Giovanni Sarnelli | Università degli Studi di Napoli "Federico II" (original) (raw)

Papers by Giovanni Sarnelli

Research paper thumbnail of Ultramicronized Palmitoylethanolamide Inhibits NLRP3 Inflammasome Expression and Pro-Inflammatory Response Activated by SARS-CoV-2 Spike Protein in Cultured Murine Alveolar Macrophages

Metabolites

Despite its possible therapeutic potential against COVID-19, the exact mechanism(s) by which palm... more Despite its possible therapeutic potential against COVID-19, the exact mechanism(s) by which palmitoylethanolamide (PEA) exerts its beneficial activity is still unclear. PEA has demonstrated analgesic, anti-allergic, and anti-inflammatory activities. Most of the anti-inflammatory properties of PEA arise from its ability to antagonize nuclear factor-κB (NF-κB) signalling pathway via the selective activation of the PPARα receptors. Acting at this site, PEA can downstream several genes involved in the inflammatory response, including cytokines (TNF-α, Il-1β) and other signal mediators, such as inducible nitric oxide synthase (iNOS) and COX2. To shed light on this, we tested the anti-inflammatory and immunomodulatory activity of ultramicronized(um)-PEA, both alone and in the presence of specific peroxisome proliferator-activated receptor alpha (PPAR-α) antagonist MK886, in primary cultures of murine alveolar macrophages exposed to SARS-CoV-2 spike glycoprotein (SP). SP challenge caused ...

Research paper thumbnail of Engineered Lactobacillus paracasei Producing Palmitoylethanolamide (PEA) Prevents Colitis in Mice

International Journal of Molecular Sciences

Palmitoylethanolamide (PEA) is an N-acylethanolamide produced on-demand by the enzyme N-acylphosp... more Palmitoylethanolamide (PEA) is an N-acylethanolamide produced on-demand by the enzyme N-acylphosphatidylethanolamine-preferring phospholipase D (NAPE-PLD). Being a key member of the larger family of bioactive autacoid local injury antagonist amides (ALIAmides), PEA significantly improves the clinical and histopathological stigmata in models of ulcerative colitis (UC). Despite its safety profile, high PEA doses are required in vivo to exert its therapeutic activity; therefore, PEA has been tested only in animals or human biopsy samples, to date. To overcome these limitations, we developed an NAPE-PLD-expressing Lactobacillus paracasei F19 (pNAPE-LP), able to produce PEA under the boost of ultra-low palmitate supply, and investigated its therapeutic potential in a murine model of UC. The coadministration of pNAPE-LP and palmitate led to a time-dependent release of PEA, resulting in a significant amelioration of the clinical and histological damage score, with a significantly reduced n...

Research paper thumbnail of Symptoms and Pathophysiological Correlations in Patients with Constipation and Functional Dyspepsia

Research paper thumbnail of Cannabidiol Reduces Intestinal Inflammation through the Control of Neuroimmune Axis

Research paper thumbnail of The Importance of the Enteric Glia and its Related Product S100b Protein in Gut Inflammation

Research paper thumbnail of Palmitoylethanolamide regulates production of pro-angiogenic mediators in a model of β amyloid-induced astrogliosis in vitro

CNS & neurological disorders drug targets, Jan 17, 2015

Aβ-induced astrogliosis can worsen the eziopathogenesis of Alzheimer disease (AD) by the release ... more Aβ-induced astrogliosis can worsen the eziopathogenesis of Alzheimer disease (AD) by the release of pro-inflammatory and pro-oxidant mediators. Activated glial cells may release also pro-angiogenic molecules. The role of angiogenesis in AD is still controversial: although angiogenesis brings oxygen and nutrients to injured tissue, it may also exacerbate reactive gliosis. Moreover, by altering blood-brain barrier permeability pro-angiogenic mediators promote passage of inflammatory/immune-competent cells into the brain, thereby exacerbating gliosis. The release of pro-angiogenic factors during astrogliosis may thus be a key-step in controlling AD progression. The endogenous fatty acid amide, palmitoylethanolamide (PEA), is a pleiotropic mediator exerting anti-inflammatory, antinociceptive and anti-angiogenic effects in several in vitro and in vivo models of chronic-degenerative disease. In this study, we investigated the effects of PEA in AD angiogenesis and neuroinflammation by usin...

