Clinical relevance of the Helicobacter pylori gene for blood-group antigen-binding adhesin

Infection with Helicobacter pylori is associated with different human gastric diseases. Biochemical studies, in vitro adherence assays, and in vivo animal models revealed that epithelial attachment of H. pylori can be mediated by the blood-group antigen-binding adhesin (BabA) targeting human Lewisb surface epitopes. Studies with transgenic mice expressing the Lewisb epitope have shown that such attachment can alter disease outcome. In the current study, the presence of the babA2 gene encoding the adhesin was investigated in clinical isolates from a German population by using PCR and reverse transcription–PCR. A positive genotype was correlated to allelic variations in the genes encoding VacA and CagA and also to the prevalence of duodenal ulcer, distal gastric adenocarcinoma, mucosa-associated lymphoid tissue lymphoma, and antral gastritis. The presence of babA2 was significantly associated with duodenal ulcer (P = 0.0002) and adenocarcinoma (P = 0.033). In contrast, type 1 strains (vacAs1- and cagA-positive) were associated with only duodenal ulcer (P = 0.004) but not adenocarcinoma (P = 0.235). Genotype presence of babA2, vacAs1, and cagA (“triple-positive” strains) showed a highly significant correlation to the prevalence of ulcer (P = 0.000002) and adenocarcinoma (P = 0.014) and discriminated significantly better between disease outcome than did the current type 1 classification. These results indicate that the babA2 gene is of high clinical relevance and would be a useful marker to identify patients who are at higher risk for specific H. pylori-related diseases.

Experimental hemochromatosis due to MHC class I HFE deficiency: Immune status and iron metabolism

The puzzling linkage between genetic hemochromatosis and histocompatibility loci became even more so when the gene involved, HFE, was identified. Indeed, within the well defined, mainly peptide-binding, MHC class I family of molecules, HFE seems to perform an unusual yet essential function. As yet, our understanding of HFE function in iron homeostasis is only partial; an even more open question is its possible role in the immune system. To advance on both of these avenues, we report the deletion of HFE α1 and α2 putative ligand binding domains in vivo. HFE-deficient animals were analyzed for a comprehensive set of metabolic and immune parameters. Faithfully mimicking human hemochromatosis, mice homozygous for this deletion develop iron overload, characterized by a higher plasma iron content and a raised transferrin saturation as well as an elevated hepatic iron load. The primary defect could, indeed, be traced to an augmented duodenal iron absorption. In parallel, measurement of the gut mucosal iron content as well as iron regulatory proteins allows a more informed evaluation of various hypotheses regarding the precise role of HFE in iron homeostasis. Finally, an extensive phenotyping of primary and secondary lymphoid organs including the gut provides no compelling evidence for an obvious immune-linked function for HFE.

Varying efficacy of Helicobacter pylori eradication regimens: cost effectiveness study using a decision analysis model

Objective: To determine how small differences in the efficacy and cost of two antibiotic regimens to eradicate Helicobacter pylori can affect the overall cost effectiveness of H pylori eradication in duodenal ulcer disease.

Heterogeneous transcription of an indoleacetic acid biosynthetic gene in Erwinia herbicola on plant surfaces

We investigated the spatial pattern of expression of ipdC, a plant inducible gene involved in indoleacetic acid biosynthesis in Erwinia herbicola, among individual cells on plants to gain a better understanding of the role of this phenotype in the epiphytic ecology of bacteria and the factors involved in the regulation of ipdC. Nonpathogenic E. herbicola strain 299R harboring a transcriptional fusion of ipdC to gfp was inoculated onto bean plants, recovered from individual leaves 48 h after inoculation, and subjected to fluorescence in situ hybridization using a 16S rRNA oligonucleotide probe specific to strain 299R. Epifluorescence images captured through a rhodamine filter were used to distinguish the 5carboxytetramethylrhodamine-labeled cells of strain 299R from other leaf microflora. Quantification of the green fluorescence intensity of individual cells by analysis of digital images revealed that about 65% of the 299R cells recovered from bean leaves had higher ipdC expression than in culture. Additionally, 10% of the cells exhibited much higher levels of green fluorescence than the median fluorescence intensity, indicating that they are more heterogeneous with respect to ipdC expression on plants than in culture. Examination of 299R cells in situ on leaf surfaces by confocal laser scanning microscopy after fluorescence in situ hybridization of cells on leaf samples showed that even cells that were in close proximity exhibited dramatically different green fluorescence intensities, and thus, were in a physical or chemical microenvironment that induced differential expression of ipdC.

