Alcohol is one of the most frequent causes of liver disease including alcohol-associated steatosis, steatohepatitis, fibrosis and cirrhosis, and alcoholic hepatitis. Patients with alcohol‐induced liver disease lose certain glycans (sugar molecules) on the surface of their intestinal epithelial cells (glycocalyx). Intestinal bacteria usually thrive on these glycans by using them as energy substrates. In the absence of these specific glycans, some bacteria lose their competitive advantage and other bacteria grow and thrive instead, changing the gut microbiome, which contributes to symptoms of alcohol‐induced liver disease.

Ulcerative colitis (UC), an inflammatory bowel disease (IBD), is characterized by chronic inflammation of the colon, with severity of mucosal inflammation being associated with a higher risk of work disability, hospitalization, colorectal cancer, and colectomy. Non-specific immunosuppressive agents targeting the host, such as steroids, thiopurines, and/or biologics, are used to offset the natural history of disease in patients with moderate-severe inflammation. These therapies are, however, associated with significant risks and often ineffective in adequately managing disease. Genomic technologies have identified associations between microbial dysbiosis, or temporal shifts in composition, and UC severity. While recent efforts extended profiling of microbiota in UC beyond genomics, it remains poorly understood if these shifts are causal or associative in nature, and which mechanisms govern pathogenic roles of the microbiome in UC.

Inflammatory bowel disease is a chronic disease, which affects the lower bowel parts or the entire GI tract, causing symptoms like abdominal pain, diarrhea, fever and weight loss. An estimated two million people in North America suffer from IBD seemingly caused by an overactive mucosal immune system. Crohn’s Disease and ulcerative colitis (UC) are the major groups of inflammatory conditions that make up IBD and are incurable, serious and chronic organic diseases of the intestinal tract.   Recently, anti-integrin monoclonal antibodies have been approved by the FDA as therapeutic agents for treatment of IBD and there are a number of phase three clinical trials ongoing using monoclonal antibody therapy. The immune system responds to the inflammation that is part of the immunopathology of IBD and acts by recruiting inflammatory cells to the intestinal lesions.  Intergrins, specifically alpha 4-β7, plays a key role in mediating leukocyte trafficking from the circulation to the vascular endothelial barrier in gut-associate lymphoid tissue with the ligand MAdCAM-1. The use of anti-integrin therapy targeting alpha 4-β7 reduces the number of immune cells to the gut endothelium. However, the precise identity of the cell subsets depleted from the intestinal lamina by these anti-integrin drugs have not been identified. Thus, there is an unmet need to further develop tools that allow for the identification of the critical effector cell subsets targeted by these drugs in the intestine.

Modeling diseases as networks has helped simplify an otherwise complex web of multi‐cellular processes; however, an exclusive reliance on symmetric relationships in these networks overlooks the existence of disease continuum states and loses information relevant to pathogenesis and for the development of therapeutics. Network‐based analyses severely influenced by symmetric analyses have helped formalize Network Medicine as a field and deliver many successes, but drugs that can predictably re‐set the network in complex multi‐component diseases are yet to emerge.

Schistosomiasis is a disease caused by infection with parasitic flatworms called schistosomes. The three major medically important species are Schistosoma mansoni (causing intestinal schistosomiasis in Africa and South America), S. japonicum (intestinal schistosomiasis in East Asia), and S. haematobium (causing genitourinary schistosomiasis in Africa and the Middle East). Signs and symptoms may include abdominal pain, diarrhea, bloody stool, or blood in the urine.  The treatment of schistosomiasis serves three purposes: reversing acute or early chronic disease, preventing complications associated with chronic infection, and preventing neuroschistosomiasis. The goal of treatment is to remove the worms that produce the eggs which, in turn, are responsible for disease morbidity and mortality. There is no effective vaccine against schistosomiasis.

A mosaic of cross-phyla chemical interactions occurs between all metazoans and their microbiomes. In humans, the gut harbors the heaviest microbial load, but many organs, particularly those with a mucosal surface, associate with highly adapted and evolved microbial consortia. The microbial residents within these organ systems are increasingly well characterized, yielding a good understanding of human microbiome composition. However, we have yet to elucidate the full chemical impact the microbiome exerts on an animal and the breadth of the chemical diversity it contributes. A number of molecular families are known to be shaped by the microbiome including short-chain fatty acids, indoles, aromatic amino acid metabolites, complex polysaccharides, and host sphingolipids and bile acids. These metabolites profoundly affect host physiology and are being explored for their roles in both health and disease. The synthesis of bile acids takes place in the liver and recent research has shown that bile acids can act as signaling molecules and activate a number of molecules. A primary focus has been on the Farnesoid X receptor (FXR) which plays an important role in bile acid synthesis and in regulation of glucose, lipid and energy metabolism.

