. Four-month-old females infected with FrCasE, treated with the 667 MAb during the neonatal period, and displaying prominent IgG1 humoral immune responses were mated. Blood samples were collected at various times before and after delivery for ELISA of anti-FrCasE IgGt, IgG2a, and IgG1. The values are presented as the mean plus standard error of the mean (SEM). (B) Anti-FrCasE IgG concentrations in milk during the breastfeeding period. Milk was collected from the stomachs of two neonates nursed by infected/treated mothers for each time point, and anti-FrCasE IgGs were assayed by ELISA in triplicate. The values are presented as the mean plus SEM.
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FIG. 2. Experimental scheme and analysis of proviral DNA in splenocytes. (A) Experimental scheme. Two infected/treated and two control noninfected/nontreated mice were mated at the same time to ensure synchronized deliveries. Immediately after birth and before breastfeeding could occur, the pups were distributed as follows: eight neonates from each litter were kept with their natural mothers for nursing, whereas another eight were transferred to a foster mother in order to have animals born to infected/treated mice nursed by control mice and vice versa. All neonates were infected with FrCasE 3 days after birth and followed for signs of illness, anti-FrCasE antibodies, and viral propagation using several criteria (see the text). Analysis at early time points required the sacrifice of two animals per time point. (B) RT-PCR detection of FrCasE Env mRNA in the spleen. Two animals per group were sacrificed at the indicated times. The spleens were recovered and pooled for RNA preparation. Subgenomic FrCasE Env mRNA accumulation was assayed by RT-PCR as described in Materials and Methods. ß-Actin was used as an internal invariant amplification standard. WM, molecular weight marker.
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TABLE 1. Physiopathological analysis of groups I to IV by 1 month post-FrCasE infection
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FIG. 3. Maternal anti-FrCasE immunoglobulins in sera of neonates after placental and/or breastfeeding immunity transfer. Anti-FrCasE IgG1s and IgG2as were assayed in the sera of group I (A and B), group II (C and D), and group III (E and F) animals. (A, C, and E) Concentrations of mothers' anti-FrCasE IgG1s and IgG2as in neonates' sera. The values are the mean ± standard error of the mean (SEM) of the data obtained from two animals sacrificed per time point. The maximal values measured for IgG2as in animals of groups I, II, and III were 195 ± 44.5, 473 ± 57, and 1 ± 0.7 µg/ml, respectively. (B, D, and F). Transfer efficiencies of anti-FrCasE IgG1s and IgG2as. The levels of immunoglobulins were calculated as percentages of immunoglobulins of the same isotype present in the mother's serum at the time of birth. The values are the mean ± SEM of the data obtained from two animals sacrificed per time point.
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Endogenous anti-FrCasE humoral responses in animals from groups I to III. Mice from groups I to III were then followed up till week 30 postinfection for their health status, viral propagation, and a possible endogenous humoral anti-FrCasE immune response. Neither signs of neurodegeneration nor signs of leukemia, as indicated by normal hematocrits and absence of spleen swelling, were observed during that period of analysis. Consistently, viremia also could not be detected. In contrast, all mice developed anti-FrCasE antibodies, but with significant differences between the various groups.
In the case of group III, the response, which was already high by week 5 postinfection, reached its maximal intensity by week 10 and, after a slight decrease, remained constant thereafter (Fig. 4A). Importantly, the higher concentration of anti-FrCasE antibodies at week 5 compared to that of day 14, as well as the fact that they were predominantly of the IgG2a isotype (Fig. 4B and C), i.e., of a different isotype from the maternal IgGs, unambiguously demonstrated that the anti-FrCasE antibodies were of endogenous origin. Interestingly, the humoral responses of group I and II animals, although sustained till the end of the analysis, were severalfold less intense than that of group III mice. The response of group I was the least intense (Fig. 4A). Moreover, the rise of anti-FrCasE IgG2as did not appear before week 10 in group II and week 23 in group I (Fig. 4B and C). The appearance of IgG2as clearly indicated the induction of endogenous antiviral responses in these two groups of animals. On the basis of our data, however, it was not possible to exclude the possibility that these responses were initiated later than in group I mice: in contrast to the transient accumulation of anti-FrCasE IgG1s seen between weeks 5 and 15 in group I sera, anti-FrCasE IgG1s decreased from weeks 5 to 10 in group II and III mice. It is therefore reasonable to assume that they corresponded to antibodies of maternal origin received in large amounts during breastfeeding and not to newly produced antibodies (Fig. 3). Finally, we compared the specific in vitro neutralization activities of anti-FrCasE antibodies generated by the various groups of mice. That of group III mice was 10-fold less than those of group I and II animals, with 50% inhibitory concentrations of 100 and 10 ng/ml, respectively, in the FIA used (Fig. 4D).
