Herman E. Popeijus

Background: Interindividual variability in intestinal cholesterol absorption contributes to differences in serum lipid concentrations and cardiovascular risk. Total cholesterol (TC)-standardized campesterol and sitosterol levels are established markers of cholesterol absorption. However, genetic variants in Europeans associated with these markers remain incompletely characterized. Methods: A genome-wide association study (GWAS) was performed in 398 healthy individuals of European ancestry. Samples were genotyped using the Precision Medicine Research Array (PMRA). After quality control, 166,037 common genetic variants with a minor allele frequency (MAF) > 20% were analyzed. Associations between genetic variants and intestinal cholesterol absorption markers (campesterol/TC and sitosterol/TC) were evaluated using additive and recessive genetic models. Results: A total of 16 SNPs were identified. Eight SNPs overlapped with both campesterol/TC and sitosterol/TC, of which 2 reached genome-wide significance. Six overlapping SNPs were associated with higher concentrations of both markers: 3 SNPs in ABCG8 (rs4299376, rs6544713, and rs4245791), 1 SNP in ADAM12 (rs4962526), and 2 SNPs in non-coding regions (rs260769 and rs5011112). Additionally, two SNPs (rs2033254 and rs12708980) in CETP were associated with lower concentrations of these markers. Five of the identified SNPs have not previously been linked to markers of intestinal cholesterol absorption. Conclusions: This GWAS confirmed previously reported associations within ABCG8 and identified candidate loci in CETP and ADAM12 that may be involved in intestinal cholesterol absorption. These findings contribute to our understanding of genetic factors underlying intestinal cholesterol absorption and highlight candidate loci for future replication and functional studies.

Background/Objectives: This study evaluated the immunomodulatory effects of multiple A. bisporus strains, applying both in vitro and in vivo murine models and aiming to identify specific strains with immune modulatory properties. Methods: Sixteen A. bisporus strains were screened in a dendritic cell (DC)–CD4⁺ T cell co-culture system, using cells from female C57BL/6 mice, for their capacity to induce Th1- and Th17-associated cytokine production. Based on these cytokine profiles, three potent strains (MES01856, MES01706, MES01637), one non-responder strain (MES01515), and the commercially available A15 strain were selected for investigation in a murine model, an ovalbumin (OVA)-induced allergic food allergy. In these sensitized female C3H/HeOuJ mice, ear swelling, anaphylactic shock scores, OVA-specific IgE, and serum mouse mast cell protease-1 (mMCP-1) were measured following an allergen challenge. Additionally, IL-6, IL-10, and TNF-α secretion from bone marrow-derived dendritic cells (BMDCs) was measured after stimulation with these A. bisporus fresh ground extracts (FGEs). Results: In vitro, increases in cytokine production were obtained, with MES01856, MES01706, and MES01637 identified as the most potent inducers. In vivo, OVA sensitization elicited significant ear swelling and elevated shock scores in the mice. Dietary supplementation with MES01706 or MES01515 significantly reduced ear swelling, while the other strains resulted in non-significant changes. No significant changes were observed in shock scores, OVA-specific IgE, or mMCP-1. Conclusions: Multiple different A. bisporus strains elicit specific immunomodulating effects both in vitro and in in vivo murine models, identifying the MES01706 strain as one with the highest potential to beneficially affect immune function.

