1
|
Webb R, Uddin N, Constantinou G, Ford E, Easter A, Shakespeare J, Hann A, Roberts N, Alderdice F, Sinesi A, Coates R, Hogg S, Ayers S. Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare. BMJ Open 2023; 13:e066703. [PMID: 37474171 PMCID: PMC10360426 DOI: 10.1136/bmjopen-2022-066703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care. OBJECTIVES To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy. DESIGN A meta-review of systematic reviews. REVIEW METHODS Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating. RESULTS A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators. CONCLUSION The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals. PROSPERO REGISTRATION NUMBER CRD42019142854.
Collapse
Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, City University, London, UK
| | - Nazihah Uddin
- Centre for Maternal and Child Health Research, City University, London, UK
| | | | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Oxford, UK
| | - Andrea Sinesi
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), University of Stirling, Stirling, UK
| | - Rose Coates
- Centre for Maternal and Child Health Research, City University, London, UK
| | - Sally Hogg
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City University, London, UK
| |
Collapse
|
2
|
Rahmani S, Caminero A, Hann A, Galipeau HJ, Anderson RP, Chirdo F, Didar TF, Verdu EF. A7 OPPORTUNISTIC PATHOGEN MODULATION OF GLUTEN-REACTIVE CD4+ T CELL ACTIVATION BY DQ2-EXPRESSING ORGANOID MONOLAYERS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991225 DOI: 10.1093/jcag/gwac036.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Bacteria have recently emerged as additional modulators of inflammation in CeD. We have shown that the elastase-like producing opportunistic pathogen, Pseudomonas (P) aeruginosa, partially metabolizes gluten into peptides that translocate the mucosal barrier and retain their immunogenicity. We previously demonstrated that organoid monolayers derived from DR3-DQ2 mice carrying the CeD risk gene HLA-DQ2 express MHC class II (HLA-DQ2) and co-stimulatory molecules under induced inflammatory conditions, priming the monolayers for gluten antigen presentation. Here we investigate the activation of human (h)CD4+ T cell co-cultured with DQ2 monolayers stimulated with gluten pre-digested, or not, by bacterial elastase. Purpose To investigate whether organoid monolayers expressing DQ2 activate T cell differentially in the presence of gluten metabolized by elastase-like producing Pseudomonas aeruginosa. Method Organoid monolayers were derived from the duodenum and proximal jejunum of gluten-sensitized DR3-DQ2 mice, following the gluten sensitization protocol previously described1. Monolayers were then stimulated with IFN-γ for 24h to induce MHC-II and co-stimulatory molecules expression. Splenic T-cell expressing hCD4 from gluten-sensitized DR3-DQ2-hCD4 mice were then co-cultured with monolayers in the presence of deamidated pepsin-trypsin-digested (DAPT)-gluten or Pseudomonas aeruginosa PA14 (WT)-digested DAPT-gluten. As a control, DAPT-gluten was incubated with a P. aeruginosa lasB mutant strain that lacks elastase-like activity (lasB△/△). Co-cultures stimulated with DAPT-gluten alone or WT-media were used as additional controls. Result(s) Increased hCD4+ T-cell proliferation was observed in co-cultures stimulated with WT-digested gluten compared with lasB△/△-digested gluten (p<0.0001), gluten alone (p=0.0002) or WT-media (p<0.0001). hCD4+ T cell co-cultured with organoid monolayers stimulated with WT-digested gluten, had an activated phenotype with increased expression of CD69, CD44 and CD25 versus those stimulated with gluten, lasB△/△-digested gluten, or WT-media. Increased levels of pro-inflammatory and T helper type 1 (Th1)-associated cytokines were detected in the supernatant of the co-cultures stimulated with WT-digested gluten, including IL-2, IFN-γ, IL-6, TNF-α, IL-1α, IL-β, and IL-15. Conclusion(s) Using a novel HLA-DQ2-expressing organoid monolayer, we demonstrate elastase-like producing P. aeruginosa, enhanced activation and proliferation of hCD4+ T cell through gluten metabolism. This in vitro model constitutes a relevant tool for studying microbial triggers and drivers of intestinal epithelial dysfunction in CeD. 1. Galipeau, H. J. et al. 1. Galipeau, H. J. et al. Sensitization to Gliadin Induces Moderate Enteropathy and Insulitis in Nonobese Diabetic-DQ8 Mice. J. Immunol.187, 4338–4346 (2011). Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; Canadian Celiac Disease Association (CCA) Disclosure of Interest None Declared
Collapse
Affiliation(s)
- S Rahmani
- Biomedical Engineering, Farncombe Family Digestive Health Research Institute
| | - A Caminero
