The impact of microbiota and ketogenic diet interventions in the management of drug-resistant epilepsy

AIM

Drug-resistant epilepsy (DRE) is a neurological disorder characterized by uncontrolled seizures. It affects between 10%-40% of the patients with epilepsy worldwide. Drug-resistant patients have been reported to have a different microbiota composition compared to drug-sensitive patients and healthy controls. Importantly, fecal microbiota transplantations (FMTs), probiotic and dietary interventions have been shown to be able to reduce seizure frequency and improve the quality of life in drug-resistant patients. The classic ketogenic diet (KD) and its modifications may reduce seizures in DRE in some patients, whereas in others they do not. The mechanisms mediating the dietary effects remain elusive, although it is known that gut microbes play an important role in transmitting dietary effects to the host. Indeed, specific commensal microbes differ even between responders and non-responders to KD treatment.

METHODS

In this narrative mini-review, we summarize what is known about the gut microbiota changes and ketogenic diets with special focus on patients with DRE.

RESULTS AND CONCLUSIONS

By highlighting unanswered questions and by suggesting future research directions, we map the route towards future improvement of successful DRE therapy.

Nutrition during pregnancy: Influence on the gut microbiome and fetal development

Pregnancy is a finely tuned process, with the health and well-being of the developing fetus determined by the metabolic status and dietary intake of the mother. The maternal gut microbiome is remodeled during pregnancy, and this, coupled with the maternal nutrient intake during gestation shapes the production of metabolites that can cross the placenta and affect fetal development. As posited by the Developmental Origins of Health and Disease Hypothesis, such environmental influences can have major effects on the developing organ systems. When occurring at particularly sensitive gestational time points, these developmental programming events can have long lasting effects on offspring adaptation to the postnatal environment, and major health implications later in life. This review will summarize current knowledge on how pregnancy and maternal dietary intake intrinsically and extrinsically modify maternal gut microbiota composition and metabolite production. Further, we will assess how these factors shape the fetal landscape and ultimately contribute to offspring health. DOHaD, fetal development, metabolites, microbiome, nutrition, pregnancy, short-chain fatty acids.

Microbiota, diet, and the gut-brain axis in multiple sclerosis and stroke

Intestinal microbiota can influence the phenotype and function of immune cell responses through the dissemination of bacterial antigens or metabolites. Diet is one of the major forces shaping the microbiota composition and metabolism, contributing to host homeostasis and disease susceptibility. Currently, nutrition is a complementary and alternative approach to the management of metabolic and neurological diseases and cancer. However, the knowledge of the exact mechanism of action of diet and microbiota on the gut-brain communication is only developing in recent years. Here, we reviewed the current knowledge on the effect of diet and microbiota on the gut-brain axis in patients with two different central nervous system diseases, multiple sclerosis and stroke. We have also highlighted the open questions in the field that we believe are important to address to gain a deeper understanding of the mechanisms by which diet can directly or indirectly affect the host via the microbiota. We think this will open up new approaches to the treatment, diagnosis, and monitoring of various diseases.

Lactation-associated macrophages exist in murine mammary tissue and human milk

Macrophages are involved in immune defense, organogenesis and tissue homeostasis. Macrophages contribute to the different phases of mammary gland remodeling during development, pregnancy and involution postlactation. Less is known about the dynamics of mammary gland macrophages in the lactation stage. Here, we describe a macrophage population present during lactation in mice. By multiparameter flow cytometry and single-cell RNA sequencing, we identified a lactation-induced CD11c⁺CX3CR1⁺Dectin-1⁺ macrophage population (liMac) that was distinct from the two resident F4/80^hi and F4/80^lo macrophage subsets present pregestationally. LiMacs were predominantly monocyte-derived and expanded by proliferation in situ concomitant with nursing. LiMacs developed independently of IL-34, but required CSF-1 signaling and were partly microbiota-dependent. Locally, they resided adjacent to the basal cells of the alveoli and extravasated into the milk. We found several macrophage subsets in human milk that resembled liMacs. Collectively, these findings reveal the emergence of unique macrophages in the mammary gland and milk during lactation.

Plastics in our ocean as transdisciplinary challenge

This conference report summarizes the current challenges of researching microplastics pollution in the ocean as debated by international experts and stakeholders at a workshop held in San Sebastián, Spain, 1-2 October 2019. The transdisciplinary, co-learning approach of this report stressed the need to incorporate multiple perspective in solving the problem of microplastics and resulted in three proposed actions: (i) filtering microplastics from waste waters; (ii) mandatory ecolabels on plastic products packages; and (iii) circular economy of packaging plastics.

The Gut-Brain Axis: How Microbiota and Host Inflammasome Influence Brain Physiology and Pathology

