Early Immunomodulatory Program Triggered by Protolerogenic Bifidobacterium pseudolongum Drives Cardiac Transplant Outcomes

BACKGROUND

Despite ongoing improvements to regimens preventing allograft rejection, most cardiac and other organ grafts eventually succumb to chronic vasculopathy, interstitial fibrosis, or endothelial changes, and eventually graft failure. The events leading to chronic rejection are still poorly understood and the gut microbiota is a known driving force in immune dysfunction. We previously showed that gut microbiota dysbiosis profoundly influences the outcome of vascularized cardiac allografts and subsequently identified biomarker species associated with these differential graft outcomes.

METHODS

In this study, we further detailed the multifaceted immunomodulatory properties of protolerogenic and proinflammatory bacterial species over time, using our clinically relevant model of allogenic heart transplantation.

RESULTS

In addition to tracing longitudinal changes in the recipient gut microbiome over time, we observed that Bifidobacterium pseudolongum induced an early anti-inflammatory phenotype within 7 d, whereas Desulfovibrio desulfuricans resulted in a proinflammatory phenotype, defined by alterations in leukocyte distribution and lymph node (LN) structure. Indeed, in vitro results showed that B pseudolongum and D desulfuricans acted directly on primary innate immune cells. However, by 40 d after treatment, these 2 bacterial strains were associated with mixed effects in their impact on LN architecture and immune cell composition and loss of colonization within gut microbiota, despite protection of allografts from inflammation with B pseudolongum treatment.

CONCLUSIONS

These dynamic effects suggest a critical role for early microbiota-triggered immunologic events such as innate immune cell engagement, T-cell differentiation, and LN architectural changes in the subsequent modulation of protolerant versus proinflammatory immune responses in organ transplant recipients.

Rapid intestinal and systemic metabolic reprogramming in an immunosuppressed environment

Intrinsic metabolism shapes the immune environment associated with immune suppression and tolerance in settings such as organ transplantation and cancer. However, little is known about the metabolic activities in an immunosuppressive environment. In this study, we employed metagenomic, metabolomic, and immunological approaches to profile the early effects of the immunosuppressant drug tacrolimus, antibiotics, or both in gut lumen and circulation using a murine model. Tacrolimus induced rapid and profound alterations in metabolic activities within two days of treatment, prior to alterations in gut microbiota composition and structure. The metabolic profile and gut microbiome after seven days of treatment was distinct from that after two days of treatment, indicating continuous drug effects on both gut microbial ecosystem and host metabolism. The most affected taxonomic groups are Clostriales and Verrucomicrobiae (i.e., Akkermansia muciniphila), and the most affected metabolic pathways included a group of interconnected amino acids, bile acid conjugation, glucose homeostasis, and energy production. Highly correlated metabolic changes were observed between lumen and serum metabolism, supporting their significant interactions. Despite a small sample size, this study explored the largely uncharacterized microbial and metabolic events in an immunosuppressed environment and demonstrated that early changes in metabolic activities can have significant implications that may serve as antecedent biomarkers of immune activation or quiescence. To understand the intricate relationships among gut microbiome, metabolic activities, and immune cells in an immune suppressed environment is a prerequisite for developing strategies to monitor and optimize alloimmune responses that determine transplant outcomes.

Rapid intestinal and systemic metabolic reprogramming in an immunosuppressed environment

Intrinsic metabolism shapes the immune environment associated with immune suppression and tolerance in settings such as organ transplantation and cancer. However, little is known about the metabolic activities in an immunosuppressive environment. In this study, we employed metagenomic, metabolomic, and immunological approaches to profile the early effects of the immunosuppressant drug tacrolimus, antibiotics, or both in gut lumen and circulation using a murine model. Tacrolimus induced rapid and profound alterations in metabolic activities within two days of treatment, prior to alterations in gut microbiota composition and structure. The metabolic profile and gut microbiome after seven days of treatment was distinct from that after two days of treatment, indicating continuous drug effects on both gut microbial ecosystem and host metabolism. The most affected taxonomic groups are Clostriales and Verrucomicrobiae (i.e., Akkermansia muciniphila), and the most affected metabolic pathways included a group of interconnected amino acids, bile acid conjugation, glucose homeostasis, and energy production. Highly correlated metabolic changes were observed between lumen and serum metabolism, supporting their significant interactions. Despite a small sample size, this study explored the largely uncharacterized microbial and metabolic events in an immunosuppressed environment and demonstrated that early changes in metabolic activities can have significant implications that may serve as antecedent biomarkers of immune activation or quiescence. To understand the intricate relationships among gut microbiome, metabolic activities, and immune cells in an immune suppressed environment is a prerequisite for developing strategies to monitor and optimize alloimmune responses that determine transplant outcomes.

Strain-specific alterations in gut microbiome and host immune responses elicited by tolerogenic Bifidobacterium pseudolongum

The beneficial effects attributed to Bifidobacterium are largely attributed to their immunomodulatory capabilities, which are likely to be species- and even strain-specific. However, their strain-specificity in direct and indirect immune modulation remain largely uncharacterized. We have shown that B. pseudolongum UMB-MBP-01, a murine isolate strain, is capable of suppressing inflammation and reducing fibrosis in vivo. To ascertain the mechanism driving this activity and to determine if it is specific to UMB-MBP-01, we compared it to a porcine tropic strain B. pseudolongum ATCC25526 using a combination of cell culture and in vivo experimentation and comparative genomics approaches. Despite many shared features, we demonstrate that these two strains possess distinct genetic repertoires in carbohydrate assimilation, differential activation signatures and cytokine responses signatures in innate immune cells, and differential effects on lymph node morphology with unique local and systemic leukocyte distribution. Importantly, the administration of each B. pseudolongum strain resulted in major divergence in the structure, composition, and function of gut microbiota. This was accompanied by markedly different changes in intestinal transcriptional activities, suggesting strain-specific modulation of the endogenous gut microbiota as a key to immune modulatory host responses. Our study demonstrated a single probiotic strain can influence local, regional, and systemic immunity through both innate and adaptive pathways in a strain-specific manner. It highlights the importance to investigate both the endogenous gut microbiome and the intestinal responses in response to probiotic supplementation, which underpins the mechanisms through which the probiotic strains drive the strain-specific effect to impact health outcomes.