Prevention and elimination of upper respiratory colonization of mice by group A streptococci by using a bacteriophage lytic enzyme

Bacteriophage lytic enzymes quickly destroy the cell wall of the host bacterium to release progeny phage. Because such lytic enzymes specifically kill the species in which they were produced, they may represent an effective way to control pathogenic bacteria without disturbing normal microflora. In this report, we studied a murein hydrolase from the streptococcal bacteriophage C1 termed lysin. This enzyme is specific for groups A, C, and E streptococci, with little or no activity toward several oral streptococci or other commensal organisms tested. Using purified lysin in vitro, we show that 1,000 units (10 ng) of enzyme is sufficient to sterilize a culture of ≈107 group A streptococci within 5 seconds. When a single dose of lysin (250 units) is first added to the oral cavity of mice, followed by 107 live group A streptococci, it provides protection from colonization (28.5% infected, n = 21) compared with controls without lysin (70.5% infected, n = 17) (P < 0.03). Furthermore, when lysin (500 units) was given orally to 9 heavily colonized mice, no detectable streptococci were observed 2 h after lysin treatment. In all, these studies show that lysin represents a unique murein hydrolase that has a rapid lethal effect both in vitro and in vivo on group A streptococci, without affecting other indigenous microorganisms analyzed. This general approach may be used to either eliminate or reduce streptococci from the upper respiratory mucosal epithelium of either carriers or infected individuals, thus reducing associated disease.

A novel nonneuronal catecholaminergic system: exocrine pancreas synthesizes and releases dopamine.

Cells of the exocrine pancreas produce digestive enzymes potentially harmful to the intestinal mucosa. Dopamine has been reported to protect against mucosal injury. In looking for the source of dopamine in the small intestine, we found that the duodenal juice contains high levels of dopamine and that the pancreas itself has a high dopamine [and dihydroxyphenylalanine (dopa)] content that does not change significantly after chemical sympathectomy. Furthermore, we were able to demonstrate tyrosine hydroxylase (TH) activity in control pancreas as well as in pancreas from rats after chemical sympathectomy. Immunostaining and in situ hybridization histochemistry confirmed both the presence of TH, dopamine, and the dopamine transporter, and the mRNAs encoding TH and dopamine transporter, and the presence of both types of vesicular monoamine transporters in the exocrine cells of the pancreas. Since there are no catecholaminergic enteric ganglia in the pancreas, the above results indicate that pancreatic cells have all the characteristics of dopamine-producing cells. We suggest that the pancreas is an important source of nonneuronal dopamine in the body, and that this dopamine has a role in protecting the intestinal mucosa and suggests that dopamine D1b receptor agonists might be used to help mucosal healing in the gastrointestinal tract.

