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Sami AS, Frazer LC, Miller CM, Singh DK, Clodfelter LG, Orgel KA, Good M. The role of human milk nutrients in preventing necrotizing enterocolitis. Front Pediatr 2023; 11:1188050. [PMID: 37334221 PMCID: PMC10272619 DOI: 10.3389/fped.2023.1188050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Necrotizing enterocolitis (NEC) is an intestinal disease that primarily impacts preterm infants. The pathophysiology of NEC involves a complex interplay of factors that result in a deleterious immune response, injury to the intestinal mucosa, and in its most severe form, irreversible intestinal necrosis. Treatments for NEC remain limited, but one of the most effective preventative strategies for NEC is the provision of breast milk feeds. In this review, we discuss mechanisms by which bioactive nutrients in breast milk impact neonatal intestinal physiology and the development of NEC. We also review experimental models of NEC that have been used to study the role of breast milk components in disease pathophysiology. These models are necessary to accelerate mechanistic research and improve outcomes for neonates with NEC.
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Affiliation(s)
- Ahmad S. Sami
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lauren C. Frazer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Claire M. Miller
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dhirendra K. Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lynda G. Clodfelter
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kelly A. Orgel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Misty Good
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Kulis MD, Smeekens JM, Burk C, Yue X, Guo R, Orgel KA, Ye P, Herlihy L, Hamilton D, Li Q, Keet C, Shreffler W, Vickery BP, Burks AW, Kim EH. Kinetics of basophil hyporesponsiveness during short-course peanut oral immunotherapy. J Allergy Clin Immunol 2022; 150:1144-1153. [PMID: 35716952 PMCID: PMC9643597 DOI: 10.1016/j.jaci.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/29/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oral immunotherapy (OIT) leads to suppression of mast cell and basophil degranulation along with changes in the adaptive immune response. OBJECTIVES This study aimed to determine how rapidly these effects occur during OIT and more broadly, the kinetics of basophil and mast cell suppression throughout the course of therapy. METHODS Twenty participants, age 4 to 12 years, were enrolled in a peanut OIT trial and assessed for desensitization and sustained unresponsiveness after 9 months of therapy. Blood was collected 5 times in the first month and then intermittently throughout to quantify immunoglobulins and assess basophil activation by CD63, CD203c, and phosphorylated SYK (pSYK). RESULTS Twelve of 16 participants that completed the trial were desensitized after OIT, with 9 achieving sustained unresponsiveness after discontinuing OIT for 4 weeks. Basophil hyporesponsiveness, defined by lower CD63 expression, was detected as early as day 90. pSYK was correlated with CD63 expression, and there was a significant decrease in pSYK by day 250. CD203c expression remained unchanged throughout therapy. Interestingly, although basophil activation was decreased across the cohort during OIT, basophil activation did not correlate with individual clinical outcomes. Serum peanut-specific IgG4 and IgA increased throughout therapy, whereas IgE remained unchanged. CONCLUSIONS Suppression of basophil activation occurs within the first 90 days of peanut OIT, ultimately leading to suppression of signaling through pSYK.
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Affiliation(s)
- Michael D Kulis
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC.
| | - Johanna M Smeekens
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Caitlin Burk
- Food Allergy Center and the Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | - Xiaohong Yue
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Rishu Guo
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Kelly A Orgel
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Ping Ye
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Lauren Herlihy
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Deanna Hamilton
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Quefeng Li
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Corinne Keet
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Wayne Shreffler
- Food Allergy Center and the Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass
| | | | - A Wesley Burks
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
| | - Edwin H Kim
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, School of Medicine, Chapel Hill, NC; UNC Food Allergy Initiative, University of North Carolina, Chapel Hill, NC
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Singh DK, Miller CM, Orgel KA, Dave M, Mackay S, Good M. Necrotizing enterocolitis: Bench to bedside approaches and advancing our understanding of disease pathogenesis. Front Pediatr 2022; 10:1107404. [PMID: 36714655 PMCID: PMC9874231 DOI: 10.3389/fped.2022.1107404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Necrotizing enterocolitis (NEC) is a devastating, multifactorial disease mainly affecting the intestine of premature infants. Recent discoveries have significantly enhanced our understanding of risk factors, as well as, cellular and genetic mechanisms of this complex disease. Despite these advancements, no essential, single risk factor, nor the mechanism by which each risk factor affects NEC has been elucidated. Nonetheless, recent research indicates that maternal factors, antibiotic exposure, feeding, hypoxia, and altered gut microbiota pose a threat to the underdeveloped immunity of preterm infants. Here we review predisposing factors, status of unwarranted immune responses, and microbial pathogenesis in NEC based on currently available scientific evidence. We additionally discuss novel techniques and models used to study NEC and how this research translates from the bench to the bedside into potential treatment strategies.