PD-L1 signaling selectively regulates T cell lymphatic transendothelial migration

Programmed death-1 (PD-1) and its ligand PD-L1 are checkpoint molecules which regulate immune responses. Little is known about their functions in T cell migration and there are contradictory data about their roles in regulatory T cell (Treg) function. Here we show activated Tregs and CD4 effector T cells (Teffs) use PD-1/PD-L1 and CD80/PD-L1, respectively, to regulate transendothelial migration across lymphatic endothelial cells (LECs). Antibody blockade of Treg PD-1, Teff CD80 (the alternative ligand for PD-L1), or LEC PD-L1 impairs Treg or Teff migration in vitro and in vivo. PD-1/PD-L1 signals through PI3K/Akt and ERK to regulate zipper junctional VE-cadherin, and through NFκB-p65 to up-regulate VCAM-1 expression on LECs. CD80/PD-L1 signaling up-regulates VCAM-1 through ERK and NFκB-p65. PD-1 and CD80 blockade reduces tumor egress of PD-1high fragile Tregs and Teffs into draining lymph nodes, respectively, and promotes tumor regression. These data provide roles for PD-L1 in cell migration and immune regulation.

Treg tissue stability depends on lymphotoxin beta-receptor- and adenosine-receptor-driven lymphatic endothelial cell responses

Regulatory T cell (Treg) lymphatic migration is required for resolving inflammation and prolonging allograft survival. Focusing on Treg interactions with lymphatic endothelial cells (LECs), we dissect mechanisms and functional consequences of Treg transendothelial migration (TEM). Using three genetic mouse models of pancreatic islet transplantation, we show that Treg lymphotoxin (LT) αβ and LEC LTβ receptor (LTβR) signaling are required for efficient Treg migration and suppressive function to prolong allograft survival. Inhibition of LT signaling increases Treg conversion to Foxp3loCD25lo exTregs. In a transwell-based model of TEM across polarized LECs, non-migrated Tregs become exTregs. Such conversion is regulated by LTβR nuclear factor κB (NF-κB) signaling in LECs, which increases interleukin-6 (IL-6) production and drives exTreg conversion. Migrating Tregs are ectonucleotidase CD39hi and resist exTreg conversion in an adenosine-receptor-2A-dependent fashion. Human Tregs migrating across human LECs behave similarly. These molecular interactions can be targeted for therapeutic manipulation of immunity and suppression.

Introspective Meditation before Seeking Pleasurable Activities as a Stress Reduction Tool among College Students: A Multi-Theory Model-Based Pilot Study

In the realm of behavioral interventions, a combined approach of yoga and a cognitive-behavioral strategy in the form of introspective meditation (manan-dhyana) may offer benefits as a stress management tool. This pilot study focuses on introspective meditation performed before seeking pleasurable activities, which is a self-reflection about whether to pursue a goal that will bring sensory pleasure in life. A non-probability sample of college students was recruited from a mid-sized Southern University of the United States using a 52-items web-based survey built in Qualtrics. Univariate, bivariate, and multivariate statistics were used to analyze data. Of total 65 students, only 21.5% students reported being engaged in the introspective meditation. The sample constituted predominantly females (75.4%), White (64.6%), and undergraduate students (87.7%). The proportions of anxiety, depression, and moderate/high stress were 50.8%, 40.0%, 86.1% respectively. In the hierarchical regression for initiation, the final model explained nearly 21.1% of variance in initiating introspective meditation among participants (n = 51) who had not been practicing it. With each unit increment in subscales of initiation (i.e., changes in physical environment), the conditional mean for initiating introspective meditation behavior increased by 0.373 units. In the hierarchical regression for sustenance, the final model explained nearly 50.5% of variance in sustaining introspective meditation behavior among participants (n = 51) who had not been practicing it. With each unit increment in subscales of sustenance (i.e., emotional transformation), the conditional mean for sustaining introspective meditation behavior increased by 0.330 units. This study can pave a way for designing interventions for college students to promote introspective meditation directed toward seeking pleasurable activities before engaging in them. This has implications for the reduction of stress as well as a preemptive measure for sexual risk-taking, indulgence in maladaptive behaviors such as smoking, vaping, alcohol, and substance use.

Ferrans and powers quality of life index for spinal cord injury

Objective: To translate and culturally adapt the Telugu version of Quality-of-Life tool among Spinal Cord Injury patients. Method: It’s a prospective cross-sectional study conducted at a tertiary neuro centre care hospital. The English version was translated into Telugu by two expert medical professionals and cross-checked by three experts in Telugu vocabulary. Nursing students who had good proficiency in reading and writing in English and Telugu languages were chosen for checking tool reliability. Initially English language was administered on the satisfaction domain followed by the importance domain one month apart. After two months Telugu version was administered in the same way as the English version. The reliability analysis was done.       Results: The tool was administered to 50 nursing students. The Cronbach’s alpha for the satisfaction domain was 0.97 and the importance domain was 0.91, indicating excellent reliability.     Conclusion: The Telugu version of the QOL tool had excellent reliability. Therefore it can be administered in the Telugu language for evaluating the quality of life of people with spinal cord injury.

