How are excellence and trust for using artificial intelligence ensured? Evaluation of its current use in EU healthcare

Context: Artificial intelligence (AI) could be a key driver in different healthcare dossiers, ranging from preventive to diagnostic and treatment purposes. The establishment of the Artificial Intelligence High-Level Expert Group in the European Commission, as well as their White Paper, show first attempts of creating policies in the domain of artificial intelligence in the EU. Despite these policy approaches, there is a need for a coherent regulatory framework that enables the efficient use of AI in the field of health. The aim of this policy brief is to evaluate current legislative gaps in terms of the introduction of AI in healthcare, focusing on the domains of Data Protection, Liability & Transparency, as well as Robustness & Accuracy. Policy Options: This policy brief identified a high degree of eHealth infrastructure fragmentation on member state level and limited action towards a structured and coherent framework for AI in healthcare, under the domains of Data Protection, Liability & Transparency, and Robustness & Accuracy. Recommendations: A unified approach at EU-level, based on proposed recommendations and merged into the form of a Directive, is advised. The development of the Health-AI-Directive will bring progress and improvement to legal certainty in the European AI-landscape. The introduction of the Health-AI-Directive is recommended to ensure trust and excellence in the use of AI in healthcare.   Acknowledgments: The authors of this policy brief would like to thank all our tutors, lecturers and professors of the M.Sc. Governance and Leadership in European Public Health, with special thanks to Kasia Czabanowska and Rok Hržič, for enabling and encouraging us in the creation of this policy brief. Authors’ contributions: All authors contributed equally to this work   Conflict of interest: None declared   Source of funding: None declare

How are excellence and trust for using artificial intelligence ensured? Evaluation of its current use in EU healthcare

Context: Artificial intelligence (AI) could be a key driver in different healthcare dossiers, ranging from preventive to diagnostic and treatment purposes. The establishment of the Artificial Intelligence High-Level Expert Group in the European Commission, as well as their White Paper, show first attempts of creating policies in the domain of artificial intelligence in the EU. Despite these policy approaches, there is a need for a coherent regulatory framework that enables the efficient use of AI in the field of health. The aim of this policy brief is to evaluate current legislative gaps in terms of the introduction of AI in healthcare, focusing on the domains of Data Protection, Liability & Transparency, as well as Robustness & Accuracy. Policy Options: This policy brief identified a high degree of eHealth infrastructure fragmentation on member state level and limited action towards a structured and coherent framework for AI in healthcare, under the domains of Data Protection, Liability & Transparency, and Robustness & Accuracy. Recommendations: A unified approach at EU-level, based on proposed recommendations and merged into the form of a Directive, is advised. The development of the Health-AI-Directive will bring progress and improvement to legal certainty in the European AI-landscape. The introduction of the Health-AI-Directive is recommended to ensure trust and excellence in the use of AI in healthcare

The food contaminant fumonisin B1 reduces the maturation of porcine CD11R1+ intestinal antigen presenting cells and antigen-specific immune responses, leading to a prolonged intestinal ETEC infection

Consumption of food or feed contaminated with fumonisin B1 (FB1), a mycotoxin produced by Fusarium verticillioides, can lead to disease in humans and animals. The present study was conducted to examine the effect of FB1 intake on the intestinal immune system. Piglets were used as a target and as a model species for humans since their gastro-intestinal tract is very similar. The animals were orally exposed to a low dose of FB1 (1 mg/kg body weight FB1) for 10 days which did not result in clinical signs. However, when compared to non-exposed animals, FB1-exposed animals showed a longer shedding of F4+ enterotoxigenic Escherichia coli (ETEC) following infection and a lower induction of the antigen-specific immune response following oral immunization. Further analyses to elucidate the mechanisms behind these observations revealed a reduced intestinal expression of IL-12p40, an impaired function of intestinal antigen presenting cells (APC), with decreased upregulation of Major Histocompatibility Complex Class II molecule (MHC-II) and reduced T cell stimulatory capacity upon stimulation. Taken together, these results indicate an FB1-mediated reduction of in vivo APC maturation

Signal regulatory protein alpha (SIRPα) regulates the homeostasis of CD103⁺CD11b⁺ DCs in the intestinal lamina propria

Signal regulatory protein alpha (SIRP alpha/CD172a) is a conserved transmembrane protein thought to play an inhibitory role in immune function by binding the ubiquitous ligand CD47. SIRP alpha expression has been used to identify dendritic cell subsets across species and here we examined its expression and function on intestinal DCs in mice. Normal mucosa contains four subsets of DCs based on their expression of CD103 and CD11b and three of these express SIRP alpha. However, loss of SIRP alpha signaling in mice leads to a selective reduction in the CD103(+)CD11b(+) subset of DCs in the small intestine, colon, and amongmigratory DCs in the mesenteric lymph node. In parallel, these mice have reduced numbers of T(H)17 cells in steady-state intestinal mucosa, and a defective T(H)17 response to Citrobacter infection. Identical results were obtained in CD47KO mice. DC precursors from SIRP alpha mutant mice had an enhanced ability to generate CD103(+)CD11b(+) DCs in vivo, but CD103(+)CD11b(+) DCs from mutant mice were more prone to die by apoptosis. These data show a previously unappreciated and crucial role for SIRP alpha in the homeostasis of CD103(+)CD11b(+) DCs in the intestine, as well as providing further evidence that this subset of DCs is critical for the development of mucosal T(H)17 responses

