From the IMMEDIATE Project to New Health Apps: Interview with Giulia Candiani

The crucial role of the gut microbiota – the community of microorganisms living in our intestines – for overall health is increasingly evident: it not only affects digestive functions, such as intestinal regularity, but also immune system mechanisms and general well-being. In particular, “good” microorganisms help maintain the balance between pro-inflammatory and anti-inflammatory processes. Through the now well-recognized gut-brain axis, it is becoming clearer how the microbiota also influences mental health, including stress.

The European IMMEDIATE project, in which Zadig participates, aims to deepen our understanding of these mechanisms, identify key factors, and learn how to steer them toward better health.

Giulia Candiani, who leads Zadig’s involvement, tells us about the most interesting aspects of the work the agency is doing.

Digital Tools for Clinical Research

«Zadig is responsible for Work Package 5», Candiani explains, «which includes several activities related to the development of digital tools. The first we created is an app designed to support clinical research: the purpose of the study was to evaluate the potential usefulness of an Akkermansia muciniphila-based supplement – Akkermansia is a bacterium naturally present in the gut – in reducing stress. Stress is associated with microbiota imbalance, and Akkermansia is thought to play a role in restoring this balance.»

To assess stress levels and the possible beneficial effects of the supplement, a clinical study was organized involving 200 healthcare professionals working in emergency departments – a role known to be particularly at risk for stress. Half of the participants received the Akkermansia supplement, while the health conditions of all participants were monitored over time.

Candiani explains: «To evaluate stress levels and differences between the group taking the supplement and the placebo group, the study included, in addition to clinical parameter assessments, several questionnaires. One in particular had to be completed weekly to measure stress levels and strategies participants used to manage it, such as meditation, yoga, or other practices. For this, an app was needed so participants could comfortably respond to the questionnaire from home».

Participants used the app developed by Zadig to collect data, reporting positive feedback and ease of use.

According to Candiani, the same type of app can be used in other clinical research contexts: «This app, like all our apps, complies with legal requirements on safety and privacy, and includes a back-end that allows differentiation of roles: those who recruit and manage participants during the study are distinct from those who collect data anonymously. Moreover, the app is modular: it can be used for other studies with different participant groups or even in citizen science contexts, when citizens collaborate with researchers to collect data… in all cases where longitudinal home data collection is needed without requiring daily clinic visits».

Measuring Heart Rate with a Smartwatch

Another aspect that emerged during the project was interest in continuously collecting a key stress-related parameter: heart rate variability. «Within IMMEDIATE,» Candiani says, «we realized it would be interesting to understand how reliable heart rate variability measurements collected via wearable devices like smartwatches are, and how they correlate with stress. One of the goals of IMMEDIATE is to identify early markers of inflammation before clinical symptoms appear, and stress can play an important role in this. Thus, finding a simple way to measure stress through changes in heart rate is crucial».

To collect heart rate data, a clinical study was launched in collaboration with the University of Eastern Piedmont and the same hospital in Szczecin (Poland) involved in the first clinical trial. Sixty healthcare professionals participated, and an economically sustainable yet reliable smartwatch was selected for data collection. In addition to heart rate variability, data on sleep quantity and quality, number of steps, and physical activity levels were collected. The same questionnaires used in the first study were employed to assess correlations with stress. This three-month study is now concluding.

Participants wore the smartwatch, which transmitted data to a platform via an app linked to the platform. «If this parameter proves reliable,» Candiani notes, «we could collect it in a future app version usable by people wearing smartwatches or similar devices, which are increasingly common».

Immedia App — For All Citizens

Finally, and no less importantly, Zadig’s work culminated in the development of a second app currently in testing, aimed at all citizens. This app allows users both to collect data by answering questionnaires and to receive personalized healthy lifestyle recommendations based on their profile.

Candiani explains: «The app, called Immedia, is under development, with a release expected in April-May. A trial version is already being tested by some users. The app can be further developed to refine and tailor health advice by collecting more specific data and offering more personalized recommendations.»

«In summary,» Candiani concludes, «IMMEDIATE has enabled Zadig to gain additional experience, particularly in the field of apps designed to collect data that help citizens adopt a more informed and proactive attitude toward their health — experience we can extend to other applications as well.»