Nausea and vomiting affect about 85% of pregnancies and can significantly impact quality of life, particularly during early pregnancy.

“The cause of nausea and vomiting during pregnancy is unknown to this date. Various theories have been proposed, but none of them is conclusive,” said Albert T. Liu, lead author for the study and a professor of obstetrics and gynecology.

“Nausea, vomiting and constipation during pregnancy can significantly diminish the quality of patients’ lives. Once nausea and vomiting during pregnancy progress, they can become difficult to control, and sometimes the patient even needs to be hospitalized,” Liu said.

Beneficial microbes

Probiotics are referred to as “beneficial bacteria.” They can be found in foods like yogurt, kimchi, kefir, sauerkraut and tempeh. Probiotics are also available as food supplements. According to the National Center for Complementary and Integrative Health, other than vitamins, probiotics or prebiotics were the third most commonly used dietary supplement for adults.

Probiotics are thought to support the community of different microbes, often referred to as the “gut microbiome,” found in the gastrointestinal tract.

During pregnancy, hormones like estrogen and progesterone increase, bringing about many physical changes. These increases can also change the gut microbiome, which likely affects the digestive system functions and causes unwanted symptoms like nausea, vomiting and constipation.

The researchers set out to determine whether supplementing with a probiotic could be beneficial for gastrointestinal function during pregnancy.

The study lasted for 16 days. A total of 32 participants took a probiotic capsule twice a day for six days and then took two days off. They then repeated the cycle.

The probiotics were available over-the-counter and mainly containedLactobacillus., a type of good bacteria. Each capsule contained approximately 10 billion live cultures at the time of manufacture.

Participants kept 17 daily observations of their symptoms during the duration of the study, for a total of 535 observations for the researchers to statistically assess.

What the researchers found was that taking the probiotic significantly reduced nausea and vomiting. Nausea hours (the number of hours participants felt nauseous) were reduced by 16%, and the number of times they vomited was reduced by 33%. Probiotic intake also significantly improved symptoms related to quality of life, such as fatigue, poor appetite and difficulty maintaining normal social activities, as scored by questionnaires.

Probiotics were also found to reduce constipation significantly.

“Over the years, I’ve observed that probiotics can reduce nausea and vomiting and ease constipation. It’s very encouraging that the study proved this to be true,” said Liu. “Probiotics have also benefited many of my other patients who weren’t in the study,” said Liu.

New clues from gut microbes and byproducts

Participants also contributed fecal specimens before and during the study. The samples were analyzed to identify the type and number of microbes and the different byproducts of digestion.

This allowed the researchers to examine whether biomarkers in the fecal specimens corresponded with more severe nausea and assess how the probiotics affected participants who began the study with different baseline biomarkers.

One finding was that a low amount of bacteria that carry an enzyme named bile salt hydrolase, which generates bile acid to absorb nutrients, was associated with more pregnancy-related vomiting. Probiotics increase bile salt hydrolase-producing bacteria, which may explain why the supplements decreased levels of nausea and vomiting.

Another finding was that high levels of the gut microbes Akkermansia and A. muciniphila at the beginning of the study were associated with more vomiting. The probiotic significantly reduced the amount of those particular microbes and also reduced vomiting. This suggests Akkermansia and A. muciniphila may be reliable biomarkers that can predict vomiting in pregnancy.

Another finding was that vitamin E levels increased after taking probiotics. Higher levels of vitamin E were associated with low vomiting scores.

“This research provides key insights about the impact of gut microbes on gastrointestinal function during pregnancy. Our gut microbiota explains why we are what we eat, and why bacteria-generated metabolites and products have a huge impact on our health,” said Wan. “They affect the gastrointestinal tract as well as skin health and neurological function.”

Although the findings are intriguing, the researchers caution that due to the small sample size, further studies will be needed to confirm the effects of the probiotics.

“Our previous work showed the benefits of probiotics in preventing liver inflammation. The current study might be one of the first to show the benefits of probiotics in pregnancy,” said Wan. “It would be interesting and important to further test whether probiotics can reduce nausea and vomiting caused by chemotherapy in cancer patients.”

Additional authors on this study include Shuai Chen from the Department of Public Health Sciences, and Prasant Kumar Jena, Lili Sheng and Ying Hu from the Department of Pathology and Laboratory Medicine at the University of California, Davis.

