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Abstract
Gut microbiota contain communities of viruses, bacteria, fungi, and Eukarya, and live as biofilms. In health, these biofilms adhere to the intestinal mucus surface without contacting the epithelium. Disruptions to the equilibrium between these biofilms and the host may create invasive pathobionts from these commensal communities and contribute to disease pathogenesis. Environmental factors appear to dominate over genetics in determining the shifts in microbiota populations and function, including when comparing microbiota between low-income and industrialized countries. The observations discussed herein carry enormous potential for the development of novel therapies targeting phenotype in microbiota dysbiosis.
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Affiliation(s)
- Andre G. Buret
- Department of Biological Sciences, Host-Parasite Interactions program, Inflammation Research Network, University of Calgary, Calgary, Canada
| | - Thibault Allain
- Department of Biological Sciences, Host-Parasite Interactions program, Inflammation Research Network, University of Calgary, Calgary, Canada
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Dionne JC, Sullivan K, Mbuagbaw L, Takaoka A, Duan EH, Alhazzani W, Devlin JW, Duprey M, Moayyedi P, Armstrong D, Thabane L, Tsang JLY, Jaeschke R, Hamielec C, Karachi T, Cartin-Ceba R, Muscedere J, Alshahrani MSS, Cook DJ. Diarrhoea: interventions, consequences and epidemiology in the intensive care unit (DICE-ICU): a protocol for a prospective multicentre cohort study. BMJ Open 2019; 9:e028237. [PMID: 31248929 PMCID: PMC6597652 DOI: 10.1136/bmjopen-2018-028237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/03/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Diarrhoea is a frequent concern in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, increased length of ICU stay, skin breakdown and renal dysfunction. However, its prevalence, aetiology and prognosis in the critically ill have been poorly studied. The primary objectives of this study are to determine the incidence, risk factors and consequences of diarrhoea in critically ill adults. The secondary objectives are to estimate the incidence of Clostridium difficile-associated diarrhoea (CDAD) in ICU patients and to validate the Bristol Stool Chart and Bliss Stool Classification System characterising bowel movements in the ICU. Our primary outcome is the incidence of diarrhoea . Our secondary outcomes include: CDAD, ICU and hospital mortality and ICU and hospital length of stay. METHODS AND ANALYSIS This international prospective cohort study will enrol patients over 10 weeks in 12 ICUs in Canada, the USA, Poland and Saudi Arabia. We will include all patients 18 years of age and older who are admitted to the ICU for at least 24 hours and follow them daily until ICU discharge. Our primary outcome is the incidence of diarrhoea based on the WHO definition, during the ICU stay. Our secondary outcomes include: CDAD, ICU and hospital mortality and ICU and hospital length of stay. We will use logistic regression to identify factors associated with diarrhoea (as defined using WHO criteria) and the kappa statistic to measure agreement on diarrhoea rates between the WHO definition and the Bristol Stool Chart and Bliss Stool Classification System. ETHICS AND DISSEMINATION The protocol has been approved by the research ethics board of all participating centres. The diarrhoea interventions, consequences and epidemiology in the intensive care unit (DICE-ICU) study will generate evidence about diarrhoea and its frequency, predisposing factors and consequences, to inform critical care practice and future research. LAY SUMMARY Diarrhoea is a frequent clinical problem for hospitalised patients including those who are critically ill in the ICU. Diarrhoea can cause complications such as skin damage, dehydration and kidney problems. It is not clear how common diarrhoea is in the ICU, the factors that cause it or the best way for clinicians to assess it. The DICE-ICU study is an international prospective observational study to examine the frequency, risk factors and outcomes of diarrhoea during critical illness.