Research paper thumbnail of P.1.147: RAGE-DEPENDENT S100B PROTEIN MODULATION OF PERIPHERAL AND MUCOSAL IMMUNE CELLS' FUNCTIONS IN PATIENTS WITH ULCERATIVE COLITIS (UC)

Research paper thumbnail of The HLA-DQβ1 insertion is a strong achalasia risk factor and displays a geospatial north-south gradient among Europeans

European journal of human genetics : EJHG, Jan 6, 2016

Idiopathic achalasia is a severe motility disorder of the esophagus and is characterized by a fai... more Idiopathic achalasia is a severe motility disorder of the esophagus and is characterized by a failure of the lower esophageal sphincter to relax due to a loss of neurons in the myenteric plexus. Most recently, we identified an eight-amino-acid insertion in the cytoplasmic tail of HLA-DQβ1 as strong achalasia risk factor in a sample set from Central Europe, Italy and Spain. Here, we tested whether the HLA-DQβ1 insertion also confers achalasia risk in the Polish and Swedish population. We could replicate the initial findings and the insertion shows strong achalasia association in both samples (Poland P=1.84 × 10(-04), Sweden P=7.44 × 10(-05)). Combining all five European data sets - Central Europe, Italy, Spain, Poland and Sweden - the insertion is achalasia associated with Pcombined=1.67 × 10(-35). In addition, we observe that the frequency of the insertion shows a geospatial north-south gradient. The insertion is less common in northern (around 6-7% in patients and 2% in controls fr...

Research paper thumbnail of Research Article S100B Inhibitor Pentamidine Attenuates Reactive Gliosis and Reduces Neuronal Loss in a Mouse Model of Alzheimer's Disease

Biomed Research International, Dec 22, 2014

Research paper thumbnail of Eosinophilic esophagitis: From pathophysiology to treatment

World journal of gastrointestinal pathophysiology, Jan 15, 2015

Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic... more Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often requi...

Research paper thumbnail of Impact of genetic polymorphisms on the pathogenesis of achalasia: An age-dependent paradigm?

Neurogastroenterology and Motility

Research paper thumbnail of Gastrointestinal regulation of food intake: Do gut motility, enteric nerves and entero-hormones play together?

Research paper thumbnail of Altered taste perception in patients with gastroesophageal reflux disease. Neurogastroenterology & Motility

Research paper thumbnail of The Bitter Taste Receptor Agonist Quinine Reduces Calorie Intake and Increases the Post-prandial Release of Cholecystokinin in Healthy Subjects

Journal of Neurogastroenterology and Motility, 2015

Bitter taste receptors are expressed throughout the digestive tract. Data on animals have suggest... more Bitter taste receptors are expressed throughout the digestive tract. Data on animals have suggested these receptors are involved in the gut hormone release, but no data are available in humans. Our aim is to assess whether bitter agonists influence food intake and gut hormone release in healthy subjects. Twenty healthy volunteers were enrolled in a double-blind cross-over study. On 2 different days, each subject randomly received an acid-resistant capsule containing either placebo or 18 mg of hydrochloride (HCl) quinine. After 60 minutes, all subjects were allowed to eat an ad libitum meal until satiated. Plasma samples were obtained during the experiment in order to evaluate cholecystokinin (CCK) and ghrelin levels. Each subject was screened to determine phenylthiocarbamide (PTC) tasting status. Calorie intake was significantly lower when subjects received HCl quinine than placebo (514 ± 248 vs 596 ± 286 kcal; P = 0.007). Significantly higher CCK ΔT90 vs T0 and ΔT90 vs T60 were found when subjects received HCl quinine than placebo (0.70 ± 0.69 vs 0.10 ± 0.86 ng/mL, P = 0.026; 0.92 ± 0.75 vs 0.50 ± 0.55 ng/mL, P = 0.033, respectively). PTC tasters ingested a significantly lower amount of calories when they received HCl quinine compared to placebo (526 ± 275 vs 659 ± 320 kcal; P = 0.005), whereas no significant differences were found for PTC non-tasters (499 ± 227 vs 519 ± 231 kcal; P = 0.525). This study showed that intra-duodenal release of a bitter compound is able to significantly affect calorie intake and CCK release after a standardized meal. Our results suggest that bitter taste receptor signaling may have a crucial role in the control of food intake.