Can the Multi-Theory Model (MTM) of Health Behavior Change Explain the Intent for People to Practice Meditation?

Meditation is gaining popularity as adjuvant therapy for many chronic ailments, mental well-being, and spiritual growth. Behavioral theories have been underutilized in understanding meditation behavior. This study aimed to test if a fourth-generation multi-theory model (MTM) could explain the intent for starting and maintaining meditation behavior in a sample of US adults. A face and content valid 48-item instrument based on MTM was administered in a cross-sectional design through an online survey (n = 330). Internal consistency (Cronbach's alpha > 0.70) and construct validation using structural equation modeling of the subscales were all acceptable. Hierarchical multiple regression revealed that, after controlling for demographic covariates, the MTM constructs of participatory dialogue (β  =  0.153; P  =  .002) and behavioral confidence (β  =  0.479; P < .001) were statistically significant in predicting intent for starting meditation behavior and accounted for 32.9% of the variance. Furthermore, after controlling for demographic covariates, the MTM constructs of emotional transformation (β  =  0.390; P < .001) and changes in the social environment (β  =  0.395; P < .001) were statistically significant and accounted for 52.9% of the variance in the intent for maintaining meditation behavior. Based on this study, it can be concluded that MTM offers a pragmatic framework to design, implement, and evaluate evidence-based (theory-based) meditation behavior change interventions.

Chronic rejection as a persisting phantom menace in organ transplantation: a new hope in the microbiota?

PURPOSE OF REVIEW

The microbiota plays an important role in health and disease. During organ transplantation, perturbations in microbiota influence transplant outcome. We review recent advances in characterizing microbiota and studies on regulation of intestinal epithelial barrier function and mucosal and systemic immunity by microbiota and their metabolites. We discuss implications of these interactions on transplant outcomes.

RECENT FINDINGS

Metagenomic approaches have helped the research community identify beneficial and harmful organisms. Microbiota regulates intestinal epithelial functions. Signals released by epithelial cells or microbiota trigger pro-inflammatory or anti-inflammatory effects on innate and adaptive immune cells, influencing the structure and function of the immune system. Assessment and manipulation of microbiota can be used for biomarkers for diagnosis, prognosis, and therapy.

SUMMARY

The bidirectional dialogue between the microbiota and immune system is a major influence on immunity. It can be targeted for biomarkers or therapy. Recent studies highlight a close association of transplant outcomes with microbiota, suggesting exciting potential avenues for management of host physiology and organ transplantation.

Correlates of COVID-19 Pandemic on Anxiety among Adults in Appalachia, USA

BACKGROUND

Anxiety problems have increased in the COVID-19 pandemic worldwide. However, very little is known about the anxiety rates in the new normal phase of the disease when adults have been assumed to be adjusted. The study aimed to find out the difference in anxiety in a convenience sample of Appalachian adults during the new normal phase of the COVID-19 pandemic, examine its association with sociodemographic factors, and compare it with the anxiety levels before the pandemic as recalled by the participants.

STUDY DESIGN

A cross-sectional study.

METHODS

The Generalized Anxiety Disorder-7 scale was used in the present study. The Chi-square test was used to examine the difference between the severity of anxiety before and during the new normal phase of the COVID-19 pandemic in terms of sociodemographic and behavioral correlates. Pearson correlation was used to see the strength of the association between anxiety and age.

RESULTS

Although the anxiety rate was stabilized by the time people approached the new normal phase of the COVID-19 pandemic, its severity increased significantly among those with preexisting anxiety (P=0.001). Anxiety was found highly associated with female and minority gender, student status, lower education and income level, marital status, cohabitation with parents, and cigarette consumption (P=0.001). A slight inverse association was observed between age and anxiety before and during the new normal phase of the COVID-19 pandemic (P=0.001).

CONCLUSION

The young and females seem to be suffering from a higher burden of anxiety. Research is suggested to identify ways to develop social support-based community programs to address this issue.

Testing Multi-Theory Model (MTM) in Explaining Sunscreen Use among Florida Residents: An Integrative Approach for Sun Protection

Florida residents have the second highest incidence of skin cancer in the nation. Sunscreen usage was found to be the one of the most effective integrative health approaches for reducing risk of skin cancer. Given the limited information on the likelihood of adopting and continuing sunscreen usage behavior, this cross-sectional study aimed to examine the correlates of initiating and sustaining sunscreen usage behavior among Florida dwellers, using the fourth-generation, multi-theory model (MTM) of behavior change. A web-based survey containing 51 questions was emailed to Florida residents aged 18 years or above, who were randomly selected from the state voter file. Psychometric validity of the survey instrument was established using structural equation modeling, and Cronbach’s alpha values were calculated for assessing the internal consistency. An independent-samples-t-test and hierarchical multiple regression tests were used to analyze the data. The results indicated that participants who engaged in sunscreen usage behavior, participatory dialogue (β = 0.062, p < 0.05), behavioral confidence (β = 0.636, p < 0.001), and changes in the physical environment (β = 0.210, p < 0.001) were statistically significant and accounted for 73.6% of the variance in initiating sunscreen usage behavior. In addition, the constructs of emotional transformation (β = 0.486, p < 0.001) and practice for change (β = 0.211, p < 0.001), as well as changes in the social environment (β = 0.148, p < 0.001) were significant predictors of maintaining sunscreen usage behavior and contributed to 59% of variance in sustenance. These findings offer a valuable insight regarding the applicability of MTM models to guiding public health interventions promoting sunscreen usage and preventing UV radiation risk and related skin cancer.

