Efficacy of mast cell directed therapies in irritable bowel syndrome: a systematic review

Background and study aim

Lately, mast cells (MCs) are increasingly implicated in the pathophysiology of irritable bowel syndrome (IBS). The aim of this systematic review was to assess the efficacy of mast cell directed therapies in reducing the main symptoms of IBS: abdominal pain and changes in stool frequency or consistency.

Patients and methods

Pubmed, Web of Science and Scopus were searched until December 19, 2022. Trials evaluating the efficacy of mast cell directed therapies, compared to placebo or any form of control group, were included. Trial selection was performed in two stages: screening titles and abstracts and reviewing full papers identified as relevant, taking into account the inclusion criteria.

Results

The search strategy identified a total of 1.384 citations. Eleven trials on 943 IBS patients and 197 controls were included: ten randomized controlled trials, two of which cross-over trials, and one cohort study. Of the 11 studies included in the systematic review, only three studies were found to be at low risk of bias. This limited evidence suggests a significant overall improvement in the key symptoms after treatment with disodium cromoglycate, ebastine, ketotifen or palmitoylethanolamide-polydatin compared to control groups.

Conclusions

Mast cell modulating therapies could be of significant value in therapy for IBS patients. Further high-quality research is needed to establish the therapeutic efficacy of mast cell targeted therapies in order to draw robust conclusions and improve the clinical management of irritable bowel syndrome.

Structural Problems Demand Structural Solutions: Addressing Domestic and Family Violence

Despite the global recognition of domestic and family violence (DFV) as an outcome of unequal power relations between men and women, dominant frameworks for addressing DFV do not target the structural nature of the problem. Drawing on research conducted in partnership with the Federation of Community Legal Centres in Australia, we argue that a distinction needs to be made between what is genuinely structural change and what is system reform. Using intersectional feminist and decolonial theory and praxis, we reflect on what a structural approach to DFV could look like: one that confronts and actively tries to change the structural conditions that give rise to women's individual and collective vulnerability and victimization.

MRGPRX2 and Immediate Drug Hypersensitivity: Insights From Cultured Human Mast Cells

BACKGROUND AND OBJECTIVES

Mast cell (MC) degranulation via activation of the Mas-related G protein-coupled receptor X2 (MRGPRX2) plays a key role in immediate drug hypersensitivity (IDH). However, data in humans are limited to observations in specific cell lines. Objective: To study the usefulness of silencing MRGPRX2 in human MCs with the aim of further unveiling the MRGPRX2 pathway in IDH.

METHODS

MCs were cultured from CD34+ progenitor cells obtained from peripheral blood (PBCMCs) and incubated with substance P (as a positive control), rocuronium, moxifloxacin, morphine, or amoxicillin. Immunophenotyping of the cells included flow cytometry and microscopy analyses of the expression of CD117, CD203c, and MRGPRX2. Intracellular calcium was measured using Fluo-4. Degranulation was analyzed by quantifying CD63 expression. For MRGPRX2 silencing, MCs were electroporated with Dicer small interference RNAs.

RESULTS

Incubation of MCs with substance P, morphine, and moxifloxacin increased intracellular calcium levels and triggered MC degranulation, which, for the drugs, is almost completely abolished by selective MRGPRX2 silencing. Despite an increase in intracellular calcium in MRGPRX2+ cells, incubation with nontoxic concentrations of rocuronium does not result in degranulation of PBCMCs. Amoxicillin has no effect on PBCMCs.

CONCLUSION

The use of MRGPRX2 silencing in human MCs can provide important insights into the role of MRGPRX2 in the pathogenesis of IDH. As induction of calcium signals does not necessarily translate into a secretory response, measurement of the degranulation reaction seems more meaningful in the context of drug testing.

[Effectiveness of anti-stigma interventions regarding severe mental illness: a systematic literature review]

Stigma is one of the greatest challenges facing people with severe mental illness (smi) and can have profound psychological, social and professional consequences.<br/> AIM: To systematically review the evidence of effectiveness of anti-stigma interventions (anti-stigma campaigns and specific interventions to reduce public stigma and self-stigma) for people with smi and to make recommendations for clinical practice.<br/> METHOD: A systematic literature search for individual studies and reviews concerning the efficacy of interventions that reduce stigma for people with smi.<br/> RESULTS: Anti-stigma interventions have small-to-medium effects. Although head-to-head comparisons do not show a clear advantage for educational or contact interventions, results suggest that the elements of contact, recovery and continuity (for public stigma) and psycho-education (for self-stigma) may yield the greatest effects. Due to the short follow-up period of most studies, there is limited evidence on the long-term effectiveness of these interventions. More specifically, it remains unknown whether these interventions lead to changes in actual behavior.<br/> CONCLUSION: Anti-stigma interventions have limited effects on knowledge, attitudes and behavior. Several methodological shortcomings, as well as short follow-up periods in most studies, preclude making firm conclusions.

