Multidisciplinary collaboration under one roof is a major condition for effective translational medicinal research. At UMC Utrecht, approximately 10 years ago all immunology laboratories were merged into one department, the Laboratory for Translational Immunology (LTI). “At strategic program I&I we support the philosophy that we should not be conducting isolated research into individual diseases. We brought all brains, facilities and resources together in a central lab that represents immunologists working in six. In this way we truly connect the researchers with the clinicians, and are able to conduct research beyond the boundaries of age and therapeutic area,” says Linde Meyaard, vice chair of the strategic program I&I. In recent years, LTI-investigators became aware that in the international field, there was a perception that it LTI was an isolated immunology lab, which does not reflect its size, capabilities and ambitions. In alignment with similar laboratories in other countries, in September 2019 the name was changed from “Laboratory for Translational Immunology (LTI)” into “Center for Translational Immunology” (CTI).
Also in 2019, the twitter account @CTI_UMCUtrecht was launched. Via this account, managed by the CTI secretariat, investigators can now disseminate their scientific news via this communication channel.
Human-to-human transfer is the main source of ESBL antibiotic resistance
Researchers from National Institute for Public Health and the Environment, Utrecht University, UMC Utrecht, the Animal Health Service and Wageningen Bioveterinary Research (all members of the ESBLAT consortium) have previously shown that ESBL antimicrobial resistance is common in humans, animals, food and the environment. However, ESBL types in humans were found to differ from those in animals and food. The most important source of contamination for humans remained unknown until now. New research published in Lancet Planetary Health shows that humans themselves are the most important source of ESBL antibiotic resistance.
According to a mathematical model, human-to-human transmission is responsible for more than 60 percent of all humans that are carriers of ESBLs in their intestines. The contribution of food was estimated at around 19 percent, contact with pets at 8 percent, hobby/recreational contact with livestock at 4 percent and swimming in surface water and contact with wild birds at 3 percent. This means that ESBLs are mainly transferred between people and that people get ESBLs to a lesser extent through animals, animal food and the environment. These results indicate that ESBL transmission and contamination has a true One Health character. The results also show that continuous exposure from different sources such as humans, animals, food and the environment maintains the occurrence of ESBLs in the population.
I&I Boost Grants 2019 selected
In September 2019, the I&I Boost Grants 2019 were selected. These grants (three in total of max € 10.000 each) are intended to stimulate new research collaborations combining expertise of both the infection and the immunity research fields. They should address pressing questions in the field with an expected promising outcome. In total, 12 research proposals were submitted. The review committee, this year composed of Janneke van de Wijgert (Julius Center), José Borghans (CTI) and Robert Jan Lebbink (MMB), has selected to following proposals:
• Staphylococcus aureus-Langerhans cell-T cell axis in skin inflammation. Applicants: Nina van Sorge (MMB, dLAB), Femke van Wijk (CTI, dLAB) and Marjolein de Bruin-Welling (dIGD).
• Neuropathic pain in Intensive Care survivors: the role of hyperinflammation. Applicants: Mienke Rijsdijk (dVF), Olaf Cremer (dVF), Niels Eijkelkamp (CTI, dLAB) and Eveline Delemarre (CTI, dLAB).
• Intravital Imaging of Catheter-Associated Biofilm Infections. Applicants: Nienke Vrisekoop (CTI, dLAB) and Suzan Rooijakkers (MMB, dLAB).
Sepsis in the spotlights at public lecture
Each year around 3500 people die from sepsis in the Netherlands. Patients who survive often have serious psychological and physical residual symptoms. Early recognition and treatment saves (the quality of) lives - and there is still a lot to gain. During a public lecture at UMC Utrecht, physicians and sepsis victims discussed what sepsis is and why more attention is needed for sepsis and the consequences.
The evening was chaired by Prof. Karin Kaasjager (acute medicine internist) who emphasized the importance of entering into discussions with experts in the field to improve the care and aftercare for patients with sepsis. Jan Willem Uffen (PhD candidate acute internal medicine) continued by explaining what sepsis is: a derailed reaction of the body to an infection, usually caused by a bacterium (but a virus, parasite or fungus is also possible). The entire body responds to the infection, rather than just the inflamed bladder or just a cut in the hand. The immune system reacts so violently that tissues are damaged and organ functions start to fail. Of the patients presenting in the ER with the suspicion of an infection, almost 13 percent have sepsis. About a third require ICU treatment. 1 in 5 of them dies. Of the patients with sepsis who do not require ICU treatment, 1 in 8 dies.
“Ook jongens krijgen HPV-vaccin: Zo kunnen we het virus langzaam uitroeien”
Patricia Bruijning-Verhagen (rtlnieuws.nl)
“Nog een ziekenhuis wil afzien van omstreden afvalsysteem”
from Jan Kluijtmans (nos.nl)
“Jaarlijks duizenden doden door sepsis, problemen met herkenning”
Karin Kaasjager (nos.nl)
“App helpt hormoonzalf doseren”
Jette de Groot en Florine Schussler- Raymaker (MaxVandaag.nl)
“Verplegen bij ESBL kan veilig op meerpersoons- kamer, mét deze contactisolatie”
Marjolein Kluijtmans-van den Bergh (nursing.nl)
“Microplastics lijken gevaarlijker dan tot nu toe gedacht”
Nienke Vrisekoop (nos.nl)
“Gebreken in riool bij Zaans MC”
Jan Kluijtmans (NRC)
Item on awareness for sepsis
Karin Kaasjager (Met het Oog op Morgen, NPO Radio 1, item at 8.07 min.)
Item on awareness for sepsis
Karin Kaasjager (NOS Journaal, NPO 1, item at 6.01 min.)
Item on immune effects of micro plastics
Nienke Vrisekoop (Nieuwsuur, NPO 2)
Risk factors Everyone can get sepsis; often it's just bad luck. There are nevertheless factors that influence the risk. For example, the pathogenicity of a bacterium, the quantity and the location. Genetic predisposition may play a role. Adults >60 and babies are also more at risk. Peatients are also more vulnerable if they use immune suppressants or have a disease that affects the immune system.
Therapy Immediate treatment is of vital importance. This consists of giving oxygen, monitoring vital signs and then treating the infection with antibiotics, if a bacteria is the cause. The infection must be localized and sometimes surgery is necessary. The blood pressure can become so low due to the inflammatory reactions that the heart cannot pump sufficient blood to provide the organs with enough oxygen: a septic shock. Then, for example, dialysis or ventilation in an ICU is required.
Awareness The next speaker was Rinke van de Brink, NOS news editor and sepsis victim. He suffered a sepsis a few years ago, after an appendix surgery. He felt it went completely wrong in the hospital and suspected a sepsis. The nurses could not confirm that - Rinke just did not fully fit all diagnosic criteria. The doctor didn't have time to come by. Only thanks to his own assertiveness and the quick intervention of another doctor, he was still treated on time. He did, however, have enormous psychological residual symptoms. Rinkes plea is therefore: more recognition for the signals and, better aftercare, increased awareness. Full support came from sepsis victim Idelette Nutma. She has been fighting for years for more attention for sepsis and its consequences. These can vary from PTTS to loss of limbs - and a lot in-between. See also her patient platform www.sepsis-en-daarna.nl.
Last speaker, internist-infectiologist Jan Jelrik Oosterheert, offered hope: more and more attention is being paid to scientific research into sepsis that focuses on early recognition. Cooperation between different disciplines remains therefore necessary, he emphasized.