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These guidelines propose initial minimum competencies for the clinical practice of HRA, against which professionals can judge themselves and providers can evaluate the effectiveness of training. Once standards have been agreed upon and validated, it may be possible to develop certification methods for individual practitioners and accreditation of sites.

Intestinal cells grown in microgravity produce a three-dimensional tissue assembly or “organoid” similar to the human intestinal mucosa, making it an ideal model for enteric infections such as cryptosporidiosis. Methods HCT8 cells were grown in a reduced-gravity, low-shear, rotating wall vessel (RWV) system and infected with C. parvum oocysts. Routine and electron microscopy (EM), immunolabelling with fluorescein-labeled Vicia villosa lectin and phycoerythrin-labeled monoclonal antibody to a 15kD surface membrane protein and quantitative polymerase chain reaction (qPCR) using probes for 18s rRNA of C. parvum and HCT8 cells were performed. Results The RWV allowed development of columnar epithelium-like structures. Higher magnification revealed well-developed brush-borders at the apical side of the tissue. Incubation with C. parvum resulted to patchy disruption of the epithelium and localized infection with the organism at the surface of several epithelial cells. EM revealed irregular stunting of microvilli, foci of indistinct tight junctions, and areas of loose paracellular spaces. Quantitative PCR showed 1.85 logs (70-fold) progression of infection from 6 to 48 hours of incubation. Conclusion The HCT8 organoid displayed morphologic changes indicative of successful and quantifiable infection with C. parvum. The HCT8 organoid culture system may have application in interventional in vitro studies for cryptosporidiosis.

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Cryptosporidiosis should be recognized as an important cause of diarrhea after SOT and is associated with elevated TAC levels and acute kidney injury. Increased TAC levels may reflect altered drug metabolism in the small intestine.