Análise crítica das técnicas de tratamento cirúrgico da obesidade mórbida

Introdução: A obesidade é uma afecção com alta prevalência no Brasil e no mundo. É fator de risco para comorbidades como Diabetes tipo 2 (DM2), Hipertensão Arterial Sistêmica (HAS), Dislipidemia, Apneia Obstrutiva do Sono (AOS), entre outras. Seu tratamento é complexo e a cirurgia bariátrica, executada por diferentes técnicas, tem sido uma das opções. Objetivo: Analisar os resultados publicados na literatura em relação às técnicas cirúrgicas de Banda Gástrica Ajustável (BGA), Gastrectomia Vertical (GV), Gastroplastia com derivação em Y de Roux (GDYR) e Derivação Biliopancreática (DBP) - técnica de \"Scopinaro\" e de \"Duodenal Switch\" quanto às complicações operatórias, à mortalidade, à perda do excesso de peso (PEP) e ao reganho, e a resolução das comorbidades após a operação. Método: Foram analisados 116 estudos selecionados na base de dados MEDLINE por meio da PubMed publicados na Língua Inglesa entre 2003 e 2014. Para comparar as diferentes técnicas cirúrgicas (BGA, GV, GDYR e DBP), realizou-se estudo estatístico por meio da análise de variância (ANOVA) aplicando os testes de Duncan e de Kruskal Wallis avaliando: complicações pós-operatórias (fístula, sangramento e óbito); perda e reganho do excesso de peso, e resolução das comorbidades. Resultados: A ocorrência de sangramento foi de 0,6% na média entre todos os estudos, sendo 0,44% na BGA; 1,29% na GV; 0,81% na GDYR e 2,09% na DBP. Já a ocorrência de fístulas foi de 1,3% na média entre todos os estudos, 0,68% para BGA; 1,93% para GV; 2,18% para GDYR e 5,23% para DBP. A mortalidade nos primeiros 30 dias pós-operatórios foi de 0,9% na média entre todos os estudos, 0,05% na BGA; 0,16% na GV; 0,60% na GDYR e 2,52% na DBP. A PEP após cinco anos na média entre todos os estudos foi de 63,86%, especificamente na BGA, foi de 48,35%; 52,7% na GV; 71,04% na GDYR e 77,90% na DBP. A taxa de DM2 resolvida foi de 76,9% na média entre todos os estudos, sendo 46,80% na BGA; 79,38% na GV; 79,86% na GDYR e 90,78% na DBP. A taxa de Dislipidemia resolvida após a operação foi de 74,0% na média de todo o estudo, sendo 51,28% na BGA; 58,00% na GV; 73,28% na GDYR e 90,75% na DBP. A taxa de HAS resolvida após a operação foi de 61,80% na média de todo o estudo, sendo 54,50% na BGA; 52,27% na GV; 68,11% na GDYR e 82,12% na DBP. A taxa de AOS resolvida após a operação foi de 75,0% na média de todo o estudo, sendo 56,85% na BGA; 51,43% na GV; 80,31% na GDYR e 92,50% na DBP. Conclusão: quando analisadas e comparada as quatro técnicas observa-se que nos primeiros 30 dias pós-operatório a taxa de sangramento é superior nos pacientes submetidos à DBP e taxa de fístula inferior nos pacientes da BGA. Quanto à mortalidade observou-se taxa mais pronunciada nos pacientes submetidos à DBP e menos nos submetidos à BGA. Quanto à PEP observou-se uma uniformidade entre os pacientes submetidos à GV, GDYR E DBP até o terceiro ano. Após esse período observa-se reganho de peso nos submetidos à GV até o quinto ano de seguimento. Já nos pacientes submetidos à BGA observou-se taxas de PEP menos pronunciadas em relação às demais desde o início do seguimento. Quanto à resolução das comorbidades observou-se taxas de resolução de DM2 inferiores nos pacientes submetidos à BGA, e não houve diferença entre nenhuma técnica quanto à resolução das demais comorbidades: HAS, AOS e dislipidemia

Effect of mode of delivery on early oral colonization and childhood dental caries: a systematic review

Background: Oral colonization starts at birth by vertical transmission. Objective: To determine whether mode of delivery influences the oral colonization of infants and contributes to the risk of childhood dental caries. Methods: A systematic review was conducted in the electronic database Web of Science for articles published from January 1995 to December 2015 by using a set of keywords. Results: From 2,644 citations identified through electronic search, ten studies met the inclusion criteria. According to the studies mode of delivery influences oral microbial density, oral microbial profile and the timing of oral colonization by cariogenic microbiota. However, there are no consistent results concerning either the prevalence of children harboring cariogenic microbiota or the prevalence of early childhood caries by mode of delivery. Conclusion: Mode of delivery influences early oral colonization. However, it seems that other determinants rather than mode of delivery could be major contributors to the development of early childhood caries. Keywords: Early childhood caries, early oral colonization, acquisition of oral microflora, mode of delivery

