Microbiota and cancer: an update

The number of microbes in the human intestine is approximately 1 × 10 14 , while the number of eukaryotic cells in the human body is around 1 × 10 13 . As a result of co-evolution of the host mucosal immune system and the microbiota, both have developed multiple mechanisms to maintain homeostasis. Nevertheless, when these mechanisms are disturbed by pathogenic bacteria, which invade this fragile environment, the immune system responds to the microbiota and may support tumour growth in the intestine. Data advocate that the microbiota and its interactions with the host could also be implicated in carcinogenesis in other organs. It is nowadays suggested that developing methods to selectively manipulate components of the microbiota and ultimately target tumorigenesis represents a complex but exciting challenge. In this review, the main pathogenetic mechanisms of the interplay between the microbiome and the innate system, which may be implicated in tumorigenesis are discussed. Also, the importance of the gut microbiota regarding efficacy and toxicity of current chemotherapeutic agents, as well as the direct antitumor properties of the microbiota, will be reviewed. © 2019, © 2019 Edizioni Scientifiche per l'Informazione su Farmaci e Terapia (Italian Society of Chemotherapy)

Testicular abscesses due to Brucella melitensis

Brucella may cause testicular masses, which may be confused with a testicular tumour. We present the case of a man with fever and oedema in the scrotum. Ultrasound and colour Doppler ultrasound with a 6 to 15 MHz high-frequency linear-array transducer was performed, revealing bilateral scrotal wall oedema, heterogeneous echo texture and slightly increased vascularization of the right testis, with hypoechoic lesions characterized by hypervascular margins and no flow within them. These findings were compatible with testicular abscesses. Three blood cultures grew Brucella melitensis, so the patient received treatment with doxycycline and rifampin for 8 weeks, which resulted in disappearance of the testicular abscesses. Keywords: Brucella melitensis, genitourinary brucellosis, testicular abscess, zoonosis, stuarti

Diabetes type 1: Can it be treated as an autoimmune disorder?

Type 1 Diabetes Mellitus (T1DM) is characterized by progressive autoimmune-mediated destruction of the pancreatic beta-cells leading to insulin deficiency and hyperglycemia. It is associated with significant treatment burden and necessitates life-long insulin therapy. The role of immunotherapy in the prevention and management of T1DM is an evolving area of interest which has the potential to alter the natural history of this disease. In this review, we give insight into recent clinical trials related to the use of immunotherapeutic approaches for T1DM, such as proinflammatory cytokine inhibition, cell-depletion and cell-therapy approaches, autoantigen-specific treatments and stem cell therapies. We highlight the timing of intervention, aspects of therapy including adverse effects and the emergence of a novel lymphocyte crucial in T1DM autoimmunity. We also discuss the role of cardiac autoimmunity and its link to excess CVD risk in T1DM. We conclude that significant advances have been made in development of immunotherapeutic targets and agents for the treatment and prevention of T1DM. These immune-based therapies promise preservation of beta-cells and decreasing insulin dependency. In their current state, immunotherapeutic approaches cannot yet halt the progression from a preclinical state to overt T1DM nor can they replace standard insulin therapy in existing T1DM. It remains to be seen whether immunotherapy will ultimately play a key role in the prevention of progression to overt T1DM and whether it may find a place in our therapeutic armamentarium to improve clinical outcomes and quality of life in established T1DM. © 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply

Diabetes mellitus and SARS-COV-2 infection: Pathophysiologic mechanisms and implications in management

Introduction: Currently, diabetes mellitus (DM), as well as coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are major public health issues worldwide. Background: It has been suggested that patients with DM are more vulnerable to SARS-CoV-2 infection and suffer from more severe forms of the disease. Methods: A literature search was performed using PubMed, Scopus, and Google search engines. Results: Angiotensin-converting enzyme-2 (ACE2) is the major receptor of SARS-CoV-2 in the human host. The differential expression of ACE2 in the lungs of patients with DM makes them more susceptible to COVID-19. Additionally, acute or chronic hyperglycemia renders individuals in an immune-suppressive state, with impaired innate and adaptive immunity function, also contributing to the severity of COVID-19 infection among patients with DM. Other factors contributing to a more severe course of COVID-19 include the coexistence of obesity in T2DM, the endothelial inflammation induced by the SARS-CoV-2 infection, which aggravates the endothelial dysfunction observed in both T1DM and T2DM, and the hypercoagulability presented in COVID-19 infection that increases the thrombotic tendency in DM. Conclusion: This review summarizes the pathophysiologic mechanisms underlying the coexistence of both pandemics as well as the current recommendations and future perspectives regarding the optimal treatment of inpatients and outpatients with DM in the era of SARS-CoV-2 infection. Notably, the currently recommended drugs for the treatment of severe COVID-19, dexamethasone and remdesivir, may cause hyperglycemia, an adverse effect that physicians should bear in mind when caring for patients with DM and COVID-19. © 2021 Bentham Science Publishers