Fecal microbiota transplantation in metabolic syndrome: History, present and future.

The history of fecal microbiota transplantation (FMT) dates back even to ancient China. Recently, scientific studies have been looking into FMT as a promising treatment of various diseases, while in the process teaching us about the interaction between the human host and its resident microbial communities. Current research focuses mainly on Clostridium difficile infections, however interest is rising in other areas such as inflammatory bowel disease (IBD) and the metabolic syndrome. With regard to the latter, the intestinal microbiota might be causally related to the progression of insulin resistance and diabetes. FMT in metabolic syndrome has proven to be an intriguing method to study the role of the gut microbiota and open the way to new therapies by dissecting in whom insulin resistance is driven by microbiota. In this article we review the history of FMT, the present evidence on its role in the pathophysiology of metabolic syndrome and its efficacy, limitations and future prospects.

Isoepoxydon dehydrogenase (idh) gene expression in relation to patulin production by Penicillium expansum under different temperature and atmosphere.

Penicillium expansum growth and patulin production occur mainly at post-harvest stage during the long-term storage of apples. Low temperature in combination with reduced oxygen concentrations is commonly applied as a control strategy to extend apple shelf life and supply the market throughout the year. Our in vitro study investigated the effect of temperature and atmosphere on expression of the idh gene in relation to the patulin production by P. expansum. The idh gene encodes the isoepoxydon dehydrogenase enzyme, a key enzyme in the patulin biosynthesis pathway. First, a reverse transcription real-time PCR (RT-qPCR) method was optimized to measure accurately the P. expansum idh mRNA levels relative to the mRNA levels of three reference genes (18S, ß-tubulin, calmodulin), taking into account important parameters such as PCR inhibition and multiple reference gene stability. Subsequently, two P. expansum field isolates and one reference strain were grown on apple puree agar medium (APAM) under three conditions of temperature and atmosphere: 20 °C - air, 4 °C - air and 4 °C - controlled atmosphere (CA; 3% O2). When P. expansum strains reached a 0.5 and 2.0 cm colony diameter, idh expression and patulin concentrations were determined by means of the developed RT-qPCR and an HPLC-UV method, respectively. The in vitro study showed a clear reduction in patulin production and down-regulation of the idh gene expression when P. expansum was grown under 4 °C - CA. The results suggest that stress (low temperature and oxygen level) caused a delay of the fungal metabolism rather than a complete inhibition of toxin biosynthesis. A good correlation was found between the idh expression and patulin production, corroborating that temperature and atmosphere affected patulin production by acting at the transcriptional level of the idh gene. Finally, a reliable RT-qPCR can be considered as an alternative tool to investigate the effect of control strategies on the toxin formation in food.

[Human epiphyseal concrements in schizophrenia]. / Konkrementy épifiza cheloveka pri shizofrenii.

The epiphysis is a gland containing firm extracellular bodies (brain sand) the number of which increases with age. Microscopy and roentgen microtomography showed that in some cases of schizophrenia the amount of brain sand decreases. In parallel, cytoplasm of pinealocytes appears to contain concrements of a new type--irregular hollow spheres of 0.1-1.5 microm in size. They may contain fluoride. Typical hydroxyapatite retaining organic stroma may dissolve starting from the center both in health and schizophrenia.

A prospective, randomized, comparative US trial of a combination hepatitis A and B vaccine (Twinrix) with corresponding monovalent vaccines (Havrix and Engerix-B) in adults.

In an open, randomized, multicenter, controlled clinical trial in the US, 773 adults were administered either a combination hepatitis vaccine (Twinrix: 720 EL.U inactivated hepatitis A antigen and 20 mcg recombinant hepatitis B surface antigen per milliliter) on a 0, 1, 6 month schedule or corresponding monovalent vaccines concurrently (Havrix, 1440 EL.U/ml of hepatitis A antigen at 0, 6 months and Engerix-B, 20 mcg of hepatitis B surface antigen at 0, 1, 6 months). Non-inferiority testing for the primary endpoint, severe soreness, and equivalence testing for the secondary endpoints, anti-HAV seroconversion and anti-HBs seroprotection, showed that safety and immunogenicity were comparable in the two groups.

A prophylactic hepatitis B vaccine with a novel adjuvant system.

