Recent developments in the epidemiology and management of tuberculosis – new solutions to old problems?

Wolfgang M Thaiss1, Cornelius C Thaiss2, Christoph A Thaiss31Christian-Albrechts-Universty, Kiel, 2Ludwig-Maximilians-University, Munich, Germany; 3Yale University School of Medicine, New Haven, CT, USAAbstract: Tuberculosis is an ancient human disease that is still a major cause of death and one of the most challenging public health problems worldwide. After decades of stagnancy, new public–private partnerships to fight the disease and the increasing awareness of a vicious circle between the tuberculosis epidemic and the obstruction of economic development have fuelled recent progress in our understanding of the disease. As a result, new strategies to improve management and treatment of tuberculosis have been initiated. At the same time, however, the devastating effect of human immunodeficiency virus on tuberculosis susceptibility and the rapid expansion of multidrug-resistant (MDR) tuberculosis threaten to undermine the advances made by tuberculosis management programs. With an estimated 9 million new cases annually, tuberculosis affects a higher number of individuals worldwide than ever before. Here, recent developments in the epidemiology and management of tuberculosis are summarized and an overview is provided of emerging strategies to combat this ancient scourge.Keywords: tuberculosis, epidemiology, management, multidrug resistance, vaccin

Membrane Vesicles from the Gut Microbiota and Their Interactions with the Host

Gut microbiota plays an essential role in maintaining intestinal homeostasis and human health. Microbiota establishes a complex network of dynamic and reciprocal interactions with the intestinal epithelium and immune system. The mucin layer that covers the epithelium prevents luminal bacteria from accessing host cells. Thus, microbiota–host communication mainly relies on secreted factors and membrane vesicles (MVs), which can cross the inner mucus layer and reach the epithelium. This chapter focuses on the role of microbiota-secreted MVs as key players in signaling processes in the intestinal mucosa. This is an emerging research topic, with the first reports dating from 2012. Microbiota-derived MVs are involved in interspecies communication in the gut, between bacteria and between microbiota and host. Here we present current knowledge on the mechanisms used by microbiota MVs to assist and control the gut microbial community and to modulate host immune and defense responses. Constant stimulation of immune receptors by microbiota MVs results in tightly controlled inflammation that contributes to tolerogenic responses essential to maintaining intestinal homeostasis. Moreover, gut microbiota MVs are emerging as physical vehicles for distribution and delivery of bacterial effectors to distal tissues in human health and disease