Non-selective beta-blockers may reduce risk of hepatocellular carcinoma: a meta-analysis of randomized trials

BACKGROUND & AIMS Non-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB on HCC by performing a systematic review with meta-analyses of randomized trials. METHODS Electronic and manual searches were combined. Authors were contacted for unpublished data. Included trials assessed NSBB for patients with cirrhosis; the control group could receive any other intervention than NSBB. Fixed and random effects meta-analyses were performed with I(2) as a measure of heterogeneity. Subgroup, sensitivity, regression and sequential analyses were performed to evaluate heterogeneity, bias and the robustness of the results after adjusting for multiple testing. RESULTS Twenty-three randomized trials on 2618 patients with cirrhosis were included, of which 12 reported HCC incidence and 23 reported HCC mortality. The mean duration of follow-up was 26 months (range 8-82). In total, 47 of 694 patients randomized to NSBB developed HCC vs 65 of 697 controls (risk difference -0.026; 95% CI-0.052 to -0.001; number needed to treat 38 patients). There was no heterogeneity (I(2) = 7%) or evidence of small study effects (Eggers P = 0.402). The result was not confirmed in sequential analysis, which suggested that 3719 patients were needed to achieve the required information size. NSBB did not reduce HCC-related mortality (RD -0.011; 95% CI -0.040 to 0.017). CONCLUSIONS Non-selective beta-blockers may prevent HCC in patients with cirrhosis.

The Gut Microbiome and Cirrhosis: Basic Aspects

In this chapter the basic aspects helping to understand the microbiome in terms of quantity, diversity, complexity, function, and interaction with the host are discussed. First the nomenclature, definitions of taxa, and measures of diversity as well as methods to unravel this kingdom are outlined. A brief summary on its physiological relevance for general health and the functions exerted specifically by the microbiome is presented. Differences in the composition of the microbiome along the gastrointestinal tract and across the gut wall and its interindividual variations, enterotypes, and stability are highlighted. The reader will be familiarized with all different modulators impacting on the microbiome, namely, intrinsic and extrinsic factors. Intrinsic factors include gastrointestinal secretions (gastric acid, bile, pancreatic juice, mucus), antimicrobial peptides, motility, enteric nervous system, and host genotype. Extrinsic factors are mainly dietary choices, hygiene, stress, alcohol consumption, exercise, and medications. The second part of the chapter focuses on quantitative and qualitative changes in microbiome in liver cirrhosis. The mechanisms contributing to dysbiosis, small intestinal bacterial overgrowth, and bacterial translocation are delineated underscoring their role for the liver-gut axis.

Translocação bacteriana para o pulmão na icterícia obstrutiva experimental em ratos

RESUMO: Objetivo: Tem sido demonstrado que a icterícia obstrutiva provoca depressão do sistema imunológico, mudança no padrão de colonização bacteriana dos intestinos e passagem de bactérias da luz intestinal para a circulação porta e sistêmica. Estudo experimental em ratos procurou observar a possibilidade de translocação bacteriana para os pulmões após a ligadura do colédoco. Método: Foram utilizados 20 ratos Wistar pesando de 178 a 215g, separados aleatoriamente em dois grupos iguais. Nos ratos do grupo I foi feita a ligadura do colédoco e nos do grupo II apenas a manipulação do colédoco com pinça atraumática (sham operation). No sétimo dia de observação os animais foram mortos com superdose de anestésico, sangue foi colhido para dosagem de bilirrubinas e os pulmões ressecados sob condições assépticas. Metade de cada pulmão foi homogeneizada e semeada em meios de cultura ágar McConkey e ágar sangue. A outra metade serviu para exame histopatológico –coloração hematoxilina e eosina. Os dados foram analisados pelo teste t, com significância 0,05. Resultados: revelaram bilirrubina total em média 18,7±3,6 no grupo I e 0,7±0,2 no grupo II. No grupo I foram isoladas colônias de Klebsiela sp nos pulmões de 30% dos animais e E. coli em 20%, e os escores histopatológicos atingiram a média 6,2±2,08. No grupo II não foram detectadas bactérias nos pulmões e os escores do exame histopatológico atingiram 1,8±1,16. A diferença dos dados analisados mostrou-se significativa (p<0,05). Conclusões: Concluiu-se que a icterícia obstrutiva por ligadura do colédoco em ratos provocou translocação de germes Gram-negativos para os pulmões e resultou em alterações histopatológicas significativas.

