title: Uncomplicated diverticular disease: innate and adaptive immunity in human gut mucosa before and after rifaximin.
abstract: OBJECTIVE
  Uncomplicated diverticular disease (UDD) is a frequent condition in adults. The pathogenesis of symptoms remains unknown. Bacteria are able to interact with Toll-like receptors (TLRs) and to induce inflammation through both innate immunity and T-cell recruitment. We investigated the pattern of TLRs 2 and 4 and the intestinal homing in patients with UDD before and after a course of Rifaximin.
  
  
  METHODS
  Forty consecutive patients with UDD and 20 healthy asymptomatic subjects were enrolled. Among UDD patients, 20 were assigned to a 2-month course of treatment with Rifaximin 1.2 g/day for 15 days/month and 20 received placebo. Blood sample and colonic biopsies were obtained from patients and controls. The samples were collected and analyzed at baseline and at the end of treatment. Flow cytometry was performed using monoclonal antibodies (CD3, CD4, CD8, CD103, TCR-gamma/delta, CD14, TLR2, and TLR4).
  
  
  RESULTS
  In UDD, TLR2 and TLR4 expression on immune cell subpopulations from blood and mucosa of the affected colon are altered as compared with controls. Rifaximin treatment induced significant modifications of altered conditions.
  
  
  CONCLUSIONS
  Our data show the role of TLRs in the development of inflammation in UDD. TLRs distribution is altered in UDD and these alterations are reversed after antibiotic treatment. This trial is registered with ClinicalTrials.gov: NCT02068482.
authors.affiliation: Department of Medical Science, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Rossella
authors.identifier: 0000-0001-5378-8442
authors.initials: R
authors.lastname: Cianci
authors.affiliation: Department of Medical Science, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Simona
authors.identifier: 0000-0002-8026-0675
authors.initials: S
authors.lastname: Frosali
authors.affiliation: Department of Medical Science, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Danilo
authors.identifier: 0000-0003-4627-1909
authors.initials: D
authors.lastname: Pagliari
authors.affiliation: Endoscopy Unit, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cesaro
authors.affiliation: Endoscopy Unit, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Petruzziello
authors.affiliation: Department of Medical Science, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Casciano
authors.affiliation: Department of Medical Science, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Raffaele
authors.identifier: 0000-0002-7913-8576
authors.initials: R
authors.lastname: Landolfi
authors.affiliation: Endoscopy Unit, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: Department of Medical Science, Catholic University of the Sacred Heart, 'A. Gemelli' University Hospital, Largo A. Gemelli, 8-00168 Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Pandolfi
mesh_terms: D056704:Adaptive Immunity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004240:Diverticulum / Q000235:genetics / Q000276:immunology* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000494:pharmacology*; D015870:Gene Expression; D006801:Humans; D007113:Immunity, Innate; D016130:Immunophenotyping; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology*; D016131:Lymphocyte Subsets / Q000276:immunology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012294:Rifamycins / Q000008:administration & dosage / Q000494:pharmacology*; D000078262:Rifaximin; D012307:Risk Factors; D051193:Toll-Like Receptors / Q000235:genetics / Q000378:metabolism; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D012294:Rifamycins; D051193:Toll-Like Receptors; D000078262:Rifaximin