Introduction: Direct and active patient involvement in health professions education (HPE) can improve learners' clinical skills and preparedness for patient‐centred care. Most research on active patient involvement is from global north (GN) regions where cultural contexts differ from those in the global south (GS). In most GS contexts, patients are not actively engaged in educational activities. Understanding how patients in these regions perceive their potential roles in education is essential to improving HPE not only in the GS but also in culturally diverse GN settings. Methods: This qualitative study explored patient perspectives on active involvement in HPE using a theory‐informed inductive approach. We conducted semistructured interviews with 13 patients at a dental teaching hospital in Pakistan. Data were analysed using Braun and Clarke's thematic analysis. Iterative team discussions were held to reach consensus during coding and theme development. Hofstede's cultural dimensions theory was used as a lens to guide conceptualization and mapping of final themes. Results: Six key themes, rooted in cultural values, captured patients' views on active participation in education: contribution to societal good; spiritual and moral obligations; nurturing and supporting students; self‐doubts; fear of negative consequences; and balancing responsibilities. Conclusion: Patient perceptions shaped by cultural factors can act as facilitators or barriers to their participation in HPE. Educators should engage with diverse communities and use culturally sensitive approaches to support patient participation. In a globally interconnected educational landscape, understanding and respecting cultural differences when involving patients in education can enable educators to better prepare future healthcare professionals.

A higher concentration of apolipoprotein A-I (ApoA-I) is associated with increased high density lipoprotein functionality and reverse cholesterol transport (RCT). A promising strategy to prevent cardiovascular diseases is therefore to improve RCT by increasing de novo ApoA-I production. Since experimental animal models have suggested effects of amino acids on hepatic lipoprotein metabolism, we here examined the effects of different amino acids on hepatic ApoA-I production. Human hepatocytes (HepG2) were exposed to six individual amino acids for 48 h. ApoA-I transcription and secreted pro-ApoA-I protein concentrations were analyzed using quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assays (ELISA), respectively. Additionally, CPT1 and KEAP1 mRNA expression, peroxisome proliferator-activated receptor alpha (PPARα) transactivation, and mechanistic target of rapamycin complex 1 (mTORC1) phosphorylation were determined. Leucine, glutamic acid, and tryptophan increased ApoA-I and CPT1 mRNA expression. Tryptophan also strongly increased PPARα transactivation. Glutamine, proline, and histidine increased pro-ApoA-I protein concentrations but mTORC1 phosphorylation remained unchanged regardless of the amino acid provided. In conclusion, individual amino acids have different effects on ApoA-I mRNA expression and pro-ApoA-I production which can partially be explained by specific effects on PPARα transactivation, while mTORC1 phosphorylation remained unaffected.

Apolipoprotein A-I (ApoA-I) is the major protein of high density lipoprotein (HDL) particles and has a crucial role in reverse cholesterol transport (RCT). It has been postulated that elevating production of de novo ApoA-I might translate into the formation of new functional HDL particles that could lower cardiovascular disease (CVD) risk via RCT. During inflammation, serum ApoA-I concentrations are reduced, which contributes to the development of dysfunctional HDL particles as Serum Amyloid A (SAA) overtakes the position of ApoA-I within the HDL particles. Therefore, instead of elevating serum HDL cholesterol concentrations, rescuing lower serum ApoA-I concentrations could be beneficial in both normal and inflamed conditions. Several nutritional compounds, amongst others short chain fatty acids (SCFAs), have shown their capacity to modulate hepatic lipoprotein metabolism. In this review we provide an overview of HDL and more specific ApoA-I metabolism, SCFAs physiology and the current knowledge regarding the influence of SCFAs on ApoA-I expression and synthesis in human liver cells. We conclude that the current evidence regarding the effect of SCFAs on ApoA-I transcription and secretion is promising, however there is a need to investigate which dietary fibres could lead to increased SCFAs formation and consequent elevated ApoA-I concentrations.