Vedolizumab (VDZ) is an effective therapy for the management of patients with moderately to severely active ulcerative colitis (UC) or Crohn’s disease (CD) who have failed conventional therapy with aminosalicylates, corticosteroids, and thiopurines, as well as biologic therapy with tumor necrosis factor (TNF) antagonists. Several studies have identified potential predictors of treatment outcomes; however, the optimal approach to integrating predictors into routine practice is uncertain.No prior decision support tools exist to predict VDZ drug exposure in UC and CD and link this back to differences in effectiveness or response to VDZ dose escalation. By having a tool that can predict at baseline prior to start of therapy whether VDZ will be effective and what a patients drug exposure profile will be with VDZ, the provider can 1) determine if VDZ is an appropriate therapy to begin, 2) proactively monitor those patients deemed high risk for treatment failure with VDZ, and 3) proactively measure drug concentrations for VDZ to then increase the dose or the interval at which VDZ is administered to improve outcomes.

The use of traditional probiotic microorganisms to provide therapeutic function for the gut microbiome has a number of limitations. Probiotic bacteria do not colonize the gut because they can’t compete with the resident flora that have evolved for that environment. Current probiotics are a single strain which when used in multiple hosts have not had great success in broad populations and are therefore unpredictable. To alleviate the above problem, a new approach is necessary to colonize the human gastrointestinal tract with greater reliability and for therapeutic value to the patient. 

The gut is a complex environment; the gut mucosa maintains immune homeostasis under physiological circumstances by serving as a barrier that restricts access of trillions of microbes, diverse microbial products, food antigens and toxins to the largest immune system in the body. The gut barrier is comprised of a single layer of epithelial cells, bound by cell-cell junctions, and a layer of mucin that covers the epithelium. Loosening of the junctions induced either by exogenous or endogenous stressors, compromises the gut barrier and allows microbes and antigens to leak through and encounter the host immune system, thereby generating inflammation and systemic endotoxemia. An impaired gut barrier (e.g. a leaky gut) is a major contributor to the initiation and/or progression of various chronic diseases including, but not limited to, metabolic endotoxemia, type II diabetes, fatty liver disease, obesity, atherosclerosis and inflammatory bowel diseases. Despite the growing acceptance of the importance of the gut barrier in diseases, knowledge of the underlying mechanism(s) that reinforce the barrier when faced with stressors is incomplete, and viable and practical strategies for pharmacologic modulation of the gut barrier remain unrealized.

Currently, there are no good mouse models to study the development of non-alcoholic steatohepatitis (NASH) and its progression to steatolic hepatocellular carcinoma (HCC) in less than one year. While there are other models of NASH in mice, none of the currently available models closely mimics the human disease and most are models of toxic liver damage associated with weight loss rather than obesity. 

Current methodology typically measures both pressure and impedance usingsensors spread over the entire length of the esophagus. Impedance is used to provide a quantitative temporal measure of the advance of bolus in the esophagus, but it does not provide a quantitative measure of the extent of esophageal cross-sectional area or segmental volume.

Many institutions are implementing anal cancer screening programs modeled on procedures used in cervical cancer. Analogous to cervical colposcopy screening procedures, the high resolution anoscopy (HRA) poses additional challenges due to unique characteristics of the procedure. This includes the uneven topography and collapsing nature of anal canal, making it a more challenging procedure than cervical colposcopy. Additionally, there is considerable variability in how HRA providers position the patient and document the position of visualized lesions. HRA practitioners about to perform a HRA follow-up examination or ablative treatment typically review prior HRA images saved in free-standing image management software (i.e. image files are generally not linked to electronic medicaI record systems). With these current limitations, there exists a need for a method to standardize how HRA results are documented in the medical record.

Chromogranin A (CHGA/Chga), a 48-kDa acidic secretory proprotein, gives rise to several peptides of biological importance, which include the dysglycemic hormone pancreastatin, the vasodilator vasostatin, and the antihypertensive peptide catestatin that inhibits catecholamine release. Initially identified as a physiological brake in catecholamine secretion, catestatin has been established as a pleiotropic hormone having effects on promoting angiogenesis and lowering blood pressure.

Ileus is the hypomotility of the gastrointestinal tract in the absence of mechanical bowel obstruction. Postoperative ileus occurs in approximately 50 percent of patients who undergo major abdominal surgery. The clinical consequences of postoperative ileus may be profound and increases medical costs due to prolonged hospital stays.

Necrotizing enterocolitis (NEC) is one of the most frequent and fatal intestinal disorders of preterm infants. Nearly 10 percent of very-low-birth-weight infants develop it, and over a quarter of NEC infants will die from this disorder. The survivors are often faced with long-term neurological impairment. Formula-fed infants are at a 6-10-fold higher risk to develop NEC; several molecules in human milk are thought to be associated with NEC protection and yet despite improvements in formula composition, formula-fed infants remain at a 6- to 10-fold higher risk than breast-fed infants. Identifying the protective component in human milk could lead to the development of better options to diagnose, treat, and perhaps even prevent, this disorder.

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