“What we say within a group, the ideas we suggest and the way we support others, signals something about who we are to our coworkers. It can attract people to us or repel them,” said Melissa Chamberlin, assistant professor of management and entrepreneurship at Iowa State University, and co-author of a paper recently published in Journal of Management.

In the paper, Chamberlin and her research team demonstrate how two different ways of communicating work-related issues shape reputations and affect the formation of teams to complete short-term projects. They found people who use “supportive voice,” which fuels trust and cooperation, have a higher chance of being recruited to a team compared to those who use a more task-oriented “challenging voice.”

Challenging voice pushes back against the status quo and offers ideas for improvement. While it has some downsides, such as perceived criticism or conflict, challenge voice tends to signal an employee’s competence or expertise. Chamberlin said managers, especially in dynamic and fast-paced industries, often value this communication behavior as something that can help teams complete tasks efficiently and effectively.

“Supportive voice is still about speaking up in the workplace, but it’s looking at what’s going well in the group or team. It might defend the status quo by saying there’s value in what the team is already doing,” said Chamberlin.

Supportive voice signals someone’s approachability and trustworthiness. It fosters strong interpersonal relationships, which Chamberlin said affects a team’s ability to communicate and coordinate efforts in order to reach goals.

To understand the effects of the two communication behaviors on team formation, the researchers collected data from a cohort of full-time, first-year Master of Business Administration students over a four-month period. The students were periodically assigned to different teams to complete projects and then asked to rate fellow team members’ use of challenging and supportive voice, quality of work, reputation and trust. Near the end of the study, students were allowed to assemble into teams without any direction from the MBA office.

The study results revealed students who ranked high on challenging voice built a reputation for conducting high-quality work, but students preferred to work in teams with those who frequently used supportive voice. Chamberlin said the results were surprising.

“Because challenging voice is the predominant form of speaking up we encourage in classrooms and as managers, we thought it was going to be strong driver of people selecting team members later. But as it turns out, this more supportive voice that helps establish relationships and a sense of trust amongst individuals in the group was more important,” Chamberlin said.

The researchers pointed out that having both types of voice would be ideal, but between the two, supportive voice was a stronger driver of team formation.

Chamberlin said the paper’s findings could help employees realize the way they speak up can have a strong effect on informal teaming up at a later point and help them move into leadership roles. As for managers, Chamberlin said the results could encourage them to foster and provide space for more supportive voice by coaching this type of behavior and rewarding employees who speak up supportively.

“There might be times that challenging voice reigns supreme but other situations where supportive voice becomes more critical for a team,” said Chamberlin. “Supportive voicers can keep teams together to make sure the work gets done.”

Story Source:

Materials provided by Iowa State University. Note: Content may be edited for style and length.

The new study, which the researchers noted is the first to demonstrate the beneficial effect of this type of meal timing intervention in humans, appears online in the journal Science Advances. It was funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.

“This is a rigorous and highly controlled laboratory study that demonstrates a potential intervention for the adverse metabolic effects associated with shift work, which is a known public health concern,” said Marishka Brown, Ph.D., director of the NHLBI’s National Center on Sleep Disorders Research. “We look forward to additional studies that confirm the results and begin to untangle the biological underpinnings of these findings.”

For the study, the researchers enrolled 19 healthy young participants (seven women and 12 men). After a preconditioning routine, the participants were randomly assigned to a 14-day controlled laboratory protocol involving simulated night work conditions with one of two meal schedules. One group ate during the nighttime to mimic a meal schedule typical among night workers, and one group ate during the daytime.

The researchers then evaluated the effects of these meal schedules on their internal circadian rhythms. That’s the internal process that regulates not just the sleep-wake cycle, but also the 24-hour cycle of virtually all aspects of your bodily functions, including metabolism.

The researchers found that nighttime eating boosted glucose levels — a risk factor for diabetes — while restricting meals to the daytime prevented this effect. Specifically, average glucose levels for those who ate at night increased by 6.4% during the simulated night work, while those who ate during the daytime showed no significant increases.

“This is the first study in humans to demonstrate the use of meal timing as a countermeasure against the combined negative effects of impaired glucose tolerance and disrupted alignment of circadian rhythms resulting from simulated night work,” said study leader Frank A.J.L. Scheer, Ph.D., professor of medicine at Harvard Medical School and director of the Medical Chronobiology Program at Brigham & Women’s Hospital in Boston.