The human microbiota has a fundamental role in host physiology and pathology. Gut microbial alteration, also known as dysbiosis, is a condition associated not only with gastrointestinal disorders but also with diseases affecting other distal organs. Recently it became evident that the intestinal bacteria can affect the central nervous system (CNS) physiology and inflammation. The nervous system and the gastrointestinal tract are communicating through a bidirectional network of signaling pathways called the gut-brain axis, which consists of multiple connections, including the vagus nerve, the immune system, and bacterial metabolites and products. During dysbiosis, these pathways are dysregulated and associated with altered permeability of the blood-brain barrier (BBB) and neuroinflammation. However, numerous mechanisms behind the impact of the gut microbiota in neuro-development and -pathogenesis remain poorly understood. There are several immune pathways involved in CNS homeostasis and inflammation. Among those, the inflammasome pathway has been linked to neuroinflammatory conditions such as multiple sclerosis, Alzheimer's and Parkinson's diseases, but also anxiety and depressive-like disorders. The inflammasome complex assembles upon cell activation due to exposure to microbes, danger signals, or stress and lead to the production of pro-inflammatory cytokines (interleukin-1β and interleukin-18) and to pyroptosis. Evidences suggest that there is a reciprocal influence of microbiota and inflammasome activation in the brain. However, how this influence is precisely working is yet to be discovered. Herein, we discuss the status of the knowledge and the open questions in the field focusing on the function of intestinal microbial metabolites or products on CNS cells during healthy and inflammatory conditions, such as multiple sclerosis, Alzheimer's and Parkinson's diseases, and also neuropsychiatric disorders. In particular, we focus on the innate inflammasome pathway as immune mechanism that can be involved in several of these conditions, upon exposure to certain microbes.

Evaluation of primer pairs for microbiome profiling from soils to humans within the One Health framework

The 'One Health' framework emphasizes the ecological relationships between soil, plant, animal and human health. Microbiomes play important roles in these relationships, as they modify the health and performance of the different compartments and influence the transfer of energy, matter and chemicals between them. Standardized methods to characterize microbiomes along food chains are, however, currently lacking. To address this methodological gap, we evaluated the performance of DNA extraction kits and commonly recommended primer pairs targeting different hypervariable regions (V3-V4, V4, V5-V6, V5-V6-V7) of the 16S rRNA gene, on microbiome samples along a model food chain, including soils, maize roots, cattle rumen, and cattle and human faeces. We also included faeces from gnotobiotic mice colonized with defined bacterial taxa and mock communities to confirm the robustness of our molecular and bioinformatic approaches on these defined low microbial diversity samples. Based on Amplicon Sequence Variants, the primer pair 515F-806R led to the highest estimates of species richness and diversity in all sample types and offered maximum diversity coverage of reference databases in in silico primer analysis. The influence of the DNA extraction kits was negligible compared to the influence of the choice of primer pairs. Comparing microbiomes using 515F-806R revealed that soil and root samples have the highest estimates of species richness, while lowest richness was observed in human faeces. Primer pair choice directly influenced the estimation of community changes within and across compartments and may give rise to preferential detection of specific taxa. This work demonstrates why a standardized approach is necessary to analyse microbiomes within and between source compartments along food chains in the context of the One Health framework.

Using Precisely Defined in vivo Microbiotas to Understand Microbial Regulation of IgE

Early life exposure to microbes plays an important role in immune system development. Germ-free mice, or mice colonized with a low-diversity microbiota, exhibit high serum IgE levels. An increase in microbial richness, providing it occurs in a critical developmental window early in life, leads to inhibition of this hygiene-induced IgE. However, whether this inhibition is dependent solely on certain microbial species, or is an additive effect of microbial richness, remains to be determined. Here we report that mice colonized with a combination of bacterial species with specific characteristics is required to inhibit IgE levels. These defined characteristics include the presence in early life, acetate production and immunogenicity reflected by induction of IgA. Suppression of IgE did not correlate with production of the short chain fatty acids propionate and butyrate, or induction of peripherally induced Tregs in mucosal tissues. Thus, inhibition of IgE induction can be mediated by specific microbes and their associated metabolic pathways and immunogenic properties.

Microbiota-derived peptide mimics drive lethal inflammatory cardiomyopathy

Myocarditis can develop into inflammatory cardiomyopathy through chronic stimulation of myosin heavy chain 6–specific T helper (TH)1 and TH17 cells. However, mechanisms governing the cardiotoxicity programming of heart-specific T cells have remained elusive. Using a mouse model of spontaneous autoimmune myocarditis, we show that progression of myocarditis to lethal heart disease depends on cardiac myosin–specific TH17 cells imprinted in the intestine by a commensalBacteroidesspecies peptide mimic. Both the successful prevention of lethal disease in mice by antibiotic therapy and the significantly elevatedBacteroides-specific CD4+T cell and B cell responses observed in human myocarditis patients suggest that mimic peptides from commensal bacteria can promote inflammatory cardiomyopathy in genetically susceptible individuals. The ability to restrain cardiotoxic T cells through manipulation of the microbiome thereby transforms inflammatory cardiomyopathy into a targetable disease.

Microbiota-gut brain axis involvement in neuropsychiatric disorders

Introduction: The microbiota-gut brain (MGB) axis is the bidirectional communication between the intestinal microbiota and the brain. An increasing body of preclinical and clinical evidence has revealed that the gut microbial ecosystem can affect neuropsychiatric health. However, there is still a need of further studies to elucidate the complex gene-environment interactions and the role of the MGB axis in neuropsychiatric diseases, with the aim of identifying biomarkers and new therapeutic targets, to allow early diagnosis and improving treatments. Areas covered: To review the role of MGB axis in neuropsychiatric disorders, prediction and prevention of disease through exploitation, integration, and combination of data from existing gut microbiome/microbiota projects and appropriate other International '-Omics' studies. The authors also evaluated the new technological advances to investigate and modulate, through nutritional and other interventions, the gut microbiota. Expert opinion: The clinical studies have documented an association between alterations in gut microbiota composition and/or function, whereas the preclinical studies support a role for the gut microbiota in impacting behaviors which are of relevance to psychiatry and other central nervous system (CNS) disorders. Targeting MGB axis could be an additional approach for treating CNS disorders and all conditions in which alterations of the gut microbiota are involved.