- Farncombe Family Digestive Health Research Institute , McMaster University, Hamilton, Canada
| | - A Hann
- Farncombe Family Digestive Health Research Institute , McMaster University, Hamilton, Canada
| | - H J Galipeau
- Farncombe Family Digestive Health Research Institute , McMaster University, Hamilton, Canada
| | - R P Anderson
- Wesley Medical Research, The Wesley Hospital, Auchenflower, Australia
| | - F Chirdo
- Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
| | - T F Didar
- Biomedical Engineering , McMaster University, Hamilton, Canada
| | - E F Verdu
- Farncombe Family Digestive Health Research Institute , McMaster University, Hamilton, Canada
| |
Collapse
|
3
|
Jackson K, Galipeau H, Hann A, Coombes B, Hosseinidoust Z, Verdu E. A32 PHAGE TREATMENT DELAYS ONSET OF CROHN’S-ASSOCIATED E. COLI DRIVEN COLITIS IN MICE COLONIZED WITH A DEFINED MICROBIOTA. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991369 DOI: 10.1093/jcag/gwac036.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Opportunistic pathogens have been postulated to drive dysregulated inflammation in inflammatory bowel disease (IBD). Indeed, adherent-invasive Escherichia coli (AIEC) isolated from IBD patients have pathobiont and pro-inflammatory characteristics. Current treatments for IBD suppress the immune response and do not target key microbial drivers, therefore novel strategies are required. Purpose Our aim was to determine whether bacteriophage therapy targeted against AIEC could reduce the severity of E. coli-driven colitis in gnotobiotic mice. Method Adult germ-free C57BL/6 mice were colonized with altered Schaedler-like flora (ASF) and E. coli NRG857c, a Crohn’s disease-associated bacterial isolate. Three weeks later, mice were treated with daily phage (selected by killing curves bioassays against E. coli NRG857c) or PBS for 2 weeks (n=6/group). Mice were then exposed to low-dose dextran sulfate sodium (2%; DSS) in drinking water for 5 days, followed by 2 days of water. PBS-treated mice (n=6) that received no DSS were used as additional negative controls. Mice were monitored daily for weight, stool consistency, and occult blood. At sacrifice, colon tissue was collected for histological analysis and fecal contents were cultured to determine bacterial load. In separate experiments, C57BL/6NTac-Il10em8Tac (IL-10-/-) mice were colonized with ASF-like microbiota and E. coli NRG857c. Three weeks later, mice (n=5) were treated with weekly phage or PBS (n=5) for 7 weeks. Mice were monitored weekly as described above. Result(s) Daily phage treatment reduced the severity of clinical symptoms induced by acute DSS administration (p < 0.001 vs. DSS-PBS treated mice). At endpoint, phage treatment was associated with lower histological scores as compared with DSS-PBS controls (p < 0.0001). A 1-log reduction in AIEC bacterial load was observed in phage treated mice as compared with DSS-PBS controls (p < 0.001). In IL-10-/- mice, weekly phage treatment delayed the spontaneous onset of colitis (p < 0.0001 vs. PBS-treated mice). At endpoint, mice treated with phage had lower colitis scores. Reduced weekly AIEC bacterial load was observed in phage-treated mice. Conclusion(s) Lytic phages, targeting a known AIEC pathobiont isolated from Crohn’s disease patients, ameliorate acute intestinal injury and delay onset of spontaneous colitis. Future work will investigate the mechanisms by which phage therapy prevents and treats colitis, to better inform clinical trial design. Disclosure of Interest None Declared
Collapse
Affiliation(s)
| | | | | | - B Coombes
- Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | | | | |
Collapse
|
4
|
Hann A, Santiago Badenas A, Galipeau HJ, Constante M, Libertucci J, Rahmani S, Jackson K, Rueda G, Rossi L, Ramachandran R, Ruf W, Caminero A, Bercik P, Verdu EF. A3 CROHN’S DISEASE PROTEOLYTIC MICROBIOTA ENHANCES INFLAMMATION THROUGH PAR2 PATHWAY IN GNOTOBIOTIC MICE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991128 DOI: 10.1093/jcag/gwac036.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background An imbalance in host proteases has been implicated in inflammatory bowel disease (IBD). Recent evidence implicates microbial proteolytic activity (PA) in ulcerative colitis but whether it also plays a role in Crohn’s disease (CD) remains unclear. Purpose We therefore investigated the colitogenic potential and underlying pathways of proteolytic CD microbiota. Method Adult germ-free (GF) C57BL/6 mice were colonized with CD microbiota selected based on high (CD-HPA) or low fecal proteolytic activity (CD-LPA), and from healthy controls with LPA (HC-LPA), after which total fecal proteolytic, elastolytic and mucolytic activity were analyzed in the mice. Microbial community