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The effects of four antibiotics on the yeast flora of the human gut were evaluated. Forty adult cancer patients who received therapy with amoxicillin-clavulanate, ciprofloxacin, sulfamethoxazole-trimethoprim or ampicillin were studied prospectively. Quantitative stool cultures for yeasts were performed immediately before, at the end of and one week after the end of the antibiotic treatment. Amoxicillin-clavulanate caused a higher and more persistent increase in gastrointestinal colonization by yeasts compared to ciprofloxacin, sulfamethoxazole-trimethoprim or ampicillin. The present results are similar to those obtained in a mouse model of gastrointestinal colonization by Candida albicans when the same antibiotics were used.

High levels of plasma adiponectin are associated with low levels of inflammatory markers and cardioprotection. The mechanism via which adiponectin exerts its anti-inflammatory effect is yet unknown. In the present study, we demonstrate that globular adiponectin (gAd) induces the expression of the inactive isoform of IL-1R-associated kinases (IRAK), IRAK-M. Homologous deletion of IRAK-M in IRAK-M−/− mice abolished the tolerogenic properties of gAd because pretreatment of IRAK-M−/− macrophages with gAd did not suppress LPS-induced proinflammatory cytokine production. GAd activated the MAPKs MEK1/2 and ERK1/2 in macrophages via their upstream regulator Tpl2. Activation of ERK1/2 via Tpl2 appeared necessary for the induction of IRAK-M because gAd did not induce IRAK-M in Tpl2−/− macrophages or in macrophages pretreated with the MEK1/2 inhibitor UO126. In addition, activation of PI3K and Akt1 also appeared necessary for the induction of IRAK-M by gAd, because treatment of Akt1−/− macrophages or pretreatment of macrophages with the PI3K inhibitor wortmannin abolished gAd-induced IRAK-M expression. Analysis of IRAK-M expression in human peripheral blood cells confirmed that serum adiponectin was negatively associated with IRAK-M and responsiveness to LPS. In conclusion, our data demonstrate that IRAK-M is a major mediator of gAd-induced endotoxin tolerance in primary macrophages, expression of which depends on the activation of Tpl2/ERK and PI3K/Akt1 signaling pathways.

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