Subclinical mastitis occurs frequently in association with dramatic changes in inflammatory/anti-inflammatory breast milk components

BACKGROUND: Subclinical mastitis (SCM) is a frequent, but poorly ch.aracterized entity that may influence immune development of breastfed infants. Mechanisms driving the emergence of SCM and changes in immunological content of human milk during SCM remain to be explored. In this study, the breast milk environment was to describe'during SCM. METHODS: One hundred and ten samples of mature breast milk were collected from 44 healthy, HIV-negative mothers, included in a large infant feeding intervention cohort (ANRS 1271Nertical Transmission Study). Immune markers related to inflammatory/anti-inflammatory balances and secreted in response to bacterial exposure were explored in SCM breast milk samples (Na/K ratio > 1) and compared to non-SCM controls. RESULTS: SCM was observed in 23% of women (95% confidence interval (CD: 21-24) and associated with higher levels of inflammatory markers ((beta 2 microgobulin, PS100A9, TNF-alpha(,) IL-6, IL-8, IL-17, and RANTES) and Th1-related cytokines (IL-2R, IL-12p40/70, IFN-alpha, IFN-gamma ,CXCL-9, and IP-10). High levels of factors secreted in response to bacteria and li,popolysaccharide (LPS) exposure were observed in SCM breast milk samples (MIP-1 alpha, MIP-1 beta, LPS binding protein, alpha-defensins, and antileukoproteinase 1). CONCLUSION: SCM is associated with important changes in breast milk microenvironment, with a proinflammatory/Th1cytokine predominant profile. During SCM, cytokine imbalances in breast milk may have a notable influence on mucosal immune system of the infant early in life.