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Affiliation(s)
- Joanna C Dionne
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kristen Sullivan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alyson Takaoka
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Erick Huaileigh Duan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, Niagara Health System, Saint Catharines Site, St. Catharines, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John W Devlin
- School of Pharamcy, Northeastern University, Bouve College of Health Sciences, Boston, Massachusetts, USA
| | - Matthew Duprey
- School of Pharamcy, Northeastern University, Bouve College of Health Sciences, Boston, Massachusetts, USA
| | - Paul Moayyedi
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - David Armstrong
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, Niagara Health System, Saint Catharines Site, St. Catharines, Ontario, Canada
| | - Roman Jaeschke
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cindy Hamielec
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - John Muscedere
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Mohammed Saeed Saad Alshahrani
- Department of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Deborah J Cook
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Armstrong H, Alipour M, Valcheva R, Bording-Jorgensen M, Jovel J, Zaidi D, Shah P, Lou Y, Ebeling C, Mason AL, Lafleur D, Jerasi J, Wong GKS, Madsen K, Carroll MW, Huynh HQ, Dieleman LA, Wine E. Host immunoglobulin G selectively identifies pathobionts in pediatric inflammatory bowel diseases. Microbiome 2019; 7:1. [PMID: 30925932 PMCID: PMC6317230 DOI: 10.1186/s40168-018-0604-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/25/2018] [Indexed: 05/08/2023]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) are a group of complex and multifactorial disorders with unknown etiology. Chronic intestinal inflammation develops against resident intestinal bacteria in genetically susceptible hosts. We hypothesized that host intestinal immunoglobulin (Ig) G can be used to identify bacteria involved in IBD pathogenesis. RESULTS IgG-bound and -unbound microorganisms were collected from 32 pediatric terminal ileum aspirate washes during colonoscopy [non-IBD (n = 10), Crohn disease (n = 15), and ulcerative colitis (n = 7)], and composition was assessed using the Illumina MiSeq platform. In vitro analysis of invasive capacity was evaluated by fluorescence in situ hybridization and gentamicin invasion assay; immune activation was measured by qPCR. Despite considerable inter-individual variations, IgG binding favored specific and unique mucosa-associated species in pediatric IBD patients. Burkholderia cepacia, Flavonifractor plautii, and Rumminococcus sp. demonstrated increased IgG binding, while Pseudomonas ST29 demonstrated reduced IgG binding, in IBD. In vitro validation confirmed that B. cepacia, F. plautii, and Rumminococcus display invasive potential while Pseudomonas protogens did not. CONCLUSION Using IgG as a marker of pathobionts in larger patient cohorts to identify microbes and elucidate their role in IBD pathogenesis will potentially underpin new strategies to facilitate development of novel, targeted diagnostic, and therapeutic approaches. Interestingly, this method can be used beyond the scope of this manuscript to evaluate altered gut pathobionts in a number of diseases associated with altered microbiota including arthritis, obesity, diabetes mellitus, alcoholic liver disease, cirrhosis, metabolic syndrome, and carcinomas.
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Affiliation(s)
- Heather Armstrong
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Misagh Alipour
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Rosica Valcheva
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Michael Bording-Jorgensen
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Physiology, University of Alberta, Edmonton, AB T6G 1C9 Canada
| | - Juan Jovel
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Deenaz Zaidi
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Prachi Shah
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Yuefei Lou
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Cory Ebeling
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Andrew L. Mason
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Dawson Lafleur
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Jeremy Jerasi
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Gane K.-S. Wong
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Karen Madsen
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Matthew W. Carroll
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Hien Q. Huynh
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Levinus A. Dieleman
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3 Canada
| | - Eytan Wine
- CEGIIR, University of Alberta, Edmonton, AB T6G 2X8 Canada
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
- Department of Physiology, University of Alberta, Edmonton, AB T6G 1C9 Canada
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Zhu D, Xie L, Kang Y, Dolai S, Bondo Hansen J, Qin T, Xie H, Liang T, Rubin DC, Osborne L, Gaisano HY. Syntaxin 2 Acts as Inhibitory SNARE for Insulin Granule Exocytosis. Diabetes 2017; 66:948-959. [PMID: 28115395 PMCID: PMC5860373 DOI: 10.2337/db16-0636] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/24/2016] [Indexed: 01/03/2023]
