Unacceptably high: an audit of Kimberley self-harm data 2014-2018.

OBJECTIVE: To explore the rates and characteristics of self-harm across the Kimberley region of Western Australia. METHOD: Retrospective, cross-sectional audit. We obtained and descriptively analysed routinely collected self-harm data from the Kimberley District of the Western Australia Police Force (2014-2018) and the Emergency Department Data Collection (June 2017-December 2018). Variables included age, sex, Indigenous status, time of incident, and alcohol and drug use. RESULTS: The rate of emergency department attendance for self-harm was three times higher in the Kimberley than the rest of Western Australia. Both emergency department and police data showed a disproportionately high percentage of incidents involving Aboriginal people, with highest rates in the 15-19 and 20-24 year age groups. Almost 80% of self-harm events recorded by police involving individuals aged 25-50 years involved alcohol. Many self-harm incidents occurred in the evening and at night. CONCLUSIONS: The rates of self-harm across the Kimberley region from 2014-2018 are unacceptably high. Increased funding and alignment of services to meet regional need are required as part of a holistic effort to reduce regional rates of self-harm.

Improving detection and management of familial hypercholesterolaemia in Australian general practice.

OBJECTIVE: Familial hypercholesterolaemia (FH) is characterised by elevated low-density lipoprotein (LDL)-cholesterol and increased risk of cardiovascular disease. However, FH remains substantially underdiagnosed and undertreated. We employed a two-stage pragmatic approach to identify and manage patients with FH in primary healthcare. METHODS: Medical records for 232 139 patients who attended 15 general practices at least once in the previous 2 years across five Australian States were first screened for potential risk of FH using an electronic tool (TARB-Ex) and confirmed by general practitioner (GP) clinical assessment based on phenotypic Dutch Lipid Clinic Network Criteria (DLCNC) score. Follow-up GP consultation and management was provided for patients with phenotypic FH. RESULTS: A total of 1843 patients were identified by TARB-Ex as at potential risk of FH (DLCNC score ≥5). After GP medical record review, 900 of these patients (49%) were confirmed with DLCNC score ≥5 and classified as high-risk of FH. From 556 patients subsequently clinically assessed by GPs, 147 (26%) were diagnosed with phenotypic FH (DLCNC score >6). Follow-up GP consultation and management for 77 patients resulted in a significant reduction in LDL-cholesterol (-16%, p<0.01). A higher proportion of these patients attained the treatment target of 50% reduction in LDL-cholesterol (74% vs 62%, p<0.001) and absolute levels of LDL-cholesterol goals compared with baseline (26% vs 12%, p<0.05). CONCLUSIONS: A pragmatic approach integrating electronic medical record tools and clinical GP follow-up consultation is a feasible method to identify and better manage patients with FH in the primary healthcare setting. TRIAL REGISTRATION NUMBER: 12616000630415.

Immunomodulatory effects of feeding with Bifidobacterium longum on allergen-induced lung inflammation in the mouse.

BACKGROUND: The intestinal microbiota has important effects on host immune responses and feeding with certain commensal organisms has anti-inflammatory effects in a variety of diseases, including experimental asthma. The aim of the current study was to examine how robust the effects of feeding with the commensal strain, Bifidobacterium longum (Bif) were on the pulmonary responses to allergen sensitization and challenge. METHODS: BALB/c mice were given two intraperitoneal injections of ovalbumin (10 µg in alum) on days 0 and 7 and were fed daily with Bif or vehicle from days 0-14. Challenges with ovalbumin (10 µg) were administered intra-nasally once on day 14 or three times on days 14, 15 and 16 and the lung inflammatory response was assessed one day later. RESULTS: Bif feeding attenuated airway inflammation following a single ovalbumin challenge, reducing bronchoalveolar lavage (BAL) eosinophilia, BAL fluid IL-4 protein and BAL cell IL-4 and IFN-γ mRNA levels. However, BAL fluid IL-5 protein was increased. There was an accompanying increase in lung regulatory T cells assessed by flow cytometry. Responses to triple challenge with ovalbumin were much less affected by Bif feeding, including unchanged cytokine levels, ovalbumin-specific IgE and airway hyperresponsiveness to methacholine. CONCLUSION: These results show modest immunoregulatory effects of oral feeding with Bif with inhibition of certain components of allergen-induced airway inflammation that is associated with the expansion of regulatory T cells in the lungs but that is overcome by repeated allergen exposure.

