Effects of a Mediterranean Diet Intervention on Maternal Stress, Well-Being, and Sleep Quality throughout Gestation-The IMPACT-BCN Trial

Stress and anxiety are frequent occurrences among pregnant women. We aimed to evaluate the effects of a Mediterranean diet intervention during pregnancy on maternal stress, well-being, and sleep quality throughout gestation. In a randomized clinical trial, 1221 high-risk pregnant women were randomly allocated into three groups at 19-23 weeks' gestation: a Mediterranean diet intervention, a Mindfulness-Based Stress Reduction program, or usual care. All women who provided self-reported life-style questionnaires to measure their anxiety (State Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS)), well-being (WHO Five Well Being Index (WHO-5)), and sleep quality (Pittsburgh sleep quality index (PSQI)) at enrollment and at the end of the intervention (34-36 weeks) were included. In a random subgroup of 106 women, the levels of cortisol and related metabolites were also measured. At the end of the intervention (34-36 weeks), participants in the Mediterranean diet group had significantly lower perceived stress and anxiety scores (PSS mean (SE) 15.9 (0.4) vs. 17.0 (0.4), p = 0.035; STAI-anxiety mean (SE) 13.6 (0.4) vs. 15.8 (0.5), p = 0.004) and better sleep quality (PSQI mean 7.0 ± 0.2 SE vs. 7.9 ± 0.2 SE, p = 0.001) compared to usual care. As compared to usual care, women in the Mediterranean diet group also had a more significant increase in their 24 h urinary cortisone/cortisol ratio during gestation (mean 1.7 ± SE 0.1 vs. 1.3 ± SE 0.1, p < 0.001). A Mediterranean diet intervention during pregnancy is associated with a significant reduction in maternal anxiety and stress, and improvements in sleep quality throughout gestation. Keywords: Mediterranean diet; pregnancy; anxiety; well-being; sleep qualit

Humoral and Cellular Immune Responses After a 3-dose Course of mRNA-1273 COVID-19 Vaccine in Kidney Transplant Recipients: A Prospective Cohort Study.

In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine. Methods: Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose' and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively. Results: After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio' 3.14; 95% confidence interval' 1.10-8.96; P = 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (P < 0.001). Conclusions: A substantial proportion of kidney transplant recipients developed late seroconversion after 2 doses. Cellular immunity was associated with the development of a stronger humoral respons

Allergenic protein and epitope recognition in food allergy: a new perspective for the molecular and clinical characterization of shellfish and lipid transfer protein allergy / Reconeixement de proteïnes i epítops al·lergènics en al·lèrgia alimentaria: una nova perspectiva per a la caracterització clínica i molecular de l’al·lèrgia al marisc i a les proteïnes de transferència de lípids