A harmonized and coordinated assessment of the abundance and composition of seafloor litter in the Adriatic-Ionian macroregion (Mediterranean Sea)

Marine litter is a threat to marine life and an economic burden for coastal communities, but efforts to address the issue are hampered by the lack of data for many countries. We performed the first harmonized assessment of seafloor litter (trawl and visual surveys) in six countries of the Adriatic-Ionian macroregion. Seafloor litter showed an uneven distribution throughout the area, with large differences in litter densities and composition among countries and locations. An emerging problem in the area resulted in short-term & single-use objects that represented the largest fraction of litter. Packaging was the economic sector contributing most to seafloor litter on the continental shelf and upper slope, while in some areas aquaculture (mussel farming) represented a key activity producing marine litter. In coastal areas and bays (e.g. Boka Kotorska bay, Montenegro), seafloor litter was mainly related to construction activities and electronic goods, which are a consequence of fly-tipping/illegal dumping.

Floating plastics in Adriatic waters (Mediterranean Sea): From the macro- to the micro-scale

Macro- and microplastics abundances were determined in the Adriatic Sea following the MSFD TG10 protocol. The studied areas included populated gulfs, river outlets and offshore waters in five Adriatic countries. The use of small ships enabled us to detect small sized plastics (2.5-5 cm) and record average macroplastics densities of 251 ± 601 items km^-2, one order of magnitude higher than previously considered. Results from manta net tows for microplastics revealed an average abundance of 315,009 ± 568,578 items km^-2 (217 ± 575 g km^-2). We found significantly higher microplastics abundances in nearshore (≤4 km) than in offshore waters (>4 km) and this trend seems to affect also the small sized macro plastic fragments (2.5-5 cm). The dominant polymers were polyethylene and polypropylene while the presence of some rare polymers and waxes used in food and dentistry indicated waste water treatment plants as potential sources of microplastics.

Antibodies Set Boundaries Limiting Microbial Metabolite Penetration and the Resultant Mammalian Host Response

Although the mammalian microbiota is well contained within the intestine, it profoundly shapes development and metabolism of almost every host organ. We questioned the range and depth of microbial metabolite penetration into the host, and how this is modulated by intestinal immunity. Chemically identical microbial and host metabolites were distinguished by stable isotope tracing from ¹³C-labeled live non-replicating Escherichia coli, differentiating ¹²C host isotopes with high-resolution mass spectrometry. Hundreds of endogenous microbial compounds penetrated 23 host tissues and fluids after intestinal exposure: subsequent ¹²C host metabolome signatures included lipidemia, reduced glycolysis, and inflammation. Penetrant bacterial metabolites from the small intestine were rapidly cleared into the urine, whereas induced antibodies curtailed microbial metabolite exposure by accelerating intestinal bacterial transit into the colon where metabolite transport mechanisms are limiting. Pervasive penetration of microbial molecules can cause extensive host tissue responses: these are limited by immune and non-immune intestinal mucosal adaptations to the microbiota.

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Metabolites from mutualistic bacteria broadly penetrate host tissues and organs

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Bacterial metabolites induce widespread host metabolic and immunological responses

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The small intestine is highly susceptible to host-microbial metabolomic exchange

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Secretory immunoglobulins accelerate microbial clearance from the small intestine

Assessment on marine litter ingested by fish in the Adriatic and NE Ionian Sea macro-region (Mediterranean)

This study presents data on the marine litter occurrence in the stomachs of fish species living in different marine habitats for the Adriatic and NE Ionian Sea macro-region. "Macro-litter" was examined in 614 specimens belonging to 11 species, while micro-litter in 230 specimens belonging to 7 species. The study highlights for the first time the presence of litter in the stomachs of the fish species Citharus linguatula. The occurrence of "macro-litter" in the guts of fish was <3% in both the NE Ionian and N Adriatic but reached 26% in the S Adriatic Sea. Micro-litter occurrence was 40 for the NE Ionian and increased to 87% in the N Adriatic (Slovenian Sea). The ingested "macro" and micro-litter differed among the areas. The marine habitat was found to affect the "macro"-litter ingestion but not the micro-litter.

Marine litter on the beaches of the Adriatic and Ionian Seas: An assessment of their abundance, composition and sources

The abundance, composition and sources of marine litter were determined on beaches located in the seven countries of the Adriatic-Ionian macroregion, namely Albania, Bosnia and Herzegovina, Croatia, Greece, Italy, Montenegro and Slovenia. A total of 70,581 marine litter items were classified and recorded through one-year long surveys carried out in 31 sites. The average litter density of 0.67 items/m² found within this study is considered to be relatively high. The beaches investigated differed in terms of human-induced pressures; their majority is classified either as semi-urban or semi-rural, while very few beaches could be characterized as urban or remote/natural. The majority of litter items were made of artificial/anthropogenic polymer materials accounting for 91.1% of all litter. Litter from shoreline sources accounted for 33.4% of all litter collected. The amount of litter from sea-based sources ranged in the different countries from 1.54% to 14.84%, with an average of 6.30% at regional level.