was assessed by 16S rRNA gene sequencing. Immune function and colonic injury were investigated by inflammatory gene expression (NanoString) and histology. Colitis severity and underlying pathways were investigated in C57BL/6, Nucleotide-binding Oligomerization Domain-2 knock-out (Nod2-/-), and Protease-Activated Receptor 2 (PAR2) cleavage resistant mice (R38E-PAR2) subjected to 2% dextran sodium sulfate in drinking water for 5 days followed by 2 days on water. Result(s) Colonization with HC-LPA or CD-LPA lowered baseline fecal proteolytic activity compared with GF mice, which was paralleled by lower acute inflammatory cell infiltrate. CD-HPA further increased proteolytic activity compared with GF mice. Fecal supernatants from CD-LPA or HC-LPA colonized mice had lower in vitro PAR2 cleavage compared to supernatants from GF and CD-HPA colonized mice. Several genes, such as Map kinases, Rhoa, Myd88, and Tollip, were increased in GF mice compared to colonized mice. 18 genes related to inflammation and barrier function (e.g., Mapk2k6, Tnf, Claudin1) were differentially expressed between CD-LPA and CD-HPA. CD-HPA mice had lower alpha diversity, distinct microbial profiles, and higher fecal proteolytic activity compared with CD-LPA. Abundance of several beneficial species (e.g., Akkermansia muciniphilia) was decreased while other taxa were increased (e.g., Hungattella hathewayi) in CD-HPA compared to CD-LPA. H. hathewayi as well as the serine protease K04772 were transcriptionally increased in fecal samples from CD-HPA colonized mice. C57BL/6 and Nod2-/- mice, but not R38E-PAR2 mice, colonized with CD-HPA developed earlier and more severe colitis compared with mice colonized with CD-LPA. Conclusion(s) CD proteolytic microbiota is proinflammatory through a PAR2 pathway. H. hathewayi correlates with the proinflammatory phenotype through the serine protease K04772 in this model. The results support a role of microbial PA in CD, which could constitute a biomarker for identifying patients who would benefit from anti-proteolytic therapies. Disclosure of Interest None Declared
Collapse
Affiliation(s)
| | | | | | | | | | | | - K Jackson
- Medicine,Chemical Engineering, McMaster University, Hamilton
| | | | | | - R Ramachandran
- Physiology and Pharmacology, Western University, London, Canada
| | - W Ruf
- Immunology and Microbiology, The Scripps Research Institute, La Jolla, United States,Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center, Mainz, Germany
| | | | | | | |
Collapse
|
5
|
Rahmani S, Hann A, Galipeau HJ, Chirdo FG, Didar T, Verdu E. A5 GLUTEN-SPECIFIC T CELL ACTIVATION BY MHC CLASS II EXPRESSING ORGANOID MONOLAYERS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859341 DOI: 10.1093/jcag/gwab049.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
NOT PUBLISHED AT AUTHOR’S REQUEST Funding Agencies: CIHR
Collapse
Affiliation(s)
- S Rahmani
- McMaster University, Hamilton, ON, Canada
| | - A Hann
- McMaster University, Hamilton, ON, Canada
| | - H J Galipeau
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - F G Chirdo
- Universidad Nacional de la Plata, La Plata, Argentina
| | - T Didar
- McMaster University, Hamilton, ON, Canada
| | - E Verdu
- McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Jackson K, Hann A, Galipeau HJ, Constante M, Coombes BK, Verdu E, Hosseinidoust Z. A200 CROHN’S-ASSOCIATED E. COLI WORSEN COLITIS SEVERITY IN MICE COLONIZED WITH DEFINED MICROBIOTA. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Bacterial infections have been postulated to drive the dysregulated inflammation found in inflammatory bowel disease (IBD). In particular, adherent-invasive Escherichia coli (AIEC) isolated from patients with IBD have pathobiont characteristics and have been implicated in IBD pathogenesis.
Aims
Our aim was to characterize and compare the level of intestinal inflammation and potential microbiota shifts induced by E. coli clinical isolates using a gnotobiotic mouse model of colitis.
Methods
Adult germ-free C57BL/6 mice were transferred to ISO positive cages in a gnotobiotic facility and colonized with altered Schaedler flora-like (ASF) microbiota and one of three clinical E. coli isolates: E. coli C0004 (n = 5), E. coli LF82 (n = 9), E. coli NRG857c (n = 6), or ASF alone (n = 6). Three weeks later, mice were treated for 5 days with low dose dextran sodium sulphate in drinking water (2%; DSS), followed by 2 days of water. Mice were monitored daily for clinical symptoms (weight, stool consistency, and occult blood). At sacrifice, colon tissue was collected for histological analysis. Cecum contents were cultured to determine bacterial load. Fecal samples were collected for 16S rRNA gene sequencing analysis before and after DSS treatment.