Quality of Life after Surviving a Spinal Cord Injury: An Observational Study in South India

Background

Spinal cord injury (SCI) and its negative impact on the quality of life (QOL) is a significant public health concern in India. People with SCI suffer from serious health, economic, and social consequences in their lives. Often, care for SCI survivors is left to their immediate family members in India. Appropriate planning is needed for prevention, rehabilitation, health, and psychological care for SCI in the country.

Purpose

This study assessed the overall QOL of SCI survivors and their satisfaction levels with specific domains and their importance of QOL.

Materials and Methods

In this observational study, two instruments, Farrens and Power for QOL and Barthel Index for functional abilities, were administered to a convenience sample of participants drawn from Narayana Medical College, Nellore, in South India.

Results

Statistically, SCI survivors were found moderately and very satisfied with their QOL. Their perception about importance of health, functioning, social, and economic subscale also did not differ statistically.

Mechanisms of exTreg induction

CD4+ CD25+ Foxp3+ Tregs play an important role in the maintenance of the immune system by regulating immune responses and resolving inflammation. Tregs exert their function by suppressing other immune cells and mediating peripheral self-tolerance. Under homeostatic conditions, Tregs are stable T-cell populations. However, under inflammatory environments, Tregs are converted to CD4+ CD25low Foxp3low cells. These cells are termed "exTreg" or "exFoxp3" cells. The molecular mechanism of Treg transition to exTregs remains incompletely understood. Uncertainties might be explained by a lack of consensus of biological markers to define Treg subsets in general and exTregs in particular. In this review, we summarize known markers of Tregs and factors responsible for exTreg generation including cytokines, signaling pathways, transcription factors, and epigenetic mechanisms. We also identify studies demonstrating the presence of exTregs in various diseases and sources of exTregs. Understanding the biology of Treg transition to exTregs will help in designing Treg-based therapeutic approaches.

LTβR Signaling Controls Lymphatic Migration of Immune Cells

The pleiotropic functions of lymphotoxin (LT)β receptor (LTβR) signaling are linked to the control of secondary lymphoid organ development and structural maintenance, inflammatory or autoimmune disorders, and carcinogenesis. Recently, LTβR signaling in endothelial cells has been revealed to regulate immune cell migration. Signaling through LTβR is comprised of both the canonical and non-canonical-nuclear factor κB (NF-κB) pathways, which induce chemokines, cytokines, and cell adhesion molecules. Here, we focus on the novel functions of LTβR signaling in lymphatic endothelial cells for migration of regulatory T cells (Tregs), and specific targeting of LTβR signaling for potential therapeutics in transplantation and cancer patient survival.

Deficiency of Rbpj Leads to Defective Stress-Induced Hematopoietic Stem Cell Functions and Hif Mediated Activation of Non-canonical Notch Signaling Pathways

Deregulated notch signaling has been associated with human pathobiology. However, functions of notch pathways in hematopoiesis remain incompletely understood. Here, we ablated canonical notch pathways, through genetic deletion of Rbpj, in hematopoietic stem cells (HSCs). Our data identified that loss of canonical notch results in normal adult HSC pool, at steady state conditions. However, HSC maintenance and functions in response to radiation-, chemotherapy-, and cytokine- induced stress were compromised in the absence of canonical notch. Rbpj deficient HSCs exhibit decreased proliferation rates and elevated expression of p57^Kip2. Surprisingly, loss of Rbpj resulted in upregulation of key notch target genes and augmented binding of Hes1 to p57 and Gata2 promoters. Further molecular analyses identified an increase in notch activity, elevated expression and nuclear translocation of Hif proteins, and augmented binding of Hif1α to Hes1 promoter in the absence of Rbpj. These studies, for the first time, identify a previously unknown role for non-canonical notch signaling and establish a functional link between Hif and Notch pathways in hematopoiesis.

Important Aspects of Human Behavior in Road Traffic Accidents

Worldwide road traffic accidents have been increasing. Human behaviors and environmental factors are often responsible for such events. This being a serious public health concern, public health interventions are needed to minimize the rate of road traffic accidents. We aimed to identify broader human behaviors, sociodemographic factors, and environmental factors associated with the risk of road traffic accidents. We searched for the relevant studies in electronic database including PubMed, Cochrane, Web of Science, Google Scholar, and World Health Organization global health library. In addition, a manual search was also performed. Findings from scientific literature were presented in a summative form. Young age, male gender, speed, influence of substance, use of mobile phone, driving experience, temperament, attitude, aggression, stress, anxiety, emotionality, fatigue, lack of sleep, and road conditions were found closely associated with a risk of road traffic accidents. Despite having substantial driving training and ability to handling motor vehicles, professional drivers such as bus and taxi drivers are very vulnerable to road traffic accidents. This study reports that the increasing prevalence of road traffic accidents can be addressed significantly by applying behavior change theories. The health belief model was found useful in promoting safer driving.

Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) crisis has greatly affected human lives across the world. Uncertainty and quarantine have been affecting people's mental health. Estimations of mental health problems are needed immediately for the better planning and management of these concerns at a global level. A rapid scoping review was conducted to get the estimation of mental health problems in the COVID-19 pandemic during the first 7 months. Peer-reviewed, data-based journal articles published in the English language were searched in the PubMed, Medline, and Google Scholar electronic databases from December 2019 to June 2020. Papers that met the inclusion criteria were analyzed and discussed in this review. A total of 16 studies were included. Eleven studies were from China, two from India, and one from Spain, Italy, and Iran. Prevalence of all forms of depression was 20%, anxiety 35%, and stress 53% in the combined study population of 113,285 individuals. The prevalence rate of all forms of depression, anxiety, stress, sleep problems, and psychological distress in general population was found to be higher during COVID-19 pandemic.

