News Round-up

 

Effective Multidisciplinary Working – Free online course

The course is an excellent exploration of effective multidisciplinary working – the College worked with the MND Association and a wide range of professionals to develop it. Following a successful year in 2019 we are pleased to advise that it is running again this year.

The course is endorsed by the College so we hope you will make use of it. The content is interesting, and the learning from it practical and easily applied in real life settings.

The course focuses on motor neurone disease but has significant transferable learning. It runs over 6 weeks and during that time participants are encouraged to interact online with fellow students. Each week considers a different aspect of multidisciplinary working and is explored through recommended reading, videos, and case studies. By the end of the course, participants will be able to:

• Identify the recommendations within the NICE MND Guideline NG42 relating to MDT good practice
• Explain the importance of an effective MDT in MND cases
• Describe the MDT, and its operation, in their area
• Understand how to apply good MDT practice in their own work setting
• Reflect on current practice in their own work setting and recommend useful improvements.

The course next runs from 9 March 2020 and will give you at least 18 hours of CPD. We strongly encourage you to enrol. There will be further opportunities in May and September if March does not work for you. Sign up for this challenging and interesting course by following this link: https://tinyurl.com/MNDA-MDW

 

How Diet Affects Mental Health – What's the evidence?

A new expert review confirms that diet significantly influences mental health and wellbeing, but cautions that the evidence for many diets is comparatively weak. This, the most up to date overview of the new field of Nutritional Psychiatry, is produced by the Nutrition Network of the European College of Neuropsychopharmacology (ECNP) and is published in the peer-reviewed journal European Neuropsychopharmacology.

Lead author, Professor Suzanne Dickson (University of Gothenburg, Sweden) said: "We have found that there is increasing evidence of a link between a poor diet and the worsening of mood disorders, including anxiety and depression. However, many common beliefs about the health effects of certain foods are not supported by solid evidence."

The researchers found that there are some areas where this link between diet and mental health is firmly established, such as the ability of a high fat and low carbohydrate diet (a ketogenic diet) to help children with epilepsy, and the effect of vitamin B12 deficiency on fatigue, poor memory, and depression.

They also found that there is good evidence that a Mediterranean diet, rich in vegetables and olive oil, shows mental health benefits, such as giving some protection against depression and anxiety. However, for many foods or supplements, the evidence is inconclusive, as for example with the use of vitamin D supplements, or with foods believed to be associated with ADHD or autism.

"With individual conditions, we often found very mixed evidence," said Professor Dickson. "With ADHD for example, we can see an increase in the quantity of refined sugar in the diet seems to increase ADHD and hyperactivity, whereas eating more fresh fruit and vegetables seems to protect against these conditions. But there are comparatively few studies, and many of them don't last long enough to show long-term effects."

The study confirms that while certain foods can be associated with a mental health condition, this tells us little about why the food causes this effect. It concludes that the need to link mental health effects with provable dietary causes needs to be the main focus of future research in nutritional psychiatry.

"There is a general belief that dietary advice for mental health is based on solid scientific evidence. In reality, it is very difficult to prove that specific diets or specific dietary components contribute to mental health,” said Professor Dickson.

The scientists confirmed that some foods had readily provable links to mental health, for example, that nutrition in the womb and in early life can have significant effects on brain function in later life. Proving the effect of diet on mental health in the general population was more difficult.

Professor Dickson continued: "In healthy adults, dietary effects on mental health are fairly small, and that makes detecting these effects difficult: it may be that dietary supplementation only works if there are deficiencies due to a poor diet. We also need to consider genetics: subtle differences in metabolism may mean that some people respond better to changes in diet that others.

There are also practical difficulties which need to be overcome in testing diets. A food is not a drug, so it needs to be tested differently to a drug. We can give someone a dummy pill to see if there is an improvement due to the placebo effect, but you can't easily give people dummy food. Nutritional psychiatry is a new field. The message of this paper is that the effects of diet on mental health are real, but that we need to be careful about jumping to conclusions on the base of provisional evidence. We need more studies on the long-term effects of everyday diets."

^{Adan RAH, et al. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019; 29(12): 1321-1332. doi:10.1016/j.euroneuro.2019.10.011}

 

Diet has Rapid Effects on Sperm Quality

Sperm are influenced by diet, and the effects arise rapidly. This is the conclusion of a study by researchers at Linköping University, Sweden, in which healthy young men were fed a diet rich in sugar. The study, which has been published in PLOS Biology, gives new insight into the function of sperm, and may in the long term contribute to new diagnostic methods to measure sperm quality.

