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Med."],"abstract":"<jats:p>Breastfeeding is recommended by the World Health Organization for at least 6 months up to 2 years of age, and breast milk protects against several diseases and infections. Intriguingly, few viruses are transmitted <jats:italic>via<\/jats:italic> breastfeeding including Human T-cell leukemia virus Type 1 (HTLV-1). HTLV-1 is a highly oncogenic yet neglected retrovirus, which primarily infects CD4<jats:sup>+<\/jats:sup> T-cells <jats:italic>in vivo<\/jats:italic> and causes incurable diseases like HTLV-1-associated inflammatory conditions or Adult T-cell leukemia\/lymphoma (ATLL) after lifelong viral persistence. Worldwide, at least 5\u201310 million people are HTLV-1-infected and most of them are unaware of their infection posing the risk of silent transmissions. HTLV-1 is transmitted <jats:italic>via<\/jats:italic> cell-containing body fluids such as blood products, semen, and breast milk, which constitutes the major route of mother-to-child transmission (MTCT). Risk of transmission increases with the duration of breastfeeding, however, abstinence from breastfeeding as it is recommended in some endemic countries is not an option in resource-limited settings or underrepresented areas and populations. Despite significant progress in understanding details of HTLV-1 cell-to-cell transmission, it is still not fully understood, which cells in which organs get infected <jats:italic>via<\/jats:italic> the oral route, how these cells get infected, how breast milk affects this route of infection and how to inhibit oral transmission despite breastfeeding, which is an urgent need especially in underrepresented areas of the world. Here, we review these questions and provide an outlook how future research could help to uncover prevention strategies that might ultimately allow infants to benefit from breastfeeding while reducing the risk of HTLV-1 transmission.<\/jats:p>","DOI":"10.3389\/fmed.2022.867147","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T06:50:36Z","timestamp":1646981436000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Milk Transmission of HTLV-1 and the Need for Innovative Prevention Strategies"],"prefix":"10.3389","volume":"9","author":[{"given":"Sebastian","family":"Millen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea K.","family":"Thoma-Kress","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1016\/S0140-6736(18)30974-7","article-title":"Time to eradicate HTLV-1: an open letter to WHO.","volume":"391","author":"Martin","year":"2018","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2012.00388","article-title":"Epidemiological aspects and world distribution of HTLV-1 infection.","volume":"3","author":"Gessain","year":"2012","journal-title":"Front Microbiol."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009717","article-title":"Blocking HTLV-1\/2 silent transmission in Brazil: current public health policies and proposal for additional strategies.","volume":"15","author":"Rosadas","year":"2021","journal-title":"PLoS Negl Trop Dis."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0008761.,","article-title":"Health state utility values in people living with HTLV-1 and in patients with HAM\/TSP: the impact of a neglected disease on the quality of life.","volume":"14","author":"Rosadas","year":"2020","journal-title":"PLoS Negl Trop Dis."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.812016","article-title":"HTLV-1 and co-infections.","volume":"9","author":"Rosadas","year":"2022","journal-title":"Front Med."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.00999","article-title":"Mother-to-child HTLV-1 transmission: unmet research needs.","volume":"10","author":"Rosadas","year":"2019","journal-title":"Front Microbiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"152","DOI":"10.2183\/pjab.87.152","article-title":"Establishment of the milk-borne transmission as a key factor for the peculiar endemicity of human T-lymphotropic virus type 1 (HTLV-1): the ATL prevention program Nagasaki.","volume":"87","author":"Hino","year":"2011","journal-title":"Proc Jpn Acad Ser B Phys Biol Sci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1093\/jpids\/piu070","article-title":"Mother-to-child transmission of human T-cell lymphotropic viruses-1\/2: what we know, and what are the gaps in understanding and preventing this route of infection.","author":"Carneiro-Proietti","year":"2014","journal-title":"J Pediatric Infect Dis Soc."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-016-3366-5","article-title":"Human T-lymphotropic virus type 1 infection in an indigenous australian population: epidemiological insights from a hospital-based cohort study.","volume":"16","author":"Einsiedel","year":"2016","journal-title":"BMC Public Health."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)93181-l","article-title":"HTLV-I transmission from mother to fetus via placenta.","volume":"340","author":"Fujino","year":"1992","journal-title":"Lancet."},{"key":"B11","doi-asserted-by":"publisher","first-page":"6171","DOI":"10.1172\/JCI135525","article-title":"HTLV-1 targets human placental trophoblasts in seropositive pregnant women.","volume":"130","author":"Tezuka","year":"2020","journal-title":"J Clin Invest."},{"key":"B12","year":"2021","journal-title":"Human T-Lymphotropic Virus Type 1: Technical Report. 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