A Family Study of Consanguinity in Children with Intellectual Disabilities in Barwani, India

Background:

Intellectual disability (ID) can be inherited in families through consanguineous marriage. The ID in an individual can be associated with the ID, epilepsy, and mental illness in their parents. Such connections can be seen more closely among consanguineous marriages in tribal and nontribal population in India.

Objective:

This study shows a few common patterns of the consanguineous relationship in the parents of children with ID in India.

Materials and Methods:

This is a case series research design. Extreme or deviant case sampling was applied. Data were collected in homes, camps, and clinical settings in the Barwani district of Madhya Pradesh, India. The patterns of consanguineous marriages and the relationship between children with ID and their relatives with ID, epilepsy, and mental illness were analyzed and reported with pedigree charts.

Results:

Multiple patterns of consanguineous marriages in tribal and nontribal populations were observed. ID was found to be associated in children with their relatives of the first, second, and third generations.

Conclusion:

ID may inherit in individuals from their relatives of the first, second, and third generations who have ID, epilepsy, or mental illness and married in the relationship. Appropriate knowledge, guidance, and counseling may be provided to potential couples before planning a consanguineous marriage.

Cyclooxygenase 2 augments osteoblastic but suppresses chondrocytic differentiation of CD90+ skeletal stem cells in fracture sites

Cyclooxygenase 2 (COX-2) is essential for normal tissue repair. Although COX-2 is known to enhance the differentiation of mesenchymal stem cells (MSCs), how COX-2 regulates MSC differentiation into different tissue-specific progenitors to promote tissue repair remains unknown. Because it has been shown that COX-2 is critical for normal bone repair and local COX-2 overexpression in fracture sites accelerates fracture repair, this study aimed to determine the MSC subsets that are targeted by COX-2. We showed that CD90⁺ mouse skeletal stem cells (mSSCs; i.e., CD45^-Tie2^-AlphaV⁺ MSCs) were selectively recruited by macrophage/monocyte chemoattractant protein 1 into fracture sites following local COX-2 overexpression. In addition, local COX-2 overexpression augmented osteoblast differentiation and suppressed chondrocyte differentiation in CD90⁺ mSSCs, which depended on canonical WNT signaling. CD90 depletion data demonstrated that local COX-2 overexpression targeted CD90⁺ mSSCs to accelerate fracture repair. In conclusion, CD90⁺ mSSCs are promising targets for the acceleration of bone repair.

Substance Use Disorder in People with Intellectual Disabilities: Current Challenges in Low- and Middle-Income Countries

Use of illegal and prescription drugs has significantly increased in recent years all over the world in most populations. Greater worldwide awareness in this regard has substantially improved the epidemiological understanding of substance use, its risk factors, and impact on life. People with intellectual disabilities constitute 0.5%–1.5% of the world's population. It can be conjectured that they might be experiencing similar or even a greater burden of substance use in their lives. This article highlights some important aspects of substance use among this population in low- and middle-income countries that need urgent attention.

Role of MicroRNA-423-5p in posttranscriptional regulation of the intestinal riboflavin transporter-3

Riboflavin (RF) is essential for normal cellular functions and health. Humans obtain RF from exogenous sources via intestinal absorption that involves a highly specific carrier-mediated process. We have recently established that the riboflavin transporter-3 (RFVT3) is vital for the normal intestinal RF uptake process and have characterized certain aspects of its transcriptional regulation. Little is known, however, about how this transporter is regulated at the posttranscriptional level. We address this issue by focusing on the role of microRNAs. Using bioinformatics, we identified two potential interacting miRNAs with the human (h) RFVT3-3'-UTR, and showed (using pmirGLO-hRFVT3-3'-UTR) that the hRFVT3-3'-UTR is, indeed, a target for miRNA effect. Of the two putative miRNAs identified, miR-423-5p was found to be highly expressed in intestinal epithelial cells and that its mimic affected luciferase reporter activity of the pmirGLO-hRFVT3-3'-UTR construct, and also led to inhibition in RF uptake by intestinal epithelial Caco-2 and HuTu-80 cells. Furthermore, cells transfected with mutated seed sequences for miR-423-5p showed an abrogation in inhibitory effect of the miR-423-5p mimic on luciferase activity. While miR-423-5p did not affect the level of expression of the hRFVT3 mRNA, it did lead to a significant inhibition in the level of expression of its protein. Similarly, miR-423-5p was found to affect the level of expression of the mouse RFVT3 in cultured intestinal enteroids. These findings demonstrate, for the first time, that the RFVT3 is a target for posttranscriptional regulation by miRNAs in intestinal epithelial cells and that this regulation has functional consequences on intestinal RF uptake.NEW & NOTEWORTHY Our findings show for the first time that RFVT3 is a target for posttranscriptional regulation by miR-423-5p in intestinal epithelial cells, and this regulation has functional consequences on intestinal riboflavin (RF) uptake process.

The National Trust: A viable model of care for adults with intellectual disabilities in India

The longevity of people with intellectual disabilities is increasing in developing nations. However, developing nations lack a proper system of care for aging persons with intellectual disabilities. Until now the care has been provided by parents and relatives in the home environment in developing countries, but this scenario is also changing; therefore, there is a strong need to explore a plan of care for this population which is also feasible and replicable. The National Trust is an autonomous body of the Government of India which has developed a comprehensive plan of care for adults with intellectual disabilities. In this article, the National Trust is discussed using a socioecological model. The replicability and suitability of this model for other developing countries are discussed.