Subsets of migrating intestinal dendritic cells

Dendritic cells (DCs) in the intestine are heterogeneous. Phenotypically different populations of conventional DCs have been identified in the intestinal lamina propria, Peyer's patches, and in the draining mesenteric lymph nodes, to which these DCs constitutively migrate. Markers used to identify these populations include major histocompatibility complex class II, CD11c, CD8α, CD11b, and CD103. Extensive studies in rats, summarized here, which involved collection of migrating DCs by thoracic duct cannulation after mesenteric lymphadenectomy, have clearly demonstrated that the subsets of migrating intestinal lymph DCs have different functional properties. The subsets might play different roles in the induction of oral tolerance and in driving systemic immune responses after vaccination or intestinal stimulation with Toll-like receptor ligands. The use of these surgical techniques allows investigation of the functions of purified subsets of migrating DCs. However, in the rat, these studies are limited by the range of available reagents and are difficult to compare with data from other species in this fast-moving field. Recent refinements have enabled the collection of migrating intestinal DCs from mice; our initial results are described here. We believe that these studies will generate exciting data and have the potential to resolve important questions about the functions of migrating intestinal DC subsets

CD103 (αE Integrin) Undergoes Endosomal Trafficking in Human Dendritic Cells, but Does Not Mediate Epithelial Adhesion

Dendritic cell (DC) expression of CD103, the α subunit of αEβ7 integrin, is thought to enable DC interactions with E-cadherin-expressing gastrointestinal epithelia for improved mucosal immunosurveillance. In the stomach, efficient DC surveillance of the epithelial barrier is crucial for the induction of immune responses to H. pylori, the causative agent of peptic ulcers and gastric cancer. However, gastric DCs express only low levels of surface CD103, as we previously showed. We here tested the hypothesis that intracellular pools of CD103 in human gastric DCs can be redistributed to the cell surface for engagement of epithelial cell-expressed E-cadherin to promote DC-epithelial cell adhesion. In support of our hypothesis, immunofluorescence analysis of tissue sections showed that CD103+ gastric DCs were preferentially localized within the gastric epithelial layer. Flow cytometry and imaging cytometry revealed that human gastric DCs expressed intracellular CD103, corroborating our previous findings in monocyte-derived DCs (MoDCs). Using confocal microscopy, we show that CD103 was present in endosomal compartments, where CD103 partially co-localized with clathrin, early endosome antigen-1 and Rab11, suggesting that CD103 undergoes endosomal trafficking similar to β1 integrins. Dynamic expression of CD103 on human MoDCs was confirmed by internalization assay. To analyze whether DC-expressed CD103 promotes adhesion to E-cadherin, we performed adhesion and spreading assays on E-cadherin-coated glass slides. In MoDCs generated in the presence of retinoic acid, which express increased CD103, intracellular CD103 significantly redistributed toward the E-cadherin-coated glass surface. However, DCs spreading and adhesion did not differ between E-cadherin-coated slides and slides coated with serum alone. In adhesion assays using E-cadherin-positive HT-29 cells, DC binding was significantly improved by addition of Mn2+ and decreased in the presence of EGTA, consistent with the dependence of integrin-based interactions on divalent cations. However, retinoic acid failed to increase DC adhesion, and a CD103 neutralizing antibody was unable to inhibit DC binding to the E-cadherin positive cells. In contrast, a blocking antibody to DC-expressed E-cadherin significantly reduced DC binding to the epithelium. Overall, these data indicate that CD103 engages in DC-epithelial cell interactions upon contact with epithelial E-cadherin, but is not a major driver of DC adhesion to gastrointestinal epithelia

Development of immune cells in the intestinal mucosa can be affected by intensive and extensive farm environments, and antibiotic use

Epidemiological studies have demonstrated that exposure to farm environments during childhood can be linked to reductions in the incidence of immune disorders, but generating an appropriate model is difficult. 108 half-sibling piglets were born on either extensive (outdoor) or intensive (indoor) farms: at 1 day old, a subset of piglets from each litter were transferred to a high-hygiene isolator facility to create differences in rearing environment either during birth/first day or during the subsequent 56 days of life. Interactions between CD14, CD16, MHCIIDR, and capillary endothelium were assessed using four-color quantitative fluorescence immunohistology. Effects of birth and rearing environment on the antigen-presenting microenvironment of the proximal and distal jejunum (professional and stromal) were apparent at 5, 28, and 56 days after birth However, effects on CD4+CD25+Foxp3+ regulatory T-cells (Tregs) in the intestinal mucosa were apparent around weaning at 28 days but had disappeared by 56 days. These Tregs were reduced in the isolator piglets compared to their farm-reared siblings, but this effect was less marked in piglets born on the extensive farm and required administration of antibiotics. Our results suggest that there may be at least two windows of opportunity in which different farm environments were influencing immune development: one during the perinatal period (up to the first day of life), and one during later infancy. Furthermore, the differences on Tregs suggest that the effects of early life influences may be particularly critical around weaning