Stability of interleukin 8 and neutrophil elastase in bronchoalveolar lavage fluid following long-term storage.

BACKGROUND: Interleukin-8 (IL-8) and neutrophil elastase (NE) are commonly measured markers of inflammation in bronchoalveolar lavage (BAL) fluid from patients with cystic fibrosis. Longitudinal analysis assumes uniform stability during storage, however the effect of extended low-temperature storage on these markers remains unclear. METHODS: BAL fluid from 104 children with cystic fibrosis was assayed for IL-8 and NE after storage at 4 ° C for 7 days and -80 ° C for up to 6 years and compared with the initial assays performed soon after collection. RESULTS: IL-8 levels were stable after any measured length of time at -80 ° C or 4 ° C. NE levels were stable for 6 months at -80 ° C but decreased beyond that or after 7 days at 4 ° C. CONCLUSIONS: Our data support the stability of IL-8 in BAL stored at -80 ° C for prolonged periods. NE in BAL decreases with storage and should be assayed as soon as practical after collection.

Interpretation of urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine is adversely affected by methodological inaccuracies when using a commercial ELISA.

The DNA lesion 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), a urinary marker of oxidative stress, is produced from reactions of reactive oxygen species with host DNA 2'-deoxyribonucleotides. The current gold-standard assessment is by complex chromatographic methods using HPLC or LC-MS/MS. Several studies have reported that commercial 8-oxodG ELISA kits correlate sufficiently with chromatographic techniques to be an easier alternative for laboratories without access to gold-standard techniques. However, the assumption that significant correlation translates into a similar ability to differentiate disease categories or treatment groups is yet to be tested. Using LC-MS/MS and two variants of a commercial ELISA, we measured urinary 8-oxodG and creatinine concentrations in young children with cystic fibrosis, a disease associated with oxidative stress, and age-matched controls. We show that, despite significant correlation, both ELISAs overestimate the levels of 8-oxodG, and neither ELISA accurately depicted the difference in group means that was observed by gold-standard LC-MS/MS. The implications of these findings for study outcomes add further support for chromatographic techniques, despite their cost and complexity, to remain the gold standard in urinary 8-oxodG assessment.

Modulation of pathogen-induced CCL20 secretion from HT-29 human intestinal epithelial cells by commensal bacteria.

BACKGROUND: Human intestinal epithelial cells (IECs) secrete the chemokine CCL20 in response to infection by various enteropathogenic bacteria or exposure to bacterial flagellin. CCL20 recruits immature dendritic cells and lymphocytes to target sites. Here we investigated IEC responses to various pathogenic and commensal bacteria as well as the modulatory effects of commensal bacteria on pathogen-induced CCL20 secretion. HT-29 human IECs were incubated with commensal bacteria (Bifidobacterium infantis or Lactobacillus salivarius), or with Salmonella typhimurium, its flagellin, Clostridium difficile, Mycobacterium paratuberculosis, or Mycobacterium smegmatis for varying times. In some studies, HT-29 cells were pre-treated with a commensal strain for 2 hr prior to infection or flagellin stimulation. CCL20 and interleukin (IL)-8 secretion and nuclear factor (NF)-kappaB activation were measured using enzyme-linked immunosorbent assays. RESULTS: Compared to untreated cells, S. typhimurium, C. difficile, M. paratuberculosis, and flagellin activated NF-kappaB and stimulated significant secretion of CCL20 and IL-8 by HT-29 cells. Conversely, B. infantis, L. salivarius or M. smegmatis did not activate NF-kappaB or augment CCL20 or IL-8 production. Treatment with B. infantis, but not L. salivarius, dose-dependently inhibited the baseline secretion of CCL20. In cells pre-treated with B. infantis, C. difficile-, S. typhimurium-, and flagellin-induced CCL20 were significantly attenuated. B. infantis did not limit M. Paratuberculosis-induced CCL20 secretion. CONCLUSION: This study is the first to demonstrate that a commensal strain can attenuate CCL20 secretion in HT-29 IECs. Collectively, the data indicate that M. paratuberculosis may mediate mucosal damage and that B. infantis can exert immunomodulatory effects on IECs that mediate host responses to flagellin and flagellated enteric pathogens.