Pré-condicionamento isquêmico em diferentes tempos e seu efeito na translocação bacteriana induzida por isquemia e reperfusão intestinal em ratos

Para avaliar os efeitos de diferentes tempos de pré-condicionamento isquêmico (IPC) em translocação bacteriana intestinal (BT). MÉTODOS: Trinta ratos Wistar pesando 280 ± 27g foram divididos em cinco grupos. No grupo IV (n = 6), a laparotomia foi realizada e a artéria mesentérica superior foi obstruído por um microclampe atraumática durante 30 minutos. Nos quatro grupos de pré-condicionamento (n = 6 cada) antes dos 30 minutos de isquemia-reperfusão (I / R), os ratos foram submetidos a IPC para duas, cinco, dez e 15 minutos, seguido pelo mesmo momento da reperfusão. A fim de avaliar se o tempo de pré-condicionamento influenciaram o surgimento de translocação bacteriana, as amostras de nódulos linfáticos mesentéricos, fígado e baço foram colhidas em condições estéreis, 24 horas após os procedimentos para a quantificação de unidades formadoras de colónias de bactérias por grama de tecido (CFU / g). O sangue foi recolhido para a medição de citoquinas. RESULTADOS: No grupo I / R, o total de CFU / g em gânglios linfáticos mesentéricos, baço, fígado, bem como o soro de TNF-a, IL-1A e IL-6 foram significativamente mais elevados do que nos outros grupos (p <0,05). Pré-condicionamento por 15 minutos significativamente atenuada BT e citocinas séricas quando comparado a outros períodos de pré-condicionamento (p <0,05). CONCLUSÃO: Nossos dados sugerem que o pré-condicionamento como um fator chave para reduzir a translocação bacteriana intestinal em I / R. Numa escala de dois a 15 minutos, o melhor tempo de pré-condicionamento isquémico pela atenuação da translocação bacteriana foi de 15 minutos

Translocação bacteriana para o pulmão na icterícia obstrutiva experimental em ratos

RESUMO: Objetivo: Tem sido demonstrado que a icterícia obstrutiva provoca depressão do sistema imunológico, mudança no padrão de colonização bacteriana dos intestinos e passagem de bactérias da luz intestinal para a circulação porta e sistêmica. Estudo experimental em ratos procurou observar a possibilidade de translocação bacteriana para os pulmões após a ligadura do colédoco. Método: Foram utilizados 20 ratos Wistar pesando de 178 a 215g, separados aleatoriamente em dois grupos iguais. Nos ratos do grupo I foi feita a ligadura do colédoco e nos do grupo II apenas a manipulação do colédoco com pinça atraumática (sham operation). No sétimo dia de observação os animais foram mortos com superdose de anestésico, sangue foi colhido para dosagem de bilirrubinas e os pulmões ressecados sob condições assépticas. Metade de cada pulmão foi homogeneizada e semeada em meios de cultura ágar McConkey e ágar sangue. A outra metade serviu para exame histopatológico –coloração hematoxilina e eosina. Os dados foram analisados pelo teste t, com significância 0,05. Resultados: revelaram bilirrubina total em média 18,7±3,6 no grupo I e 0,7±0,2 no grupo II. No grupo I foram isoladas colônias de Klebsiela sp nos pulmões de 30% dos animais e E. coli em 20%, e os escores histopatológicos atingiram a média 6,2±2,08. No grupo II não foram detectadas bactérias nos pulmões e os escores do exame histopatológico atingiram 1,8±1,16. A diferença dos dados analisados mostrou-se significativa (p<0,05). Conclusões: Concluiu-se que a icterícia obstrutiva por ligadura do colédoco em ratos provocou translocação de germes Gram-negativos para os pulmões e resultou em alterações histopatológicas significativas.