Groove pancreatitis a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

A desregulação da homeostase do ferro: base molecular e patologias associadas

A homeostase do ferro requer um rigoroso processo de regulação, uma vez que este é um elemento essencial para alguns dos mecanismos celulares básicos mas, quando se encontra em excesso, origina profundos danos celulares e falha de órgãos. Dado que o organismo humano não possui um mecanismo ativo de excreção de ferro, é essencial que a sua homeostase seja estabelecida através de uma estreita comunicação entre os locais de absorção, utilização e armazenamento. Esta interligação é conseguida, essencialmente, através da ação de uma hormona circulante, a hepcidina. A hepcidina é sintetizada ao nível dos hepatócitos do fígado, sendo a sua expressão aumentada pelos níveis de ferro e inflamação e suprimida pela eritropoiese e hipoxia. A hepcidina regula negativamente a absorção duodenal do ferro proveniente da alimentação, a libertação pelos macrófagos do ferro resultante da fagocitose dos glóbulos vermelhos senescentes, assim como a libertação do ferro armazenado nos hepatócitos. A hemocromatose hereditátria (HH) do tipo 1 é uma doença de transmissão autossómica recessiva associada a mutações no gene HFE (p.Cys282Tyr e p.His63Asp). É a patologia humana mais comum de sobrecarga primária em ferro, apresenta penetrância incompleta, e é um dos distúrbios genéticos mais frequentes em caucasianos de ascendência Norte-Europeia. Na hemocromatose, apesar de haver um excesso de ferro no organismo, este facto não é refletido no nível de expressão da hormona hepcidina (cujos níveis deveriam aumentar). Pelo contrário, o nível de expressão da hepcidina encontra-se diminuído o que perpetua a constante absorção do ferro a nível duodenal. Os sintomas associados à doença iniciam-se geralmente na meia-idade e começam por consistir em sintomas gerais de fadiga e dores articulares. No entanto, a progressiva acumulação do ferro em vários órgãos (tais como fígado, coração e pâncreas) provoca aí graves danos, tais como cirrose, carcinoma hepatocelular, cardiomiopatias e diabetes. Para além da HH do tipo 1, podem ocorrer outros tipos de hemocromatose por mutações noutros genes relacionados com o metabolismo do ferro (tais como TFR2, HJV, HAMP, SLC40A1, etc). Mutações em genes como HAMP e HJV associam-se a hemocromatoses mais graves, de início ainda na juventude (hemocromatose juvenil). A implementação no nosso laboratório da nova metodologia de Next-Generation Sequencing permitiu-nos realizar a pesquisa de variantes simultaneamente em 6 genes relacionados com o metabolismo do ferro, em 88 doentes com fenótipo de hemocromatose hereditária não-clássica. Foram identificadas 54 variantes diferentes sendo algumas delas novas. Estudos in silico e estudos funcionais in vitro (em linhas celulares) permitiram-nos comprovar a patogenicidade de algumas das variantes novas e compreender os mecanismos moleculares subjacentes ao desenvolvimento da sobrecarga em ferro. Pelo contrário, no lado oposto do espetro das patologias relacionadas com o ferro, encontram-se as anemias por falta de ferro (anemias ferropénicas). A Organização Mundial de Saúde define anemia quando os níveis de hemoglobina no sangue são menores do que 12 g/dL na Mulher e 13 g/dL no Homem. A hemoglobina é a proteína existente nos glóbulos vermelhos do sangue, responsável pelo transporte de oxigénio no organismo, e cuja molécula é um tetrâmero formado por 4 cadeias polipeptídicas (as globinas) e 4 grupos heme que contêm 4 átomos de ferro. A falta de ferro impede que se formem as moléculas de hemoglobina a níveis normais em cerca de 20% da população portuguesa e isso é devido a carências alimentares ou a dificuldades na absorção do ferro proveniente da alimentação. Entre os fatores genéticos moduladores desta última situação parecem estar algumas variantes polimórficas no gene TMPRSS6, codificante da proteína Matriptase-2, um dos agentes envolvidos na regulação da expressão da hepcidina. Por outro lado, mutações neste gene dão origem a anemias ferropénicas graves, refratárias ao tratamento oral com ferro (Iron Refractory Iron Deficiency Anaemia - IRIDA). As Hemoglobinopatias são outro tipo de anemia hereditária. Estas não estão relacionadas com o défice de ferro mas sim com defeitos nas cadeias globínicas, constituintes da hemoglobina (α2β2). As hemoglobinopatias que estão relacionadas com um problema quantitativo, ou seja quando há ausência ou diminuição de síntese de uma cadeia globínica, denominam-se talassémias: beta-talassémia, alfa-talassémia, delta-talassémia, etc, consoante o gene afetado. Por outro lado, quando o problema é de carácter qualitativo, ou seja ocorre a síntese de uma cadeia globínica estruturalmente anómala, esta é denominada uma variante de hemoglobina. Enquadra-se neste último grupo a Anemia das Células Falciformes ou Drepanocitose. As hemoglobinopatias são das patologias genéticas mais frequentes no mundo, sendo que nalguns locais são um grave problema de saúde pública. Em Portugal foram realizados estudos epidemiológicos que permitiram determinar a frequência de portadores na população e foi implementado um programa de prevenção.