Inflammasomes make the case for littermate-controlled experimental design in studying host-microbiota interactions

Several human diseases are thought to evolve due to a combination of host genetic mutations and environmental factors that include alterations in intestinal microbiota composition termed dysbiosis. Although in some cases, host genetics may shape the gut microbiota and enable it to provoke disease, experimentally disentangling cause and consequence in such host-microbe interactions requires strict control over non-genetic confounding factors. Mouse genetic studies previously proposed Nlrp6/ASC inflammasomes as innate immunity regulators of the intestinal ecosystem. In contrast, using littermate-controlled experimental setups, we recently showed that Nlrp6/ASC inflammasomes do not alter the gut microbiota composition. Our analyses indicated that maternal inheritance and long-term separate housing are non-genetic confounders that preclude the use of non-littermate mice when analyzing host genetic effects on intestinal ecology. Here, we summarize and discuss our gut microbiota analyses in inflammasome-deficient mice for illustrating the importance of littermate experimental design in studying host-microbiota interactions.

Nlrp6- and ASC-Dependent Inflammasomes Do Not Shape the Commensal Gut Microbiota Composition

The gut microbiota regulate susceptibility to multiple human diseases. The Nlrp6-ASC inflammasome is widely regarded as a hallmark host innate immune axis that shapes the gut microbiota composition. This notion stems from studies reporting dysbiosis in mice lacking these inflammasome components when compared with non-littermate wild-type animals. Here, we describe microbial analyses in inflammasome-deficient mice while minimizing non-genetic confounders using littermate-controlled Nlrp6-deficient mice and ex-germ-free littermate-controlled ASC-deficient mice that were all allowed to shape their gut microbiota naturally after birth. Careful microbial phylogenetic analyses of these cohorts failed to reveal regulation of the gut microbiota composition by the Nlrp6- and ASC-dependent inflammasomes. Our results obtained in two geographically separated animal facilities dismiss a generalizable impact of Nlrp6- and ASC-dependent inflammasomes on the composition of the commensal gut microbiota and highlight the necessity for littermate-controlled experimental design in assessing the influence of host immunity on gut microbial ecology.

Regulation of type 1 diabetes development and B-cell activation in nonobese diabetic mice by early life exposure to a diabetogenic environment

Microbes, including viruses, influence type 1 diabetes (T1D) development, but many such influences remain undefined. Previous work on underlying immune mechanisms has focussed on cytokines and T cells. Here, we compared two nonobese diabetic (NOD) mouse colonies, NOD^low and NOD^high, differing markedly in their cumulative T1D incidence (22% vs. 90% by 30 weeks in females). NOD^high mice harbored more complex intestinal microbiota, including several pathobionts; both colonies harbored segmented filamentous bacteria (SFB), thought to suppress T1D. Young NOD^high females had increased B-cell activation in their mesenteric lymph nodes. These phenotypes were transmissible. Co-housing of NOD^low with NOD^high mice after weaning did not change T1D development, but T1D incidence was increased in female offspring of co-housed NOD^low mice, which were exposed to the NOD^high environment both before and after weaning. These offspring also acquired microbiota and B-cell activation approaching those of NOD^high mice. In NOD^low females, the low rate of T1D was unaffected by cyclophosphamide but increased by PD-L1 blockade. Thus, environmental exposures that are innocuous later in life may promote T1D progression if acquired early during immune development, possibly by altering B-cell activation and/or PD-L1 function. Moreover, T1D suppression in NOD mice by SFB may depend on the presence of other microbial influences. The complexity of microbial immune regulation revealed in this murine model may also be relevant to the environmental regulation of human T1D.

Preliminary study to characterize plastic polymers using elemental analyser/isotope ratio mass spectrometry (EA/IRMS)

Plastic waste is a growing global environmental problem, particularly in the marine ecosystems, in consideration of its persistence. The monitoring of the plastic waste has become a global issue, as reported by several surveillance guidelines proposed by Regional Sea Conventions (OSPAR, UNEP) and appointed by the EU Marine Strategy Framework Directive. Policy responses to plastic waste vary at many levels, ranging from beach clean-up to bans on the commercialization of plastic bags and to Regional Plans for waste management and recycling. Moreover, in recent years, the production of plant-derived biodegradable plastic polymers has assumed increasing importance. This study reports the first preliminary characterization of carbon stable isotopes (δ¹³C) of different plastic polymers (petroleum- and plant-derived) in order to increase the dataset of isotopic values as a tool for further investigation in different fields of polymers research as well as in the marine environment surveillance. The δ¹³C values determined in different packaging for food uses reflect the plant origin of "BIO" materials, whereas the recycled plastic materials displayed a δ¹³C signatures between plant- and petroleum-derived polymers source. In a preliminary estimation, the different colours of plastic did not affect the variability of δ¹³C values, whereas the abiotic and biotic degradation processes that occurred in the plastic materials collected on beaches and in seawater, showed less negative δ¹³C values. A preliminary experimental field test confirmed these results. The advantages offered by isotope ratio mass spectrometry with respect to other analytical methods used to characterize the composition of plastic polymers are: high sensitivity, small amount of material required, rapidity of analysis, low cost and no limitation in black/dark samples compared with spectroscopic analysis.

Gut Microbiome Standardization in Control and Experimental Mice

Mouse models are used extensively to study human health and to investigate the mechanisms underlying human disease. In the past, most animal studies were performed without taking into consideration the impact of the microbiota. However, the microbiota that colonizes all body surfaces, including the gastrointestinal tract, respiratory tract, genitourinary tract, and skin, heavily impacts nearly every aspect of host physiology. When performing studies utilizing mouse models it is critical to understand that the microbiome is heavily impacted by environmental factors, including (but not limited to) food, bedding, caging, and temperature. In addition, stochastic changes in the microbiota can occur over time that also play a role in shaping microbial composition. These factors lead to massive variability in the composition of the microbiota between animal facilities and research institutions, and even within a single facility. Lack of experimental reproducibility between research groups has highlighted the necessity for rigorously controlled experimental designs in order to standardize the microbiota between control and experimental animals. Well controlled experiments are mandatory in order to reduce variability and allow correct interpretation of experimental results, not just of host-microbiome studies but of all mouse models of human disease. The protocols presented are aimed to design experiments that control the microbiota composition between different genetic strains of experimental mice within an animal unit. © 2017 by John Wiley & Sons, Inc.