Apolipoprotein A-I (ApoA-I) concentrations are decreased during inflammation, which may reduce high-density lipoprotein (HDL) functionality. Thus, rescuing ApoA-I concentrations during inflammation might help to prevent atherosclerosis. Recent studies have shown that butyric acid (C4) has anti-inflammatory effects and rescues ApoA-I production. However, whether intestinal short chain fatty acids (SCFAs) are able to influence hepatic processes is unknown. Therefore, we investigated C4 anti-inflammatory effects on ApoA-I transcription in the intestine-liver co-culture model. C4 dose-response experiments in the presence or absence of cytokines were performed in a co-culture system including Caco-2 cells, HepG2 cells, or both. Changes in ApoA-I transcription in Caco-2 cells and HepG2 cells were analyzed using qPCR. C4 increased ApoA-I expression in HepG2 cells that cultured alone. When both cells were cultured together, C4 decreased ApoA-I expression in Caco-2 cells and increased ApoA-I expression in HepG2 cells. However, adding C4 to apical Caco-2 cells resulted in a smaller effect in HepG2 cells compared with adding C4 directly to the hepatocytes. Moreover, C4 rescued ApoA-I expression in inflamed HepG2 cells. These findings suggests that intestinal SCFAs can affect hepatic processes. However, the smaller effect in the co-culture experiment indicates cross-talk between intestine and liver.

Concentrations of apolipoprotein A-I (ApoA-I) decrease during inflammation, which may lead to dysfunctional ApoA-I-poor high-density lipoprotein (HDL) particles, and as such, elevate cardiovascular risk. Therefore, rescuing ApoA-I concentrations, especially during inflammation, seems beneficial. Recently, short-chain fatty acids (SCFAs) have received more attention as a strategy in reversing atherosclerosis. We here evaluated the effects of SCFAs on inflammatory pathways in relation to ApoA-I transcription. SCFAs dose–response studies were performed in the presence and absence of inflammatory cytokines. ApoA-I and interleukin 8 (IL-8) mRNA expression were analyzed using qPCR and ELISA, respectively. To study underlying mechanisms, nuclear factor kappa B (NF-κB) transactivation and changes in mRNA expressions of the genes targets of bromodomain and extra-terminal (BET) inhibition, peroxisome proliferator-activated receptor-alpha (PPARα) transactivation and activator protein 1 (AP-1) pathway were analyzed. SCFAs (except hexanoic acid) increased ApoA-I mRNA transcription in both normal and inflammatory conditions and lowered IL-8 mRNA expression. This anti-inflammatory effect of SCFAs was confirmed by inhibition of NF-κB transactivation. Moreover, butyric acid increased carnitine palmitoyltransferase 1 (CPT1), PPARα target gene, mRNA transcription in both conditions, and there was a negative correlation between CPT1 and NF-κB. Therefore, PPARα transactivation is probably involved in the anti-inflammatory effects of SCFAs, which rescues ApoA-I transcription. In conclusion, propionate, butyrate and valerate elicit anti-inflammatory effects which might rescue ApoA-I transcription in inflammatory conditions via PPARα transactivation mediated NF-κB inhibition.

In a recent human study, we observed that amoxicillin treatment decreased HDL-C concentration. We hypothesize that antibiotics lower the transcription and secretion of ApoA-I, the responsible protein for HDL production. HepG2 and Caco-2 cells were exposed to increasing dose of amoxicillin, penicillin, and streptomycin. Secreted ApoA-I protein and mRNA transcripts were analyzed using ELISA and qPCR, respectively. To unravel underlying mechanisms, KEAP1, CPT1, and CHOP mRNA expressions were determined as well as PPARα transactivation. In HepG2 and Caco-2, amoxicillin decreased ApoA-I transcription and secretion. Effects on ApoA-I expression were clearly there for amoxicillin while no effects were observed for penicillin or streptomycin. KEAP1, CPT1, and CHOP mRNA expressions were reduced by amoxicillin treatments. Moreover, a significant correlation between ApoA-I and CPT1 mRNA expressions was found. Furthermore, amoxicillin lowered PPARα transactivation. All together, these data suggest that inhibited PPARα transactivation is involved in the effects of amoxicillin on ApoA-I. In conclusion, the direct effect of amoxicillin in treated HepG2 and Caco-2 cells was a lower ApoA-I secretion and transcription. Based on evaluating alterations in KEAP1, CPT1, and CHOP mRNA expressions plus PPARα transactivation, we suggest that a reduced PPARα activation is a potential mechanism behind the observed amoxicillin effects on ApoA-I expression.