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Aponte Marti D.,ACED | Avellaneda C.B.,El Bosque University | Flores N.S.,La Gran Colombia University | Acosta A.Y.F.,Pontifical Xavierian University | And 4 more authors.
Revista Colombiana de Gastroenterologia | Year: 2012

Purpose of the work. The practice of endoscopy in Colombia was modified when Resolution 1043 of 2006 authorized specialists in general surgery, internal medicine and pediatrics to perform endoscopy after completing one year of training in endoscopy at an institution of higher education. This, together with the development of relationships with different specialties within endoscopy, generated a disordered scenario which many considered to be unjust and unequal. Training requirements became differentiated. A world of tensions and interests among specialists, scientists, health care providers and service providers led to this consensus. Starting with fundamental agreements, it makes recommendations for unification of educational features that will allow endoscopic practices which aim for quality and whose central axis is the best interest of our patients. Materials and Methods. This consensus is a descriptive, cross-sectional social research study with a mixed approach (qualitative and quantitative) based on the Delphy method. The information in this study was obtained from the event titled "Acuerdo en lo fundamental" (agreement on fundamental issues) organized on June 23, 2012 by the president of the Colombian Association of Digestive Endoscopy (ACED). Qualitative data were taken from four roundtables discussions in which 34 participants discussed 25 survey questions. The quantitative data were taken from final voting and from an individual, private electronic survey. 75% or greater agreement was defined as consensus. Qualitative analysis employed discourse analysis oriented around five variables related to formative aspects. Basic descriptive statistics centered around percentages were used for quantitative analysis. Results. Participants in the consensus included 34 directors or representatives of 8 of the 9 graduate university programs with specialties in the digestive tract, former presidents of 11 scientific associations, professors of gastrointestinal endoscopy, the vice president of the Ibero-American Nurses Association, directors of institutes of endoscopy, teachers at institutes of endoscopy and four chiefs of graduate resident programs. Some issues upon which consensus was reached include: 81.9% agreed that endoscopy is not simply a diagnostic technique; 88.2% disagreed with one year training as recommended for gastrointestinal endoscopy with quality parameters; 100% underlined that training in endoscopy should take place within qualified and accredited university teaching; More than 84.9% did not recommend training general practitioners, nurses or medical technicians in endoscopy; 85.3% recommended 2-year programs for basic training in endoscopy with 1 to 2 years for advanced endoscopy. Conclusions. The Colombian consensus agrees that endoscopy is an element of support for both diagnostic and therapeutic practice. Training for quality endoscopy requires solid theoretical knowledge and skills, solid technical skills and knowledge and training in how to make ethical judgments. The basic requirement for training in gastrointestinal endoscopy should be that the student is enrolled in a clinical, surgical or pediatric gastroenterology subspecialty program. Responsibility for training in endoscopy should be in the hands of university professors and at well supported teaching hospitals and medical centers. The training time for basic endoscopy should be two years while advanced endoscopy requires at least another year and should be targeted towards a specific advanced field. © 2012 Asociaciones Colombianas de Gastroenterología, Endoscopia digestiva, Coloproctología y Hepatología.

Gianfrani C.,National Research Council Italy | Maglio M.,University of Naples Federico II | Aufiero V.R.,National Research Council Italy | Camarca A.,National Research Council Italy | And 8 more authors.
American Journal of Clinical Nutrition | Year: 2012

Background: Research is intense to find wheat of low or null toxicity for patients with celiac disease (CD). Among candidates, there are diploid wheat species. Objective: We compared the immunological properties of 2 lines of diploid monococcum wheat (Triticum monococcum ssp. monococcum), Monlis and ID331, with those of common wheat (Triticum aestivum). Design: Interferon-γ production and the proliferation of intestinal gliadin-specific T cell lines and clones were measured as evidence of T cell activation by peptic and tryptic (PT) digests of gliadins from 2 monococcum lines. Furthermore, organ cultures of jejunal biopsies from 28 CD patients were set up to assess the effects of PT gliadin on innate and adaptive immune response by using immunohistochemistry. Results: Monlis and ID331 induced interferon-γ production and proliferation in celiac mucosal T cells. In organ cultures, Monlis PT digest induced a significant increase of IL-15 epithelial expression and crypt enterocyte proliferation, whereas ID331 had no effect. Both monococcum lines caused intraepithelial T cell infiltration and lamina propria T cell activation. Conclusions: Our data show that the monococcum lines Monlis and ID331 activate the CD T cell response and suggest that these lines are toxic for celiac patients. However, ID331 is likely to be less effective in inducing CD because of its inability to activate the innate immune pathways. © 2012 American Society for Nutrition.