Bacterial signalling overrides cytokine signalling and modifies dendritic cell differentiation.

Heterogeneity of dendritic cells (DC) is evident in the gut-associated lymphoid tissue and determined, in part, by incompletely understood local environmental factors. Bacterial signalling is likely to be a dominant influence on precursor cells when recruited to the mucosa. We assessed the influence of commensal bacteria on DC differentiation and function. Murine bone marrow progenitors were exposed to Lactobacillus salivarius, Bifidobacterium breve or Bifidobacterium infantis. Differences in cell surface phenotype and function were assessed. Myeloid differentiation factor 88(-/-) (MyD88) cells were used to determine the influence of Toll-like receptor signalling. While bacterial strains varied in impact, there was a consistent dose-dependent inhibition of DC differentiation with a shift toward a Gr-1(+) CD11b(+) monocyte-like phenotype. A single bacterium on a per cell basis (1 : 1) was sufficient to alter cell phenotype. The effect was only evident in early precursors. Enhanced interleukin-10 production correlated with increased Forkhead box P3 expression and reduced T-cell proliferation. The bacterial effect on DC differentiation was found to be MyD88-dependent. Signalling by enteric commensals through pattern recognition receptors on precursor cells alters DC differentiation and results in cells that are phenotypically monocyte-like and functionally suppressive. This may account for some of the features of mucosal immune tolerance to the microbiota.

Probiotic effects on inflammatory bowel disease.

Components of the commensal flora, including Bifidobacteria and Lactobacilli, have been associated with beneficial effects on the host. These beneficial effects include maintenance of intestinal homeostasis, competitive exclusion of pathogens, production of antimicrobial compounds, promotion of gut barrier function, and immune modulation. Probiotics currently can be administered in dairy yogurts and drinks and also in the form of sachets or capsules. Although preliminary studies are clearly promising, placebo-controlled, randomized, double-blind clinical trials are required to clarify the role of probiotic bacteria in the treatment of inflammatory bowel disease. The choice of probiotic bacteria, the optimal dose, mode of administration, and duration of therapy still need to be established. Detailed strain characterization is also required for all potential probiotic strains. As evidence accumulates to suggest a breakdown in tolerance toward ubiquitous intestinal bacteria, it appears logical to intervene by modulating the enteric flora. Increasingly, research suggests that probiotics may offer an alternative or adjuvant approach to conventional therapy by altering the intestinal microflora and modulating the host immune system.

Comparative and functional analysis of sortase-dependent proteins in the predicted secretome of Lactobacillus salivarius UCC118.

Surface proteins are important factors in the interaction of probiotic and pathogenic bacteria with their environment or host. We performed a comparative bioinformatic analysis of four publicly available Lactobacillus genomes and the genome of Lactobacillus salivarius subsp. salivarius strain UCC118 to identify secreted proteins and those linked to the cell wall. Proteins were identified which were predicted to be anchored by WXL-binding domains, N- or C-terminal anchors, GW repeats, lipoprotein anchors, or LysM-binding domains. We identified 10 sortase-dependent surface proteins in L. salivarius UCC118, including three which are homologous to mucus-binding proteins (LSL_0152, LSL_0311, and LSL_1335), a collagen-binding protein homologue (LSL_2020b), two hypothetical proteins (LSL_1838 and LSL_1902b), an enterococcal surface protein homologue (LSL_1085), a salivary agglutinin-binding homologue (LSL_1832b), an epithelial binding protein homologue (LSL_1319), and a proteinase homologue (LSL_1774b). However, two of the genes are gene fragments and four are pseudogenes, suggesting a lack of selection for their function. Two of the 10 genes were not transcribed in vitro, and 1 gene showed a 10-fold increase in transcript level in stationary phase compared to logarithmic phase. The sortase gene was deleted, and three genes encoding sortase-dependent proteins were disrupted. The sortase mutant and one sortase-dependent protein (mucus-binding homologue) mutant showed a significant reduction in adherence to human epithelial cell lines. The genome-wide investigation of surface proteins can thus help our understanding of their roles in host interaction.