The first assessment of marine debris in a Site of Community Importance in the north-western Adriatic Sea (Mediterranean Sea)

At present, few studies have investigated the marine litter abundance, composition and distribution on rocky bottoms due to sampling constraints. We surveyed by means of the ROV imaging technique a system of biogenic rocky outcrops classified as a Site of Community Importance in the Adriatic Sea. A mean density of 3.3 (±1.8) items/100m² was recorded, with a strong dominance of fishing- and aquaculture-related debris, accounting for 69.4% and 18.9% of the total, respectively. The abundance of litter over the rocky bottoms was significantly higher than that on soft substrates, and its spatial distribution proved to be related to hydrographic factors. Litter-fauna interactions were high, with most of the debris (65.7%) entangling or covering benthic organisms, in particular habitat constructors such as the endangered sea sponge Geodia cydonium. Unless appropriate measures are undertaken to address this problem, the abundance of marine litter in the area is likely to increase.

Seabed litter composition, distribution and sources in the Northern and Central Adriatic Sea (Mediterranean)

Detecting the origin of marine benthic litter is fundamental for developing policies aimed at achieving the Good Environmental Status in European Seas by 2020, as requested by the Marine Strategy Framework Directive (MSFD). The abundance and composition of benthic litter in the Northern and Central Adriatic Sea were investigated at 67 stations with bottom trawl nets. Average density of benthic litter was 913±80items/km², ranking the Adriatic as one of the most polluted basins worldwide. Plastic was dominant in terms of numbers (80%) and weight (62%), and mainly consisted in bags, sheets and mussel nets. Higher quantities of litter were found in coastal areas, especially in front river mouths, coastal cities and mussel farms. In deep waters, litter hotspots were associated with most congested shipping lanes, indicating an additional litter input to the basin. Benthic litter composition resulted to be largely driven by the vicinity to local sources, i.e. mussel farming installations and most congested shipping routes. These findings provide useful insights to set measures to manage marine litter in the Adriatic region, and possibly to minimize this anthropogenic pollution.

Detrimental effect of systemic antimicrobial CD4+ T-cell reactivity on gut epithelial integrity

Healthy host-microbe mutualism relies on compartmentalization and proper regulation of systemic and mucosal immune responses. Nevertheless, the systemic immune system is frequently exposed to bouts of bacteraemia, which can trigger systemic antimicrobial immune reactivity including CD4⁺ T cells. Low-level bacteraemia can occur when immune compartmentalization is compromised, for example in the presence of innate immune deficiency or following use of non-steroidal anti-inflammatory drugs. We generated an Escherichia coli strain expressing a defined T helper neo-epitope to study systemic antigen-specific antimicrobial CD4⁺ T cells and their potential involvement in the pathogenisis of inflammatory bowel diseases. We found that the dose of bacteria required for the induction of systemic antimicrobial CD4⁺ T-cell proliferation was high and not easily reached under physiological conditions. Importantly, however, when intestinal barrier function was compromised by induced damage to the intestinal epithelium, the presence of systemic antimicrobial CD4⁺ T cells specific for a single neo-antigen resulted in dramatically increased levels of bacterial translocation. This study therefore demonstrates that systemic antimicrobial CD4⁺ T-cell reactivity might impact adversely on the mucosa under conditions of reduced barrier function and that despite strong mucosal immune regulation, antigen-specific recognition is still sensitive.

Interindividual variability in the expression of surfactant protein A and B in the human lung during development

The surfactant complex, thanks to its multiple actions including decrease of surface- tension and antimicrobial activity, plays a fundamental role in newborn survival, lowering the risk of respiratory distress syndrome. The aim of this work was to determine if the synthesis of two surfactant proteins (SP), SPA and pro-SPB, shows some inter-individual variability during lung development in the intrauterine life. Immunoreactivity for SPA and pro-SPB was investigated in the lungs of  40 subjects, including 15 fetuses, ranging from 14 to 22 weeks of gestation, and 25 neonates, from 24 to 41 weeks. Lung samples were formalin fixed, paraffin-embedded and routinely processed. SPA and pro-SPB were detected utilizing commercial antibodies.  A semi-quantitative grading system (1 to 4) was applied, based on the number of reactive cells and the intensity of immunostaining. Surfactant protein immunostaining was found in  three compartments: bronchi, bronchioles and alveoli, starting from 14 weeks of gestation in the bronchial epithelium and from the 21st week in the alveolar spaces. Differences were found regarding SPA and pro-SPB expression in the vast majority of subjects: in some lungs, SPA was more expressed whereas in others pro-SPB showed an higher degree of immunoreactivity. The expression of both surfactant proteins was not strictly correlated with gestational age. Whereas the highest levels of reactivity were detected in at term neonates, on the other hand one case with grade 3 was detected at 22 weeks and one negative case for both proteins was observed at 31 weeks. Our data clearly show a marked inter-individual variability regarding the production of SPA and pro-SPB and suggest the existence of other epigenetic factors, acting during gestation, that might influence surfactant production and, consequently, the survival potential of  neonates at birth.