Pré-condicionamento isquêmico em diferentes tempos e seu efeito na translocação bacteriana induzida por isquemia e reperfusão intestinal em ratos

Para avaliar os efeitos de diferentes tempos de pré-condicionamento isquêmico (IPC) em translocação bacteriana intestinal (BT). MÉTODOS: Trinta ratos Wistar pesando 280 ± 27g foram divididos em cinco grupos. No grupo IV (n = 6), a laparotomia foi realizada e a artéria mesentérica superior foi obstruído por um microclampe atraumática durante 30 minutos. Nos quatro grupos de pré-condicionamento (n = 6 cada) antes dos 30 minutos de isquemia-reperfusão (I / R), os ratos foram submetidos a IPC para duas, cinco, dez e 15 minutos, seguido pelo mesmo momento da reperfusão. A fim de avaliar se o tempo de pré-condicionamento influenciaram o surgimento de translocação bacteriana, as amostras de nódulos linfáticos mesentéricos, fígado e baço foram colhidas em condições estéreis, 24 horas após os procedimentos para a quantificação de unidades formadoras de colónias de bactérias por grama de tecido (CFU / g). O sangue foi recolhido para a medição de citoquinas. RESULTADOS: No grupo I / R, o total de CFU / g em gânglios linfáticos mesentéricos, baço, fígado, bem como o soro de TNF-a, IL-1A e IL-6 foram significativamente mais elevados do que nos outros grupos (p <0,05). Pré-condicionamento por 15 minutos significativamente atenuada BT e citocinas séricas quando comparado a outros períodos de pré-condicionamento (p <0,05). CONCLUSÃO: Nossos dados sugerem que o pré-condicionamento como um fator chave para reduzir a translocação bacteriana intestinal em I / R. Numa escala de dois a 15 minutos, o melhor tempo de pré-condicionamento isquémico pela atenuação da translocação bacteriana foi de 15 minutos

Implication of gut microbiota in nonalcoholic fatty liver disease

International audience

Early Adaptation of Small Intestine After Massive Small Bowel Resection in Rats

Background: It is important that the residual bowel adapts after massive resection. The necessary intestinal adaptation is a progressive recovery from intestinal failure through increase in absorptive surface area and functional capacity and includes both morphological and functional adaptations. Objectives: The aim of this study was to investigate intestinal morphological and functional adaptations of small bowel syndrome (SBS) model rats (SBS1W) 7 days after bowel resection. Materials and Methods: Male sprague–dawley rats (n = 20/group) underwent either a 75% proximal small bowel resection (SBS1W group) or a control operation (control group). Markers of morphological adaptation were revealed by TEM analysis of H&E-stained tissue samples. The intestinal barrier condition was assessed by BT, and sIgA concentration in intestinal mucus was measured by ELISA. Contractility and the slow wave rhythm of the entire intestinal remnant were measured and recorded. Results: The SBS1W group experienced more weight loss than control group and had a clearly different intestinal morphology as revealed in TEM images. Compared with control rats, the SBS1W group had a lower sIgA concentration in intestinal mucus and higher BT to lymph nodes (70% vs 40%; level I), portal blood (40% vs 10%; level II), and peripheral blood (60% vs 30%; level III). Disorder of spontaneous rhythmic contraction, irregular amplitude, and slow frequency were detected in the SBS1W group by a muscle strips test. Similarly, the slow wave of the entire intestinal remnant in the SBS1W group was irregular and uncoordinated. Conclusions: The finding of intestinal adaptation following massive SBR in SBS1W rats provides more understanding of the mechanisms of progressive recovery from the intestinal failure that underlies SBS. The mechanical, chemical, immunological, and biological barriers were all impaired at 7 days following bowel resection, indicating that the SBS model rats were still in the intestinal adaptation phase.

Nitrosative stress, hypernitrosylation, and autoimmune responses to nitrosylated proteins: new pathways in neuroprogressive disorders Including depression and chronic fatigue syndrome.

