-
Beneficial Microbes Dec 2018Chemotherapy and radiotherapy treatment regimens for gastrointestinal, peritoneal and pelvic tumours can disrupt the intestinal microbiome and intestinal epithelia. Such...
Chemotherapy and radiotherapy treatment regimens for gastrointestinal, peritoneal and pelvic tumours can disrupt the intestinal microbiome and intestinal epithelia. Such disturbances can provoke symptoms such as diarrhoea, nausea and vomiting. Chemotherapy and radiotherapy induced gastrointestinal toxicity aggravating intestinal microbiome dysbiosis is postulated to adversely alter the intestinal microbiome, with a consequent induced pro-inflammatory effect that disrupts the intestinal microbiome-epithelia-mucosal immunity axis. Although not widely recognised, the intestinal mucosa is the largest and most densely and dynamically populated immune-environment. Cancer treatment adverse effects that affect intestinal and mucosal cells inadvertently target and disrupt resident intestinal macrophages, the cells that marshal immune activity in the intestinal mucosa by shaping pro-inflammatory and anti-inflammatory activities to control and eradicate infectious insults and maintain local homeostasis. Pathobionts (bacteria capable of pathogenic pro-inflammatory activity) and noxious environmental and bacterial antigens use the intestinal epithelia and gap junctions as a point of entry into the systemic circulation. This translocation movement promotes toxic sequelae that obstruct intestinal macrophage functions resulting in uncontrolled local and systemic pro-inflammatory activity, loss of phagocytic function and loss of expression of tight junction proteins. Probiotic bacteria as an adjunctive treatment shows efficacy in ameliorating enteropathies such as mucositis/diarrhoea resulting from chemotherapy or radiotherapy regimens. As such we posit that an important benefit that warrants a further focused research effort is the administration of adjuvant probiotics to help reduce the incidence of febrile neutropenia.
Topics: Antineoplastic Agents; Bacterial Translocation; Dysbiosis; Gastrointestinal Neoplasms; Humans; Incidence; Pelvic Neoplasms; Peritoneal Neoplasms; Probiotics; Radiotherapy; Treatment Outcome
PubMed: 30232908
DOI: 10.3920/BM2017.0172 -
The Cochrane Database of Systematic... Sep 2018Placing a small volume of colostrum directly onto the buccal mucosa of preterm infants during the early neonatal period may provide immunological and growth factors that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Placing a small volume of colostrum directly onto the buccal mucosa of preterm infants during the early neonatal period may provide immunological and growth factors that stimulate the immune system and enhance intestinal growth. These benefits could potentially reduce the risk of infection and necrotising enterocolitis (NEC) and improve survival and long-term outcome.
OBJECTIVES
To determine if early (within the first 48 hours of life) oropharyngeal administration of mother's own fresh or frozen/thawed colostrum can reduce rates of NEC, late-onset invasive infection, and/or mortality in preterm infants compared with controls. To assess trials for evidence of safety and harm (e.g. aspiration pneumonia). To compare effects of early oropharyngeal colostrum (OPC) versus no OPC, placebo, late OPC, and nasogastric colostrum.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8), MEDLINE via PubMed (1966 to August 2017), Embase (1980 to August 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to August 2017). We also searched clinical trials registries for ongoing and recently completed trials (clinicaltrials.gov; the World Health Organization International Trials Registry (www.whoint/ictrp/search/en/), and the ISRCTN Registry), conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We performed the last search in August 2017. We contacted trial investigators regarding unpublished studies and data.
SELECTION CRITERIA
We searched for published and unpublished randomised controlled trials comparing early administration of oropharyngeal colostrum (OPC) versus sham administration of water, oral formula, or donor breast milk, or versus no intervention. We also searched for studies comparing early OPC versus early nasogastric or nasojejunal administration of colostrum. We considered only trials that included preterm infants at < 37 weeks' gestation. We did not limit the review to any particular region or language.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened retrieved articles for inclusion and independently conducted data extraction, data analysis, and assessments of 'Risk of bias' and quality of evidence. We graded evidence quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We contacted study authors for additional information or clarification when necessary.