Studies with recombinant hepatitis B vaccines show seroprotection rates varying between 91 and 100%. Thus, a limited risk may remain for non-responding populations (e.g. non-responders, haemodialysis patients, elderly) who could benefit from a more immunogenic hepatitis B vaccine. One strategy to enhance the immune response is the use of novel adjuvants. SmithKline Beecham has developed a new adjuvant system containing alum and 3-deacylated monophosphoryl lipid A: SBAS4 (SmithKline Beecham Adjuvant System 4). Pilot studies showed that SBAS4 improved in vivo humoral and in vitro cellular immune responses compared to the response to classical recombinant hepatitis B vaccines and was safe and well-tolerated. Several studies assessed the profile of the HBsAg/SBAS4 vaccine in a healthy population, non-responders or elderly. In general the HBsAg/SBAS4 vaccine was well tolerated. Compared to an established recombinant hepatitis B vaccine, we observed an increased local reactogenicity but few symptoms were reported as severe. The HBsAg/SBAS4 vaccine elicits a strong immune response: subjects are protected faster and the GMTs are usually much higher. HBsAg/SBAS4 thus has the potential to protect those subjects who fail to be protected by well established hepatitis B vaccines.

A comparison of two commercial recombinant vaccines for hepatitis B in adolescents.

The immunogenicity and reactogenicity profiles of three doses each of Engerix-B(R) (10 microg hepatitis B surface antigen) and Recombivax(R) (5 microg hepatitis B surface antigen), given on a 0, 1, 6 month schedule to healthy adolescents were compared in a single-blind, randomized clinical trial. One month following the third dose, seroprotection rates after Engerix-B and Recombivax were similar (99 and 98%, respectively). The geometric mean titre (GMT) was statistically significantly higher following vaccination with Engerix-B (3961 vs. 1001 mIU/ml; P=0.0001, Fisher's exact test). Most of the symptoms reported were mild or moderate in intensity and transient. There were no vaccine-related serious adverse events.

Reactogenicity and immunogenicity of a Lyme disease vaccine in children 2-5 years old.

Two doses of a recombinant Lyme disease vaccine (15 and 30 microg) were administered to children 2-5 years old (0-1-month schedule) and were well tolerated. Both doses were highly immunogenic with geometric mean titers 1 month after vaccination of 4366 and 9877 ELISA units (EU)/mL, respectively. Nearly all subjects had antibody levels of > or = 1400 EU/mL, suggesting protective tick titre for one tick season.

Does the concurrent administration of an inactivated hepatitis A vaccine influence the immune response to other travelers vaccines?

BACKGROUND: Travelers seeking protection from hepatitis A also often need protection against other infections, prevalent at their destinations. METHODS: A total of 396 volunteers received not only a hepatitis A vaccine but also either a vaccine against polio, hepatitis B, diphtheria, tetanus, yellow fever, Japanese encephalitis, typhoid fever or rabies according to their individual needs. We investigated the potential influence of the hepatitis A vaccination on the immune response to the other travelers vaccines that were administered concurrently. RESULTS: With seroprotection rates of 100% for yellow fever, Japanese encephalitis and rabies immunization and tetanus boosters our data demonstrate that the concurrent administration of hepatitis A vaccine does not compromise the immune response of these vaccines. Also for oral typhoid, hepatitis B and diphtheria vaccination we did not detect a negative influence of concurrent hepatitis A vaccine administration as compared with respective vaccinations when given alone. Prior to vaccination, more than one third of our subjects lacked protective antibody levels against diphtheria and only 44% of initially seronegative travelers seroconverted to an anti-diphtheria titer > or = 0.01 mIU/mL, supporting a need for an additional dose. Furthermore, only two thirds of the vaccinees tested prior to vaccination were protected against polio type 3, and the seroconversion rate following the administration of oral polio vaccine, was lower for viral type 3 (80%), as has been previously demonstrated in settings without concurrent other vaccinations. CONCLUSION: No negative effect of concurrent travelers vaccinations on the immune response of a hepatitis A vaccine has been detected in a previous report, and, likewise our data suggest no impairment of the antibody response of these travelers vaccines by the concurrent administration of the hepatitis A vaccine.

Immunogenicity of a recombinant Borrelia burgdorferi outer surface protein A vaccine against Lyme disease in children.

