Search

Like TNFα, IL-6 is upregulated in Crohn's disease (CD) especially in patients associated with Mycobacterium avium paratuberculosis (MAP) infection, and both cytokines have been targeted as a therapeutic option for the treatment of the disease despite the accepted partial response in some patients. Limited response to anti-IL-6 receptor-neutralizing antibodies therapy may be related to the homeostatic dual role of IL-6. In this study, we investigated the effects and the signaling mechanism of IL-6 involved in intestinal epithelial integrity and function during MAP infection using an in vitro model that consists of THP-1, HT-29 and Caco-2 cell lines. Clinically, we determined that plasma samples from MAP-infected CD patients have higher IL-6 levels compared to controls (P-value < 0.001). In CD-like macrophages, MAP infection has significantly upregulated the secretion of IL-6 and the shedding of (IL-6R) from THP-1 macrophages, P-value < 0.05. Intestinal cell lines (Caco-2 and HT-29) were treated with the supernatant of MAP-infected THP-1 macrophages with or without a neutralizing anti-IL-6R antibody. Treating intestinal Caco-2 cells with supernatant of MAP-infected macrophages resulted in significant upregulation of intestinal damage markers including claudin-2 and SERPINE1/PAI-1. Interestingly, blocking IL-6 signaling exacerbated that damage and further increased the levels of the damage markers. In HT-29 cells, MAP infection upregulated MUC2 expression, a protective response that was reversed when IL-6R was neutralized. More importantly, blocking IL-6 signaling during MAP infection rescued damaged Caco-2 cells from MAP-induced apoptosis. The data clearly supports a protective role of IL-6 in intestinal epithelia integrity and function especially in CD patients associated with MAP infection. The findings may explain the ineffective response to anti-IL6 based therapy and strongly support a therapeutic option that restores the physiologic level of IL-6 in patient's plasma. A new treatment strategy based on attenuation of IL-6 expression and secretion in inflammatory diseases should be considered. [ABSTRACT FROM AUTHOR]

Evidence shows that Autism Spectrum Disorder (ASD) stems from an interplay of genetic and environmental factors, which may include propionic acid (PPA), a microbial byproduct and food preservative. We previously reported that in vitro treatment of neural stem cells with PPA leads to gliosis and neuroinflammation. In this study, mice were exposed ad libitum to a PPA-rich diet for four weeks before mating. The same diet was maintained through pregnancy and administered to the offspring after weaning. The brains of the offspring were studied at 1 and 5 months postpartum. Glial fibrillary acidic protein (astrocytic marker) was significantly increased (1.53 ± 0.56-fold at 1 M and 1.63 ± 0.49-fold at 5 M) in the PPA group brains. Tubulin IIIβ (neuronal marker) was significantly decreased in the 5 M group. IL-6 and TNF-α expression were increased in the brain of the PPA group (IL-6: 2.48 ± 1.25-fold at 5 M; TNF-α: 2.84 ± 1.16-fold at 1 M and 2.64 ± 1.42-fold, at 5 M), while IL-10 was decreased. GPR41 and p-Akt were increased, while PTEN (p-Akt inhibitor) was decreased in the PPA group. The data support the role of a PPA-rich diet in glia over-proliferation and neuro-inflammation mediated by the GPR41 receptor and PTEN/Akt pathway. These findings strongly support our earlier study on the role of PPA in ASD. [ABSTRACT FROM AUTHOR]