MAIN RESULTS
We included six studies that compared early oropharyngeal colostrum versus water, saline, placebo, or donor, or versus no intervention, enrolling 335 preterm infants with gestational ages ranging from 25 to 32 weeks' gestation and birth weights of 410 to 2500 grams. Researchers found no significant differences between OPC and control for primary outcomes - incidence of NEC (typical risk ratio (RR) 1.42, 95% confidence interval (CI) 0.50 to 4.02; six studies, 335 infants; P = 0.51; I² = 0%; very low-quality evidence), incidence of late-onset infection (typical RR 0.86, 95% CI 0.56 to 1.33; six studies, 335 infants; P = 0.50; I² = 0%; very low-quality evidence), and death before hospital discharge (typical RR 0.76, 95% CI 0.34 to 1.71; six studies, 335 infants; P = 0.51; I² = 0%; very low-quality evidence). Similarly, meta-analysis showed no difference in length of hospital stay between OPC and control groups (mean difference (MD) 0.81, 95% CI -5.87 to 7.5; four studies, 293 infants; P = 0.65; I² = 49%). Days to full enteral feeds were reduced in the OPC group with MD of -2.58 days (95% CI -4.01 to -1.14; six studies, 335 infants; P = 0.0004; I² = 28%; very low-quality evidence).The effect of OPC was uncertain because of small sample sizes and imprecision in study results (very low-quality evidence).No adverse effects were associated with OPC; however, data on adverse effects were insufficient, and no numerical data were available from the included studies.Overall the quality of included studies was low to very low across all outcomes. We downgraded GRADE outcomes because of concerns about allocation concealment and blinding, reporting bias, small sample sizes with few events, and wide confidence intervals.
AUTHORS' CONCLUSIONS
Large, well-designed trials would be required to evaluate more precisely and reliably the effects of oropharyngeal colostrum on important outcomes for preterm infants.
Topics: Administration, Oral; Colostrum; Enterocolitis, Necrotizing; Hospital Mortality; Humans; Immunity, Mucosal; Infant, Newborn; Infant, Premature; Length of Stay; Mouth Mucosa; Oropharynx; Randomized Controlled Trials as Topic; Sepsis
PubMed: 30191961
DOI: 10.1002/14651858.CD011921.pub2 -
Journal of Behavioral Medicine Aug 2018Yoga is an ancient mind-body practice that is increasingly recognized to have health benefits in a variety of clinical and non-clinical conditions. This systematic...
Yoga is an ancient mind-body practice that is increasingly recognized to have health benefits in a variety of clinical and non-clinical conditions. This systematic review summarizes the findings of randomized controlled trials examining the effects of yoga on immune system functioning which is imperative to justify its application in the clinic. Fifteen RCTs were eligible for the review. Even though the existing evidence is not entirely consistent, a general pattern emerged suggesting that yoga can downregulate pro-inflammatory markers. In particular, the qualitative evaluation of RCTs revealed decreases in IL-1beta, as well as indications for reductions in IL-6 and TNF-alpha. These results imply that yoga may be implemented as a complementary intervention for populations at risk or already suffering from diseases with an inflammatory component. Beyond this, yoga practice may exert further beneficial effects by enhancing cell-mediated and mucosal immunity. It is hypothesized that longer time spans of yoga practice are required to achieve consistent effects especially on circulating inflammatory markers. Overall, this field of investigation is still young, hence the current body of evidence is small and for most immune parameters, more research is required to draw distinct conclusions.
Topics: Biomarkers; Humans; Immune System; Randomized Controlled Trials as Topic; Yoga
PubMed: 29429046
DOI: 10.1007/s10865-018-9914-y -
Neurogastroenterology and Motility Jan 2018Increases in mucosal immune cells have frequently been observed in irritable bowel syndrome (IBS) patients. However, this finding is not completely consistent between... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
Increases in mucosal immune cells have frequently been observed in irritable bowel syndrome (IBS) patients. However, this finding is not completely consistent between studies, possibly due to a combination of methodological variability, population differences and small sample sizes. We performed a meta-analysis of case-control studies that compared immune cell counts in colonic biopsies of IBS patients and controls.
METHODS
PubMed and Embase were searched in February 2017. Results were pooled using standardized mean difference (SMD) and were considered significant when zero was not within the 95% confidence interval (CI). Heterogeneity was assessed based on I statistics where I ≤ 50% and I > 50% indicated fixed and random effect models, respectively.
KEY RESULTS
Twenty-two studies on 706 IBS patients and 401 controls were included. Mast cells were increased in the rectosigmoid (SMD: 0.38 [95% CI: 0.06-0.71]; P = .02) and descending colon (SMD: 1.69 [95% CI: 0.65-2.73]; P = .001) of IBS patients. Increased mast cells were observed in both constipation (IBS-C) and diarrhea predominant IBS (IBS-D). CD3 T cells were increased in the rectosigmoid (SMD: 0.53 [95% CI: 0.21-0.85]; P = .001) and the descending colon of the IBS patients (SMD: 0.79, 95% CI [0.28-1.30]; P = .002). This was possibly in relation to higher CD4 T cells in IBS (SMD: 0.33 [95% CI: 0.01-0.65]; P = .04) as there were no differences in CD8 T cells.