Results
All mice colonized with an E. coli isolate displayed significantly greater clinical and microscopic scores of colitis compared to ASF alone, but the severity was dependent on the colonized E. coli strain. E. coli NRG857c-colonized mice exhibited more severe symptoms (p < 0.001) two days earlier than mice colonized with other E. coli isolates. Mice colonized with E. coli LF82 or E. coli NRG857c had higher histological scores of colitis compared to mice colonized with E. coli C0004, which were also significantly greater than ASF alone (p < 0.0001). 16S rRNA gene sequencing revealed that ASF-alone-colonized mice lacked Proteobacteria. All E. coli-colonized mice had comparable bacterial loads, which were verified by 16S rRNA analysis. Following DSS, E. coli LF82 and E. coli NRG857c relative abundance remained stable, whereas the relative abundance of Roseburia/ASF 492 declined significantly in all E. coli colonized mice.
Conclusions
The presence of E. coli pathobionts in mice drive the severity of chemically induced colitis, with AIEC NRG857c inducing the greatest severity. This gnotobiotic mouse model enables us to control the severity of colitis in a well-defined microbiota that is dependent on the colonized E. coli isolate. Using this model, we will be able to assess therapeutic candidates that aim to treat colitis at varying stages of its disease progression.
Funding Agencies
CCC, CIHRNSERC
Collapse
Affiliation(s)
- K Jackson
- McMaster University, Hamilton, ON, Canada
| | - A Hann
- McMaster University, Hamilton, ON, Canada
| | - H J Galipeau
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada
| | - M Constante
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada
| | | | - E Verdu
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada
| | | |
Collapse
|
7
|
Hann A, Santiago A, Galipeau HJ, Constante M, Jackson K, Bercik P, Verdu E. A144 CHRONIC DSS LEADS TO ALTERED EXPRESSION OF IRAK4/TPL2 PATHWAYS IN UC-COLONIZED MICE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859237 DOI: 10.1093/jcag/gwab049.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Ulcerative colitis (UC) is one of two forms of inflammatory bowel disease (IBD). The exact cause of IBD is unknown but altered host-microbe interactions and genetic susceptibility are involved in its pathogenesis. Many patients with IBD do not respond to biological therapies targeting single cytokines, therefore new therapies that target common immune pathways are being developed and need to be tested in relevant preclinical models. Previously we have shown that mice colonized with UC microbiota upregulated genes related to inflammation without induction of colitis compared to healthy volunteer-colonized mice. We thus investigated whether IRAK4 and TPL2-induced pathways, new therapeutic targets in development upstream of inflammatory cytokine gene activation, are upregulated in mice colonized with UC microbiota and chronic colitis. Aims Our aim was to characterize TPL2 and IRAK4 signalling pathways and T cell phenotypes in UC-colonized mice following chronic low-dose dextran sodium sulfate (DSS) colitis. Methods 10-16-week-old germ-free C57BL/6 mice were colonized with fecal microbiota from a patient with UC experiencing a flare (n=16). Mice were housed in a gnotobiotic facility during the experiment. Three weeks following colonization, colitis was induced in half of the mice by three cycles (5 d each; 2.0%, 1.5% and 1.5%, respectively) of DSS in drinking water with a 5-d wash-out period between cycles. All mice were fed a control diet (7004, Teklad). Fecal samples were collected weekly. At sacrifice, disease activity (colon length, occult blood in feces, stool consistency, and spleen weight) was measured and colon tissue was collected for histological analysis and RNA sequencing. Mesenteric lymph nodes (MLNs) were acquired for flow cytometry to analyze T cell phenotypes. Results In UC-colonized mice, chronic low-dose DSS induced softer feces (p<0.0001), shorter colon length (p<0.0001), and increased spleen weight (p<0.0001), compared with water treated mice. This was paralleled by detectable blood in stool, development of moderate colitis (DSS: 1.9+/-1.4 vs H2O: 0.5+/-0.2; p<0.02) and higher proportion of IL-17 (p=0.003) and IFN-γ-producing T cells (p=0.06) in MLNs compared with water treated mice. RNA sequencing revealed that inflammatory genes, mainly related to the IRAK4/TPL2 pathway (e.g., Gadd45b, Socs3, Il1b), were significantly increased (p≤0.05) in the colon of mice treated with DSS compared with water. Conclusions When challenged with a chronic low-dose chemical injury agent, mice colonized with UC microbiota develop clinical and histological signs of colitis and upregulation of genes involved in inflammation like Gadd45b, Socs3, and Il1b. Thus, this model represents a new valuable tool for preclinical testing of new drug candidates, such as those related to the modulation of IRAK4/TPL2 pathways. Funding Agencies CCC
Collapse
Affiliation(s)
- A Hann
- McMaster University, Hamilton, ON, Canada
| | - A Santiago
- McMaster University, Hamilton, ON, Canada
| | | | | | - K Jackson
- McMaster University, Hamilton, ON, Canada
| | - P Bercik
- Medicine, McMaster University, Hamilton, ON, Canada
| | - E Verdu
- McMaster University, Hamilton, ON, Canada
| |
Collapse
|
8
|
Santiago Badenas A, Hann A, Galipeau HJ, Constante M, Bercik P, Verdu E. A13 A HIGH SALT DIET SYNERGIZES WITH UC MICROBIOTA TO INDUCE A PROINFLAMMATORY IMMUNE TONE IN IMMUNOCOMPETENT GNOTOBIOTIC MICE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The exact cause for inflammatory bowel disease (IBD) is unknown, however, there is consensus that a combination of genetic, environmental, and immune factors, participate in its pathogenesis. Recently, high salt diet (HSD) has been shown to increase the severity of experimental colitis through depletion of lactobacilli in specific pathogen-free mice. However, whether HSD-microbiota interaction occurs in mice colonized with microbiota from patients with IBD, is unknown.