Experimental priming of encephalitogenic Th1/Th17 cells requires pertussis toxin-driven IL-1β production by myeloid cells

CD4⁺ Th17 are heterogeneous in terms of cytokine production and capacity to initiate autoimmune diseases, such as experimental autoimmune encephalomyelitis (EAE). Here we demonstrate that experimental priming of encephalitogenic Th cells expressing RORγt and T-bet and producing IL-17A, IFN-γ and GM-CSF but not IL-10 (Th1/Th17), is dependent on the presence of pertussis toxin (PTX) at the time of immunization. PTX induces early production of IL-1β by CD11b⁺CCR2⁺Gr1⁺ myeloid cells, which are rapidly recruited to antigen-draining lymph nodes. PTX-induced generation of Th1/Th17 cells is impaired in IL-1β- and ASC-deficient mice and in mice in which myeloid cells are depleted or fail to migrate to lymph nodes and requires expression of IL-1R1 and MyD88 on both T cells and non-T cells. Collectively, these data shed light on the enigmatic function of PTX in EAE induction and suggest that inflammatory monocytes and microbial infection can influence differentiation of pathogenic Th1/Th17 cells in autoimmune diseases through production of IL-1β.

Pertussis toxin enhances the induction of autoreactive T cells in mouse models of autoimmunity. Here the authors show that stimulation of IL-1β production in myeloid cells by pertussis toxin is necessary to prime pathogenic Th1/Th17 cells in experimental autoimmune encephalopathy.

Somatic mutations and affinity maturation are impaired by excessive numbers of T follicular helper cells and restored by Treg cells or memory T cells

We previously reported that Cd3e‐deficient mice adoptively transferred with CD4⁺ T cells generate high numbers of T follicular helper (Tfh) cells, which go on to induce a strong B‐cell and germinal center (GC) reaction. Here, we show that in this system, GC B cells display an altered distribution between the dark and light zones, and express low levels of activation‐induced cytidine deaminase. Furthermore, GC B cells from Cd3e^–/– mice accumulate fewer somatic mutations as compared with GC B cells from wild‐type mice, and exhibit impaired affinity maturation and reduced differentiation into long‐lived plasma cells. Reconstitution of Cd3e^–/– mice with regulatory T (Treg) cells restored Tfh‐cell numbers, GC B‐cell numbers and B‐cell distribution within dark and light zones, and the rate of antibody somatic mutations. Tfh‐cell numbers and GC B‐cell numbers and dynamics were also restored by pre‐reconstitution of Cd3e^–/– mice with Cxcr5^–/– Treg cells or non‐regulatory, memory CD4⁺ T cells. Taken together, these findings underline the importance of a quantitatively regulated Tfh‐cell response for an efficient and long‐lasting serological response.

The liver may act as a firewall mediating mutualism between the host and its gut commensal microbiota

A prerequisite for establishment of mutualism between the host and the microbial community that inhabits the large intestine is the stringent mucosal compartmentalization of microorganisms. Microbe-loaded dendritic cells trafficking through lymphatics are arrested at the mesenteric lymph nodes, which constitute the firewall of the intestinal lymphatic circulation. We show in different mouse models that the liver, which receives the intestinal venous blood circulation, forms a vascular firewall that captures gut commensal bacteria entering the bloodstream during intestinal pathology. Phagocytic Kupffer cells in the liver of mice clear commensals from the systemic vasculature independently of the spleen through the liver's own arterial supply. Damage to the liver firewall in mice impairs functional clearance of commensals from blood, despite heightened innate immunity, resulting in spontaneous priming of nonmucosal immune responses through increased systemic exposure to gut commensals. Systemic immune responses consistent with increased extraintestinal commensal exposure were found in humans with liver disease (nonalcoholic steatohepatitis). The liver may act as a functional vascular firewall that clears commensals that have penetrated either intestinal or systemic vascular circuits.

Nocturnal distance sampling of a Mediterranean population of fallow deer is consistent with population projections

Context Precise and accurate methods are essential to assess wildlife populations for sound management. We surveyed a managed population of fallow deer (Dama dama) in a Mediterranean environment in Italy, where this non-native ungulate has a negative impact on biodiversity. Aims We compare nocturnal distance-sampling (deer are detected by thermal imagery at night) population estimates with demographic projections of the same population. Methods We estimated natural survival in fawns (0.86), yearlings (0.83), adult males (0.70) and adult females (0.90) using capture–mark–recapture. By integrating survival estimates with population structure, reproductive traits and harvest data, we performed demographic projections. We performed nocturnal distance sampling on foot by using a thermal imagery once a year (in autumn) from 2001 to 2005. We walked 75–77 km (71 transects) per each survey. Key results We showed that our survey design met distance-sampling assumptions. Distance sampling and demographic projections yielded similar and precise (12.6% < CV <24.1%) population estimates, showing a decreasing (–164.64 deer year–1) population trend from 2755 deer in 2001 to 1877 in 2005. Conclusions We showed that nocturnal distance sampling is useful to monitor wild deer populations in forests effectively and that it represents a cost-effective tool to develop sounded management policy for this non-native species. We also provided, for the first time, a comprehensive stochastic population model for fallow deer in a Mediterranean environment. Using these population estimates, managers could reduce fallow deer population size to a level compatible with the conservation of the endangered Italian roe deer and improve forest regeneration. Implications Nocturnal distance sampling can be used to assess ungulate population living in dense forested habitats effectively and efficiently.