This study, conducted between 4 October 2013, and 30 November 2018, tested the hypothesis that triple antimicrobial therapy, targeting Mycobacterium avium subspecies paratuberculosis (MAP), long considered a putative cause, would favorably affect Crohn's disease. A double-blind multicenter study of adults with active Crohn's disease, (i.e., Crohn's Disease Activity Index [CDAI] 220–450 plus C-reactive protein ≥ 1.0 mg/dL, fecal calprotectin (FCP) >162.9 µg/g stool, or recent endoscopic or radiographic confirmation of active disease) receiving concomitant standard-of-care Crohn's disease treatment (Clinicaltrials.gov: NCT01951326) were stratified by anti-tumor necrosis factor use and randomized (1:1) to anti-MAP RHB-104 (clarithromycin 95 mg, rifabutin 45 mg, and clofazimine 10 mg per capsule) (n = 166), resulting in clarithromycin 950 mg/day, rifabutin 450 mg/day, and clofazimine 100 mg/day, or placebo (n = 165) for up to 52 weeks. A greater proportion of RHB-104 versus placebo-treated patients met the primary endpoint—remission (i.e., CDAI < 150)—at week 26 (36.7% [61/166] vs. 22.4% [37/165], respectively; 95% CI for difference: 4.6, 24.0, p = 0.0048; chi-square test). Clinical response (reduction of CDAI by ≥100 points from baseline) at week 26 (first secondary endpoint) was also higher among the patients treated with RHB-104 (73/166 [44.0%]) compared with placebo (50/165 [30.3%]; 95% CI for difference: 3.4, 24.0, p = 0.0116), and it remained higher at week 52 among the patients treated with RHB-104 (59/166 [35.5%] vs. (35/165 [21.2%] for placebo; 95% CI for difference: 4.7, 23.9, p = 0.0042). A statistically significantly greater decline in FCP (another prospective efficacy endpoint) was also observed in RHB-104-treated patients, compared with placebo, at weeks 12, 26, and 52. The rates of serious adverse events were similar between groups (RHB-104: 18.7%; placebo: 18.8%). No patient died during the study. Antimicrobial therapy directed against MAP resulted in significantly greater improvement in clinical and laboratory (FCP) measures of active Crohn's disease. [ABSTRACT FROM AUTHOR]

Hedera helix L., a member of the Araliaceae family, is a commonly known decorative plant with recognized medicinal activities. In this study, the ethanolic extract from H. helix leaves was investigated for its total polyphenolic and flavonoid contents, as well as its antioxidant and antibacterial properties. The aim was to evaluate its potential for controlling certain infections by screening its antibacterial activity against selected pathogenic bacteria. The total phenolic and flavonoid contents of the extract were determined using colorimetric methods. The antioxidant activity was assessed through two assay methods: the 1, 1-diphenyl-2-picryl hydrazyl (DPPH) free radical scavenging activity and the reducing power ferric reducing/antioxidant power (FRAP). The antibacterial activity against different pathogenic bacteria, including Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, and Pseudomonas aeruginosa, was evaluated using the well diffusion method. The total phenolic and flavonoid contents of the H. helix extract were found to be 134.3 ± 4.9 mg gallic acid/g and 42.4 ± 3.6 mg catechin/g, respectively. The extract exhibited antioxidant activity, with a reducing power represented by an FRAP value of 9.5 ± 0.9 mmol Fe+2/g DW and a percentage inhibition of DPPH of 64.7 ± 3.8 at 80 µg/mL. The extract demonstrated antibacterial activity, inhibiting the growth of K. pneumoniae and S. aureus with zone of inhibition values of 18.5 and 23.2 mm, respectively, using 25 mg/well. However, E. coli and P. aeruginosa exhibited resistance to the extract. The findings of this study highlight the antibacterial and antioxidant properties of the ethanolic extract from H. helix leaves. The extract exhibited significant phenolic and flavonoid contents, as well as antioxidant activity. It also demonstrated antibacterial activity against selected pathogenic bacteria, suggesting its potential for controlling certain infections. Further research is warranted to identify the active compounds responsible for these activities and to explore their mechanisms of action. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by deficits in communication and social interactions, restrictive and repetitive behavior, and a wide range of cognitive impediments. The prevalence of ASD tripled in the last 20 years and now affects 1 in 44 children. Although ASD's etiology is not yet elucidated, a growing body of evidence shows that it stems from a complex interplay of genetic and environmental factors. In recent years, there has been increased focus on the role of gut microbiota and their metabolites, as studies show that ASD patients show a significant shift in their gut composition, characterized by an increase in specific bacteria and elevated levels of short-chain fatty acids (SCFAs), especially propionic acid (PPA). This review aims to provide an overview of the role of microbiota and SCFAs in the human body, as well as possible implications of microbiota shift. Also, it highlights current studies aiming to compare the composition of the gut microbiome of ASD-afflicted patients with neurotypical control. Finally, it highlights studies with rodents where ASD-like symptoms or molecular hallmarks of ASD are evoked, via the grafting of microbes obtained from ASD subjects or direct exposure to PPA. [ABSTRACT FROM AUTHOR]