Aims
Our aim was to determine whether mice colonized with microbiota from patients with active ulcerative colitis (UC), one of two forms of IBD, develop more severe inflammation when fed a HSD.
Methods
10–15 week-old germ-free C57BL/6 mice were colonized with fecal microbiota from a healthy control (HC, n=13) or from a patient with UC experiencing a flare (UC, n=13). Colonized mice were housed in ISO positive cages (Techniplast) in a gnotobiotic facility during the experiment. For each group, half of the mice were kept on a control diet (7004, Teklad) and the other half were fed a HSD (7004 supplemented with 4% NaCl) plus 1% NaCl in drinking water for 3 weeks. At sacrifice, colon tissue was collected for histological analysis, RNA sequencing, and flow cytometry. Fecal samples were collected for lipocalin-2 determination.
Results
Colonic polymorphonuclear (PMN) cells were higher in UC compared with HC mice, regardless of diet (p<0.01). In mice fed HSD, UC mice also had higher PMN cell counts than HC mice (p<0.001). Administration of HSD to UC, but not to HC mice, also increased the proportion of α4+IFNg-producing T cells in the colonic lamina propria, compared with UC mice fed control diet (p<0.01). This was paralleled by higher fecal lipocalin-2 in UC mice fed HSD compared with control diet (p<0.05). Targeted analysis of RNA sequencing data revealed that 7 genes, mainly related to the JAK/STAT pathway (i.e., Stat2, Tyk2, Tlr7) were differentially expressed (p≤0.05) between HC and UC mice fed the control diet. A different gene expression signature was found in mice fed HSD compared with control diet, with an increase in proinflammatory genes in UC colonized mice compared to HC colonized mice, such as Il12a and Il6 (p<0.05).
Conclusions
Immunocompetent mice colonized with microbiota from a UC patient in flare spontaneously developed a proinflammatory immune tone, which was exacerbated by HSD. The different pattern of gene induction observed in mice colonized with the microbiota from the same UC donor, but fed HSD, suggests independent and synergistic pathways conducive to inflammation. Future studies will explore the preclinical therapeutic effect of novel drug candidates for the inhibition of such pathways.
Funding Agencies
CCC
Collapse
Affiliation(s)
| | - A Hann
- Medicine, McMaster University, Hamilton, ON, Canada
| | - H J Galipeau
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - P Bercik
- Medicine, McMaster University, Hamilton, ON, Canada
| | - E Verdu
- McMaster University, Hamilton, ON, Canada
| |
Collapse
|
9
|
Hann A, Lembach H, Dassanayake B, Carvalheiro A, McKay S, Rajoriya N, Armstrong MJ, Bartlett D, David M, Perera MTPR. Severe Sepsis Mimicking Primary Nonfunction Following Liver Transplantation: Normothermic Machine Perfusion Is a Potential Environment for Bacterial Overgrowth and Transmission From Donor to Recipient. A Case Report. Transplant Proc 2020; 52:2781-2785. [PMID: 32741664 DOI: 10.1016/j.transproceed.2020.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/29/2020] [Indexed: 01/07/2023]
Abstract
Primary nonfunction (PNF) in the early postoperative period following liver transplantation is fatal if not managed appropriately with early retransplantation. Severe early allograft dysfunction can mimic PNF. The identification of treatable causative factors such as sepsis, hepatic artery, or portal vein thrombosis is essential to distinguish it from PNF, and their early management may avoid the need for retransplantation. In this article, we describe a case of sepsis-induced severe liver dysfunction from a contaminated graft perfused with normothermic machine perfusion (NMP), which presented in a manner similar to PNF. The implications of graft contamination are poorly described. To our knowledge, this is the first report of bacterial contamination of a graft that underwent NMP and subsequently caused severe sepsis in the recipient. The conditions created with NMP may be optimal for certain micro-organisms to thrive. The role of the liver in the immune system is complex as it provides an essential barrier to enterically derived portal venous pathogens and produces numerous acute phase proteins that augment the systemic immune response. Additionally, the liver is also known to restrain harmful and excessive systemic immune responses such as those that occur with the sepsis syndrome. The relationship between bacterial graft contamination, sepsis, and graft dysfunction may be multidirectional.