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FIG. 4. Anti-FrCasE immunoglobulin responses in group I to III mice to week 30 postinfection. (A) IgGts. Anti-FrCasE IgGts were assayed by ELISA in the sera of 12 animals per group from week 5 to week 30 postinfection. Assays were performed in triplicate, and the values are presented as the mean ± standard error of the mean. (B and C) Anti-FrCasE IgG2a and IgG1s, respectively. The same sera as in panel A were used for assay of anti-FrCasE IgG2as and IgG1s. (D) Neutralization activities of sera of group I to III mice at week 30. Neutralization activity was assayed by FIA as explained in Materials and Methods, and the results are expressed relative to the amount of anti-FrCasE IgGt assayed for panel A.
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Absence of detectable viremia and stimulation of the antiviral humoral response in FrCasE-challenged animals of groups I to III. Next, we tested whether mice from groups I to III could resist an FrCasE challenge 30 weeks after the first infection. To this end, the virus was administered to three mice from each group, as well as to three naive age-matched control animals, and serum samples were collected at different times for 18 days to assay both viremia and anti-FrCasE antibodies. High, but transient, virus titers were measured in control animals, whereas no viremia was detected in any of the mice from groups I to III (Fig. 5A). A slow and modest rise in anti-FrCasE IgGs was observed in control animals on and after day 14 postchallenge, which contrasted with a fast and robust increase in those from groups I and III (Fig. 5B). This suggested a normally occurring primary immune response in the control group and a strong response in the other two. IgG2a was the main antibody subclass contributing to these responses in all animals, whether they were subjected to a challenge or a primary infection (data not shown). Mice from group II showed a lower increase (30 to 40%) of anti-FrCasE antibodies than those of groups I and III after virus challenge. Whether this was due to a more protective preexisting anti-FrCasE immunity in these animals, however, could not be studied. All mice were sacrificed after 18 days for RT-PCR analysis of FrCasE Env mRNA expression in the spleen. No signal was detected in the challenged mice from groups I to III, except for one animal in group III, which showed a weak signal (Fig. 5C). In contrast, strong signals were seen in the three control mice (Fig. 5C). In conclusion, our data support the idea that animals from groups I to III all resisted reinfection by FrCasE due to a preexisting antiviral immune response, which was clearly restimulated, albeit more strongly in groups I and III than in group II.
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FIG. 5. Viremia, anti-FrCasE immunoglobulins, and FrCasE RNA in challenged group I to III mice. (A) Viremia. FrCasE was administered to three mice from each group and three control animals in week 30. Serum samples were collected at different times for 18 days, and viremia was assayed by FIA. (B) Assay of anti-FrCasE IgGs. IgGts were assayed by ELISA. The values are presented as the mean of the values obtained for each mouse of each group ± standard error of the mean. (C) FrCasE Env mRNA in the spleen. The presence of Env mRNA was assayed by RT-PCR in total spleen RNAs from animals sacrificed 18 days postinfection. ß-Actin was used as an internal standard of amplification.
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FIG. 6. Pre- and postnatal treatment of mothers with the 667 MAb and follow-up of 667 accumulation in neonates. The 667 MAb (30 µg/injection) was administered intraperitoneally twice a week to two 4-month-old females during a period extending from 14 days before to 10 days after delivery. Newborns were infected with FrCasE 3 days after birth and were nursed by their mothers without any additional treatment. (A) 667 levels in the sera and milk of treated mothers. 667 MAb levels were determined by ELISA in serum samples from mothers collected at different times and in milk recovered from the stomachs of two nursed pups sacrificed for this purpose per time point. (B) 667 levels in the sera of nursed pups. The 667 MAb was assayed in the sera of the same pups used for panel A. After day 14, serum 667 was assayed from blood samples withdrawn at various times. The values are the results of two experiments performed in triplicate and are presented as the mean ± standard error of the mean.