Iacomino G.,CNR Institute of Neuroscience | Marano A.,CNR Institute of Neuroscience | Stillitano I.,CNR Institute of Neuroscience | Aufiero V.R.,CNR Institute of Neuroscience | And 6 more authors.
Molecular and Cellular Biochemistry | Year: 2016

Different approaches have been used to study the pattern of cytokines in celiac disease (CD). Laser capture microdissection (LCM) is a powerful tool for the isolation of specific tissue compartments. We aimed to investigate the mucosal immune response that takes place in different intestinal compartments of CD patients, dissected by LCM, analyzing cytokine expression profile. Frozen section of jejunum was obtained from 15 untreated CD and 15 control. Surface epithelium and lamina propria compartment were isolated by LCM. RNA from each LCM sample was extracted and, after a retrotranscription step, messenger RNA levels for MxA, IL-15, TNF-α, IFN-γ, IL-17α, IL-21, IL-10, and TGF-β were determined by quantitative reverse transcriptase-PCR. Increased gene expression levels of MxA, IL-15, TNF-α, IL-10, and TGF-β was observed in the surface epithelium of untreated CD with respect to control. Furthermore, all the cytokines investigated were upregulated in the lamina propria of untreated CD as compared to control. Within the untreated CD group the expression of IL-15 was higher, in the surface epithelium than in the lamina propria, whereas the expression levels of IL-17 and IL-21 were higher in the lamina propria than in the surface epithelium. Finally, high levels of IL-10 and TGF-β were detected in both compartments of untreated CD biopsies. In CD, surface epithelium and lamina propria compartments, play a prominent role in determining innate and adaptive immunity, respectively. Conversely, surface epithelium and lamina propria produce high levels of anti-inflammatory cytokines, suggesting that both compartments are involved in the immunoregulatory response. © 2015, Springer Science+Business Media New York.

Maglio M.,University of Naples Federico II | Mazzarella G.,National Research Council Italy | Barone M.V.,University of Naples Federico II | Gianfrani C.,National Research Council Italy | And 13 more authors.
Scandinavian Journal of Gastroenterology | Year: 2011

Objective. Most of the recent studies suggest that oats are well tolerated by celiac disease (CD) patients. However, it is still possible that different oat cultivars may display different biological properties relevant for CD pathogenesis. We aimed to investigate biological and immunological properties of two oat varieties, Avena genziana and Avena potenza, in relation to their safety for CD patients. Material and Methods. Phosphorylation of extracellular signal-regulated kinase (ERK) and trans-epithelial electrical resistance (TEER) were evaluated in CaCo-2 cells treated with peptictryptic (PT) digests from the two oats and from gliadin (PTG). With the same PT-digests, duodenal biopsies from 22 CD patients were treated in vitro for 24 h and density of CD25 + cells in lamina propria and of intraepithelial CD3 + T cells was measured, as well as crypt cell proliferation and epithelial expression of interleukin 15. Finally, interferon γ (IFN-γ) production was measured as evidence of gliadin-specific T-cell activation by PT-digests. Results. In contrast to PTG, oats PT-digests were not able to induce significant increase in ERK phosphorylation and decrease in TEER in CaCo-2 cells. In the organ culture system, oats PT-digests, unlike PTG, did not induce significant increase in crypt enterocyte proliferation, increase in interleukin 15 expression or in lamina propria CD25 + cells. Nevertheless Avena potenza increased intraepithelial T-cell density, while Avena genziana-induced IFN-γ production in 3/8 CD intestinal T cell lines. Conclusions. Our data show that Avena genziana and Avena potenza do not display in vitro activities related to CD pathogenesis. Some T-cell reactivity could be below the threshold for clinical relevance. © 2011 Informa Healthcare.

Zanzi D.,University of Naples Federico II | Stefanile R.,CNR Institute of Neuroscience | Santagata S.,University of Naples Federico II | Iaffaldano L.,University of Naples Federico II | And 10 more authors.
American Journal of Gastroenterology | Year: 2011

Objectives: Celiac disease (CD) is a condition in which the regulation of the mucosal immune response to dietary gliadin might be altered. The transcription factor forkhead box P3 (Foxp3) has been identified as a marker of a subset of regulatory T cells (Treg). In this study, we have investigated the presence and the suppressive function of Treg cells in the celiac small intestinal mucosa, their correlation with the disease state, and the inducibility by gliadin in an organ culture system; moreover, we tried to define whether interleukin 15 (IL-15), overexpressed in CD, could influence the regulatory activity of such cells. Methods: The expression of Foxp3, CD3, CD4, and CD8 were analyzed by immunohistochemistry and flow cytometry in duodenal biopsies taken from patients with untreated CD, treated CD, and from non-CD controls, as well as in vitro cultured biopsy samples from treated CD patients, upon challenge with gliadin. Furthermore, we analyzed the suppressive function of CD4CD25 T cells, isolated from untreated CD biopsy samples, on autologous responder CD4CD25 T cells, in the presence of a polyclonal stimulus, with or without IL-15. Results: Higher density of CD4CD25Foxp3 T cells was seen in duodenal biopsy samples from active CD patients in comparison with treated CD and non-CD controls. In coculture, CD4CD25 T cells were functionally suppressive, but their activity was impaired by IL-15. Cells from CD subjects showed increased sensitivity to the IL-15 action, likely due to enhanced expression of IL-15 receptor. Finally, we demonstrated an expansion of Foxp3 in treated CD mucosa following in vitro challenge with gliadin. Conclusions: These data suggest that CD4CD25Foxp3 T cells are induced in situ by gliadin. However, their suppressor capacity might be impaired in vivo by IL-15; this phenomenon contributes to maintain and expand the local inflammatory response in CD. © 2011 by the American College of Gastroenterology.

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