Collapse
Affiliation(s)
- A Hann
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - H Lembach
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - B Dassanayake
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - A Carvalheiro
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S McKay
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - N Rajoriya
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - M J Armstrong
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - D Bartlett
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - M David
- Department of Microbiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - M T P R Perera
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
| |
Collapse
|
10
|
Seufferlein T, Ettrich T, Stein A, Arnold D, Prager G, Kasper S, Niedermeier M, Mueller L, Kubicka S, König AO, Büchner-Steudel P, Wille K, Kestler A, Hann A, Perkhofer L, Berger A, Lausser L, Kestler H. A biomarker combination indicating resistance to FOLFOX plus bevacizumab in metastatic colorectal cancer: Results of phase I of the PERMAD trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Seufferlein T, Lausser L, Stein A, Prager G, Kasper S, Niedermeier M, Müller L, Kubicka S, König AO, Büchner-Steudel P, Wille K, Perkhofer L, Hann A, Berger A, Arnold D, Kestler H, Ettrich T. A novel biomarker combination and its association with resistance to chemotherapy combinations with bevacizumab: First results of the PERMAD trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Hann A, Bohle W, Egger J, Zoller WG. Improvement in advanced pancreatic cancer survival with novel chemotherapeutic strategies - experience of a community based hospital. Z Gastroenterol 2016; 54:1138-1142. [PMID: 27723905 DOI: 10.1055/s-0042-110793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: New chemotherapeutic strategies for locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) have been shown to improve survival in randomized clinical trials. Little is known about the use of such chemotherapies and their benefit in community-based hospitals. This retrospective study analyzes the overall survival of these patients under "real life conditions" before and after the introduction of FOLFIRINOX in 2011. Methods: We retrospectively identified consecutive patients with PDAC who were treated at our hospital from 2011 to June 2014 (2011+ cohort) and 2004 to 2010 (historical cohort). Patients were included if PDAC was diagnosed in a locally advanced or metastatic state and at least 1 cycle of chemotherapy was given. Survival was assessed until April 2016. Patients with FOLFIRINOX were further analyzed regarding drug administration and side effects. Results: 128 patients met the inclusion criteria. Of the 74 patients in the historical cohort, 62 patients received Gemcitabine. Of the 54 patients diagnosed between 2011 and June 2014, 28 patients received FOLFIRINOX and 22 Gemcitabine as the first-line chemotherapy. Only 34 % of the patients in the historical cohort received a second-line chemotherapy in comparison to 69 % in the 2011+ cohort. Median overall survival (OS) showed a survival of 13.1 months (95 % CI; 11.6 - 14.5) for the 2011+ cohort compared to 9.6 months (95 % CI; 6.1 - 13.1) in the historical group. Conclusion: This study shows a marked improvement in survival of patients diagnosed with locally advanced or metastatic PDAC in a community-based hospital during the past 4 years. The most likely reasons are the use of new polychemotherapies like FOLFIRINOX and the use of second-line chemotherapy.
Collapse
Affiliation(s)
- A Hann
- Department of Internal Medicine, Katharinenhospital, Stuttgart, Germany
| | - W Bohle
- Department of Internal Medicine, Katharinenhospital, Stuttgart, Germany
| | - J Egger
- Institute for Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - W G Zoller
- Department of Internal Medicine, Katharinenhospital, Stuttgart, Germany
| |
Collapse
|
13
|
Hann A, Trenker C, Westhoff C, Goerg C. Unusual Hyperechoic Appearance of Hodgkin’s Lymphoma in the Liver. Ultrasound Int Open 2015; 1:E25-6. [DOI: 10.1055/s-0035-1549916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
14
|
Watkinson PJ, Barber VS, Price JD, Hann A, Tarassenko L, Young JD. A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients. Anaesthesia 2006; 61:1031-9. [PMID: 17042839 DOI: 10.1111/j.1365-2044.2006.04818.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We conducted a randomised controlled trial of mandated five-channel physiological monitoring vs standard care, in acute medical and surgical wards in a single UK teaching hospital. In all, 402 high-risk medical and surgical patients were studied. The primary outcome was the proportion of patients experiencing one or more major adverse events, including urgent staff calls, changes to higher care levels, cardiac arrests or death, in 96 h following randomisation. Secondary outcomes were the proportion of patients requiring acute treatment changes, and the 30-day and hospital mortality. In the 96 h following randomisation, 113 (56%) patients in the monitored arm and 116 (58%) in the control arm (OR 0.94, 95% CI 0.63-1.40, p = 0.76) had a major event. An acute change in treatment was necessary in 107 (53%) monitored patients and 101 (50%) control patients (OR 0.55, 95% CI 0.87-1.29). Thirty-four (17%) monitored patients and 35 (17%) control patients died within 30 days. Thirteen patients in the control group received full five-channel monitoring at the request of the ward staff. We conclude that mandated electronic vital signs monitoring in high risk medical and surgical patients has no effect on adverse events or mortality.