Abstract
Of the four syntaxins specialized for exocytosis, syntaxin (Syn)-2 is the least understood. In this study, we used Syn-2/epimorphin knockout mice to examine the role of Syn-2 in insulin secretory granule (SG) exocytosis. Unexpectedly, Syn-2 knockout mice exhibited paradoxical superior glucose homeostasis resulting from an enhanced insulin secretion. This was confirmed in vitro by pancreatic islet perifusion showing an amplified biphasic glucose-stimulated insulin secretion arising from an increase in size of the readily releasable pool of insulin SGs and enhanced SG pool refilling. The increase in insulin exocytosis was attributed mainly to an enhanced recruitment of the larger pool of newcomer SGs that undergoes no residence time on plasma membrane before fusion and, to a lesser extent, also the predocked SGs. Consistently, Syn-2 depletion resulted in a stimulation-induced increase in abundance of exocytotic complexes we previously demonstrated as mediating the fusion of newcomer SGs (Syn-3/VAMP8/SNAP25/Munc18b) and predocked SGs (Syn-1A/VAMP2/SNAP25/Muncn18a). This work is the first to show in mammals that Syn-2 could function as an inhibitory SNARE protein that, when relieved, could promote exocytosis in pancreatic islet β-cells. Thus, Syn-2 may serve as a potential target to treat diabetes.
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Affiliation(s)
- Dan Zhu
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Li Xie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Youhou Kang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Subhankar Dolai
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Tairan Qin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Huanli Xie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tao Liang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Deborah C Rubin
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
- Department of Developmental Biology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Lucy Osborne
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Herbert Y Gaisano
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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James PD, Meng ZW, Zhang M, Belletrutti PJ, Mohamed R, Ghali W, Roberts DJ, Martel G, Heitman SJ. The incremental benefit of EUS for identifying unresectable disease among adults with pancreatic adenocarcinoma: A meta-analysis. PLoS One 2017; 12:e0173687. [PMID: 28319148 PMCID: PMC5358870 DOI: 10.1371/journal.pone.0173687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/24/2017] [Indexed: 12/18/2022] Open
Abstract
Background and study aims It is unclear to what extent EUS influences the surgical management of patients with pancreatic adenocarcinoma. This systematic review sought to determine if EUS evaluation improves the identification of unresectable disease among adults with pancreatic adenocarcinoma. Patients and methods We searched MEDLINE, EMBASE, bibliographies of included articles and conference proceedings for studies reporting original data regarding surgical management and/or survival among patients with pancreatic adenocarcinoma, from inception to January 7th 2017. Our main outcome was the incremental benefit of EUS for the identification of unresectable disease (IBEUS). The pooled IBEUS were calculated using random effects models. Heterogeneity was explored using stratified meta-analysis and meta-regression. Results Among 4,903 citations identified, we included 8 cohort studies (study periods from 1992 to 2007) that examined the identification of unresectable disease (n = 795). Random effects meta-analysis suggested that EUS alone identified unresectable disease in 19% of patients (95% confidence interval [CI], 10–33%). Among those studies that considered portal or mesenteric vein invasion as potentially resectable, EUS alone was able to identify unresectable disease in 14% of patients (95% CI 8–24%) after a CT scan was performed. Limitations The majority of the included studies were retrospective. Conclusions EUS evaluation is associated with increased identification of unresectable disease among adults with pancreatic adenocarcinoma.
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Affiliation(s)
- Paul D. James
- Department of Medicine and the Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
- Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada
- * E-mail:
| | - Zhao Wu Meng
- Department of Medicine and the Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Mei Zhang
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Paul J. Belletrutti
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
- Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada
| | - Rachid Mohamed
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
- Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada
| | - William Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Steven J. Heitman
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
- Calgary Research and Education in Advanced Therapeutic Endoscopy (CREATE), Calgary, Canada
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