The researchers said that the mechanisms behind the observed effects are complex. They believe that the nighttime eating effects on glucose levels during simulated night work are caused by circadian misalignment. That corresponds to the mistiming between the central circadian “clock” (located in the brain’s hypothalamus) and behavioral sleep/wake, light/dark, and fasting/eating cycles, which can influence peripheral “clocks” throughout the body. The current study shows that, in particular, mistiming of the central circadian clock with the fasting/eating cycles plays a key role in boosting glucose levels. The work further suggests the beneficial effects of daytime eating on glucose levels during simulated night work may be driven by better alignment between these central and peripheral “clocks.”

“This study reinforces the notion that when you eat matters for determining health outcomes such as blood sugar levels, which are relevant for night workers as they typically eat at night while on shift,” said the study co-leader Sarah L. Chellappa, M.D., Ph.D., a researcher in the nuclear medicine department at the University of Cologne, Germany. Chellappa formerly worked with Scheer in Brigham & Women’s Medical Chronobiology Program.

To translate these findings into practical and effective meal timing interventions, the researchers said more study is needed, including with real-life shift workers in their typical work environment.

Researchers from MIT, the La Jolla Institute for Immunology, and other institutions have now designed a new nanoparticle adjuvant that may be more potent than others now in use. Studies in mice showed that it significantly improved antibody production following vaccination against HIV, diphtheria, and influenza.

“We started looking at this particular formulation and found that it was incredibly potent, better than almost anything else we had tried,” says Darrell Irvine, the Underwood-Prescott Professor with appointments in MIT’s departments of Biological Engineering and Materials Science and Engineering; an associate director of MIT’s Koch Institute for Integrative Cancer Research; and a member of the Ragon Institute of MGH, MIT, and Harvard.

The researchers now hope to incorporate the adjuvant into an HIV vaccine that is currently being tested in clinical trials, in hopes of improving its performance.

Irvine and Shane Crotty, a professor at the Center for Infectious Disease and Vaccine Research at the La Jolla Institute for Immunology, are the senior authors of the study, which appears today in Science Immunology. The lead authors of the paper are Murillo Silva, a former MIT postdoc, and Yu Kato, a staff scientist at the La Jolla Institute.

More powerful vaccines

Although the idea of using adjuvants to boost vaccine effectiveness has been around for decades, there are only a handful of FDA-approved vaccine adjuvants. One is aluminum hydroxide, an aluminum salt that induces inflammation, and another is an oil and water emulsion that is used in flu vaccines. A few years ago, the FDA approved an adjuvant based on saponin, a compound derived from the bark of the Chilean soapbark tree.

Saponin formulated in liposomes is now used as an adjuvant in the shingles vaccine, and saponins are also being used in a cage-like nanoparticle called an immunostimulatory complex (ISCOM) in a Covid-19 vaccine that is currently in clinical trials.

Researchers have shown that saponins promote inflammatory immune responses and stimulate antibody production, but how they do that is unclear. In the new study, the MIT and La Jolla team wanted to figure out how the adjuvant exerts its effects, and to see if they could make it more potent.

They designed a new type of adjuvant that is similar to the ISCOM adjuvant but also incorporates a molecule called MPLA, which is a toll-like receptor agonist. When these molecules bind to toll-like receptors on immune cells, they promote inflammation. The researchers call their new adjuvant SMNP (saponin/MPLA nanoparticles).

“We expected that this could be interesting because saponin and toll-like receptor agonists are both adjuvants that have been studied separately and shown to be very effective,” Irvine says.

The researchers tested the adjuvant by injecting it into mice along with a few different antigens, or fragments of viral proteins. These included two HIV antigens, as well as diphtheria and influenza antigens. They compared the adjuvant to several other approved adjuvants and found that the new saponin-based nanoparticle elicited a stronger antibody response than any of the others.

One of the HIV antigens that they used is an HIV envelope protein nanoparticle, which presents many copies of the gp120 antigen that is present on the HIV viral surface. This antigen recently completed initial testing in phase 1 clinical trials. Irvine and Crotty are part of the Consortium for HIV/AIDS Vaccine Development at the Scripps Research Institute, which ran that trial. The researchers now hope to develop a way to manufacture the new adjuvant at large scale so it can be tested along with an HIV envelope trimer in another clinical trial beginning next year. Clinical trials that combine envelope trimers with the traditional vaccine adjuvant aluminum hydroxide are also underway.

“Aluminum hydroxide is safe but not particularly potent, so we hope that (the new adjuvant) would be an interesting alternative to elicit neutralizing antibody responses in people,” Irvine says.