"We see that diet influences the motility of the sperm, and we can link the changes to specific molecules in them. Our study has revealed rapid effects that are noticeable after one to two weeks," says Anita Öst, Senior Lecturer in the Department of Clinical and Experimental Medicine at Linköping University, and head of the study.

Sperm quality can be harmed by several environmental and lifestyle factors, of which obesity and related diseases, such as type 2 diabetes, are well-known risk factors for poor sperm quality. The research group that carried out the new study is interested in epigenetic phenomena, which involve physical properties or levels of gene expression changing, even when the genetic material, the DNA sequence, is not changed. In certain cases, such epigenetic changes can lead to properties being transferred from a parent to offspring via the sperm or the egg.

In a previous study, the scientists showed that male fruit flies which had consumed excess sugar shortly before mating more often produced offspring who became overweight. Similar studies on mice have suggested that small fragments of RNA known as tsRNA play a role in these epigenetic phenomena that appear in the next generation. These RNA fragments are present in unusually large amounts in the sperm of many species, including humans, fruit flies and mice. So far, their function has not been examined in detail. Scientists have speculated that the RNA fragments in sperm may be involved in epigenetic phenomena, but it is too early to say whether this is the case in humans. The new study was initiated by the researchers to investigate whether a high consumption of sugar affects the RNA fragments in human sperm.

The study examined 15 normal, non-smoking young men, who followed a diet in which they were given all food from the scientists for two weeks. The diet was based on the Nordic Nutrition Recommendations for healthy eating with one exception: during the second week the researchers added sugar, corresponding to around 3.5 litres of fizzy drinks, or 450 gm of confectionery, every day. The sperm quality and other indicators of the participants' health were investigated at the start of the study, after the first week (during which they ate a healthy diet), and after the second week (when the participants had additionally consumed large amounts of sugar).

At the beginning of the study, one third of the participants had low sperm motility. Motility is one of several factors that influence sperm quality, and the fraction of people with low sperm motility in the study corresponded to that in the general population. The researchers were surprised to discover that the sperm motility of all participants became normal during the study.

"The study shows that sperm motility can be changed in a short period, and seems to be closely coupled to diet. This has important clinical implications. But we can't say whether it was the sugar that caused the effect, since it may be a component of the basic healthy diet that has a positive effect on the sperm," says Anita Öst.

The researchers also found that the small RNA fragments, which are linked to sperm motility, also changed. They are now planning to continue the work and investigate whether there is a link between male fertility and the RNA fragments in sperm. They will also determine whether the RNA code can be used for new diagnostic methods to measure sperm quality during in vitro fertilisation.

^{The study has been carried out in collaboration with the Reproductive Medicine Center at Linköping University Hospital, with financial support from the Swedish Research Council, the Knut and Alice Wallenberg Foundation, and the Ragnar Söderberg Foundation. Nätt D, et al (2019). Human Sperm Displays Rapid Responses to Diet. PLOS Biology; doi: 10.1371/journal.pbio.3000559.}

 

 

Five Major Advances in Inflammatory Bowel Disease (IBD) Treatment - Breakthrough Research Presented at the Crohn's & Colitis Congress^®

The Crohn's & Colitis Foundation and the American Gastroenterological Association (AGA) joined forces on the Crohn's & Colitis Congress – an annual meeting where IBD care providers gather to learn about the latest advancements in IBD patient care.

Lymphoma not associated with anti-TNF therapy in paediatric IBD patients

Study title: Low risk of lymphoma in paediatric patients with inflammatory bowel disease treated using anti-tumour necrosis factor agents
Presented by: Matthew D. Egberg, University of North Carolina, Chapel Hill

Significance: Anti-tumour necrosis factor (aTNF) drugs are among the most effective medications used to treat paediatric IBD. Despite their effectiveness, concerns regarding an association with lymphoma limit their use in everyday practice. Based on a large, geographically diverse administrative insurance claims database of 9,284 paediatric IBD patients, treatment with aTNF agents and/or immune modulators was not associated with an increased risk of malignancy. These results support prioritization of the clinical benefits of aTNF agents over the low risk for malignancy.