Pathogen-induced human TH17 cells produce IFN-γ or IL-10 and are regulated by IL-1β

IL-17-producing CD4+ T helper cells (TH17) have been extensively investigated in mouse models of autoimmunity. However, the requirements for differentiation and the properties of pathogen-induced human TH17 cells remain poorly defined. Using an approach that combines the in vitro priming of naive T cells with the ex vivo analysis of memory T cells, we describe here two types of human TH17 cells with distinct effector function and differentiation requirements. Candida albicans-specific TH17 cells produced IL-17 and IFN-γ, but no IL-10, whereas Staphylococcus aureus-specific TH17 cells produced IL-17 and could produce IL-10 upon restimulation. IL-6, IL-23 and IL-1β contributed to TH17 differentiation induced by both pathogens, but IL-1β was essential in C. albicans-induced TH17 differentiation to counteract the inhibitory activity of IL-12 and to prime IL-17/IFN-γ double-producing cells. In addition, IL-1β inhibited IL-10 production in differentiating and in memory TH17 cells, whereas blockade of IL-1β in vivo led to increased IL-10 production by memory TH17 cells. We also show that, after restimulation, TH17 cells transiently downregulated IL-17 production through a mechanism that involved IL-2-induced activation of STAT5 and decreased expression of ROR-γt. Taken together these findings demonstrate that by eliciting different cytokines C. albicans and S. aureus prime TH17 cells that produce either IFN-γ or IL-10, and identify IL-1β and IL-2 as pro- and anti-inflammatory regulators of TH17 cells both at priming and in the effector phase.

On the role of IL-1β and CNS myeloid cells in EAE pathogenesis (101.34)

IL-1β has been shown to play a role in several inflammatory disorders including mouse experimental autoimmune encephalomyelitis (EAE). We found that mice deficient for the apoptosis-associated speck-like protein containing a caspase recruitment domain, or ASC, did not develop EAE following immunization with MOG in CFA and pertussis toxin (PT). Autoreactive T cells were primed in wild-type (WT) and ASC-/- mice but expanded poorly in ASC-/- mice with reduced capacity to produce simultaneously several inflammatory cytokines, such as IL-17, IL-22, IFNγ, and GM-CSF. The induction of these T cells in WT mice but not ASC-/- mice was dependent on the presence of PT. PT was found to induce IL-1β secretion from antigen-presenting cells, such as DCs and microglia. These data suggest that the disease-inducing effect of PT may be due to its ability to induce production of IL-1β which in turn triggers differentiation of pathogenic multifunctional T cells. In addition to its effect in the induction phase, we are testing whether IL-1β, or other inflammasome-related cytokines, may be required in the effector phases of EAE. We found that ASC-/- mice are resistant to passive EAE induction. In addition, bone marrow chimera experiments of mice transplanted with bone marrow cells from WT mice or ASC-/- mice, showed that IL-1β production by microglial cells, CNS-resident myeloid cells and CNS-migrating inflammatory monocytes is important for EAE pathogenesis.

Impaired SLAM-SLAM homotypic interaction between invariant NKT cells and dendritic cells affects differentiation of IL-4/IL-10-secreting NKT2 cells in nonobese diabetic mice

The regulatory function of invariant NKT (iNKT) cells for tolerance induction and prevention of autoimmunity is linked to a specific cytokine profile that comprises the secretion of type 2 cytokines like IL-4 and IL-10 (NKT2 cytokine profile). The mechanism responsible for iNKT cell differentiation toward a type 2 phenotype is unknown. Herein we show that costimulatory signals provided by the surface receptor signaling lymphocytic activation molecule (SLAM) on myeloid dendritic cells (mDC) to iNKT cells is crucial for NKT2 orientation. Additionally, we demonstrate that the impaired acquisition of an NKT2 cytokine phenotype in nonobese diabetic (NOD) mice that spontaneously develop autoimmune diabetes is due to defective SLAM-induced signals generated by NOD mDC. Mature mDC of C57BL/6 mice express SLAM and induce C57BL/6 or NOD iNKT cells to acquire a predominant NKT2 cytokine phenotype in response to antigenic stimulation with the iNKT cell-specific Ag, the alpha-galactosylceramide. In contrast, mature NOD mDC express significantly lower levels of SLAM and are unable to promote GATA-3 (the SLAM-induced intracellular signal) up-regulation and IL-4/IL-10 production in iNKT cells from NOD or C57BL/6 mice. NOD mice carry a genetic defect of the Slamf1 gene that is associated with reduced SLAM expression on double-positive thymocytes and altered iNKT cell development in the thymus. Our data suggest that the genetic Slamf1 defect in NOD mice also affects SLAM expression on other immune cells such as the mDC, thus critically impairing the peripheral differentiation of iNKT cells toward a regulatory NKT2 type.

Immune regulation by invariant NKT cells in autoimmunity

Invariant NKT cells are important regulators of T cell immunity and autoimmunity. In this review we describe evidence that supports their regulatory role in the prevention of autoimmune disease. Moreover, we will discuss the current knowledge on iNKT cell biology, antigen recognition, acquisition of a specific cytokine profile, and mechanism of action that suggest a key role for iNKT cells as negative regulators of autoimmune diseases.

Thrombocytopenic purpura as adverse reaction to recombinant hepatitis B vaccine

Three cases of immune thrombocytopenic purpura after the first dose of recombinant hepatitis B vaccine occurred in infants under 6 months of age. Other possible causes of this condition were excluded. Antiplatelet antibodies were present. A defect in platelet production was excluded in two children. Corticosteroid treatment was effective. Subsequent administration of other vaccines (against polio, diphtheria, and tetanus) did not cause relapse of thrombocytopenia.

