ABSTRACT
OBJECTIVE: Mesenteric fat hyperplasia is a hallmark of Crohn's disease (CD), and C reactive protein (CRP) is correlated with disease activity. The authors investigated whether mesenteric adipocytes may be a source of CRP in CD and whether inflammatory and bacterial triggers may stimulate its production by adipocytes. DESIGN: CRP expression in the mesenteric and subcutaneous fats of patients with CD and the correlation between CRP plasma concentrations and mesenteric messenger RNA (mRNA) levels were assessed. The impact of inflammatory and bacterial challenges on CRP synthesis was tested using an adipocyte cell line. Bacterial translocation to mesenteric fat was studied in experimental models of colitis and ileitis and in patients with CD. RESULTS: CRP expression was increased in the mesenteric fat of patients with CD, with mRNA levels being 80 ± 40 (p<0.05) and 140 ± 65 (p=0.04) times higher than in the mesenteric fat of patients with ulcerative colitis and in the subcutaneous fat of the same CD subjects, respectively, and correlated with plasma levels. Escherichia coli (1230 ± 175-fold, p<0.01), lipopolysaccharide (26 ± 0.5-fold, p<0.01), tumour necrosis factor α (15 ± 0.3-fold, p<0.01) and interleukin-6 (10 ± 0.7-fold, p<0.05) increased CRP mRNA levels in adipocyte 3T3-L1 cells. Bacterial translocation to mesenteric fat occurred in 13% and 27% of healthy and CD subjects, respectively, and was increased in experimental colitis and ileitis. Human mesenteric adipocytes constitutively expressed mRNA for TLR2, TLR4, NOD1 and NOD2. CONCLUSION: Mesenteric fat is an important source of CRP in CD. CRP production by mesenteric adipocytes may be triggered by local inflammation and bacterial translocation to mesenteric fat, providing a mechanism whereby mesenteric fat hyperplasia may contribute to inflammatory response in CD.
Subject(s)
Abdominal Fat/metabolism , Bacterial Translocation , C-Reactive Protein/metabolism , Crohn Disease/metabolism , Escherichia coli/physiology , Mesentery/metabolism , Abdominal Fat/microbiology , Adult , Animals , Cell Line , Colitis, Ulcerative/metabolism , Colitis, Ulcerative/microbiology , Crohn Disease/microbiology , Escherichia coli/metabolism , Female , Humans , Ileitis/metabolism , Ileitis/microbiology , Interleukin-6/metabolism , Lipopolysaccharides/metabolism , Lymph Nodes/microbiology , Male , Mesentery/microbiology , Mice , Prospective Studies , Tumor Necrosis Factor-alpha/metabolismABSTRACT
INTRODUCTION: Reports of pertussis have been increasing since 2008 in North of France. A large part of reported cases involved healthcare workers (HCWs) in nurseries and maternity hospitals. The objective of this study was to determine HCWs' knowledge regarding pertussis and its cross-transmission in the maternity hospitals in North of France. METHODS: This study was conducted in the 38 maternity hospitals set in North of France. Head midwives and nurses, infection control teams and occupational health practitioners were asked through a self-administered questionnaire survey to assess there knowledge regarding pertussis: vaccination, diagnosis, cross-transmission control. RESULTS: 36 on the 38 maternity hospitals' staffs returned the survey. Most of the respondents viewed pertussis as a serious and highly transmissible illness but 30% of them considered it a paediatric illness. Only a minority of the participants knew the last recommendations for pertussis vaccination in HCWs (37%) and in adults (16%). Only a few maternity hospitals staffs have set a formal organization to prevent and control pertussis cross-transmission. CONCLUSION: Awareness about pertussis vaccination and its cross-transmission control needs to be increased among maternity hospital staffs. A close liaison between HCWs, occupational health, infection control teams and biologists is necessary to prepare operational procedures to control pertussis cross transmission.