Recent insights into the mucosal reactions associated with Giardia lamblia infections.

Giardia lamblia is an intestinal protozoan parasite infecting humans and various other mammalian hosts. The most important clinical signs of giardiasis are diarrhoea and malabsorption. Giardia lamblia is able to undergo continuous antigenic variation of its major surface antigen, named VSP (variant surface protein). While intestinal antibodies, and more specifically anti-VSP IgA antibodies, were proven to be involved in modulating antigenic variation of the parasite the participation of the local antibody response in control of the parasite infection is still controversial. Conversely, previous studies based on experimental infections in mice showed that cellular immune mechanisms are essential for elimination of the parasite from its intestinal habitat. Furthermore, recent data indicated that inflammatory mast cells have a potential to directly, or indirectly, interfere in duodenal growth of G. lamblia trophozoites. However, this finding was challenged by other reports, which did not find a correlation between intestinal inflammation and resistance to infection. Since intestinal infiltration of inflammatory cells and/or CD8+T-cells were demonstrated to coincide with villus-shortening and crypt hyperplasia immunological reactions were considered to be a potential factor of pathogenesis in giardiasis. The contribution of physiological factors to pathogenesis was essentially assessed in vitro by co-cultivation of G. lamblia trophozoites with epithelial cell lines. By using this in vitro model, molecular (through surface lectins) and mechanical (through ventral disk) adhesion of trophozoites to the epithelium was shown to be crucial for increased epithelial permeability. This phenomenon as well as other Giardia-induced intestinal abnormalities such as loss of intestinal brush border surface area, villus flattening, inhibition of disaccharidase activities, and eventually also overgrowth of the enteric bacterial flora seem to be involved in the pathophysiology of giardiasis. However, it remains to be elucidated whether at least part of these pathological effects are causatively linked to the clinical manifestation of the disease.

Experimental infections of neonatal mice with cysts of Giardia lamblia clone GS/M-83-H7 are associated with an antigenic reset of the parasite.

