Technical and clinical validation of three commercial real-time PCR kits for the diagnosis of neuroborreliosis in cerebrospinal fluid on three different real-time PCR platforms.

This study reports the evaluation of the technical and clinical validation of the O-DiaBorburg kit (DIA), Borrelia burgdorferi PCR kit, ISEX (GENE), and Borrelia burgdorferi sensu lato Real-TM (SAC) for the diagnosis of neuroborreliosis in cerebrospinal fluid based on both Borrelia DNA and CSF samples from patients with clinical suspicion of neuroborreliosis. This validation study was done by analysing the kits on the Rotorgene Q (RGQ), CFX96, and LightCycler480 (LC480). For all kits, the linear range was larger on RGQ than on CFX96 and LC480. A good reproducibility was obtained for all assays on all instruments. Storage at -20 °C resulted in a decreased reproducibility for SAC. Results of the limit of detection (LOD95) experiments indicated a better sensitivity than described in the kit insert for all kits on all PCR platforms. No cross-reactivity was found for genetically related organisms nor for other pathogens which may be present in CSF. All species of the Borrelia burgdorferi sensu lato complex were detected with the GENE and SAC kits. The DIA kit failed to detect B. lusitaniae. The results seemed to indicate a better overall performance for the GENE kit on RGQ. However, its diagnostic value could not be confirmed in the clinical validation study, wherein none of the 103 CSF samples from clinical neuroborreliosis cases showed a positive real-time PCR result with the GENE kit analysed on RGQ.

Kinetics of butyrate metabolism in the normal colon and in ulcerative colitis: the effects of substrate concentration and carnitine on the ß-oxidation pathway.

BACKGROUND: Butyrate, a colonic metabolite of carbohydrates, is considered as the major energy source for the colonic mucosa. An impaired butyrate metabolism has been reported in ulcerative colitis (UC), however, the cause still remains unknown. AIM: In the present study, we investigated whether higher butyrate concentrations could normalise the oxidation rate in UC. Furthermore, it was investigated whether carnitine could enhance the butyrate oxidation. METHODS: Mucosal biopsies from a total of 26 UC patients and 25 controls were incubated with (14)C-labelled Na-butyrate and the produced (14)CO(2) was measured. First, the rate of oxidative metabolism was compared at three different concentrations of Na-butyrate (0.05 mm, 1 mm and 10 mm). Then, incubations of biopsies were performed with carnitine alone or combined with ATP. RESULTS: Overall, butyrate oxidation in UC was significantly lower than that in controls. The maximum rate of butyrate oxidation was achieved in UC and control subjects from 1 mm onwards. Increasing the butyrate concentration to a level to be present in the colonic lumen, i.e. 10 mm, did not increase the rate of butyrate oxidation in UC to the rate observed in controls. Addition of carnitine alone or combined with ATP caused no effects. CONCLUSIONS: Saturation of butyrate kinetics was achieved from 1 mm in UC and control subjects. The rate of butyrate metabolism was significantly impaired in active ulcerative colitis. The addition of compounds interfering with the ß-oxidation pathway had no effect on the butyrate metabolism in UC.

Analysis of the urinary glucose-[¹5N, ¹5N]-ureide content in the study of the lactose-[¹5N, ¹5N]-ureide metabolism in healthy humans.

BACKGROUND/OBJECTIVES: Lactose-[(15)N, (15)N]-ureide is used to study the fate of the colonic urea-nitrogen metabolism. During the passage through the gastrointestinal tract, lactose ureide is hydrolysed to glucose ureide, which is absorbed to a limited extent from the small intestine and is excreted urinarily. In the present study, a procedure has been developed to quantify the urinary excretion of glucose-[(15)N, (15)N]-ureide. In addition, urine and faecal samples obtained during a dietary intervention study with the prebiotic lactulose were retrospectively analysed. SUBJECTS/METHODS: The glucose ureide and lactose ureide content was measured by GC-MS in 19 healthy volunteers. After consumption of a standard test meal containing 75 mg lactose-[(15)N, (15)N]-ureide, six healthy volunteers performed a fractionated 24 h urine collection to investigate the urinary excretion of glucose-[(15)N, (15)N]-ureide. In 13 volunteers, the effect of lactulose administration on the urinary excretion of glucose-[(15)N, (15)N]-ureide was analysed. RESULTS: The urinary excretion of glucose-[(15)N, (15)N]-ureide reached its maximum level in the 3-6 h urine collection and decreased in the 6-9 h urine. The label was still detectable in the 9-24 h urine collection. The cumulative excretion of (15)N-labelled glucose ureide after 24 h amounted 12.91%. No significant differences in glucose-[(15)N, (15)N]-ureide excretion were found in either of the urine fractions after administration of lactulose, compared with baseline. In none of the urine samples lactose-[(15)N, (15)N]-ureide was detected. CONCLUSIONS: In conclusion, the results obtained in the present study indicated that the percentage dose glucose-[(15)N, (15)N]-ureide recovered in urine is rather constant and not influenced by the presence of lactulose.