Unique Regenerative Mechanism to Replace Bone Lost During Dietary Bone Depletion in Weanling Mice

The present study was undertaken to determine the mechanism whereby calcitropic hormones and mesenchymal stem cell progeny changes are involved in bone repletion, a regenerative bone process that restores the bone lost to calcium deficiency. To initiate depletion, weanling mice with a mixed C57BL/6 (75%) and CD1 (25%) genetic background were fed a calcium-deficient diet (0.01%) for 14 days. For repletion, the mice were fed a control diet containing 1.2% calcium for 14 days. Depletion decreased plasma calcium and increased plasma parathyroid hormone, 1,25(OH)2D (calcitriol), and C-terminal telopeptide of type I collagen. These plasma parameters quickly returned toward normal on repletion. The trabecular bone volume and connectivity decreased drastically during depletion but were completely restored by the end of repletion. This bone repletion process largely resulted from the development of new bone formation. When bromodeoxyuridine (BrdU) was administered in the middle of depletion for 3 days and examined by fluorescence-activated cell sorting at 7 days into repletion, substantial increases in BrdU incorporation were seen in several CD105 subsets of cells of osteoblastic lineage. When BrdU was administered on days 1 to 3 of repletion and examined 11 days later, no increases in BrdU were seen in these subsets. Additionally, osteocytes that stained positively for BrdU were increased during depletion. In conclusion, the results of the present study have established a unique regenerative mechanism to initiate bone repair during the bone insult. Calcium homeostatic mechanisms and the bone repletion mechanism are opposing functions but are simultaneously orchestrated such that both endpoints are optimized. These results have potential clinical relevance for disease entities such as type 2 osteoporosis.

Lipopolysaccharide inhibits colonic biotin uptake via interference with membrane expression of its transporter: a role for a casein kinase 2-mediated pathway

Biotin (vitamin B7), an essential micronutrient for normal cellular functions, is obtained from both dietary sources as well as gut microbiota. Absorption of biotin in both the small and large intestine is via a carrier-mediated process that involves the sodium-dependent multivitamin transporter (SMVT). Although different physiological and molecular aspects of intestinal biotin uptake have been delineated, nothing is known about the effect of LPS on the process. We addressed this issue using in vitro (human colonic epithelial NCM460 cells) and in vivo (mice) models of LPS exposure. Treating NCM460 cells with LPS was found to lead to a significant inhibition in carrier-mediated biotin uptake. Similarly, administration of LPS to mice led to a significant inhibition in biotin uptake by native colonic tissue. Although no changes in total cellular SMVT protein and mRNA levels were observed, LPS caused a decrease in the fraction of SMVT expressed at the cell surface. A role for casein kinase 2 (CK2) (whose activity was also inhibited by LPS) in mediating the endotoxin effects on biotin uptake and on membrane expression of SMVT was suggested by findings that specific inhibitors of CK2, as well as mutating the putative CK2 phosphorylation site (Thr⁷⁸Ala) in the SMVT protein, led to inhibition in biotin uptake and membrane expression of SMVT. This study shows for the first time that LPS inhibits colonic biotin uptake via decreasing membrane expression of its transporter and that these effects likely involve a CK2-mediated pathway.

Behaviour Problems in Children with Intellectual Disabilities in a Resource-Poor Setting in India - Part 1: Association with Age, Sex, Severity of Intellectual Disabilities and IQ

BACKGROUND

Behaviour problems are most common in people with intellectual disabilities. Nature of behaviour problems can vary depending upon the age, sex and intellectual level (IQ).

OBJECTIVES

This study examined the distribution of behaviour problems across intellectual disability categories and their association with IQ age and sex in children with intellectual disabilities.

METHODS

This is a cross-sectional study design. A total of 104 participants (57 males and 47 females), aged 3-18 years, with intellectual disabilities were administered The Behavioural Assessment Scale for Indian Children with Mental Retardation (BASIC-MR).

RESULTS

It was found that violent and destructive, temper tantrum and self-injurious behaviours were differently distributed with reference to intellectual disability levels (P > 0.05) but cumulative scores per se problem behaviours did not vary with the level of intellectual disabilities. IQ showed a significant positive correlation with destructive and violent and misbehaves with other; and a significant negative correlation with temper tantrums and self-injurious behaviours. Age was significantly, positively associated with violent and destructive, odd, and hyperactive behaviours and inversely with self-injurious problem behaviours. There was no significant relationship between the sex of the child and problem behaviours. There was no significant interactive effect of sex and level of intellectual disabilities of the child on problem behaviours.

CONCLUSION

Behaviour problems, in general, are not equally distributed in all categories of intellectual disabilities. Relationship between behaviour problems and age, sex and IQ may not be uniform. But specific behaviours are more associated with specific age group and intellectual disability levels.

Down syndrome in tribal population in India: A field observation

CONTEXT

Down syndrome (DS) is a prevalent genetic disorder in intellectual disability (ID) in India. Its prevalence in tribal population is not known.

AIMS

The study aimed to understand the profile of DS in a tribal population with an objective of finding the prevalence of DS among those with ID.

SETTINGS AND DESIGN

This is a community-based study with a survey design.

SUBJECTS AND METHODS

A door-to-door survey was conducted by trained, community-based rehabilitation workers under close supervision of multidisciplinary team to identify people with ID. A standardized screening instrument National Institute for Mentally Handicapped-Developmental Screening Schedule was used in the survey. All identified ID cases were evaluated by therapists in IDs for diagnosis of ID on developmental screening test and Vineland social maturity scale. Clinical examination was performed by medical doctors for DS on people identified as ID. Only two parents brought their children for further lab investigations at Ashagram Trust, Barwani.