Noteworthy new drug in pipeline for Crohn's disease

Study title: AZD4205, a selective, GI tract-enriched selective JAK1 inhibitor for Crohn's disease: preclinical evidence and Phase I data
Presented by: Mei Wang, Dizal Pharmaceuticals

Significance: There is no cure for Crohn's disease and currently available drugs do not work for all patients, so advances in treatments are closely watched by physicians and patients. An early Phase I study shows promise for AZD4205 for the treatment of Crohn's disease. AZD4205 is an oral, ATP-competitive, JAK1 selective inhibitor. Nonclinical data showed its higher drug concentration within the GI tract relative to plasma in the rodents, suggesting its potential as an effective and safe treatment option for patients with Crohn's disease. AZD4205 was also evaluated in a Phase I study in healthy volunteers where it was well-tolerated with no drug-related adverse events. A Phase II study in moderate-to-severe Crohn's disease is planned.

This microbiome-targeting diet improves symptoms for IBD patients

Study title: Diet as a microbiome-centered therapy for IBD
Presented by: Ana Maldonado-Contreras, UMASS Medical School

Significance: IBD patients have an imbalance of gut bacteria, which contributes to inflammation. Researchers at UMASS Medical School developed the IBD-Anti-Inflammatory Diet to restore the balance between helpful and harmful bacteria while promoting good nutrition. In their trial, the majority (61.3%) of patients who complied with the diet for at least 8 weeks reported a dramatic decrease in disease severity. IBD-AID^TM also prompted an increase in the abundance of bacteria that produce short-chain fatty acids (SCFAs) thus dampening inflammation and assisting in patient's remission. The diet focuses on increased intake of prebiotic and probiotic foods and other beneficial foods while substituting certain carbohydrates and other adverse foods.

This research was funded in part by the AGA Research Foundation.

Thanks to biologics, less ulcerative colitis patients need their colon removed

Study title: Natural history of colectomy among hospitalized patients with ulcerative colitis in the contemporary era of treatments
Presented by: Fernando Velayos, Kaiser Permanente

Significance: The rate of colectomy (surgical removal of a patient's colon) within the first year after hospital admission for ulcerative colitis has declined in the modern era of biologics. A study conducted at a large health care delivery organization identified that 5.3% of patients underwent colectomy during their first hospitalization for ulcerative colitis and 11.9% underwent colectomy within the first year after hospitalization, compared to historical rates of 20% and 30%, respectively, in the same population pre-biologics. This research provides cause for optimism that the natural history of colectomy in acute severe ulcerative colitis may be different and modifiable in the modern biologic era compared to the past.

Siblings close in age may make the best faecal microbiota donor for ulcerative colitis patients

Study title: Donor selection of faecal microbiota transplantation is important to long-term maintenance of ulcerative colitis
Presented by: Koki Okahara, Juntendo University Hospital

Significance: Faecal microbiota transplantation (FMT) is still an emerging treatment for ulcerative colitis. This study is the first to reveal importance of FMT donor selection for long-term maintenance for ulcerative colitis. Ulcerative colitis patients treated with fresh FMT from a spouse or relative following triple-antibiotic therapy (amoxicillin, fosfomycin and metronidazole) had a significantly higher response compared to patients who just received antibiotic therapy. Siblings relationship has a significantly higher maintenance rate at 12 months compared to parent-child relationship. Furthermore, response was significantly higher in cases where the age difference between donor and patient was less than 10 years.

All abstracts accepted to the Crohn's & Colitis Congress were published in Inflammatory Bowel Diseases^® (the official journal of the Crohn's & Colitis Foundation) and Gastroenterology (the official journal of the American Gastroenterological Association) on Jan. 23, 2020.

^{About the Crohn's & Colitis Congress®: The Crohn's & Colitis Congress®, took place Jan. 23-25, 2020, in Austin, Texas, combining the strengths of the USA's leading IBD patient organisation, Crohn's & Colitis Foundation, and the premier GI professional association, American Gastroenterological Association (AGA). Together they are committed to convening the greatest minds in IBD to transform patient care. The Crohn's & Colitis Congress is the must-attend meeting for all IBD professionals. Learn more at crohnscolitiscongress.org.
For further information on the Crohn's & Colitis Foundation: www.crohnscolitisfoundation.org
For further information on the AGA Institute: www.gastro.org}

 

Common Foods Can Help 'Landscape' the Jungle of Our Gut Microbiome

Researchers at San Diego State University have found a new way to harness food as medicine, which has far reaching implications to control harmful microbes in our gut while balancing microbial diversity by fostering the growth of beneficial bacteria.