Nitric oxide plays an indispensable role in modulating cellular signaling and redox pathways. This role is mainly effected by the readily reversible nitrosylation of selective protein cysteine thiols. The reversibility and sophistication of this signaling system is enabled and regulated by a number of enzymes which form part of the thioredoxin, glutathione, and pyridoxine antioxidant systems. Increases in nitric oxide levels initially lead to a defensive increase in the number of nitrosylated proteins in an effort to preserve their function. However, in an environment of chronic oxidative and nitrosative stress (O&NS), nitrosylation of crucial cysteine groups within key enzymes of the thioredoxin, glutathione, and pyridoxine systems leads to their inactivation thereby disabling denitrosylation and transnitrosylation and subsequently a state described as "hypernitrosylation." This state leads to the development of pathology in multiple domains such as the inhibition of enzymes of the electron transport chain, decreased mitochondrial function, and altered conformation of proteins and amino acids leading to loss of immune tolerance and development of autoimmunity. Hypernitrosylation also leads to altered function or inactivation of proteins involved in the regulation of apoptosis, autophagy, proteomic degradation, transcription factor activity, immune-inflammatory pathways, energy production, and neural function and survival. Hypernitrosylation, as a consequence of chronically elevated O&NS and activated immune-inflammatory pathways, can explain many characteristic abnormalities observed in neuroprogressive disease including major depression and chronic fatigue syndrome/myalgic encephalomyelitis. In those disorders, increased bacterial translocation may drive hypernitrosylation and autoimmune responses against nitrosylated proteins.

The role of the microbial metabolites including tryptophan catabolites and short chain fatty acids in the pathophysiology of immune-inflammatory and neuroimmunue disease.

There is a growing awareness that gut commensal metabolites play a major role in host physiology and indeed the pathophysiology of several illnesses. The composition of the microbiota largely determines the levels of tryptophan in the systemic circulation and hence, indirectly, the levels of serotonin in the brain. Some microbiota synthesize neurotransmitters directly, e.g., gamma-amino butyric acid, while modulating the synthesis of neurotransmitters, such as dopamine and norepinephrine, and brain-derived neurotropic factor (BDNF). The composition of the microbiota determines the levels and nature of tryptophan catabolites (TRYCATs) which in turn has profound effects on aryl hydrocarbon receptors, thereby influencing epithelial barrier integrity and the presence of an inflammatory or tolerogenic environment in the intestine and beyond. The composition of the microbiota also determines the levels and ratios of short chain fatty acids (SCFAs) such as butyrate and propionate. Butyrate is a key energy source for colonocytes. Dysbiosis leading to reduced levels of SCFAs, notably butyrate, therefore may have adverse effects on epithelial barrier integrity, energy homeostasis, and the T helper 17/regulatory/T cell balance. Moreover, dysbiosis leading to reduced butyrate levels may increase bacterial translocation into the systemic circulation. As examples, we describe the role of microbial metabolites in the pathophysiology of diabetes type 2 and autism.

Discovery of an archetypal protein transport system in bacterial outer membranes

Bacteria have mechanisms to export proteins for diverse purposes, including colonization of hosts and pathogenesis. A small number of archetypal bacterial secretion machines have been found in several groups of bacteria and mediate a fundamentally distinct secretion process. Perhaps erroneously, proteins called 'autotransporters' have long been thought to be one of these protein secretion systems. Mounting evidence suggests that autotransporters might be substrates to be secreted, not an autonomous transporter system. We have discovered a new translocation and assembly module (TAM) that promotes efficient secretion of autotransporters in proteobacteria. Functional analysis of the TAM in Citrobacter rodentium, Salmonella enterica and Escherichia coli showed that it consists of an Omp85-family protein, TamA, in the outer membrane and TamB in the inner membrane of diverse bacterial species. The discovery of the TAM provides a new target for the development of therapies to inhibit colonization by bacterial pathogens.