STATISTICAL ANALYSIS USED

Descriptive statistics was applied manually to treat the data.

RESULTS

The frequency of DS population in tribal population closely matches with DS prevalence in the USA. Mothers of DS children in the tribal community are relatively younger.

CONCLUSION

Prevalence of DS in tribal population of India may greatly vary with that of the US data, but it is markedly associated with younger maternal age. Further studies are needed for prevalence and identification of potential correlates of this condition.

An estimation of the prevalence of intellectual disabilities and its association with age in rural and urban populations in India

Background:

Intellectual disability (ID) is a global public health concern. Prevalence of ID and its association with age and other demographic factors is required for planning purposes in India.

Objective:

This study analyzed the age-adjusted prevalence of ID in rural and urban populations and its correlation with age in children and adults.

Materials and Methods:

Disability data published in the report (2002) of National Sample Survey Organization were analyzed, using Z-test to measure differences in age-adjusted prevalence. Spearman rho was calculated to determine strength and direction of the association, and regression analysis was used to predict prevalence rate, based on age in rural and urban population settings.

Results:

Overall, India has a prevalence of 10.5/1000 in ID. Urban population has slightly higher rate (11/1000) than rural (10.08/1000; P = 0.044). Age was found to be highly correlated with prevalence of ID in rural children (ϱ =0.981, P = 0.019) as well as in children (ϱ = −0.954, P = 0.000) and adults (ϱ = −0.957, P = 0.000) in urban population. The possibility of confounding or the existence of covariates for children in urban settings was noted.

Conclusion:

Results of this study match findings in other epidemiological studies. However, multistage, large-scale studies are recommended for investigating prevalence rates with different severity levels of ID.

Profile of Social, Environmental and Biological Correlates in Intellectual Disability in A Resource-Poor Setting in India

BACKGROUND

Intellectual disability (ID) is a major public health issue in India. Social, environmental and biological factors all contribute to the nation's high rate of ID.

OBJECTIVE

We aimed to investigate the distribution, differences and the association of social, environmental and biological factors with different types of ID in a mixed (tribal and non-tribal) population in India.

MATERIALS AND METHODS

Secondary data was collected during a community-based rehabilitation project and analyzed with descriptive statistics: Frequency, percentage and χ(2).

RESULTS

Poverty, low levels of parental education and a family history of epilepsy and ID were all associated in both tribal and non-tribal populations (P < 0.05).

CONCLUSION

The outcome of this study may be helpful in planning public health initiatives that aim to reduce the burden of ID in mixed populations.

Local administration of AAV-DJ pseudoserotype expressing COX2 provided early onset of transgene expression and promoted bone fracture healing in mice

We have previously obtained compelling proof-of-principle evidence for COX2 gene therapy for fracture repair using integrating retroviral vectors. For this therapy to be suitable for patient uses, a suitable vector with high safety profile must be used. Accordingly, this study sought to evaluate the feasibility of AAV as the vector for this COX2 gene therapy, because AAV raises less safety issues than the retroviral vectors used previously. However, an appropriate AAV serotype is required to provide early increase in and adequate level of COX2 expression that is needed for fracture repair. Herein, we reported that AAV-DJ, an artificial AAV pseudoserotype, is highly effective in delivering COX2 gene to fracture sites in a mouse femoral fracture model. Compared with AAV-2, the use of AAV-DJ led to ~5-fold increase in infectivity in mesenchymal stem cells (MSCs) and provided an earlier and significantly higher level of transgene expression at the fracture site. Injection of this vector at a dose of 7.5 × 10(11) genomic copies led to high COX2 level at the fracture site on day 3 after injections and significantly promoted fracture union at 21 days, as analyzed by radiography and μ-CT. The therapeutic effect appears to involve enhanced osteoblastic differentiation of MSCs and remodeling of callus tissues to laminar bone. This interpretation is supported by the enhanced expression of several key genes participating in the fracture repair process. In conclusion, AAV-DJ is a promising serotype for the AAV-based COX2 gene therapy of fracture repair in humans.

Identifying Children with Intellectual Disabilities in the Tribal Population of Barwani District in State of Madhya Pradesh, India

BACKGROUND

Low-and middle-income countries (LAMI) lack an integrated and systematic approach to identify people with intellectual disabilities. Screening surveys are considered resource-intensive; therefore, alternative approaches are needed. This study attempted to identify children up to age 18 years with intellectual disabilities through a mixed-method approach involving focus group interviews (FGIs) and door-to-door surveys.

MATERIALS AND METHODS

Focus groups were conducted with the assistance and involvement of local leaders in four villages of Barwani district of Madhya Pradesh with a 99% tribal population in all four villages. A formal survey of the community was then conducted to determine the prevalence of intellectual disabilities based on a standardized screening instrument (NIMH-DDS).

RESULTS

Thirty focus group interviews were conducted involving 387 participants (males 284, females 103) over a period of 13 days. The entire adult population (N = 8797) was then surveyed for intellectual disabilities using a standardized screening instrument. The data revealed a close similarity in the prevalence rates of intellectual disabilities, as determined by the two approaches (Focus Group Interviews, 5.22/1000 versus Survey, 5.57/1000).

CONCLUSION

A qualitative method using FGIs successfully identified people with intellectual disabilities in an economically deprived tribal area, showing that a community-based approach provides a close estimate of intellectual disabilities based on a formal survey using standard diagnostic criteria. These data suggest that FGI, along with other qualitative data, could be helpful in designing and in serving as an entree for community-based interventions.

National sample survey organization survey report: An estimation of prevalence of mental illness and its association with age in India

BACKGROUND

The Indian population suffers with significant burden of mental illness. The prevalence rate and its association with age and other demographic indicators are needed for planning purpose.