Foods we eat commonly affect our gut microbiota. New research shows they do so by triggering the production of bacteriophage - viruses that infect and replicate inside bacteria. Compounds in these foods have an antimicrobial effect which causes the phage to replicate.

The researchers began by identifying which foods were antimicrobial, then analyzed them before narrowing it down to a shortlist. When examining growth curves of bacteria, they observed that while bacteria multiply over time, eventually their numbers plateau. However, if phages are activated, then bacterial growth stops altogether and their numbers drop dramatically until they're depleted.

Foods they tested that had antimicrobial effects include honey, licorice, stevia (a sugar substitute derived from the stevia plant), aspartame, hot sauce, herbs such as oregano, spices such as cinnamon and clove, rhubarbs, uva ursi (bear berry), and neem extract. They also tested toothpaste, since it's known to contain antimicrobial compounds. Of these, honey, stevia, aspartame, neem and uva ursi had the most impact in triggering phage production.

"The microbiome is composed of hundreds of different bacteria and the phages they host," said Lance Boling, an SDSU molecular biologist and research associate. "We could actually tackle certain conditions by adjusting the foods we consume, that will affect microbial diversity which in turn will influence health and diseases."

"We also found some foods acted as phage inhibitors and could be used to control pathogenic viruses," Boling added.

Our gut microbiome can affect cognitive ability, metabolism, weight gain or loss, our moods, and even cause depression. It can also cause inflammation that could lead to cancer, diabetes, Crohn's disease and irritable bowel syndrome. With careful analysis and planning, food could be used as medicine to correct imbalances.

"This shows we could sculpt the human gut microbiome with common dietary compounds," said Forest Rohwer, an SDSU microbial ecologist and pioneer of viromics research. "The ability to kill specific bacteria, without affecting others, makes these compounds very interesting."

Boling works on microbiome research in Rohwer's lab. Their findings will be published Jan. 13 in Gut Microbes.

Identifying phage triggers

When phage replicate they kill the host cell and exit into the environment, which can lead to a cascade effect where they infect bacterial cells around them. Each bacterial cell that bursts - when the phage grows inside them - can have hundreds of new phages that emerge. When they release in the microbiome, if there are more bacteria present, they will continue to infect the bacteria.

"There aren't many known chemical triggers, and we wanted to find these 'prophage' inducers – or what causes the phage DNA to detach and replicate," Boling said.

Once the researchers chose foods with known and perceived antimicrobial effects, they then selected bacteria representative of the two major gut phyla, Bacteroidetes and Firmicutes, including strains of pathogenic as well as beneficial bacteria. They narrowed the food compounds down to 28 from 117 candidates on which they conducted the prophage induction assay. Bacterial growth was observed with and without food compounds, for comparison. The samples were processed using flow cytometry, a sensitive method for detecting particles as tiny as viruses.

Future applications

While other studies have focused on increasing the abundance of therapeutic phages, this research goes further to explore the reductive effect of 117 commonly consumed foods, chemical additives, and plant extracts on the growth and phage production capacity of common gut bacteria.

This reductive approach is "akin to pulling weeds from a garden so that more desirable plants have room to grow," Boling explained, hence the term 'landscaping' the gut.

Conversely, over-consumption of broad-spectrum antimicrobial foods could contribute to the same metabolic states correlated with low gut diversity that may be produced by the administration of antibiotic medicines. Proper understanding and utilization of these food compounds could aid in the treatment or prevention of conditions associated with gut imbalances, and promote overall health.

"We are excited about finding more prophage inducers and determining the molecular mechanisms by which they work," Rohwer said. "There are probably thousands of compounds that would be useful for eliminating unwanted bacteria."

The researchers recommend that foods found to be prophage inducers should be studied further to elucidate their molecular mechanisms. While the importance of phages and the fact that they are the most prolific biological entity in the biosphere is well-established, little is understood about the triggers that cause bacteria to produce phage and release them into the environment. Elucidating these mechanisms will further our understanding of how bacteria and phage shape the ecosystems that they populate.

^{This research was funded by the National Institutes of Health.}

 

 

 

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