Interleukin-6 (IL-6) is a key mediator cytokine of the immune response as well as a regulator of many physiological and pathological processes. In Crohn's disease (CD), cytokine imbalance rules the intestinal microenvironment and leads to chronic inflammation of the gut. Pro-inflammatory cytokines are generally upregulated in inflammatory bowel disease (IBD) including TNFa and IL-6. Consequently, drugs that target these cytokines have been long sought and approved. Despite the short-term success in treating CD patients with anti-TNFa, many patients stopped responding to treatment, which made IL-6 an alternative target to alleviate inflammation in these patients. IL-6 has long been approached as part of the therapeutic strategies to treat CD and other inflammatory disorders. Clinical trials of CD patients have targeted IL-6 signaling in different mechanisms: blocking IL-6, neutralizing IL-6 receptor (IL-6R), or trapping the soluble IL-6/IL-6R complex. These trials have faced challenges and side effects in patients with gastrointestinal perforations and ulcers, for example, all of which highlight the dual role of IL-6 during intestinal inflammation and the need for this cytokine for intestinal tissue integrity. IL-6 is involved in a complex of upstream regulators and downstream signaling cascades and maintaining a physiological level of IL-6 in the blood and in the intestine is key for achieving health and homeostasis. In this review, we describe IL-6 biology and signaling and its involvement in intestinal health and inflammation. We also discuss the current strategies for targeting IL-6 pathways in CD patients, as well as molecular regulators representing potential therapeutic targets for IL-6 attenuation. [ABSTRACT FROM AUTHOR]