Collapse
Affiliation(s)
- P J Watkinson
- Intensive Care Society Clinical Trials Group, John Radcliffe Hospital, Oxford, UK
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
Recently there has been an upsurge of interest in strategies for detecting at-risk patients in order to trigger the timely intervention of a Medical Emergency Team (MET), also known as a Rapid Response Team (RRT). We review a real-time automated system, BioSign, which tracks patient status by combining information from vital signs monitored non-invasively on the general ward. BioSign fuses the vital signs in order to produce a single-parameter representation of patient status, the Patient Status Index. The data fusion method adopted in BioSign is a probabilistic model of normality in five dimensions, previously learnt from the vital sign data acquired from a representative sample of patients. BioSign alerts occur either when a single vital sign deviates by close to +/-3 standard deviations from its normal value or when two or more vital signs depart from normality, but by a smaller amount. In a trial with high-risk elective/emergency surgery or medical patients, BioSign alerts were generated, on average, every 8 hours; 95% of these were classified as 'True' by clinical experts. Retrospective analysis has also shown that the data fusion algorithm in BioSign is capable of detecting critical events in advance of single-channel alerts.
Collapse
Affiliation(s)
- L Tarassenko
- Department of Engineering Science, Parks Road, University of Oxford, Oxford OX1 3PJ, UK.
| | | | | |
Collapse
|
16
|
Abstract
BACKGROUND The skin represents an accessible somatic tissue for therapeutic gene transfer. The superficial lipophilic layer of the skin, the stratum corneum, however, constitutes a major obstacle to the cutaneous delivery of charged macromolecules such as DNA. OBJECTIVES To determine whether silicon-based microneedles, microfabricated via a novel isotropic etching/BOSCH reaction process, could generate microchannels in the skin of sufficient dimensions to facilitate access of lipid : polycation : pDNA (LPD) nonviral gene therapy vectors. METHODS Scanning electron microscopy was used to visualize the microconduits created in heat-separated human epidermal sheets after application of the microneedles. Following confirmation of particle size and particle surface charge by photon correlation spectrocopy and microelectrophoresis, respectively, the diffusion of fluorescent polystyrene nanospheres and LPD complexes through heat-separated human epidermal sheets was determined in vitro using a Franz-type diffusion cell. In-vitro cell culture with quantification by flow cytometry was used to determine gene expression in human keratinocytes (HaCaT cells). RESULTS The diffusion of 100 nm diameter fluorescent polystyrene nanospheres, used as a readily quantifiable predictive model for LPD complexes, through epidermal sheets was significantly enhanced following membrane treatment with microneedles. The delivery of LPD complexes either into or through the membrane microchannels was also demonstrated. In both cases considerable interaction between the particles and the epidermal sheet was observed. In-vitro cell culture was used to confirm that LPD complexes mediated efficient reporter gene expression in human keratinocytes in culture when formulated at the appropriate surface charge. CONCLUSIONS These studies demonstrate the utility of silicon microneedles in cutaneous gene delivery. Further studies are required to elucidate fully the influence of the physicochemical characteristics of gene therapy vectors, e.g. particle diameter and surface charge, on their diffusion through microchannels and to quantify gene expression in vivo.
Collapse
Affiliation(s)
- F Chabri
- Welsh School of Pharmacy, Cardiff University, Cardiff, UK
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Pycroft JM, Hann A, Moxham BJ. Apoptosis in the connective tissues of the periodontal ligament and gingivae of rat incisor and molar teeth at various stages of development. Connect Tissue Res 2003; 43:265-79. [PMID: 12489169 DOI: 10.1080/03008200290000763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Apoptosis in the periodontal connective tissues was studied using the TUNEL technique, supported by electron microscopy. For 16 rats (aged 3, 8, or 104 weeks), nuclear fragmentation was assessed using the TUNEL technique (for 4 of the animals aged 8 weeks, incisor eruption was experimentally increased by trimming of teeth to the gingival margin--unimpeded eruption). A further 8 rats (aged 8 and 104 weeks) were employed for electron microscopy. For the incisor, prior to aging, and regardless of eruptive behavior (i.e., for both impeded and unimpeded incisors), there was little evidence of apoptosis in the periodontal ligament or gingival connective tissues. For the molar, apoptosis was also not usually detected when the teeth were erupting or in the mature, erupted state. In the aged animals, however, there was a marked increase in apoptosis (as assessed by the TUNEL technique) within the periodontal ligament and gingivae of both the molars and incisors (where eruption rates also increased). Nevertheless, electron microscopy indicated that significant numbers of apoptotic cells were only in the incisor periodontium. These findings are not consistent with the view that the periodontal fibroblasts provide a component of the force(s) responsible for eruption.
