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The impact of flavonoids on fatigue has not been investigated in relapsing and remitting multiple sclerosis (RRMS).Objective: To determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS.Methods: A randomised double-blind placebo-controlled feasibility study in people recently diagnosed with RRMS and fatigue, throughout the Thames Valley, UK (ISRCTN69897291). During a 6-week intervention participants consumed a high or low flavonoid cocoa beverage daily. Fatigue and fatigability were measured at three visits (weeks 0, 3 and 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation.Results: 40 people with multiple sclerosis (10 men, 30 women, age 44±10 years) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data were <20% and adherence to intervention of allocated individuals was >75%. There was a small effect on fatigue (Neuro-QoL: effect size (ES) 0.04, 95% CI -0.40 to 0.48) and a moderate effect on fatigability (6 min walk test: ES 0.45, 95% CI -0.18 to 1.07). There were seven adverse events (four control, three intervention), only one of which was possibly related and it was resolved.Conclusion: A flavonoid beverage demonstrates the potential to improve fatigue and fatigability in RRMS. [ABSTRACT FROM AUTHOR]

Epithelial cells (enterocytes) form part of the intestinal barrier, the largest human interface between the internal and external environments, and responsible for maintaining regulated intestinal absorption and immunological control. Under inflammatory conditions, the intestinal barrier and its component enterocytes become inflamed, leading to changes in barrier histology, permeability, and chemical mediator production. Omega-3 (ω-3) polyunsaturated fatty acids (PUFAs) can influence the inflammatory state of a range of cell types, including endothelial cells, monocytes, and macrophages. This review aims to assess the current literature detailing the effects of ω-3 PUFAs on epithelial cells. Marine-derived ω-3 PUFAs, eicosapentaenoic acid and docosahexaenoic acid, as well as plant-derived alpha-linolenic acid, are incorporated into intestinal epithelial cell membranes, prevent changes to epithelial permeability, inhibit the production of pro-inflammatory cytokines and eicosanoids and induce the production of anti-inflammatory eicosanoids and docosanoids. Altered inflammatory markers have been attributed to changes in activity and/or expression of proteins involved in inflammatory signalling including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), peroxisome proliferator activated receptor (PPAR) α and γ, G-protein coupled receptor (GPR) 120 and cyclooxygenase (COX)-2. Effective doses for each ω-3 PUFA are difficult to determine due to inconsistencies in dose and time of exposure between different in vitro models and between in vivo and in vitro models. Further research is needed to determine the anti-inflammatory potential of less-studied ω-3 PUFAs, including docosapentaenoic acid and stearidonic acid. [ABSTRACT FROM AUTHOR]

The gut epithelium is a protective interface between the external environment and the human body. This epithelium interacts with a multitude of internal stimuli from the bloodstream and immune cells, and luminal stimuli from microorganisms and the diet. Disruptions to the epithelium are seen in inflammatory bowel diseases and coeliac disease. The human adenocarcinoma cell line (Caco-2) is an in vitro model used to assess the interactions between nutrients and gut epithelium. Long-chain omega-3 (n-3) polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have anti-inflammatory effects via the production of anti-inflammatory eicosanoids, interactions with immune cells and reductions in pro-inflammatory cytokines and chemokines. The aim of this study is to assess the anti-inflammatory properties of DHA and EPA in stimulated Caco-2 monolayers. Caco-2 cells were seeded at 70,000 cells/cm2 and grown to confluence before being allowed to fully differentiate (approx. 21 days total). Cytokines (TNF-α, IFN-γ, and IL-1β) and peptic-tryptic (PT-) gliadin were used as inflammatory stimulants. EPA and DHA incubations occurred 48 hours pre-stimulation. Tight junction function and morphology was determined using trans-epithelial electrical resistance measurements and confocal microscopy. Inflammatory markers, including IL-6, IL-8, and IL-17, were assessed by multiplex. Stimulatory cytokines induced tight junction dysfunction and increased pro-inflammatory mediator production in Caco-2 cells. PT-gliadin, DHA and EPA treatment did not alter paracellular permeability or stimulant-induced production of pro-inflammatory mediators. Further investigation of the inflammatory role of n-3 PUFAs and PT-gliadin in the Caco-2 model is required. Future work will assess the composition of PT-gliadin by electrophoresis and whether co-incubation of n-3 PUFAs and inflammatory cytokines will alter paracellular permeability and mediator output of Caco-2 cells. [ABSTRACT FROM AUTHOR]