BACKGROUND AND OBJECTIVE: A recombinant lipoprotein vaccine against Lyme disease, containing 30 microg of Borrelia burgdorferi outer surface protein A (OspA) with aluminum adjuvant, has been shown in a large US field trial of subjects >/=15 years of age to offer 76% efficacy against clinical Lyme disease after 3 injections given at 0, 1, and 12 months. Lyme disease is also an important problem in children; thus, OspA vaccine trials in children are needed. The purpose of this study was to investigate the safety and immunogenicity of 2 different doses of lipoprotein OspA with aluminum adjuvant vaccine in healthy children 5 to 15 years of age in a double-blind, randomized study. STUDY DESIGN: In a double-blind study, 250 children from the Czech Republic were randomly assigned to receive 15 microg or 30 microg of OspA vaccine at 0, 1, and 2 months. Serum samples, obtained before vaccination and 1 month after the second and third doses, were analyzed for antiOspA antibody. Solicited and unsolicited symptoms were collected from diary cards. RESULTS: Local pain at the injection site was reported by approximately 76% of the 250 children. Headaches (after 5% to 18% of the injections) and malaise (after 2% to 16% of the injections) were the most frequently reported general symptoms. Local and generalized symptoms were not different between the 15 microg and 30 microg groups, and all symptoms resolved within 4 days. Both doses were highly immunogenic, with the 30 microg dose eliciting higher antibody levels. Seroconversion occurred in 99% of the 250 children. CONCLUSIONS: The OspA vaccine against Lyme disease was well tolerated and highly immunogenic in children.

Hepatite A: uma doença possível de prevenção com vacina / Hepatitis A can be prevented with a vaccine

A doença causada pelo virus da hepatite A (VHA) costuma ser considerada como benigna, afetando principalmente os pré-escolares. Contudo, nesta revisäo se discutem os vários grupos da populaçäo em geral, nos quais a infecçäo pelo VHA pode apresentar consequências mais graves. Em consequência da alteraçäo epidemiológica verificada na América Latina, um número cada vez maior de adolescentes e adultos jovens se mantêm suscetíveis à infecçäo pelo VHA. A infecçäo por esse vírus, neste grupo etário, irá representar grave impacto no futuro, ausência prolongada ao trabalho e/ou escola e custos maiores para os sistemas locais de saúde. Em estudos recentes na Argentina e Chile, o VHA foi, também, o agente etiológico mais prevalente nos casos de insuficiência hepática fulminante em pré-escolares. A hepatite A aguda em pacientes com doença hepática crônica subjacente, especialmente hepatite C crônica, tem sido associada à insuficiência hepática grave ou fulminante. A prevençäo da hepatite A através da vacinaçäo parece ser o meio mais potente de se conter o VHA. As vacinas inativadas contra a hepatite A comprovaram ser seguras, altamente imunogênicas e indutoras de proteçäo duradoura contra infecçöes pelo VHA

Deterioration of sperm quality in young healthy Belgian men.

We have retrospectively analysed the sperm characteristics of 416 consecutive healthy young men who presented themselves in the past 19 years as candidate sperm donors. Ejaculate volume increased slightly (P = 0.067), and average sperm concentration decreased (P = 0.035) by 12.4 x 10(6)/ml over the observation period, so that sperm count per ejaculate remained unchanged (P = 0.91). In contrast, sperm morphology (r = - 0.23, P < 0.0001), rapid progressive motility (r = - 0.42, P < 0.0001) and total motility (r = - 0.33, P < 0.0001) presented an important and time-related decrease. When a quadratic model was used rather than a linear one to analyse the data on rapid progressive motility, there appeared to have been no further decline since 1990. The average proportion of spermatozoa with normal morphology decreased from 39.2% in the period 1977-1980 to 26.6% in 1990-1995 (P < 0.0001), and the mean percentage of spermatozoa with rapid progressive motility decreased from 52.7 to 31.7% (P < 0.0001). The percentage of candidate donors with sperm characteristics below the 5th percentile cut-off value of a normal fertile population increased from 13 to 54% during the observation period (P < 0.0001). Since the technique of semen analysis has remained essentially unchanged in-so-far as has been practically possible, as has the method of recruitment of candidate sperm donors, the observed deterioration of sperm characteristics is considered to reflect degeneration of sperm production among men aged between 20 and 40 years.

Statement on the general reduction in sperm quality.

Over a period of 17 years, 360 young healthy men presented themselves as candidate donors for the sperm bank of the University Hospital of Ghent. Semen characteristics of these men were assessed using unaltered methods, and analysis was performed on the first sample delivered before any donor selection was performed. Sperm motility and morphology, but not the total sperm count per ejaculate, exhibited a highly significant decrease. Over 40% of candidate donors since 1990 exhibited subnormal sperm characteristics, as against only 5% of the group investigated before 1980.