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Here, we have examined whether such an acquired anti-FrCasE immunity could be maternally transmitted via the placenta and/or breastfeeding to generate a long-term immune response comparable to that occurring upon 667 treatment of infected neonates. Our data show that this is the case, as regardless of the immunity transmission mode, all animals escaped neurodegeneration, remained healthy with no detectable sign of leukemia, developed an endogenous anti-FrCasE humoral response, and showed a clear antiviral response in a challenge experiment, which was accompanied by an easily detectable secondary immune response.
Although both mice that received maternal antiviral immunity via the placenta and those that received immunity via breastfeeding did not develop pathology and were able to mount secondary antiviral responses, significant differences were still observed. Thus, (i) FrCasE was not eradicated in the former group, whereas it remained undetectable in the latter; (ii) serum anti-FrCasE IgGs of the former group of animals accumulated in larger amounts; and (iii) they were less neutralizing than those of the latter group. It is reasonable to assume that the differences in levels of maternally transmitted antiviral antibodies were responsible for differential stimulation of the endogenous immune system by influencing the quantity, nature, and duration of presentation of viral antigens. Thus, the much smaller amounts of maternal antiviral antibodies received in the case of placental transfer permitted longer exposure to nonneutralized propagating virus particles. In contrast, a larger fraction of virus particles engaged in immune complexes may have led to a stronger stimulation of APCs of breastfed animals, albeit for a shorter period due to faster viremia control. Further studies are still necessary to formally demonstrate the latter point. It is, however, worth noting that introduction of viruses into hosts with preexisting antiviral antibodies is known to result in the formation of antigen-antibody complexes in a variety of settings and that high maternal antibody-antigen ratios are important for optimal activation of neonatal APCs. This activation could be a key element for induction of an adult-like Th1 response in early life characterized, in particular, by a prominent IgG2a humoral contribution (31).
The observation that protection against a neonatally inoculated murine retrovirus could be achieved by maternal antibodies is not entirely new. Saha et al. (27) have already suggested that protection efficiency may be related to the levels of antiviral antibodies, using ts1, a thermosensitive mutant of the Moloney murine leukemia virus TB strain that induces fatal immunodeficiencies and neurological disorders. These experiments, however, significantly differed from ours on several points. First, maternal immunity was naturally acquired upon infection by ts1 in adulthood and was not induced by MAb-based immunotherapy of infected pups, which most likely triggers a more optimal antiviral response (13). Second, the authors did not investigate whether the mothers' antiviral response was isotype polarized, in contrast to our study, which showed that a predominant IgG1-type maternal immunity can lead to a predominant IgG2a response in infected neonates. Third, even though all the animals did not develop disease after ts1 infection, as in our experiments, only a fraction of them were protected from neurodegeneration upon placental immunity transfer only (although the authors acknowledged that some form of protection may have been conferred by antibody-rich colostrum before neonates born of immune mothers were moved to nonimmune foster mothers). The better protective effect observed in our study, therefore, is suggestive of a stronger antiviral response generated in the case of mothers infected and treated with a neutralizing MAb during the neonatal period. Finally, the authors did not study whether infected neonates, after blunting of viral replication by maternal antibodies, developed a protective immune response capable of both containing the virus after infection and blocking virus propagation in a later virus challenge, as reported here for FrCasE. Determining whether this would be the case would be interesting, as it would indicate that our observations could be extended to both other retroviruses and other means of induction of antiviral immune responses.
Generation and nature of the anti-FrCasE response in infected animals receiving maternal immunity.
In our previous work (13), we reported that the majority of mice infected neonatally by FrCasE and treated with the 667 IgG2a/
MAb for a few days developed a sustained long-term protective humoral immunity dominated by IgG2as. Here, we have taken advantage of the few mice that developed a dominant anti-FrCasE IgG1 response as a first approach to test whether induction of the protective response could be induced by isotypes other than IgG2a. Our data support this possibility, as all pups that received maternal antiviral immunity, whether via the placenta or via breastfeeding, remained healthy and developed their own anti-FrCasE responses. Even though IgG2as were transferred to pups less efficiently than IgG1s, further work with anti-FrCasE MAbs of various isotypes is still necessary to demonstrate this point formally, as a significant fraction of antibodies transmitted by the mothers, in addition to being polyclonal, were IgG2as. We are currently developing such MAbs, which will be used in direct passive immunotherapy of infected neonates, as in our previous study (13), as well as in indirect therapy of pregnant mice, as described here.