Baseline microbiota activity and initial bifidobacteria counts influence responses to prebiotic dosing in healthy subjects.

BACKGROUND: Dietary intervention with prebiotics can cause changes in the colonic microbiota and their metabolic activities. AIM: To investigate whether the response to prebiotic dosing is influenced by the baseline metabolic activity of the colonic flora and bifidobacteria counts. METHODS: The 4-week effect of lactulose (10 g bid.; n = 29) and oligofructose-enriched inulin (10 g bid.; n = 19) was evaluated in healthy human volunteers. Lactose-[(15)N, (15)N]-ureide was used to study the colonic NH(3)-metabolism. Urine (48 h) and faeces (72 h) were collected and analysed for p-cresol and (15)N-content by gas chromatography-mass spectrometry and isotope ratio mass spectrometer, respectively. Faecal bifidobacteria were quantified by real-time polymerase chain reaction. RESULTS: After the 4-week prebiotic administration period, the urinary excretion of p-cresol and (15)N was significantly decreased in both groups (P < 0.05) corresponding to a significantly higher faecal excretion of (15)N (P < 0.05). The decrease in urinary (15)N and p-cresol excretion significantly correlated with baseline (15)N and p-cresol levels (P < 0.05), indicating that subjects with higher baseline levels showed a higher response to prebiotic dosing. Furthermore, a significant correlation was seen between baseline bifidobacteria counts and the effect of prebiotic intake (P < 0.05). CONCLUSION: The response to prebiotic dosing, as indicated by the fate of NH(3), p-cresol and bifidobacteria, is determined by the initial colonic conditions.

Effect of dietary intervention with different pre- and probiotics on intestinal bacterial enzyme activities.

OBJECTIVE: To investigate the influence of different pre- and probiotics on faecal beta-glucuronidase and beta-glucosidase activity, as one of the claimed beneficial effects of pre- and probiotics is the hypothesis that these substrates are able to reduce the production of toxic and carcinogenic metabolites by suppressing specific enzyme activities in the colon. SETTING: Department of Gastrointestinal Research, University Hospital Gasthuisberg, KU Leuven, Belgium. DESIGN AND SUBJECTS: The effect was evaluated in a randomized, crossover study in 53 healthy volunteers who were randomly assigned to one of five treatment groups. INTERVENTIONS: At the start and after a 4-week treatment period, the healthy volunteers collected faeces during 72 h. Lactulose and oligofructose-enriched inulin (OF-IN) were chosen as prebiotics, whereas Lactobacillus casei Shirota, Bifidobacterium breve and Saccharomyces boulardii were selected as probiotics. Two synbiotic combinations were evaluated as well. The enzyme activity was assessed spectrophotometricly. RESULTS: Lactulose and OF-IN significantly decreased beta-glucuronidase activity, whereas a tendency to a decreased beta-glucuronidase activity was observed after L. casei Shirota and B. breve intake. To the contrary, B. breve increased beta-glucosidase levels. Supplementation with the synbiotic did not appear to be more beneficial than either compound alone. No influence of S. boulardii was noted. CONCLUSIONS: Administration of lactulose, OF-IN, L. casei Shirota or B. breve resulted in a decrease of the beta-glucuronidase activity, which is considered beneficial for the host.

Effect of lactulose and Saccharomyces boulardii administration on the colonic urea-nitrogen metabolism and the bifidobacteria concentration in healthy human subjects.