Patients with Crohn's disease (CD) have higher risk for osteoporosis following decreased level of osteocalcin. We hypothesize that active inflammation following Mycobacterium avium subsp. paratuberculosis (MAP) infection results in elevation of undercarboxylated osteocalcin (ucOC) and downregulation of active osteocalcin in CD patients and cow-disease model (Johne's disease). In this study, we measured ucOC, active osteocalcin, and calcium levels in sera from 42 cattle (21 infected with MAP and 21 healthy cattle), 18 CD patients, and 20 controls. The level of ucOC in [MAP.sup.+] bovine samples was higher than that in MAP-controls (318 [+ or -] 57.2 nmol/mL vs. 289 [+ or -] 95.8 nmol/mL, P > 0.05). Consequently, mean calcium level in bovine MAP+ was significantly higher than that in bovine-MAP- samples (9.98 [+ or -] 0.998 mg/dL vs. 7.65 [+ or -] 2.12 mg/dL, P < 0.05). Also, the level of ucOC was higher in [CD-MAP.sup.+] than in [CD-MAP.sup.-] (561 [+ or -] 23.7 nmol/mL vs. 285 [+ or -] 19.6 nmol/mL, P < 0.05). Interestingly, the mean osteocalcin level in [MAP.sup.+] bovine was lower than that in MAP- bovine (797 [+ or -] 162 pg/mL vs. 1190 [+ or -] 43 pg/mL) and it was lower in [CD-MAP.sup.+] than in [CD-MAP.sup.-] infection (1.89 [+ or -] 0.184 ng/mL vs. 2.19 [+ or -] 0.763 ng/mL) (P < 0.05). The correlation between MAP infection and elevation of sera ucOC, reduction of active osteocalcin and increased calcium supports MAP infection role in CD and complications with osteoporosis. Key words: Mycobacterium avium subsp. paratuberculosis, Crohn's disease, osteocalcin, undercarboxylated osteocalcin, osteoporosis, IBD. Les patients atteints de la maladie de Crohn (MC) sont exposes a un risque plus eleve d'osteoporose a la suite d'une diminution des taux d'osteocalcine. Nous avons formule l'hypothese selon laquelle l'inflammation active subsequente a une infection par Mycobacterium avium subsp. paratuberculosis (MAP) entraine une hausse des taux d'osteocalcine decarboxylee (OCdc) et une regulation a la baisse de l'osteocalcine active chez les patients MC et dans un modele de la maladie chez la vache (maladie deJohne). Dans cette etude, nous avons mesure les taux d'OCdc et de calcium dans le serum chez 42bovins (21infectes parle MAP et 21 en bonne sante), 18 patients MC et 20 temoins. Les taux d'OCdc dans les echantillons de bovins MAP+ etaient plus eleves que chez les temoins [MAP.sup.-] (318 [+ or -] 57,2 nmol/mL vs. 289 [+ or -] 95,8 nmol/mL; P > 0,05). Consequemment, les taux moyens de calcium etaient nettement plus eleves chez les bovins [MAP.sup.+] que chez les bovins [MAP.sup.-] (9,98 [+ or -] 0,998 mg/dL vs. 7,65 [+ or -] 2,12 mg/dL; P < 0,05). En outre, les taux d'OCdc etaient plus eleves chez les patients MC MAP+ que chez les patients MC [MAP.sup.-] (561 [+ or -] 23,7 nmol/mL vs. 285 [+ or -] 19,6 nmol/mL; P < 0,05). Il est interessant de noter que les taux moyens d'osteocalcine etaient moins eleves chez les bovins [MAP.sup.+] (797 [+ or -] 162 pg/mL) que chez les bovins MAP- (1190 [+ or -] 43 pg/mL) et qu'ils etaient moins eleves chez les patients MC [MAP.sup.+] que chez les patients MC [MAP.sup.-] (1,89 [+ or -] 0,184 ng/mL vs. 2,19 [+ or -] 0,763 ng/mL) (P < 0,05). La correlation entre l'infection par le MAP et la hausse des taux seriques d'OCdc, la baisse de l'osteocalcine active et la hausse du calcium vient appuyer le role de l'infection par le MAP dans la MC et des complications avec l'osteoporose. [Traduit par la Redaction] Mots-cles : Mycobacterium avium subsp. paratuberculosis, maladie de Crohn, osteocalcine, osteocalcine decarboxylee, osteoporose, maladie inflammatoire de l'intestin., Introduction Crohn's disease (CD) is a severe relapsing form of inflammatory bowel disease (IBD), which has been associated with increasing number of fracture incidents and osteoporosis prevalence among affected patients [...]

Folate and vitamin B12 deficiency is highly prevalent among Crohn's disease (CD) patients. Furthermore, CD pathology can be mediated by Mycobacterium avium subsp. paratuberculosis (MAP) infection. However, the direct effect of folate (B9) and cobalamin (B12) deficiency during MAP infection remains uncharacterized. This study investigates how folate and B12 deficiency impedes macrophage apoptosis and exacerbates the inflammation in macrophages infected with MAP isolated from CD patients. Accordingly, we measured folate and B12 in ex vivo plasma samples collected from CD patients with or without MAP infection (N = 35 per group). We also measured the expression of the pro-inflammatory cytokines IL-1β and TNF-α, cellular apoptosis and viability markers, and bacterial viability in MAP-infected macrophages cultured in folate and B12 deficient media. We determined that MAP-positive CD patients have significantly lower plasma folate and B12 in comparison to MAP-negative CD patients [414.48 ± 94.60 pg/mL vs. 512.86 ± 129.12 pg/mL, respectively]. We further show that pro-inflammatory cytokines IL-1β and TNF-α are significantly upregulated during folate and vitamin B12 deprivation following MAP infection by several folds, while supplementation significantly reduces their expression by several folds. Additionally, depletion of folate, B12, and folate/B12 following MAP infection, led to decreased macrophage apoptosis from 1.83 ± 0.40-fold to 1.04 ± 0.08, 0.64 ± 0.12, and 0.45 ± 0.07 in folate-low, B12-low, and folate/B12-low cells, respectively. By contrast, folate and folate/B12 supplementation resulted in 3.38 ± 0.70 and 2.58 ± 0.14-fold increases in infected macrophages. Interestingly, changes in overall macrophage viability were only observed in folate-high, folate/B12-high, and folate/B12-low media, with 0.80 ± 0.05, 0.82 ± 0.02, and 0.91 ± 0.04-fold changes, respectively. Incubation of Caco-2 intestinal epithelial monolayers with supernatant from infected macrophages revealed that folate/B12 deficiency led to increased LDH release independent of oxidative stress. Overall, our results indicate that folate and B12 are key vitamins affecting cell survival and inflammation during MAP infection. [ABSTRACT FROM AUTHOR]