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Affiliation(s)
- Dhirendra K Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Claire M Miller
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kelly A Orgel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mili Dave
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Stephen Mackay
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Misty Good
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Smeekens JM, Johnson-Weaver BT, Hinton AL, Azcarate-Peril MA, Moran TP, Immormino RM, Kesselring JR, Steinbach EC, Orgel KA, Staats HF, Burks AW, Mucha PJ, Ferris MT, Kulis MD. Fecal IgA, Antigen Absorption, and Gut Microbiome Composition Are Associated With Food Antigen Sensitization in Genetically Susceptible Mice. Front Immunol 2021; 11:599637. [PMID: 33542716 PMCID: PMC7850988 DOI: 10.3389/fimmu.2020.599637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/25/2020] [Indexed: 01/04/2023] Open
Abstract
Food allergy is a potentially fatal disease affecting 8% of children and has become increasingly common in the past two decades. Despite the prevalence and severe nature of the disease, the mechanisms underlying sensitization remain to be further elucidated. The Collaborative Cross is a genetically diverse panel of inbred mice that were specifically developed to study the influence of genetics on complex diseases. Using this panel of mouse strains, we previously demonstrated CC027/GeniUnc mice, but not C3H/HeJ mice, develop peanut allergy after oral exposure to peanut in the absence of a Th2-skewing adjuvant. Here, we investigated factors associated with sensitization in CC027/GeniUnc mice following oral exposure to peanut, walnut, milk, or egg. CC027/GeniUnc mice mounted antigen-specific IgE responses to peanut, walnut and egg, but not milk, while C3H/HeJ mice were not sensitized to any antigen. Naïve CC027/GeniUnc mice had markedly lower total fecal IgA compared to C3H/HeJ, which was accompanied by stark differences in gut microbiome composition. Sensitized CC027/GeniUnc mice had significantly fewer CD3+ T cells but higher numbers of CXCR5+ B cells and T follicular helper cells in the mesenteric lymph nodes compared to C3H/HeJ mice, which is consistent with their relative immunoglobulin production. After oral challenge to the corresponding food, peanut- and walnut-sensitized CC027/GeniUnc mice experienced anaphylaxis, whereas mice exposed to milk and egg did not. Ara h 2 was detected in serum collected post-challenge from peanut-sensitized mice, indicating increased absorption of this allergen, while Bos d 5 and Gal d 2 were not detected in mice exposed to milk and egg, respectively. Machine learning on the change in gut microbiome composition as a result of food protein exposure identified a unique signature in CC027/GeniUnc mice that experienced anaphylaxis, including the depletion of Akkermansia. Overall, these results demonstrate several factors associated with enteral sensitization in CC027/GeniUnc mice, including diminished total fecal IgA, increased allergen absorption and altered gut microbiome composition. Furthermore, peanuts and tree nuts may have inherent properties distinct from milk and eggs that contribute to allergy.
