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Secretory IgA is a key mucosal component ensuring host-microbiota mutualism. Here we use nutritional geometry modelling in mice fed 10 different macronutrient-defined, isocaloric diets, and identify dietary protein as the major driver of secretory IgA production. Protein-driven secretory IgA induction is not mediated by T-cell-dependent pathways or changes in gut microbiota composition. Instead, the microbiota of high protein fed mice produces significantly higher quantities of extracellular vesicles, compared to those of mice fed high-carbohydrate or high-fat diets. These extracellular vesicles activate Toll-like receptor 4 to increase the epithelial expression of IgA-inducing cytokine, APRIL, B cell chemokine, CCL28, and the IgA transporter, PIGR. We show that succinate, produced in high concentrations by microbiota of high protein fed animals, increases generation of reactive oxygen species by bacteria, which in turn promotes extracellular vesicles production. Here we establish a link between dietary macronutrient composition, gut microbial extracellular vesicles release and host secretory IgA response. Secretory IgA plays vital roles interfacing between the host immune system and the resident microbiota at the mucosal surface. Here the authors explore the effect of dietary protein on the production of secretory IgA, driven by the production of extracellular vesicles by the intestinal microbiota.

The gut microbiome describes the complex community of microorganisms that populate the gastrointestinal tract. Gut microbes in the large bowel utilise both dietary-derived nutrients, such as host-indigestible carbohydrates (fibre) and excess protein, host-derived nutrients (intestinal mucin), and also interact with the by-products of digestion such as bile acids. They transform these compounds into a series of metabolites that can profoundly shape host physiology both locally and systemically. These metabolites can fundamentally alter host outcomes, promoting either gut health, or sub-optimal conditions in the gut that contribute to poor health, including increased risk of cancer. The microbiome of an individual has also been shown to impact response to cancer treatment strategies, including both treatment efficacy and side-effects in the gut and more systemically. This makes the microbiome a powerful potential tool for therapeutic purposes, once we overcome the challenges associated with individual variation in microbial community composition. As the gut microbial ecosystem is primarily altered by nutrient availability, diet therefore represents an important asset in therapeutically altering the gut microbiome.

Background Quality improvement (QI) projects depend on the active involvement of healthcare professionals. However, their engagement remains suboptimal, specially in humanitarian settings such as Sudan. Our study aimed to describe healthcare professionals’ engagement and to identify facilitators and barriers to conducting QI projects. Methods An online-based cross-sectional survey was conducted in Sudan between July and November 2024 using convenience sampling. The survey was distributed to healthcare professionals through different social media platforms. Data were manually cleaned in Excel sheet and analysed using Statistical Package for the Social Sciences Version 20 (SPSS 20). Chi Square test, Mann Whitney U test and Kruskal Walis test were used to identify factors associated with experience and self-efficacy in QI. Results A total of 1007 healthcare professionals were included in the study; the mean age was 27 ± 5 years, and the majority (67.9%) were females. Most of the participants (74.7%) were physicians, and (15.7%) were nurses. Only (18%) of participants reported that they have prior experience with QI projects. Older age, male gender and increased years of experience were found to be significantly associated with QI experience (p value < 0.05). Factors that influence self-efficacy in conducting QI projects were older age groups and increased years of experience, in addition to professional development opportunities such as formal training in QI, professional workshops in QI, and QI organisational membership. Barriers to conducting QI projects were lack of organisational support (59.1%), no access to QI content (48.6%), lack of time (39.8%), and lack of mentorship (31.5%). Conclusion The study reveals low engagement of healthcare professionals in QI projects. Organisational support and professional development opportunities are essential to ensure effective healthcare professionals’ engagement in QI projects, thereby enhancing the quality of care and ensuring favourable outcomes.