A neurophysiological study in children and adolescents with Crigler-Najjar syndrome type I

We studied the neurophysiological features of five patients (age range: 4-20 years) suffering from Crigler-Najjar syndrome type I (CNsI) by means of multimodal (brainstem, somatosensory, motor) evoked potentials and periodic EEG-polygraphic recordings (follow-up: 3 months-4.5 years). Two patients presented with neurological disturbances, consisting mainly of mental slowing, motor impairment and seizures. Both of them presented an abnormal EEG, characterized by slowing of background activity associated with paroxysmal discharges. Liver transplantation was performed in one of these two patients and was followed by improvement of both the neurological picture and EEG activity. In a third patient, clinically normal, after two years of follow-up, the EEG started to show paroxysmal activity during sleep or when evoked by intermittent photic stimulation. In these three patients, multimodal evoked potentials were unremarkable. The remaining two younger subjects did not show any clinical or EEG abnormality. Our findings suggest that, whereas in newborns and infants evoked potentials have been demonstrated as reliable techniques to monitor bilirubin neurotoxicity, in children and adolescents with CNsI, EEG seems to be more sensitive in evaluating patients for neurological damage and effectiveness of therapeutic strategies adopted.

Genetic heterogeneity of Crigler-Najjar syndrome type I: a study of 14 cases

Crigler-Najjar syndrome type I (CN-I) is an autosomal recessive condition characterized by severe unconjugated hyperbilirubinemia caused by the lack of bilirubin-UDP-glucuronosyltransferase (B-UGT) activity in the liver. Two B-UGTs are coded for by a gene complex (UGT1) that maps to chromosome 2q37 and that also encodes two phenol-UDP-glucuronosyltransferases. Here, we report eleven mutations (including nine novel mutations) of the B-UGT1 gene in a large series of 14 unrelated CN-I children of various geographic origins: France (seven patients: A401P, Q357X, W335X, A368T, 1223insG, A291V, K426E, K437X); Portugal (two patients: G308E); Tunisia (two patients; Q357R); Turkey (one patient: S381R); italy (two siblings: S381R). Interestingly, 6/14 mutant alleles carried by unrelated probands of French ancestry bore the A401P mutation, indicating a founder effect; this effect is probably also present in Portugal, Turkey, and Tunisia. Since mutations occurred in exons 2-5 shared by all mRNAs species of the gene, a combined deficiency of B-UGT and P-UGT was observed in the liver of five patients in whom these activities were measured. The present study confirms that CN-I is genetically heterogeneous and suggests that different founder effects are involved in Western Europe, the Middle East, and North Africa.

[Conservative elective surgery in kidney neoplasms]

After the good results of "necessary" conservative surgery in the treatment of kidney neoplasms (bilateral neoplasms, congenital, acquired or functional solitary kidney), conservative surgery itself has been employed as elective treatment in selected cases presenting without the overmentioned problems. The authors report two cases of elective conservative surgery in kidney neoplasm with good results after 18 and 24 months.

[Interpretation of experimental data in the presence of accidental perturbations: characterization of the bladder]

Some tests are subject to the influence of a special kind of "irreducible" effects which do not satisfy the Central Limit Theorem of statistics, even though they show no systematic character or tendency. These effects especially present when physiological experiments are concerned "in vivo". In such the lack of specific methods to reduce these effects brings about the necessity of special case in minimizing the loss of information. Contained in the experimental data as well as the accumulation of useless information. Recent work has suggested the extensive use of several indexes derived from combination of available variables and their respective mathematic correlation. The information obtained by following this methodology has the character of "working hypothesis" so it needs many favorable confirmation to assess its reliability. It is convenient to analyze a large number of relations in order to emphasize the concordant effects and discord the others. In order to obtain some preliminary indication of the reliability of this procedure we have analyzed some CMG curves in prostatic and non-prostatic subject. The final slope of the curves (urge point) t = dP/dVr has been adapted as an index of the "elasticity" of the bladder; it was compared with the filling volume, the muscular volume and their ratio, i.e. with a geometric index of the bladder shape. The correlation show that the index t can, to some extent significantly represent the mechanical behaviour of the bladder in its physiological condition or when there is a partial obstruction of urine deflection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pyeloureteral junction syndrome caused by "anomalous vessel"]

In presenting and describing the pathogenesis of the pyeloureteral junction syndrome, the Authors report their recent experience with four cases due to an "abnormal vessel". Symptoms, diagnosis, and surgical techniques are discussed.

[Preliminary clinico-urodynamic study of diabetic uropathy of the bladder]

Twenty-eight diabetic patients of type one have been evaluated in a preliminary study starting from the conclusions of a previous work of the Authors, where the existence of four types of autonomic bladder neuropathies was demonstrated, in opposition to the classic theory of diabetic cistopathy. The examined cases confirm on the basis of clinical trials (HBA1C, cardiovascular autonomic neuropathy tests) and urodynamic tests (urofluxometric test, cistomanometric test, urethral pressure profile) the pleiomorphism of this syndrome and its relations with diabetic disease. On the total amount of the examined cases, 16 patients (57%) showed high values of HBA1C and 17 (60.7%) positive tests for autonomic neuropathy. Distribution of different types of cistopathy confirmed furthermore, beside the higher incidence of the sensitive form (14 pts.), an important percentage of sensitive motory types (4 pts.) and hyperreflexic ones (3 pts.). On the basis of the reported data, a correct and precocious differential diagnostics is recommended in order to face in a better way the serious consequences which may tardily affect the urinary apparatus.