Methodological aspects of sperm morphology evaluation: comparison between strict and liberal criteria.

OBJECTIVE: To compare the methodological accuracy of different sperm morphology criteria. SETTING: A multicenter study including 10 laboratories with high expertise in semen analysis. PATIENTS: Semen preparations of subfertile men with a variable degree of teratozoospermia and of fertile semen donors. INTERVENTIONS: Detailed assessment of sperm morphology on 10 air-dried semen smears, of which 3 originated from the same ejaculate. RESULTS: The average coefficient of variation calculated on the three smears of the same ejaculate was higher when strict criteria for morphological normality were used and borderline cells were classified as abnormal than when criteria of abnormality were applied and borderline cells were considered normal. The correspondence between individual centers mutually and of each center with the average result of all centers was better when the latter approach was taken. The performance of two computer-assisted systems was intermediate between that of the two approaches, whereas one system gave unreliable results. CONCLUSIONS: Strict criteria for normality of sperm morphology, with borderline cells considered abnormal, gives results that are less reproducible and less accurate than the approach that classifies sperm as abnormal, with borderline cells considered normal.

Structure of rat genes encoding androgen-regulated cystatin-related proteins (CRPs): a new member of the cystatin superfamily.

Cystatin-related proteins (CRPs) are abundant androgen-regulated secretory glycoproteins that are specifically synthesized in the ventral prostate and lachrymal gland of the rat. Two complete 6-kb genes, Crp1 and Crp2, have been cloned and characterized. They are differentially expressed and encode slightly different proteins. The genes each contain four exons which are interrupted by large introns. An alignment of their sequences demonstrates an overall homology of 90%. The 3' end of a third gene, Crp3, from which only a 1.5-kb fragment was isolated, displays a sequence identity of 84%. These data indicate the existence of a Crp multigene family. The 5' flanking regions of Crp1 and Crp2 are highly homologous and contain a GATAAA sequence 29 nt upstream from the transcription start point. This TATA-box-like element is also found in the promoters of the genes encoding cystatin type-2 proteins. No other recognizable transcription control elements can be detected. Potential binding sites (ARE) for the androgen receptor are scattered throughout the entire genes. The exon/intron organization of the genes encoding CRPs, the size of the exons and their encoding amino acid sequences exhibiting a characteristic spacing of the Cys residues are structural elements displaying a remarkable similarity with the corresponding elements in the genes encoding cystatin type-2 proteins. CRPs must therefore belong to the cystatin superfamily. However, due to their additional domain encoded in an extra exon 2, CRPs must be classified as a new family, type 5.

The 4.4-kilodalton proline-rich polypeptides of the rat ventral prostate are the proteolytic products of a 637-kilodalton protein displaying highly repetitive sequences and encoded in a single exon.

We have determined the complete sequence of the 637-kilodalton precursor for the proline-rich polypeptides (PRPs). This protein is encoded in one large exon of a single copy gene. The acidic precursor of 5761 residues comprises a signal peptide and three large domains displaying a high proline content (11-15%). The sequence of domain A (928 residues) is unique and contains several small clusters of acidic amino acids. Domain B (830 residues) exhibits seven tandem repeats, four of them displaying a strongly diverged sequence. In domain C (3914 residues) 39 units, of which only 8 are degenerate, occur in a tandem repeat. Their sequence of 100 amino acids shows a high structural similarity (76-92%) and contains all the PRP variants which are produced by specific proteolytic processing. The COOH-terminal part (35 residues) is basic. Two variant PRP-precursor alleles occur which slightly differ in the number of repeats in domain C. The high degree of sequence conservation within the repeat regions suggests that the gene presumably evolved by multiple amplification and dispersion of two internal segments. In the 5097-base pair genomic region 5' upstream from the translation start, several control elements for transcription are recognized. A potential binding site for the Sp1 factor (GGGCGG) separated by 47 nucleotides from an initiator motif, most probably elements of the promoter, is detected in the vicinity of the ATG codon. Several putative androgen response elements (TGTYCT) are found in the 5' adjacent region and far upstream two Alu type III repeats and two (CA)n repeats are located. These results provide the basis for a detailed study of the androgen-regulated and tissue-specific expression of the PRP-precursor gene.