Infection with Mycobacterium avium subsp. paratuberculosis causes Johne's disease in cattle and is also implicated in cases of Crohn's disease in humans. Another closely related strain, M. avium subsp. avium, is a health problem for immunocompromised patients. To understand the molecular pathogenesis of M. avium subspecies, we analyzed the genome contents of isolates collected from humans and domesticated or wildlife animals. Comparative genomic hybridizations indicated distinct lineages for each subspecies where the closest genomic relatedness existed between M. avium subsp. paratuberculosis isolates collected from human and clinical cow samples. Genomic islands (n = 24) comprising 846 kb were present in the reference M. avium subsp. avium strain but absent from 95% of M. avium subsp. paratuberculosis isolates. Additional analysis identified a group of 18 M. avium subsp. Paratuberculosis-associated islands comprising 240 kb that were absent from most of the M. avium subsp. avium isolates. Sequence analysis of DNA regions flanking the genomic islands identified three large inversions in addition to several small inversions that could play a role in regulation of gene expression. Analysis of genes encoded in the genomic islands reveals factors that are probably important for various mechanisms of virulence. Overall, M. avium subsp. avium isolates displayed a higher level of genomic diversity than M. avium subsp. paratuberculosis isolates. Among M. avium subsp. paratuberculosis isolates, those from wildlife animals displayed the highest level of genomic rearrangements that were not observed in other isolates. The presented findings will affect the future design of diagnostics and vaccines for Johne's and Crohn's diseases and provide a model for genomic analysis of closely related bacteria.

Background Most recently we reported that RHBâ104 triple antibiotics combination in culture is bactericidal and should be effective for treatment of Crohn's disease (CD)-associated with Mycobacterium avium subspecies paratuberculosis (MAP) (Alcedo et al. in Gut Pathog 14:32, 2016). The combination exhibited unique synergistic antimicrobial growth activity. The proprietary RHB-104 capsule formulation contains active ingredients (63.3 % Clarithromycin (CLA), 6.7 % Clofazimine (CLO) and 30 % Rifabutin (RIF)). In our earlier study, we could not dissolve the proprietary RHB-104 capsule formulation in one compatible solvent. Consequently, we re-created RHB-104 analog by adding appropriate concentrations of each of the three antibiotics into the cultures. The Minimum inhibitory concentration (MIC) for RHB-104 analog, CLA, CLO, RIF, CLA-CLO, CLA-RIF, CLO-RIF and their individual solvents were reported earlier (Alcedo et al. in Gut Pathog 14:32, 2016). In this study, we succeeded in dissolving the proprietary RHB-104 capsule formulation in a single proprietary solvent. This study is designed to compare of the MIC the proprietary RHB-104 capsule formulation to RHB-104 analog against MAP and other microorganisms. Methods BD Bactec[TM] MGIT[TM] Para-TB medium (Sparks, MD) system was used to determine the MIC of the proprietary RHB-104 capsule formulation and RHB-104 analog and their solvents against MAP and several other microorganisms. The final concentration of solvents used to dissolve all the drugs were [less than or equai to]0.5 % (v/v). Results The MIC for the RHB-104 proprietary solvent against MAP was consistent against all microorganisms tested in the study at 12.5 % (v/v). The MIC for the proprietary RHB-104 capsule formulation was similar to RHB-104 analog against several MAP clinical strains with MIC [less than or equai to] 0.2 [mu]g/mL. The MIC for the proprietary RHB-104 capsule formulation was at 2.0 [mu]g/mL against MAP strain MS 137 and M. avium strain JF7 compared to 4.0 ug/mL for RHB-104 analog. Similarly, the MIC of RHB-104 formulation capsule was significantly lower than RHB-104 analog against M. tuberculosis HR237, M. fortuitism subspecies fortuitum, M. smegmatis ATCC 27199, Staphylococcus aureus ATCC 25923 and Listeria monocytogenes ATCC 19112. Conclusion The data demonstrated that the proprietary RHB-104 capsule formulation is more potent in culture against Mycobacteria and other microorganisms especially those with MIC >0.2. Formulation of multi-drugs in a single capsule results in potent synergistic anti-microbial activity far exceeds treatment the culture with multi-individually dissolved drugs. RHB-104 capsule formulation should be more effective to eradicate MAP infection in patients with CD. The study provides evidence that combining weak antibiotics in one formulation might be the new silver bullet to combat bacteria. Keywords: Mycobacterium paratuberculosis (MAP), Crohn's disease, RHB-104, MIC, Antibiotics, IBD, Author(s): Ahmad Qasem[sup.1] , Mitra Safavikhasraghi[sup.1] and Saleh A. Naser[sup.1] Background The current treatment guidelines of Crohn's disease (CD) include immunosuppressants, anti-inflammatory drugs, nutritional therapy and antibiotics. Mycobacterium avium subspecies [...]