Mechanistic details of the membrane perforation and passive translocation of TAT peptides

The trans-activator of transcription (TAT) peptide is regarded as the “gold standard” for cell-penetrating peptides, capable of traversing a mammalian membrane passively into the cytosolic space. This characteristic has been exploited through conjugation of TAT for applications such as drug delivery. However, the process by which TAT achieves membrane penetration remains ambiguous and unresolved. Mechanistic details of TAT peptide action are revealed herein by using three complementary methods: quartz crystal microbalance with dissipation (QCM-D), scanning electrochemical microscopy (SECM) and atomic force microscopy (AFM). When combined, these three scales of measurement define that the membrane uptake of the TAT peptide is by trans-membrane insertion using a “worm-hole” pore that leads to ion permeability across the membrane layer. AFM data provided nanometre-scale visualisation of TAT punctuation using a mammalian-mimetic membrane bilayer. The TAT peptide does not show the same specificity towards a bacterial mimetic membrane and QCM-D and SECM showed that the TAT peptide demonstrates a disruptive action towards these membranes. This investigation supports the energy-independent uptake of the cationic TAT peptide and provides empirical data that clarify the mechanism by which the TAT peptide achieves its membrane activity. The novel use of these three biophysical techniques provides valuable insight into the mechanism for TAT peptide translocation, which is essential for improvements in the cellular delivery of TAT-conjugated cargoes including therapeutic agents required to target specific intracellular locations.

Oxalate decarboxylase from Agrobacterium tumefaciens C58 is translocated by a twin arginine translocation system

Oxalate decarboxylases (OXDCs) (E.C. 4.1.1.2) are enzymes catalyzing the conversion of oxalate to formate and CO2. The OXDCs found in fungi and bacteria belong to a functionally diverse protein superfamily known as the cupins. Fungi-originated OXDCs are secretory enzymes. However, most bacterial OXDCs are localized in the cytosol, and may be involved in energy metabolism. In Agrobacterium tumefaciens C58, a locus for a putative oxalate decarboxylase is present. In the study reported here, an enzyme was overexpressed in Escherichia coli and showed oxalate decarboxylase activity. Computational analysis revealed the A. tumefaciens C58 OXDC contains a signal peptide mediating translocation of the enzyme into the periplasm that was supported by expression of signal-peptideless and full-length versions of the enzyme in A. tumefaciens C58. Further site-directed mutagenesis experiment demonstrated that the A. tumefaciens C58 OXDC is most likely translocated by a twin-arginine translocation (TAT) system.

Structural and functional studies of bacterial protein tyrosine kinases

While protein tyrosine kinases (PTKs) have been extensively characterized in eukaryotes, far less is known about their emerging counterparts in prokaryotes. Studies of close to 20 homologs of bacterial protein tyrosine (BY) kinases have inaugurated a blooming new field of research, all since just the end of the last decade. These kinases are key regulators in the polymerization and exportation of the virulence-determining polysaccharides which shield the bacterial from the non-specific defenses of the host. This research is aimed at furthering our understanding of the BY kinases through the use of X-ray crystallography and various in vitro and in vivo experiments. We reported the first crystal structure of a bacterial PTK, the C-terminal kinase domain of E. coli tyrosine kinase (Etk) at 2.5Å resolution. The fold of the Etk kinase domain differs markedly from that of eukaryotic PTKs. Based on the observed structure and supporting evidences, we proposed a unique activation mechanism for BY kinases in Gram-negative bacteria. The phosphorylation of tyrosine residue Y574 at the active site and the specific interaction of P-Y574 with a previously unidentified key arginine residue, R614, unblock the Etk active site and activate the kinase. Both in vitro kinase activity and in vivo antibiotics resistance studies utilizing structure-guided mutants further support the novel activation mechanism. In addition, the level of phosphorylation of their C-terminal Tyr cluster is known to regulate the translocation of extracellular polysaccharides. Our studies have significantly clarified our understanding of how the phosphorylation status on the C-terminal tyrosine cluster of BY kinases affects the oligomerization state of the protein, which is likely the machinery of polysaccharide export regulation. In summary, this research makes a substantial contribution to the rapidly progressing research of bacterial tyrosine kinases.