Molecular cloning and characterization of multiple isoforms of the snowdrop (Galanthus nivalis L.) lectin.

Screening of a copy-DNA (cDNA) library constructed from RNA isolated from young developing ovaries of snowdrop (Galanthus nivalis) resulted in the isolation of five lectin clones which clearly differed from each other with regard to their nucleotide sequence and deduced amino-acid sequence. Sequence comparison between the coding regions of different lectin cDNAs revealed the highest homology between lectin clones LECGNA 3 and LECGNA 5, showing 96.4% and 93.6% similarity at the nucleotide level and at the deduced amino-acid level, respectively, whereas lectin clones LECGNA 1 and LECGNA 3 showed the lowest homology of 81.6% and 68.6% for the nucleotide sequence and the amino-acid sequence, respectively. Only very few lectin cDNA clones containing a polyadenylated tail could be isolated. Moreover all these cDNA clones were derived from isolectin 3 and showed some variability within the length of the 3' untranslated region. The major transcription initiation site was located 30 bases upstream from the AUG codon as could be deduced from primer-extension analysis. Taking into account the small 5' untranslated region of the lectin clones, the size of the lectin mRNA, which is approx. 780 nucleotides as determined by Northern blot analysis, is in good agreement with the length of the cDNA clones isolated. Besides the ovary tissue, both the leaf and the flower tissue were also shown to express the lectin mRNA in a flowering snowdrop plant.

Tissue-specific expression and androgen regulation of different genes encoding rat prostatic 22-kilodalton glycoproteins homologous to human and rat cystatin.

22-Kilodalton (kDa) protein cDNA clones were isolated from a rat prostatic library. Nucleotide sequence analysis revealed three different cDNA sequences encoding two somewhat different open reading frames of 176 amino acids. The N-terminal 24 amino acids of these sequences show the typical characteristics of signal peptides of secretory proteins. The C-terminal end of the derived protein sequences displays sequence similarity to a number of cysteine proteinase inhibitors, called cystatins, suggesting a common physiological function. Upon Northern blotting with a labeled cDNA fragment, three different 22-kDa protein mRNAs, i.e. 950 nucleotides (nt), 920 nt and 860 nt, could be detected in the rat ventral prostate and the lacrymal gland. In both tissues these messengers were regulated by androgens showing the most rapid androgen response for the 950 nt mRNA form. Administration of cycloheximide nearly completely abolished the observed androgen effect suggesting that a short-living protein is required for the full induction of the 22-kDa protein genes. Hybridization experiments with specific oligonucleotides which distinguish between the mRNAs encoding both 22-kDa protein variants indicate that one protein form is less androgen dependent in the ventral prostate and not expressed in the lacrymal gland.

Localization of the PRR1 gene coding for rat prostatic proline-rich polypeptides to chromosome 10 by in situ hybridization.

The gene coding for rat ventral prostatic proline-rich polypeptides (PRR1) was mapped to chromosome region 10q26----q31 by in situ hybridization. The high percentage (40%) of specific hybridization signal obtained is probably the result of the highly repetitive structure of the PRR1 gene.

A single 12.5-kilobase androgen-regulated mRNA encoding multiple proline-rich polypeptides in the ventral prostate of the rat.

Synthetic 32P-labeled oligonucleotides have been used to identify the prostatic proline-rich polypeptide (PRP) mRNA which has partially been characterized. The 14-mer d(G-G-T-T-C-T-G-C-A-T-A-A-T-G) complementary to the coding sequence for His-Tyr-Ala-Glu-Pro, a sequence element occurring in all 38-residue PRP variants, hybridizes specifically with a 12.5-kilobase mRNA which is clearly androgen-controlled. This oligonucleotide was used as an efficient primer for the construction of a PRP-specific lambda gt10 cDNA library. The nucleotide sequence of the inserts from several recombinant clones has been determined. This structural analysis revealed a PRP mRNA encoding a large precursor containing a number of tandemly repeated units. Each repeat codes for a sequence of 100 amino acids in which the highly conserved PRP sequence is embedded. From this polyprotein the large number of PRP variants must be generated by a post-translational processing mechanism which is still unknown. The high degree of conservation of both nucleotide and amino acid sequence in the entire unit also indicates that the PRP gene(s) likely evolved by multiplication of a 300-base pair ancestral DNA sequence. This has resulted in a noninterrupted repetitive DNA coding segment which is detected at the genomic level.