Research paper thumbnail of S100B Inhibitor Pentamidine Attenuates Reactive Gliosis and Reduces Neuronal Loss in a Mouse Model of Alzheimer's Disease

BioMed research international, 2015

Among the different signaling molecules released during reactive gliosis occurring in Alzheimer&#... more Among the different signaling molecules released during reactive gliosis occurring in Alzheimer's disease (AD), the astrocyte-derived S100B protein plays a key role in neuroinflammation, one of the hallmarks of the disease. The use of pharmacological tools targeting S100B may be crucial to embank its effects and some of the pathological features of AD. The antiprotozoal drug pentamidine is a good candidate since it directly blocks S100B activity by inhibiting its interaction with the tumor suppressor p53. We used a mouse model of amyloid beta- (Aβ-) induced AD, which is characterized by reactive gliosis and neuroinflammation in the brain, and we evaluated the effect of pentamidine on the main S100B-mediated events. Pentamidine caused the reduction of glial fibrillary acidic protein, S100B, and RAGE protein expression, which are signs of reactive gliosis, and induced p53 expression in astrocytes. Pentamidine also reduced the expression of proinflammatory mediators and markers, th...

Research paper thumbnail of S100B-p53 disengagement by pentamidine promotes apoptosis and inhibits cellular migration via aquaporin-4 and metalloproteinase-2 inhibition in C6 glioma cells

Research paper thumbnail of Food intake and gastrointestinal motility. A complex interplay

Nutrition, Metabolism and Cardiovascular Diseases, 2004

The complex network between the central nervous system and the enteric nervous system plays a piv... more The complex network between the central nervous system and the enteric nervous system plays a pivotal role in preparing the digestive tract to receive food, process it to activate digestion and control food intake itself. This field has always stimulated researchers and is now receiving notable impetus by the availability of sophisticated technologies able to provide an increasing amount of complex data. This article describes recent findings that underline the role of feeding and the gastrointestinal system in regulating food intake.

Research paper thumbnail of Pathogen and Probiotic Bacteria Differentially Stimulate Nitric Oxide Production and S100B Protein Expression in Human Enteroglial Cells

Research paper thumbnail of Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia

The American journal of gastroenterology, 2003

The relationship between functional dyspepsia and delayed gastric emptying of solids or liquids i... more The relationship between functional dyspepsia and delayed gastric emptying of solids or liquids is still unclear. The aim of the present study was to investigate in dyspeptic patients the prevalence of delayed gastric emptying for solids or for liquids and to investigate the relationship to the dyspepsia symptom pattern. In 392 and 330 patients with functional dyspepsia, the solid and liquid gastric emptying, respectively, was measured using breath tests, and the severity of eight dyspeptic symptoms was scored. Gastric emptying of solids and liquids were delayed in 23% and 35% of the patients. Multivariate analysis showed that the presence of vomiting and postprandial fullness was associated with delayed solid emptying (OR 2.65, 95% CI = 1.62-4.35 and OR 3.08, 95% CI = 1.28-9.16, respectively). Postprandial fullness was also associated with the risk of delayed liquid emptying when symptom was present (OR 3.5, 95% CI = 1.57-8.68), relevant or severe (OR 2.504, 95% CI = 1.41-4.65), an...