[eng] Currently food allergy diagnostic tests are not able to predict clinical reactivity in sensitized patients (those with specific IgE against a particular allergen). Traditionally, allergy diagnostic tests used complete extracts of allergenic sources containing multiple molecules, some allergic and others not. This greatly limits the accuracy in the diagnosis and identification of possible allergic reactions to different foods by the existence of cross reactivity. Through the last decades, thanks to advances in the characterization of allergens at molecular level, the concept of Component-Based Diagnosis has been developed. This is based on the reasoning that the presence of specific IgE for the protein actually responsible for the allergic response should be detected and not the one against a mixture of molecules. Furthermore, the study of IgE and IgG4 recognition at epitope level using microarrays of synthetic peptides has been described as a useful tool for diagnosis, prognosis and development of a therapy for food allergy. The hypothesis of this thesis is that these new methodologies can improve the diagnosis of shellfish and lipid transfer protein (LTP) allergy. The aim of this thesis is to characterize clinically and at a molecular level these two types of food allergies, using these new methodologies. Regarding shellfish allergy, we found that tropomyosin, sarcoplasmic protein binding of calcium and myosin light chain are the allergens associated with clinical reactivity, i.e, are more common in shrimp allergic patients than in tolerant individuals sensitized shrimp. On the other hand, arginine kinase and hemocyanin allergens would be more involved in the phenomena of cross-reactivity with other arthropods (mites and/or cockroach). Additionally the synthetic peptide microarray has identified differential recognition of IgE and IgG4 epitopes among allergic and tolerant individuals. Regarding allergy to LTP, allergenic proteins ubiquitously distributed in the plant kingdom, we observed that patients suffer from reactions with a wide range of plant foods to which are sensitized, being peach the most common one. Furthermore, these patients have a variety of clinical symptoms from very mild to very severe and life-threatening as in the case of anaphylaxis, which can be attributed to allergens from different families. The component-based diagnosis in a microarray format that includes a diverse panel of allergenic proteins from different families is useful for diagnosing these patients, since the only proteins identified as responsible for the clinical symptoms are the LTPs, although the symptoms are diverse and sometimes more closely resemble to those caused by other allergens such as profilins or homologues of Bet v 1. Moreover, it offers an overview of positive and negative sensitivities in these patients in a single trial, with its multiplex properties. Cases of anaphylaxis with a cofactor involvement, such as NSAIDs, were frequently observed in these patients. The simultaneous presence of these drugs with the food allergen triggers allergic reactions in the individual that would not occur without the presence of the drug or would have been of less severity. We have developed a preliminary in vitro model based on the basophil activation test that allowed us to observe the in vitro effect observed in vivo. We observed an increase of degranulation/activation of basophils when stimulation is done with food in the presence the drug, compared to when stimulated only with food. In this thesis we can conclude that both the component-based diagnosis and epitope mapping are useful tools for the characterization of food allergy to shellfish proteins and LTP, and that they should be considered to improve the efficiency of diagnosis of these two types of food allergies.[cat] Actualment els mètodes diagnòstics de l'al•lèrgia alimentària no són capaços de predir la reactivitat clínica dels pacients sensibilitzats (els que tenen IgE específica davant un determinat al•lergen). Tradicionalment les proves diagnòstiques de l'al•lèrgia han utilitzat extractes complets de fonts al•lergèniques que contenen múltiples molècules, algunes al•lergèniques i altres no. Això limita enormement la precisió en el diagnòstic i la possibilitat d'identificar reaccions al•lèrgiques a diferents aliments per l'existència de reactivitats creuades. Gràcies a la caracterització dels al•lèrgens a nivell molecular, s'ha desenvolupat el concepte del Diagnòstic Basat en Components que es basa en el raonament de detectar la presència d'IgE específica per a la proteïna realment responsable de la resposta al•lèrgica i no per una mescla de molècules. Addicionalment, l'estudi del reconeixement IgE i IgG4 a nivell d'epítops amb microarrays de pèptids sintètics pot ser una eina útil per al diagnòstic, pronòstic i desenvolupament d'una teràpia per l'al•lèrgia alimentària. La hipòtesi d'aquesta tesi és que aquestes noves metodologies poden millorar el diagnòstic de l'al•lèrgia al marisc i a les proteïnes de transferència de lípids (LTP), presents en múltiples aliments vegetals. L'objectiu és doncs caracteritzar clínicament i a nivell molecular aquests dos tipus d'al lèrgies alimentàries, utilitzant aquestes noves metodologies. Respecte a l'al•lèrgia al marisc, els al lèrgens tropomiosina, proteïna sarcoplàsmica d'unió de calci i la cadena lleugera de miosina s'associen amb la reactivitat clínica a la gamba. D'altra banda, els al•lèrgens arginina quinasa i hemocianina estarien més implicats en fenòmens de reactivitat creuada amb altres artròpodes. Addicionalment, amb el microarray de pèptids sintètics s'ha pogut identificar un reconeixement diferencial d'epítops IgE i IgG4 entre pacients al•lèrgics i tolerants. Respecte a l'al•lèrgia a les LTP, els pacients pateixen reaccions amb un ampli ventall d'aliments vegetals, sent el préssec el més freqüent, amb una gran diversitat de símptomes clínics, que poden atribuir-se a al•lèrgens de diferents famílies. El diagnòstic basat en components en el format d'un microarray que inclou proteïnes al•lergèniques de diferents famílies és útil per al diagnòstic d'aquests pacients, ja que permet identificar que les úniques proteïnes responsables els símptomes clínics són les LTP, encara que els símptomes siguin molt variats i en algunes ocasions s'assemblin més als provocats per altres al•lèrgens com les profilines o els homòlegs de Bet v 1. En aquests pacients són freqüents els casos d'anafilàxia en què està involucrat un cofactor, com els antiinflamatoris no esteroïdals. La presència del fàrmac amb l'al•lergen alimentari desencadena reaccions al•lèrgiques que sense el fàrmac no es donarien o serien de menor severitat. Hem desenvolupat un model preliminar in vitro basat en el test d'activació de basòfils que ens ha permès observar in vitro l'efecte observat in vivo. En conclusió, el diagnòstic basat en components i el mapatge d'epítops són eines útils per a la caracterització de l'al•lèrgia alimentària al marisc i a les proteïnes LTP, i s'han de considerar per millorar l'eficiència del diagnòstic d'aquests dos tipus d'al•lèrgies alimentàries