BACKGROUND: Protein fermentation products, especially ammonia, are implicated in the pathogenesis of certain diseases. AIM: To investigate the influence of lactulose and Saccharomyces boulardii cells on the composition of the intestinal microbiota and on the metabolic fate of ammonia by means of lactose-[(15)N, (15)N]-ureide. METHODS: An at random, placebo-controlled, crossover study was performed in 43 healthy volunteers to evaluate the influence of lactulose and/or S. boulardii cells either administered as a single dose or after a 4-week intake period. Urine and faeces were collected. All samples were analysed for (15)N-content by combustion-isotope ratio mass spectrometry. Real-time polymerase chain reaction was applied to determine the composition of the predominant faecal microbiota. RESULTS: A single administration of lactulose significantly decreased urinary (15)N-excretion in a dose-dependent way. After long-term administration of lactulose, a significant reduction of the urinary (15)N-excretion was observed, which was accompanied with a significant increase in the faecal (15)N-output, more specifically more (15)N was found in the bacterial fraction. A significant rise in the Bifidobacterium population was found after lactulose intake. No significant effects were observed after S. boulardii intake. CONCLUSION: Dietary addition of lactulose can exert a bifidogenic effect accompanied by a favourable effect on the colonic NH(3)-metabolism.

In vivo evaluation of a colonic delivery system using isotope techniques.

AIM: To evaluate, using isotope techniques, the in vivo effectiveness of a pH-dependent colonic delivery system. METHODS: In order to dispose of differently labelled substrates for measurement of orocaecal transit time, inulin-14C-carboxylic acid was evaluated as an alternative substrate to inulin and lactose-13C-ureide. Secondly, the time of release of 13C- and 15N-urea from the colonic delivery system was compared with the orocaecal transit time, measured using inulin and inulin-14C-carboxylic acid. This study was repeated after a 2-week lactulose intake period. RESULTS: The orocaecal transit time determined using inulin-14C-carboxylic acid (398 min) was not significantly different from the orocaecal transit time determined using inulin (420 min) or lactose-13C-ureide (396 min). Before lactulose intake, the 13CO2 excretion time was 358 min and the orocaecal transit times determined with the inulin-14C-carboxylic acid and inulin breath test were 376 and 375 min respectively. After lactulose, the 13CO2 excretion time was 383 min and orocaecal transit times were 354 min for inulin-14C-carboxylic acid and 392 min for inulin. A highly significant correlation was found. Good agreement was found between the urinary 15N excretion and the appearance of 13CO2 in breath. CONCLUSION: Isotope techniques provide an excellent non-invasive tool for the in vivo evaluation of a colonic delivery system.

The in vivo use of the stable isotope-labelled biomarkers lactose-[15N]ureide and [2H4]tyrosine to assess the effects of pro- and prebiotics on the intestinal flora of healthy human volunteers.

Amongst the various claimed beneficial effects of pro- and prebiotics for the human host, it has been hypothesised that functional foods are able to suppress the generation and accumulation of toxic fermentation metabolites (NH3, p-cresol). Direct evidence supporting this hypothesis is lacking mainly because of the unavailability of reliable biomarkers. Preliminary data indicate that lactose-[15N]ureide and [2H4]tyrosine may be potential biomarker candidates. The aim of the present study was to evaluate the effect of pro- and prebiotics on the colonic fate of these biomarkers in a randomised, placebo-controlled, cross-over study with nineteen healthy volunteers. At the start of the study and at the end of each 2-week study period, during which they were administered either a probiotic (n 10; 6.5 x 10(9) Lactobacillus casei Shirota cells twice daily) or a prebiotic (n 9; lactulose 10 g twice daily), the volunteers consumed a test meal containing the two biomarkers. Urine was collected during 48 h. Results were expressed as percentage of the administered dose. As compared with the placebo, the decrease in the percentage dose of p-[2H4]cresol in the 24-48 h urine fraction was significantly higher after probiotic intake (P=0.042). Similar changes were observed for the 15N tracer (P=0.016). After prebiotic intake, a significantly higher decrease in the percentage dose of p-[2H4]cresol (P=0.005) and 15N tracer (P=0.029) was found in the 0-24 h urine collection. The present results demonstrate that suppression of the generation and accumulation of potentially toxic fermentation metabolites by pro- and prebiotics can reliably be monitored in vivo by the use of stable isotope-labelled biomarkers.