Long-term donor site morbidity in head and neck cancer patients and its impact on quality of life: a cross-sectional study

Modern head and neck reconstructive surgery offers a multitude of different reconstructive options. In such cases, donor site morbidity is an important factor in the affected patient's decision-making. The aim of this study was to perform an objective comparison of donor site morbidity for the five most frequent microvascular donor sites in head and neck reconstructive surgery (radial forearm, anterolateral thigh, fibula, iliac crest, and scapula) using a uniform testing system. In this cross-sectional study, 117 donor sites were analyzed (106 for malignant disease and 11 for non-malignant disease): 73 radial forearm, 14 scapula, 12 anterolateral thigh, 10 fibula, and eight iliac crest. Testing consisted of range of motion, muscle strength, and sensation. The non-affected side served as the control. Quality of life was assessed using the Washington Quality of Life Questionnaire version 4 in its German translation. Range of motion was restricted in 15 cases (12.8%). Muscle strength was decreased in 58 cases (49.6%). Sensation was reduced in 70 cases (60%). Concerning quality of life, 31.2% of patients were limited in their daily activities. The scapula flap showed the highest incidence of overall donor site morbidity. However, correlation between objective and subjective donor site impairment was weak and the majority of patients experienced only minor limitations.

Immediate moxifloxacin hypersensitivity: Is there more than currently meets the eye?

Immediate drug hypersensitivity reactions (IDHR) to moxifloxacin constitute a pathomechanistic conundrum and a diagnostic challenge. Our objective was to study whether simultaneous phenotyping and quantification of histamine release might add to our knowledge about the basophil activation properties of moxifloxacin and constitute a reliable diagnostic aid. Fifteen patients with an IDHR to moxifloxacin and nine moxifloxacin challenged controls were selected. All had a basophil activation test (BAT) with moxifloxacin. Flow cytometric analysis of basophil responses implied labeling for CD63, CD203c, and intracellular histamine. Unlike tolerant challenged controls, basophilic upregulation of CD203c in response to moxifloxacin was observed in seven of 15 patients. Only two of these seven patients demonstrated appearance of CD63 and release of histamine. In the remainder eight patients, no basophil responses were demonstrable. In conclusion, immediate hypersensitivity to moxifloxacin might involve mechanisms difficult to capture by traditional CD63-/CD203c-based BAT. Deciphering the complexity of quinolone IDHR seems mandatory.

Cannabis sativa allergy: looking through the fog

IgE-mediated Cannabis (C. sativa, marihuana) allergy seems to be on the rise. Both active and passive exposure to cannabis allergens may trigger a C. sativa sensitization and/or allergy. The clinical presentation of a C. sativa allergy varies from mild to life-threatening reactions and often seems to depend on the route of exposure. In addition, sensitization to cannabis allergens can result in various cross-allergies, mostly for plant foods. This clinical entity, designated as the 'cannabis-fruit/vegetable syndrome', might also imply cross-reactivity with tobacco, natural latex and plant-food-derived alcoholic beverages. Hitherto, these cross-allergies are predominantly reported in Europe and appear mainly to rely upon cross-reactivity between nonspecific lipid transfer proteins or thaumatin-like proteins present in C. sativa and their homologues, ubiquitously distributed throughout plant kingdom. At present, diagnosis of cannabis-related allergies predominantly rests upon a thorough history completed with skin testing using native extracts from crushed buds and leaves. However, quantification of specific IgE antibodies and basophil activation tests can also be helpful to establish correct diagnosis. In the absence of a cure, treatment comprises absolute avoidance measures. Whether avoidance of further use will halt the extension of related cross-allergies remains uncertain.

Amélioration fonctionnelle sous palmitate de paliperidone à doses flexibles chez des patients aigus ou non aigus atteints de schizophrénie, après échec d’un traitement par antipsychotiques oraux

Objectifs

Évaluer l’amélioration fonctionnelle chez des patients atteints de schizophrénie sous palmitate de paliperidone (PP) à doses flexibles après échec d’un traitement par antipsychotiques oraux.

Méthodes

Analyse menée dans deux sous-groupes de patients atteints de schizophrénie : aigus (n = 202) et non aigus (n = 593) après échec d’un traitement par antipsychotiques oraux, inclus dans une étude internationale, prospective, de six mois.

Critères d’évaluation

Changement du score total à la PANSS (Positive and Negative Syndrome Scale), à la PSP (Personal and Psychosocial Performance scale), et à la Mini-ICF-APP (Mini International Classification of Functionality, Disability and Health Rating for Activity and Participation Disorders in Psychological Illnesses).

Résultats

Les deux sous-groupes ont présenté une amélioration significative du score total à la PANSS : de 98,5 ± 20,1 à l’inclusion à 67,4 ± 24,0 à la fin de l’étude (diminution moyenne = −31,0 ± 29,0) chez les patients aigus et de 71,5 ± 14,6 à 59,7 ± 18,1 (diminution moyenne = −11,7 ± 15,9) chez les patients non aigus. Cette réponse thérapeutique était associée à une augmentation significative du score total à la PSP de 43,9 ± 15,0 à 62,9 ± 17,1 (amélioration moyenne = 19,0 ± 18,7, p <0,0001) chez les patients aigus, et de 58,1 ± 13,4 à 66,1 ± 15,7 (amélioration moyenne =8,0 ± 14,0, p < 0,0001) chez les patients non aigus. Il existait une amélioration significative du score à la Mini-ICF-APP qui diminuait de 26,8 ± 8,5 à 18,5 ± 9,8 (diminution moyenne = −8,0 ± 10,4, p < 0,0001) chez les patients aigus et de 19,8 ± 7,9 à 15,9 ± 8,8 (diminution moyenne = −4,0 ± 7,5, p < 0,0001) chez les patients non aigus.

Conclusions

L’amélioration symptomatique sous PP à doses flexibles chez des patients aigus ou non-aigus atteints de schizophrénie après échec d’un traitement par antipsychotique oral s’est accompagnée d’une amélioration fonctionnelle cliniquement significative.