Rapid flow

When vaccines are injected into the arm, they travel through lymph vessels to the lymph nodes, where they encounter and activate B cells. The research team found that the new adjuvant speeds up the flow of lymph to the nodes, helping the antigen to get there before it starts to break down. It does this in part by stimulating immune cells called mast cells, which previously were not known to be involved in vaccine responses.

“Getting to the lymph nodes quickly is useful because once you inject the antigen, it starts slowly breaking down. The sooner a B cell can see that antigen, the more likely it’s fully intact, so that B cells are targeting the structure as it will be present on the native virus,” Irvine says.

Additionally, once the vaccine reaches the lymph nodes, the adjuvant causes a layer of cells called macrophages, which act as a barrier, to die off quickly, making it easier for the antigen to get into the nodes.

Another way that the adjuvant helps boost immune responses is by activating inflammatory cytokines that drive a stronger response. The TLR agonist that the researchers included in the adjuvant is believed to amplify that cytokine response, but the exact mechanism for that is not known yet.

This kind of adjuvant could also be useful for any other kind of subunit vaccine, which consists of fragments of viral proteins or other molecules. In addition to their work on HIV vaccines, the researchers are also working on a potential Covid-19 vaccine, along with J. Christopher Love’s lab at the Koch Institute. The new adjuvant also appears to help stimulate T cell activity, which could make it useful as a component of cancer vaccines, which aim to stimulate the body’s own T cells to attack tumors.

The research was funded by the National Institute of Allergy and Infectious Diseases, the Koch Institute’s Marble Center for Cancer Nanomedicine, the U.S. Army Research Office through the Institute for Soldier Nanotechnologies at MIT, the Koch Institute Support (core) Grant from the National Cancer Institute, the International AIDS Vaccine Initiative, and the Ragon Institute.

Moreover, Wraparound may hold the potential for reducing disparities in outcomes for youth of color, which has long been found in mental health services.

A team of researchers, led by Jonathan Olson, PhD, at the University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA, conducted a meta-analysis of 17 controlled studies, and their results, published between 1996 and 2019 in order to compare the effects of Wraparound to regular services in youth with SED (serious emotional disorders).

“For many years, public systems have used Wraparound because it makes sense and provides families with the kind of compassionate approach, something that all families say they want and need,” said Dr. Eric Bruns, Professor of Psychiatry and senior author on the research team. “Now we have clear results that support what many have seen in their own local systems of care: that Wraparound is more effective and cost-effective than traditional services.”

Significant effects in favor of Wraparound across a range of important youth outcomes were found — including reduced out-of-home placements and improved mental health functioning and school outcomes. The study also found significantly lower overall care costs for youth in Wraparound care, due to less spending on costly out-of-home placements. Across the 17 studies, Wraparound effects were more positive for samples with higher proportions of youth of color.

“Wraparound lives up to principles we want to uphold — for example, being youth- and family-driven, strengths-based and using a team of people with a blank checkbook to ‘do whatever it takes’ to meet the needs of the youth and family,” added Dr. Bruns. “While many states have taken Wraparound to scale, others have been more hesitant, saying it wasn’t ‘evidence-based.’ This study should help address those concerns.”

Wraparound was established in the 1980s as an alternative to service delivery strategies that kept youth and family services in fragmented siloes, driven by professionals and often relying on costly institution-based care rather than investing in community supports. Instead, Wraparound invests in a care coordinator with a low caseload who convenes a team that includes the family, friends and members of the wider community, as well as service and support providers.

Dr. Olson also points out, however, that the study additionally reinforced how important it is to implement high-quality Wraparound services that are true to the model: “Unfortunately, many studies were conducted before there were measures of fidelity, or measures of ‘doing Wraparound right,'” he said. “However, for studies that did measure fidelity, we saw more positive outcomes for youth and families who received care that was of high-quality and closely adhered to Wraparound principles.”

The potential for Wraparound to better meet the needs of youth of color was an unexpected finding, concluded Dr. Bruns, but perhaps not surprising: “We need to remember that in all these studies, Wraparound was compared to more traditional services delivered in mental health, child welfare and juvenile justice.

“There is a long history of research showing disparities in access and outcomes for youth of color and their families. It may be that by allowing for more youth and family voice and choice, and teams that include family, friends, and community members, Wraparound helps reduce those disparities. However, such questions were not the explicit focus of these studies. We need to investigate the issue of what may address disparities with greater rigor.”

Story Source:

Materials provided by Elsevier. Note: Content may be edited for style and length.