Research paper thumbnail of S100B protein in the gut: The evidence for enteroglial-sustained intestinal inflammation

World Journal of Gastroenterology, 2011

Research paper thumbnail of Ultramicronized Palmitoylethanolamide Inhibits NLRP3 Inflammasome Expression and Pro-Inflammatory Response Activated by SARS-CoV-2 Spike Protein in Cultured Murine Alveolar Macrophages

Metabolites

Despite its possible therapeutic potential against COVID-19, the exact mechanism(s) by which palm... more Despite its possible therapeutic potential against COVID-19, the exact mechanism(s) by which palmitoylethanolamide (PEA) exerts its beneficial activity is still unclear. PEA has demonstrated analgesic, anti-allergic, and anti-inflammatory activities. Most of the anti-inflammatory properties of PEA arise from its ability to antagonize nuclear factor-κB (NF-κB) signalling pathway via the selective activation of the PPARα receptors. Acting at this site, PEA can downstream several genes involved in the inflammatory response, including cytokines (TNF-α, Il-1β) and other signal mediators, such as inducible nitric oxide synthase (iNOS) and COX2. To shed light on this, we tested the anti-inflammatory and immunomodulatory activity of ultramicronized(um)-PEA, both alone and in the presence of specific peroxisome proliferator-activated receptor alpha (PPAR-α) antagonist MK886, in primary cultures of murine alveolar macrophages exposed to SARS-CoV-2 spike glycoprotein (SP). SP challenge caused ...

Research paper thumbnail of Engineered Lactobacillus paracasei Producing Palmitoylethanolamide (PEA) Prevents Colitis in Mice

International Journal of Molecular Sciences

Palmitoylethanolamide (PEA) is an N-acylethanolamide produced on-demand by the enzyme N-acylphosp... more Palmitoylethanolamide (PEA) is an N-acylethanolamide produced on-demand by the enzyme N-acylphosphatidylethanolamine-preferring phospholipase D (NAPE-PLD). Being a key member of the larger family of bioactive autacoid local injury antagonist amides (ALIAmides), PEA significantly improves the clinical and histopathological stigmata in models of ulcerative colitis (UC). Despite its safety profile, high PEA doses are required in vivo to exert its therapeutic activity; therefore, PEA has been tested only in animals or human biopsy samples, to date. To overcome these limitations, we developed an NAPE-PLD-expressing Lactobacillus paracasei F19 (pNAPE-LP), able to produce PEA under the boost of ultra-low palmitate supply, and investigated its therapeutic potential in a murine model of UC. The coadministration of pNAPE-LP and palmitate led to a time-dependent release of PEA, resulting in a significant amelioration of the clinical and histological damage score, with a significantly reduced n...

Research paper thumbnail of Symptoms and Pathophysiological Correlations in Patients with Constipation and Functional Dyspepsia

Research paper thumbnail of Cannabidiol Reduces Intestinal Inflammation through the Control of Neuroimmune Axis

Research paper thumbnail of The Importance of the Enteric Glia and its Related Product S100b Protein in Gut Inflammation

Research paper thumbnail of Palmitoylethanolamide regulates production of pro-angiogenic mediators in a model of β amyloid-induced astrogliosis in vitro

CNS & neurological disorders drug targets, Jan 17, 2015

Aβ-induced astrogliosis can worsen the eziopathogenesis of Alzheimer disease (AD) by the release ... more Aβ-induced astrogliosis can worsen the eziopathogenesis of Alzheimer disease (AD) by the release of pro-inflammatory and pro-oxidant mediators. Activated glial cells may release also pro-angiogenic molecules. The role of angiogenesis in AD is still controversial: although angiogenesis brings oxygen and nutrients to injured tissue, it may also exacerbate reactive gliosis. Moreover, by altering blood-brain barrier permeability pro-angiogenic mediators promote passage of inflammatory/immune-competent cells into the brain, thereby exacerbating gliosis. The release of pro-angiogenic factors during astrogliosis may thus be a key-step in controlling AD progression. The endogenous fatty acid amide, palmitoylethanolamide (PEA), is a pleiotropic mediator exerting anti-inflammatory, antinociceptive and anti-angiogenic effects in several in vitro and in vivo models of chronic-degenerative disease. In this study, we investigated the effects of PEA in AD angiogenesis and neuroinflammation by usin...