OBJECTIVE

This study attempted to calculate age-wise prevalence of mental illness for rural and urban settings, and its association with age.

MATERIALS AND METHODS

Data published in National Sample Survey Organization (2002) report on disability is used for the analysis. Spearman correlation for strength of association, z-test for difference in prevalence, and regression statistics for predicting the prevalence rate of mental illness are used.

RESULT

Overall population have 14.9/1000 prevalence of mental illness. It is higher in rural setting 17.1/1000 than urban 12.7/1000 (P < 0.001). There is a strong correlation found with age in rural (ϱ = 0.910, P = 0.001) and urban (ϱ = 0.940, P = 0.001).

CONCLUSION

Results of this study confirm other epidemiological research in India. Large-population epidemiological studies are recommended.

Behavioral management in children with intellectual disabilities in a resource-poor setting in Barwani, India

BACKGROUND

Management of behavioral problems in children with intellectual disabilities (ID) is a great concern in resource-poor areas in India. This study attempted to analyze the efficacy of behavioral intervention provided in resource-poor settings.

OBJECTIVE

This study was aimed to examine the outcome of behavioral management provided to children with ID in a poor rural region in India.

MATERIALS AND METHODS

We analyzed data from 104 children between 3 and 18 years old who received interventions for behavioral problems in a clinical or a community setting. The behavioral assessment scale for Indian children with mental retardation (BASIC-MR) was used to quantify the study subjects' behavioral problems before and after we applied behavioral management techniques (baseline and post-intervention, respectively). The baseline and post-intervention scores were analyzed using the following statistical techniques: Wilcoxon matched-pairs signed-rank test for the efficacy of intervention; χ(2) for group differences.

RESULTS

The study demonstrated behavioral improvements across all behavior domains (P < 0.05). Levels of improvement varied for children with different severities of ID (P = 0.001), between children who did and did not have multiple disabilities (P = 0.011).

CONCLUSION

The outcome of this behavioral management study suggests that behavioral intervention can be effectively provided to children with ID in poor areas.

Alcohol consumption is a leading risk for morbidity and mortality; public health initiatives needed

I read the article authored by Dasgupta et al “Alcohol Consumption by workers in automobile repair shops of a slum of Kolkata: An assessment with AUDIT instrument” with great interest. This article was published in the Nepal Journal of Epidemiology in volume 3, issue 3, 2013. Alcoholism leads several health, economic and social problems in the lives of people who consume it. It also affects their families and community. Social issues such as violence, suicide, child neglect, work place absent, conflict in relationship, and divorce are some common outcomes of alcohol consumption.DOI: http://dx.doi.org/10.3126/nje.v3i4.9520

Intelligence quotient is associated with epilepsy in children with intellectual disability in India

Background:

Epilepsy is a disorder that is commonly found in people with intellectual disability (ID). The prevalence of epilepsy increases with the severity of ID. The objective of this study was to determine if there is an association between intelligence quotient (IQ) and epilepsy in children with ID.

Materials and Methods:

A total of 262 children, aged 3-18 years, with ID were identified as part of a community-based rehabilitation project. These children were examined for epilepsy and diagnosed by a psychiatrist and physicians based on results of electroencephalogram tests. A Spearman's correlation (ρ) was used to determine if there was an association between IQ scores and the occurrence of epilepsy. X² statistics used to examine the relationship of epilepsy with gender, socioeconomic status, population type, severity of ID, family history of mental illness, mental retardation, epilepsy, and coexisting disorder.

Results:

Spearman's rho –0.605 demonstrates inverse association of IQ with epilepsy. X² demonstrates statistically significant association (P < 0.05) with gender, severity of ID, cerebral palsy, behavior problems, and family history of mental illness, mental retardation, and epilepsy.

Conclusions:

Lower IQ score in children with ID has association with occurrence of epilepsy. Epilepsy is also found highly associated with male gender and lower age.

Social, Environmental and Biological Determinants of Cerebral Palsy in Children with Intellectual Disabilities (ID) in India

Background   Cerebral palsy (CP) is a global public health problem affecting 2.12 to 2.45 per 1000 live birth across the world. Cerebral palsy is an upper motor neuron, non-progressive disorder commonly associated with intellectual disability. The presence of cerebral palsy effects person’s overall life. Objectives This study primarily sought predictive capacity of social, environmental and biological determinants of CP in ID. Materials and Methods This is a cross-sectional study design. A total of 262 children, aged 3 to 18 years, with ID were assessed for cerebral palsy and diagnosed on basis of clinical examination in a community based rehabilitation project in Barwani, India. Information was collected by parent interviews, on social, environmental and biological determinants. A logistic regression model has been applied between determinants and CP.  Results Logistic regression demonstrated that likelihood of CP in ID children can be predicted on bases of their age (odd ratio = 0.856, CI 95% - 0.76-0.95), intelligence quotients (IQ) (odd ratio = 0.782, CI 95% - 0.73-0.83) and family history of intellectual disabilities (odd ratio = 0.051, CI 95% - 2.36 -0.99) and epilepsy (odd ratio = 0.008, CI 95% - 2.58-1.28). Comorbid conditions of downs syndrome and epilepsy also predicts likelihood of CP in ID. Conclusion Likelihood of CP in ID children can be predicted by their age, IQ, family history of intellectual disability, epilepsy and comorbid conditions of downs syndrome and epilepsy. Gender, socio-economic status and population (tribal versus non-tribal) determinants have no predictive relation with CP in the group. DOI: http://dx.doi.org/10.3126/nje.v3i3.9187 Nepal Journal of Epidemiology 2013;3(3): 262-268