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ENT-AL Newsletter: 11 - Health Updates and Insights


Exploring the Interplay Between Gut Microbiota, Brain Axis, and Innate
Immunity in the Context of Inflammatory and Infectious Diseases1:

The microbiota-gut-brain axis is a pivotal player in regulating inflammatory and infective diseases. This review delves into the structure of the microbiota-gut-brain axis, communication modes, and profound implications of this axis for understanding diseases. Focusing on Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, autism spectrum disorder, depression, psoriasis, irritable bowel syndrome, and inflammatory bowel diseases, the authors explored the role of this microbiota-gut-brain axis in diverse conditions. Additionally, the authors investigated the regulatory functions of innate immune signaling pathways, including the inflammasome, type I interferons (IFN-I), nuclear factor kappa B (NF-kB), and PARK7/DJ-1, in the context of inflammatory and infective diseases. To conclude, understanding as well as treating inflammatory diseases through the microbiota-gut-brain axis, particularly the gut microbiota, requires careful consideration due to individual variations, methodological challenges, and diverse mechanisms.

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The Influence of the Microbiome on the Pathophysiology of Necrotizing Enterocolitis in Preterm Neonates2:

Despite advancements in neonatal care increasing the survival of extremely preterm neonates with necrotizing enterocolitis, the disease remains a severe and life-threatening challenge. Current therapeutic approaches are mainly symptomatic, and the mortality rate remains high, particularly in neonates requiring surgery. To address this, emphasis should be placed on preventive strategies and modifiable risk factors. The pathophysiology of necrotizing enterocolitis is intricate, involving the immaturity of immune and barrier protective mechanisms in the premature gut and an exaggerated proinflammatory response to triggers like gut hypoxia, enteral nutrition, or microbial dysbiosis. While research has long explored the role of the intestinal microbiome in necrotizing enterocolitis, no specific pathogen or dysbiosis type has been conclusively linked to its development. This review evaluates the current understanding of the role of intestinal microbiota in necrotizing enterocolitis pathophysiology and explores potential avenues for positive intervention. The article concludes that addressing the impact of necrotizing enterocolitis on preterm neonates requires re-evaluating diagnostic criteria, understanding dysbiosis, standardizing microbiome evaluation, and exploring preventive measures for improved outcomes.

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Establishing Microbiota-Immune Homeostasis in Early Life3:

As the incidence of allergy and autoimmune diseases escalates in developed societies, a nuanced comprehension of the mechanistic underpinnings of microbiota-immune homeostasis has become imperative for guiding therapeutic strategies in instances of dysbiosis. Emphasizing the significance of alterations in intestinal microbiota during the crucial neonatal phase, when the immune system is particularly susceptible to environmental influences, this review focuses on recent literature elucidating the mechanisms governing early life microbiota-immune homeostasis. Furthermore, the discussion delves into the potential therapeutic avenues aimed at rectifying dysbiosis in the early stages of life. This knowledge synthesis seeks to provide insights that can aid in making strategies to address the escalating challenges of allergy and autoimmune diseases in contemporary industrialized societies. The article concludes that early correction of neonatal dysbiosis is critical for preventing allergy and autoimmune diseases. Further research on the impact of microbial restoration and understanding the precise timeline of human neonatal development will optimize clinical strategies for disease prevention.

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The KAAACI (Korean Academy of Asthma Allergy and Clinical Immunology) Guidelines for Allergen Immunotherapy4:

Allergen immunotherapy serves as a fundamental treatment for diverse allergic conditions like allergic rhinitis, allergic asthma, and bee venom allergy, fostering tolerance to triggering allergens. Given the continual discovery of potential allergen immunotherapy candidates and the evolving interest in new therapeutic approaches, there is a growing demand for standardized practice guidelines in this field. This updated guideline, a revision of the 2010 recommendations from the Korean Academy of Asthma Allergy and Clinical Immunology, presents expert opinions from specialists in allergy, pediatrics, and otorhinolaryngology. Rooted in an extensive literature review, the guideline addresses essential aspects of allergen immunotherapy, encompassing mechanisms, clinical efficacy, patient selection, selection of allergen extracts, scheduling and dosing, management of adverse reactions, efficacy measurements, and considerations specific to pediatrics.

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The Role of Dendritic Cell-Derived Exosomes in Allergic Rhinitis5:

Allergic rhinitis is a prevalent otorhinolaryngological condition, increasingly burdening global populations. The immunopathogenesis involves dendritic cell activation, leading to the production of dendritic cell-derived exosomes. These exosomes, containing crucial substances for intercellular communication, play a role in allergic immune responses. Additionally, dendritic cell-derived exosomes offer a potential avenue for the effective delivery of anti-allergy agents, presenting a novel approach to understanding and treating allergic rhinitis. This concise review explores the origin, composition, function, and implications of dendritic cells, exosomes, and dendritic cell-derived exosomes in the context of allergic rhinitis.

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Self-Management in Allergic Rhinitis: Strategies, Outcomes, and Integration into Clinical Care6:

Allergic rhinitis is a prevalent condition marked by typical symptoms and type 2 inflammation. While standard treatments are generally safe and available over the counter, many patients with allergic rhinitis prefer self-management, especially at the onset or for mild symptoms. However, this approach can lead to issues like inadequate control or medication misuse. This paper addresses these concerns, highlighting the importance of supervised self-management. Telemedicine emerges as a valuable tool for overseeing self-management, with the visual analog scale serving as an ideal parameter for measuring symptom severity, medication use, and allergic rhinitis control. Mobile applications now enable patients to self-manage effectively, offering crucial support in communication and decision-making. In addition, the visual analog scale remains the optimal tool for monitoring symptoms and control over time. It is essential to use both pharmacological and non-pharmacological remedies judiciously and effectively.

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  1. Yuan C, He Y, Xie K, et al. Review of microbiota gut brain axis and innate immunity in inflammatory and infective diseases. Front Cell Infect Microbiol. 2023 Oct 4;13:1282431.
  2. Stanikova A, Jouza M, Bohosova J, et al. Role of the microbiome in pathophysiology of necrotizing enterocolitis in preterm neonates. BMJ Paediatr Open. 2023 Nov;7(1):e002172.
  3. Reynolds HM, Bettini ML. Early-life microbiota-immune homeostasis. Front Immunol. 2023;14:1266876.
  4. Lee HY, Lee SM, Kang SY, et al; Korean Academy of Asthma Allergy and Clinical Immunology (KAAACI) Allergen Immunotherapy and Allergen Working Group. KAAACI guidelines for allergen immunotherapy. Allergy Asthma Immunol Res. 2023 Nov;15(6):725-756.
  5. Kang C, He H, Liu P, et al. Role of dendritic cell-derived exosomes in allergic rhinitis (Review). Int J Mol Med. 2023 Dec;52(6):117.
  6. Ciprandi G. Self-management in allergic rhinitis: strategies, outcomes and integration into clinical care. J Asthma Allergy. 2023 Oct 5;16:1087-1095.

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