Research paper thumbnail of P.1.147: RAGE-DEPENDENT S100B PROTEIN MODULATION OF PERIPHERAL AND MUCOSAL IMMUNE CELLS' FUNCTIONS IN PATIENTS WITH ULCERATIVE COLITIS (UC)

Research paper thumbnail of The HLA-DQβ1 insertion is a strong achalasia risk factor and displays a geospatial north-south gradient among Europeans

European journal of human genetics : EJHG, Jan 6, 2016

Idiopathic achalasia is a severe motility disorder of the esophagus and is characterized by a fai... more Idiopathic achalasia is a severe motility disorder of the esophagus and is characterized by a failure of the lower esophageal sphincter to relax due to a loss of neurons in the myenteric plexus. Most recently, we identified an eight-amino-acid insertion in the cytoplasmic tail of HLA-DQβ1 as strong achalasia risk factor in a sample set from Central Europe, Italy and Spain. Here, we tested whether the HLA-DQβ1 insertion also confers achalasia risk in the Polish and Swedish population. We could replicate the initial findings and the insertion shows strong achalasia association in both samples (Poland P=1.84 × 10(-04), Sweden P=7.44 × 10(-05)). Combining all five European data sets - Central Europe, Italy, Spain, Poland and Sweden - the insertion is achalasia associated with Pcombined=1.67 × 10(-35). In addition, we observe that the frequency of the insertion shows a geospatial north-south gradient. The insertion is less common in northern (around 6-7% in patients and 2% in controls fr...

Research paper thumbnail of Research Article S100B Inhibitor Pentamidine Attenuates Reactive Gliosis and Reduces Neuronal Loss in a Mouse Model of Alzheimer's Disease

Biomed Research International, Dec 22, 2014

Research paper thumbnail of Eosinophilic esophagitis: From pathophysiology to treatment

World journal of gastrointestinal pathophysiology, Jan 15, 2015

Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic... more Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often requi...

Research paper thumbnail of Impact of genetic polymorphisms on the pathogenesis of achalasia: An age-dependent paradigm?

Neurogastroenterology and Motility

Research paper thumbnail of Gastrointestinal regulation of food intake: Do gut motility, enteric nerves and entero-hormones play together?

Research paper thumbnail of Altered taste perception in patients with gastroesophageal reflux disease. Neurogastroenterology & Motility

Research paper thumbnail of The Bitter Taste Receptor Agonist Quinine Reduces Calorie Intake and Increases the Post-prandial Release of Cholecystokinin in Healthy Subjects

Journal of Neurogastroenterology and Motility, 2015

Bitter taste receptors are expressed throughout the digestive tract. Data on animals have suggest... more Bitter taste receptors are expressed throughout the digestive tract. Data on animals have suggested these receptors are involved in the gut hormone release, but no data are available in humans. Our aim is to assess whether bitter agonists influence food intake and gut hormone release in healthy subjects. Twenty healthy volunteers were enrolled in a double-blind cross-over study. On 2 different days, each subject randomly received an acid-resistant capsule containing either placebo or 18 mg of hydrochloride (HCl) quinine. After 60 minutes, all subjects were allowed to eat an ad libitum meal until satiated. Plasma samples were obtained during the experiment in order to evaluate cholecystokinin (CCK) and ghrelin levels. Each subject was screened to determine phenylthiocarbamide (PTC) tasting status. Calorie intake was significantly lower when subjects received HCl quinine than placebo (514 ± 248 vs 596 ± 286 kcal; P = 0.007). Significantly higher CCK ΔT90 vs T0 and ΔT90 vs T60 were found when subjects received HCl quinine than placebo (0.70 ± 0.69 vs 0.10 ± 0.86 ng/mL, P = 0.026; 0.92 ± 0.75 vs 0.50 ± 0.55 ng/mL, P = 0.033, respectively). PTC tasters ingested a significantly lower amount of calories when they received HCl quinine compared to placebo (526 ± 275 vs 659 ± 320 kcal; P = 0.005), whereas no significant differences were found for PTC non-tasters (499 ± 227 vs 519 ± 231 kcal; P = 0.525). This study showed that intra-duodenal release of a bitter compound is able to significantly affect calorie intake and CCK release after a standardized meal. Our results suggest that bitter taste receptor signaling may have a crucial role in the control of food intake.