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Affiliation(s)
- Johanna M. Smeekens
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | | | - Andrew L. Hinton
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina, Chapel Hill, NC, United States
| | - M. Andrea Azcarate-Peril
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States
- UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, United States
| | - Timothy P. Moran
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Robert M. Immormino
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Janelle R. Kesselring
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Erin C. Steinbach
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Kelly A. Orgel
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Herman F. Staats
- Department of Pathology, Duke University School of Medicine, Durham, NC, United States
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Immunology, Duke University School of Medicine, Durham, NC, United States
| | - A. Wesley Burks
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Peter J. Mucha
- Curriculum in Bioinformatics and Computational Biology, University of North Carolina, Chapel Hill, NC, United States
- Department of Mathematics and Department of Applied Physical Sciences, University of North Carolina, Chapel Hill, NC, United States
| | - Martin T. Ferris
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Michael D. Kulis
- Department of Pediatrics, Division of Rheumatology, Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
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Smeekens JM, Orgel KA, Kesselring J, Bagley K, Kulis MD. Model of Walnut Allergy in CC027/GeniUnc Mice Recapitulates Key Features of Human Disease. Yale J Biol Med 2020; 93:669-673. [PMID: 33380927 PMCID: PMC7757060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Tree nut allergies affect 1% of the United States population, are often severe in nature and rarely outgrown. Despite the severity and prevalence, there are no FDA-approved treatments for tree nut allergy. Development of a therapeutic would be expedited by having a mouse model that mimics the human disease. We utilized the CC027/GeniUnc mouse strain, which was previously identified as an orally reactive model of peanut allergy, to develop a model of walnut allergy. Mice were sensitized with walnut and cholera toxin for 4 weeks and subsequently challenged by oral gavage. Blood samples were collected to measure serum IgE. Walnut-sensitized mice produced high levels of walnut-IgE and were cross-sensitized to pecan. Oral challenges with walnut resulted in severe anaphylaxis and accompanying allergic symptoms. Importantly, pecan challenges also led to severe allergic reactions, indicating cross-reactivity to pecan. Overall, this novel mouse model reproduces key characteristics of human walnut allergy, which provides a platform to develop novel therapies and better understand sensitization mechanisms.
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Affiliation(s)
- Johanna M. Smeekens
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC,To whom all correspondence should be addressed:
Johanna M. Smeekens, 116 Manning Dr., Room 3004, Chapel Hill, NC 27599; Tel:
919-537-3335, ; ORCID iD: https://orcid.org/0000-0001-9651-3852.
| | - Kelly A. Orgel
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC
| | - Janelle Kesselring
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC
| | | | - Michael D. Kulis
- Department of Pediatrics, School of Medicine,
University of North Carolina, Chapel Hill, NC,UNC Food Allergy Initiative, School of Medicine,
University of North Carolina, Chapel Hill, NC
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Wright BL, Kulis M, Guo R, Orgel KA, Wolf WA, Burks AW, Vickery BP, Dellon ES. Food-specific IgG 4 is associated with eosinophilic esophagitis. J Allergy Clin Immunol 2016; 138:1190-1192.e3. [PMID: 27130859 DOI: 10.1016/j.jaci.2016.02.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/29/2016] [Accepted: 02/10/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Benjamin L Wright
- University of North Carolina School of Medicine, Chapel Hill, NC; Duke University Medical Center, Durham, NC.
| | - Mike Kulis
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rishu Guo
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kelly A Orgel
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - W Asher Wolf
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - A Wesley Burks
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Brian P Vickery
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S Dellon
- University of North Carolina School of Medicine, Chapel Hill, NC
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Abstract
Food allergy is increasing in prevalence; as a result, there is intense focus on developing safe and effective therapies. Current methods of specific immunotherapy include oral, sublingual, and epicutaneous, while nonspecific methods that have been investigated include: Chinese herbal medicine, probiotics, and anti-IgE antibodies. Although some studies have demonstrated efficacy in inducing desensitization, questions regarding safety and the potential for achieving immune tolerance remain. Although some of these therapies demonstrate promise, further investigation is required before their incorporation into routine clinical practice.
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Affiliation(s)
- Bruce J. Lanser
- Department of Pediatric, University of Colorado Denver School of Medicine, Aurora, CO, USA and National Jewish Health, 1400 Jackson Street, J322, Denver, CO 80206, USA
| | - Benjamin L. Wright
- Department of Pediatric, University of North Carolina at Chapel Hill School of Medicine, Campus Box #7231, Chapel Hill, NC 27599, USA and Allergy, Asthma & Clinical Immunology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Kelly A. Orgel
- Department of Pediatric, University of North Carolina at Chapel Hill School of Medicine, Campus Box #7231, Chapel Hill, NC 27599, USA
| | - Brian P. Vickery
- Department of Pediatric, University of North Carolina at Chapel Hill School of Medicine, Campus Box #7231, Chapel Hill, NC 27599, USA
| | - David M. Fleischer
- Department of Pediatric, University of Colorado Denver School of Medicine, Aurora, CO, USA and Children’s Hospital Colorado, 13123 E. 16th Ave, B518, Aurora, CO 80045, USA
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