CONCLUSIONS & INFERENCES
Mast cells and CD3 T cells are increased in colonic biopsies of patients with IBS vs non-inflamed controls. These changes are segmental and sometimes IBS-subtype dependent. The diagnostic value of the quantification of colonic mucosal cells in IBS requires further investigation.
Topics: CD3 Complex; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Colon; Humans; Irritable Bowel Syndrome; Mast Cells
PubMed: 28851005
DOI: 10.1111/nmo.13192 -
International Journal of Oral and... Nov 2017The aim of this study was to determine whether highly active antiretroviral therapy (HAART) is associated with the prevalence of oral lesions in HIV-positive patients.... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to determine whether highly active antiretroviral therapy (HAART) is associated with the prevalence of oral lesions in HIV-positive patients. This systematic review and meta-analysis was performed in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was conducted in seven electronic databases (PubMed, Scopus, SciELO, LILACS, Embase, Web of Science, and OpenGrey), without restriction on publication period or language. Studies that showed the prevalence of oral lesions manifested in adult HIV-positive patients, subjected or not to HAART, were selected. The meta-analysis estimate of relative risk was calculated using the Mantel-Haenszel method and DerSimonian and Laird estimator to determine the variance between studies in the random-effects model. The meta-analysis showed significant results in favour of the group on HAART, with lower prevalence for angular cheilitis, erythematous candidiasis, oral herpes, pseudomembranous candidiasis, Kaposi sarcoma, and oral hairy leukoplakia. The prevalence of oral mucosal hyperpigmentation was higher in patients on HAART. These results suggest that the prevalence of oral lesions in HIV-positive patients is lower for those on HAART, which might occur because of the improvement in immunity provided by the therapy.
Topics: Antiretroviral Therapy, Highly Active; HIV Infections; Humans; Mouth Diseases; Prevalence
PubMed: 28684301
DOI: 10.1016/j.ijom.2017.06.008 -
Journal of Clinical Periodontology Mar 2017To systematically review the evidence regarding immune senescence in the pathogenesis of periodontitis and dental caries. (Review)
Review
AIM
To systematically review the evidence regarding immune senescence in the pathogenesis of periodontitis and dental caries.
METHODS
A systematic search of electronic databases utilizing medical subject headings (MeSH terms) supplemented by screening of review articles and other relevant texts was undertaken.
RESULTS
Seventy-three articles were included (43 for periodontitis, 30 for caries). Study results were found to be generally heterogeneous. Regarding periodontitis, human studies suggest evidence for altered neutrophil function and increased production of pro-inflammatory mediators (e.g. interleukin-1β, interleukin-6 and prostaglandin E ) in older compared to younger subjects, and animal experiments suggest increased expression of genes that contribute to a pro-inflammatory state in older compared to younger animals. Regarding dental caries, research relating to changes in immune functioning and the impact of ageing is in its infancy. A small number of studies have reported components of innate and adaptive immunity that affect the composition of saliva and dental biofilms with possible impacts on caries progression.
CONCLUSION
There is evidence that immune functioning related to periodontitis and (less investigated) dental caries alters with increasing age. In both conditions, age-associated mechanistic changes in immune functioning are complex and incompletely understood and it is not clear how these relate to disease susceptibility.
Topics: Age Factors; Aged; Dental Caries; Humans; Immunosenescence; Periodontal Diseases
PubMed: 28266110
DOI: 10.1111/jcpe.12675 -
Journal of Psychosomatic Research Dec 2016Despite considerable research into associations between the effort reward imbalance (ERI) model and various health outcomes over the past 20years, the underlying... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Despite considerable research into associations between the effort reward imbalance (ERI) model and various health outcomes over the past 20years, the underlying mechanisms responsible for the association remain unclear. Recently, ERI investigations have examined associations with immune sub-systems (e.g., leukocytes, cytokines and immunoglobulins). Synthesis of the amalgamated research evidence will aid clarity to this field of enquiry. We conducted a meta-analysis and reviewed the associations of ERI and over-commitment (OC) in the workplace with immunity.
METHOD
Electronic databases were searched with the phrase 'effort reward imbalance' which initially yielded 319 studies leading to 57 full text studies being screened. Seven studies that met inclusion criteria were combined using mixed and random effects models.
RESULTS
Greater ERI was associated with lower immunity (r=-0.09, CI -0.14, -0.05, p<0.001). Sub-group analyses revealed the effect with mucosal immunity was stronger (r=-0.33, CI -0.47 to -0.18) than trends between both cytokine (r=-0.04, CI -0.07, -0.01) and leukocyte sub-groups (r=-0.02 CI -0.04, 0.01) respectively (k=7, N=9952). Over-commitment was also associated with lower immunity (r=-0.05, CI -0.09, 0.01, p=0.014); subgroup (leukocytes, cytokines, mucosal immunity) associations, however, were homogenous (Q=1.83, df=2, p=0.400, k=6, N=2358).