Research paper thumbnail of S100B Inhibitor Pentamidine Attenuates Reactive Gliosis and Reduces Neuronal Loss in a Mouse Model of Alzheimer's Disease

BioMed research international, 2015

Among the different signaling molecules released during reactive gliosis occurring in Alzheimer&#... more Among the different signaling molecules released during reactive gliosis occurring in Alzheimer's disease (AD), the astrocyte-derived S100B protein plays a key role in neuroinflammation, one of the hallmarks of the disease. The use of pharmacological tools targeting S100B may be crucial to embank its effects and some of the pathological features of AD. The antiprotozoal drug pentamidine is a good candidate since it directly blocks S100B activity by inhibiting its interaction with the tumor suppressor p53. We used a mouse model of amyloid beta- (Aβ-) induced AD, which is characterized by reactive gliosis and neuroinflammation in the brain, and we evaluated the effect of pentamidine on the main S100B-mediated events. Pentamidine caused the reduction of glial fibrillary acidic protein, S100B, and RAGE protein expression, which are signs of reactive gliosis, and induced p53 expression in astrocytes. Pentamidine also reduced the expression of proinflammatory mediators and markers, th...

Research paper thumbnail of S100B-p53 disengagement by pentamidine promotes apoptosis and inhibits cellular migration via aquaporin-4 and metalloproteinase-2 inhibition in C6 glioma cells

Research paper thumbnail of Food intake and gastrointestinal motility. A complex interplay

Nutrition, Metabolism and Cardiovascular Diseases, 2004

The complex network between the central nervous system and the enteric nervous system plays a piv... more The complex network between the central nervous system and the enteric nervous system plays a pivotal role in preparing the digestive tract to receive food, process it to activate digestion and control food intake itself. This field has always stimulated researchers and is now receiving notable impetus by the availability of sophisticated technologies able to provide an increasing amount of complex data. This article describes recent findings that underline the role of feeding and the gastrointestinal system in regulating food intake.

Research paper thumbnail of Pathogen and Probiotic Bacteria Differentially Stimulate Nitric Oxide Production and S100B Protein Expression in Human Enteroglial Cells

Research paper thumbnail of Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia

The American journal of gastroenterology, 2003

The relationship between functional dyspepsia and delayed gastric emptying of solids or liquids i... more The relationship between functional dyspepsia and delayed gastric emptying of solids or liquids is still unclear. The aim of the present study was to investigate in dyspeptic patients the prevalence of delayed gastric emptying for solids or for liquids and to investigate the relationship to the dyspepsia symptom pattern. In 392 and 330 patients with functional dyspepsia, the solid and liquid gastric emptying, respectively, was measured using breath tests, and the severity of eight dyspeptic symptoms was scored. Gastric emptying of solids and liquids were delayed in 23% and 35% of the patients. Multivariate analysis showed that the presence of vomiting and postprandial fullness was associated with delayed solid emptying (OR 2.65, 95% CI = 1.62-4.35 and OR 3.08, 95% CI = 1.28-9.16, respectively). Postprandial fullness was also associated with the risk of delayed liquid emptying when symptom was present (OR 3.5, 95% CI = 1.57-8.68), relevant or severe (OR 2.504, 95% CI = 1.41-4.65), an...

Research paper thumbnail of S100B protein in the gut: The evidence for enteroglial-sustained intestinal inflammation

World Journal of Gastroenterology, 2011