Collapse
Affiliation(s)
- J M Pycroft
- Cardiff School of Biosciences, Cardiff University, Biomedical Sciences Building, Museum Avenue, Cardiff, CF10 3US, Wales, United Kingdom
| | | | | |
Collapse
|
18
|
Pedersen H, Toldam-Andersen T, Funke K, Hann A, Wünsche JN. DETERMINATION OF LEAF DAMAGE LEVELS TOLERATED IN A LOW PESTICIDE PRODUCTION SYSTEM OF BLACKCURRANTS (RIBES NIGRUM). ACTA ACUST UNITED AC 2002. [DOI: 10.17660/actahortic.2002.585.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
19
|
Liu Yin JA, Adams JA, Brereton ML, Hann A, Harrison BD, Briggs M. Megakaryopoiesis in vitro in myelodysplastic syndromes and acute myeloid leukaemia: effect of pegylated recombinant human megakaryocyte growth and development factor in combination with other growth factors. Br J Haematol 2000; 108:743-6. [PMID: 10792278 DOI: 10.1046/j.1365-2141.2000.01916.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMGDF) can stimulate megakaryopoiesis in vitro in some myelodysplastic syndrome (MDS) and acute myeloid leukaemia (AML) patients. We assessed PEG-rHuMGDF combined with granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage CSF (GM-CSF), interleukin 3 (IL-3), IL6, stem cell factor (SCF) or erythropoietin in 40 MDS, 33 AML and 16 normal bone marrow samples. CD61-positive cells in suspension cultures increased with PEG-rHuMGDF alone in 20/25 RA + RAS, 11/14 RAEB + RAEBt and 29/33 AML cases. Further increases when IL-3 and/or SCF were added to PEG-rHuMGDF occurred in 14/20 RA + RAS, 8/13 RAEB + RAEBt and 18/26 AML cases. CFU-Mk growth was poor overall, but could be enhanced by PEG-rHuMGDF combinations in some patients. Stimulation of megakaryopoiesis by PEG-rHuMGDF can be augmented by IL-3 and SCF in many MDS and AML patients.
Collapse
Affiliation(s)
- J A Liu Yin
- University Department of Haematology, Manchester Royal Infirmary; Department of Medical Statistics, University Hospital of South Manchester, UK.
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
OBJECTIVE To determine the cellular and matrix responses to experimental wounding of articular cartilage. METHODS Immature and mature bovine articular cartilage was used as an in vitro model system to study the cellular responses to cartilage wounding. Explant cultures were wounded centrally with a trephine and maintained for up to 10 days. TUNEL labeling together with ultrastructural analyses were used to assess the nature of the observed cell death. In vitro labeling with 3H-thymidine was used to detect cell proliferation, and 2 antibodies (COL2-3/4M and BC-13) were used to detect changes in matrix turnover. RESULTS Cell death was observed as a response to wounding and was considered to be a combination of necrosis and apoptosis. In immature tissue, cell death was more pronounced, particularly in the articular surface region. Within the area of cell death, many cells that did not die subsequently underwent proliferation. The collagenous network showed evidence of denaturation in the area of the wound, but "aggrecanase" activity was not detected. CONCLUSION There are 2 contrasting, but related, responses to cartilage wounding--apoptosis and proliferation. In order to improve cartilage repair, future studies need to elucidate the regulatory mechanisms that determine these responses.
Collapse
|
21
|
Abstract
Breast cancer is a serious problem in the developed world, and the common perception of the risks of developing the disease are communicated to the public via a variety of means. This includes leaflets in doctors' surgeries, health promotion campaigns and invitations from well woman clinics to attend for various forms of screening. The national breast cancer screening programme in the UK has a very high compliance rate (which is vital) and a well oiled media machine. This article examines the way in which the risks of developing breast cancer are communicated to women of all ages in the UK, and speculates as to the reason behind the misleading manner in which health promoters offer this information.
Collapse
Affiliation(s)
- A Hann
- Department of Public Policy, De Montfort University, Leicester, UK.
| |
Collapse
|