Background Mycobacterium avium subspecies paratuberculosis (MAP) has been implicated as an etiological agent of Crohn's disease (CD), a debilitating chronic inflammatory bowel disease. Clarithromycin (CLA), clofazimine (CLO), rifabutin (RIF) and other antibiotics have been used individually or in combinations with other drugs to treat mycobacterial diseases including CD. The treatment has varied by regimen, dosage, and duration, resulting in conflicting outcomes and additional suffering to the patients. RHB-104, a drug formula with active ingredients composed of (63.3 %) CLA, (6.7 %) CLO, and (30 %) RIF, has been recently subjected to investigation in an FDA approved Phase III clinical trial to treat patients with moderate to severe CD. In this study, we determined the efficacy of RHB-104 active ingredients against MAP strains isolated from the blood, tissue, and milk of CD patients. Based on fluorescence quenching technology using the Bactec MGIT Para-TB medium, we determined the minimum inhibitory concentration (MIC) of CLA, CLO, RIF individually and in dual and triple combinations against 16 MAP clinical strains and 19 other mycobacteria. Results The MIC of all drugs against 35 different mycobacteria ranged between 0.25-20 [mu]g/mL. However, the MIC of RHB-104 active ingredients regimen was the lowest at 0.25-10 [mu]g/mL compared to the MIC of the other drugs at 0.5-20 [mu]g/mL. The components of RHB-104 active ingredients at their individual concentrations or in dual combinations were not effective against all microorganisms compared to the triple combinations at MIC level. The MIC of CLA-CLO, CLA-RIF, and CLO-RIF regimens ranged between 0.5-1.25 [mu]g/mL compared to 0.25 [mu]g/mL of bactericidal effect of the triple combination. Conclusion The data clearly demonstrated that lower concentrations of the triple combination of RHB-104 active ingredients provided synergistic anti-MAP growth activity compared to individual or dual combinations of the drugs. Consequently, this is favorable and should lead to tolerable dosage that is desirable for long-term treatment of CD and Mycobacterium avium complex disease. Keywords: Mycobacterium paratuberculosis, Crohn's disease, RHB-104, MIC, Antibiotics, IBD, Author(s): Karel P. Alcedo[sup.1] , Saisathya Thanigachalam[sup.1] and Saleh A. Naser[sup.1] Background Crohn's disease (CD), a chronic inflammatory bowel disease, is caused by the interplay between genetic predisposition, immune dysregulation, [...]

Author(s): Ahmad Qasem[sup.1] , Ahmad Abdel-Aty[sup.1] , Huda Abu-Suwa[sup.1] and Saleh A. Naser[sup.1] Background Mycobacterium avium subspecies paratuberculosis (MAP) is implicated in the etiology of multiple diseases including Crohn's disease [...]