It is noteworthy that all mice that received either natural anti-FrCasE antibodies or the 667 MAb from their mothers developed a dominant anti-FrCasE IgG2a response. This is interesting for at least two reasons. First, as already mentioned, IgG2a is the most potent isotype for complement cell lysis, for binding to Fc receptors found on a variety of cells of the immune system, and for antibody-dependent cell-mediated cytotoxicity. This makes it the antibody type with the highest activity against both viruses of various sorts and infected cells (see reference 13 for references). Second, the presence of high concentrations of IgG2as is suggestive of Th1-biased helper T-cell responses that are usually also contributed by cytotoxic-T-lymphocyte responses. It will, therefore, be interesting in future experiments to determine whether such cellular responses directed against FrCasE-infected cells have been generated and have participated in virus containment in protected animals. As mice born of immune mothers but nursed by nonimmune foster mothers showed a weaker antiviral effect than those nursed by their biological mothers, another point of interest will be to determine whether such a cytotoxic-T-lymphocyte response might be attenuated, or absent, in the former group of animals.
Therapeutic interest of treating mothers with antiviral MAbs during pregnancy and breastfeeding. Our observation that administration of the 667 MAb to pregnant mice and during breastfeeding fully protects infected pups from developing any illness and permits the induction of a protective immune response raises two questions with regard to a possible human application: can such an approach be of interest to combat human neonatal infections by infected mothers, and how must the treatments be designed? As neutralizing MAbs against HIV are available, and as neutralization of simian immunodeficiency virus has been well deciphered in animal models, HIV should be considered the first target for such an approach. Indeed, passive-immunotherapy trials with a combination of carefully selected MAbs with HIV-neutralizing properties have already been conducted. Despite the fact that two of the MAbs used (2F5 and 4E10) were later shown to display some anti-self reactivity, as they also recognize the phospholipid cardiolipin (15), encouraging outcomes were seen in humans and impressive protection of primates was obtained, especially in the context of neonatal infection (12, 19, 26). Treatment of pregnant macaque females with combinations of anti-HIV MAbs was even reported in one study (1). The experimental setting was, however, considerably different from ours, and whether MAbs might have affected the endogenous antiviral immune responses of infected newborns was not considered. Whatever the case, the application of MAb-based immunotherapy/immunoprophylaxis to humans may be complicated by the fact that mother-to-child transmission can occur, not only at delivery, but also late in utero and by breastfeeding. In the case of intrapartum infection, it can be expected that immunotherapy of the mother during late gestation would be beneficial to both the mother herself and, via MAb transplacental transfer, to her child. However, as systemic transfer of breast milk antibodies does not occur in humans, breastfed babies of infected mothers could be protected more efficiently by direct administration of MAbs rather than by administration of these MAbs to the lactating mothers. Further analysis, first in monkeys, will be necessary to establish whether passive immunotherapy of lactating mothers sufficiently reduces the risk of mucosal transmission of viruses to breastfed infants. As for the neonates, who would accumulate the MAbs received from their treated mothers during pregnancy and those administered directly after birth, it would be interesting to determine whether this two-step treatment would help them mount a long-lasting protective antiviral response in the case of contamination, as observed for FrCasE (reference 13 and this work). This is particularly important, since a follow-up of neonatally HIV type 1-infected infants has recently shown that the immune system of young children is unexpectedly reactive for generating efficient and evolving antiviral responses (11). In addition, two other points must be taken into consideration. First, the antibody compositions of colostrums and milk differ between species (18). For example, IgGs constitute the prominent antibody class in rodent milk and colostrum, whereas they are not abundant in human milk, in which secretory IgA is the main isotype and serves as a first-line defense in mucosal areas (34). Second, the relative contributions of placental and breastfeeding transfer of maternal humoral immunity are not equivalent in humans and mice. Thus, in rodents, the transfer of IgGs via breastfeeding is quantitatively more important than via the placenta (as illustrated here for anti-FrCasE antibodies in Fig. 3), in contrast to primates, due to differences in placentation (30, 32). This indicates that, on the one hand, in humans, the highest transmission efficiency of the therapeutic IgG-type MAbs should be achieved during late pregnancy and not during breastfeeding and, on the other hand, the therapeutic strategy offering the best chances of both success and safety, with regard to contamination by milk, may be immunotherapy of mothers during late pregnancy, followed by direct administration of the MAbs to neonates.
We are grateful to our colleagues J. Hernandez, H.-A. Michaud, P. Van de Perre, and V. Kalatzis for helpful discussions and critical readings of the manuscript.
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