Transmission of the protozoan parasite Giardia lamblia from one to another host individuum occurs through peroral ingestion of cysts which, following excystation in the small intestine, release two trophozoites each. Many studies have focused on the major surface antigen, VSP (for variant surface protein), which is responsible for the antigenic variability of the parasite. By using trophozoites of G. lamblia clone GS/M-83-H7 (expressing VSP H7) and the neonatal mouse model for experimental infections, we quantitatively assessed the process of antigenic variation of the parasite on the transcriptional level. In the present study, variant-specific regions identified on different GS/M-83-H7 vsp sequences served as targets for quantitative reverse transcription-PCR to monitor alterations in vsp mRNA levels during infection. Respective results demonstrated that antigenic switching of both the duodenal trophozoite and the cecal cyst populations was associated with a massive reduction in vsp H7 mRNA levels but not with a simultaneous increase in transcripts of any of the subvariant vsp genes analyzed. Most importantly, we also explored giardial variant-type formation and vsp mRNA levels after infection of mice with cysts. This infection mode led to an antigenic reset of the parasite in that a VSP H7-negative inoculum "converted" into a population of intestinal trophozoites that essentially consisted of the original VSP H7 type. This antigenic reset appears to be associated with excystation rather than with a selective process which favors expansion of a residual population of VSP H7 types within the antigenically diversified cyst inoculum. Based on these findings, the VSP H7 type has to be regarded as a predominant variant of G. lamblia clone GS/M-83-H7 which (re-)emerges during early-stage infection and may contribute to an optimal establishment of the parasite within the intestine of the experimental murine host.

Clinical lectures on the gallbladder and bile ducts,

"Radiology of the gallbladder, by Ernest E. Smith": p. 84-104. "Diagnostic and therapeutic duodenal drainage, by Harry M. Eberhard": p. 105-136.

Molecular characterization of the microbial species that colonize human ileal and colonic mucosa by using 16S rDNA sequence analysis

Aim: The aim of this study was to characterize the bacterial community adhering to the mucosa of the terminal ileum, and proximal and distal colon of the human digestive tract. Methods and Results: Pinch samples of the terminal ileum, proximal and distal colon were taken from a healthy 35-year-old, and a 68-year-old subject with mild diverticulosis. The 16S rDNA genes were amplified using a low number of PCR cycles, cloned, and sequenced. In total, 361 sequences were obtained comprising 70 operational taxonomic units (OTU), with a calculated coverage of 82.6%. Twenty-three per cent of OTU were common to the terminal ileum, proximal colon and distal colon, but 14% OTU were only found in the terminal ileum, and 43% were only associated with the proximal or distal colon. The most frequently represented clones were from the Clostridium group XIVa (24.7%), and the Bacteroidetes (Cytophaga-Flavobacteria-Bacteroides ) cluster (27.7%). Conclusion: Comparison of 16S rDNA clone libraries of the hindgut across mammalian species confirms that the distribution of phylogenetic groups is similar irrespective of the host species. Lesser site-related differences within groups or clusters of organisms, are probable. Significance and Impact: This study provides further evidence of the distribution of the bacteria on the mucosal surfaces of the human hindgut. Data contribute to the benchmarking of the microbial composition of the human digestive tract.

Comparative ultrasonographic investigations of the gastrointestinal tract and the liver in healthy and diseased pigeons

The use of ultrasound as a diagnostic tool in birds has been documented for cardiac, urogenital, and liver disease. However, its use in gastrointestinal tract disease is not defined. Therefore, the purpose of this study was to compare the ultrasonographic findings of the intestine and liver of six healthy racing pigeons with those of six racing pigeons with gastrointestinal disease. The echogenicity of the liver was significantly different between the two groups. Pigeons with gastrointestinal disease had less homogeneous liver echogenicity with focal heterogeneous areas and the hepatic blood vessels were visible and dilated. The duodenum was visualized and its mean diameter of 7.2 +/- 0.3 mm in the diseased pigeons was significantly wider (P < 0.001) than the 5.7 +/- 0.2 mm in healthy birds. The thickness of the duodenal wall in healthy and diseased pigeons was 1.6 +/- 0.1 and 2.4 +/- 0.1 mm, respectively, and they were significantly different (P < 0.001). We defined baseline measurements for the duodenal loop in pigeons and provided evidence that ultrasound can be a useful diagnostic tool for investigating intestinal disease in pigeons.