CONCLUSIONS
Greater ERI and OC were both associated with lower immunity. The association between mucosal immunity and ERI was stronger than the cytokine and leukocyte sub-groups. OC moderated the relationship between ERI and immunity.
Topics: Adult; Cross-Sectional Studies; Cytokines; Female; Humans; Immune Tolerance; Immunity, Mucosal; Job Satisfaction; Lymphocyte Count; Male; Motivation; Psychophysiologic Disorders; Reward; Stress, Psychological; Work Performance; Workplace
PubMed: 27894456
DOI: 10.1016/j.jpsychores.2016.10.003 -
Drugs in R&D Mar 2017Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality... (Review)
Review
A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI.
BACKGROUND
Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist.
OBJECTIVE
Our objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea.
DATA SOURCES
Electronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices.
LIMITATIONS
While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search.
CONCLUSIONS
We compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications.
Topics: Drug-Related Side Effects and Adverse Reactions; Humans; Oral Medicine; Salivary Glands; Sialorrhea; Xerostomia
PubMed: 27853957
DOI: 10.1007/s40268-016-0153-9 -
Current Medicinal Chemistry 2017Crohn's disease (CD) and ulcerative colitis (UC) are classified under inflammatory bowel disease (IBD) which has been linked to a multifaceted etiology involving both... (Review)
Review
Crohn's disease (CD) and ulcerative colitis (UC) are classified under inflammatory bowel disease (IBD) which has been linked to a multifaceted etiology involving both environmental and genetic factors that intersect with the vitamin D pathway. Dysfunctions in innate immune defense mechanisms in the epithelial compartment of the intestine play a crucial role in the pathogenesis of IBD. Symptoms of IBD are caused by excessive immune responses to luminal bacteria, and vitamin D has been shown to play a role in intestinal defense by aiding in the suppression of microbial invasion into the epithelium. Vitamin D, as an immunomodulator, can modify the innate immune response of the body. Vitamin D attenuates the transcription of pro-inflammatory cytokines that are upregulated in the event of epithelial stress common in patients with IBD. Vitamin D deficiency was identified in 82% of IBD patients compared to the 31% national average and has been linked to defective epithelial processes at both genomic and proteomic levels. Mucosal damage and an impaired immune response are at the center of IBD, and vitamin D aids in sustaining the structural integrity of epithelial cells while enhancing innate immune responses in the mucosa. Here we provide a systematic review of the pathophysiological effects of cytokines in IBD in the presence of vitamin D deficiency. Also, analysis of the immunomodulatory effect of vitamin D in regulating immunopathogenic factors like chemokines, growth factors, and human defensins will enhance knowledge of the underlying molecular mechanisms of the therapeutic role of vitamin D in IBD and thus aid in the development of better patient management strategies.
Topics: Humans; Immunity; Inflammatory Bowel Diseases; Vitamin D
PubMed: 27784213
DOI: 10.2174/0929867323666161026124951 -
Journal of Digestive Diseases Sep 2016To systematically review the available data on cytokine and immune cells in the peripheral blood and mucosal biopsy samples from patients with irritable bowel syndrome... (Review)
Review
OBJECTIVE
To systematically review the available data on cytokine and immune cells in the peripheral blood and mucosal biopsy samples from patients with irritable bowel syndrome (IBS).
METHODS
From a review of the literature, data on cytokines and immune cells that had been assayed in at least three independent studies were collated and trends examined.
RESULTS
Levels of interleukin (IL)-10 tended to be decreased and those of IL-6, IL-8, tumor necrosis factor-α and IL-1β increased in the systemic circulation in IBS, while in the mucosa, IL-10 was decreased and IL-8, mast cells, enterochromaffin cells and CD3 T lymphocytes were increased. However, these findings were not consistent across all studies and, in some instances, were limited to certain IBS sub-populations.
CONCLUSIONS
The interpretation of this literature is limited by several factors, such as the intrinsic heterogeneity of IBS and a lack of standardization in study design. While a number of intriguing immunological observations have been made in IBS, more work is needed before a compelling case can be made for a role for immune-mediated events in the etiology of IBS.
Topics: Cytokines; Enterochromaffin Cells; Humans; Immunity, Mucosal; Inflammation Mediators; Intestinal Mucosa; Irritable Bowel Syndrome; Mast Cells; T-Lymphocyte Subsets
PubMed: 27426409
DOI: 10.1111/1751-2980.12379