Medical, ethical, and legal aspects of hematopoietic stem cell transplantation for Crohn's disease in Brazil.

Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. The etiology of CD is unknown; however, genetic, epigenetic, environmental, and lifestyle factors could play an essential role in the onset and establishment of the disease. CD results from immune dysregulation due to loss of the healthy symbiotic relationship between host and intestinal flora and or its antigens. It affects both sexes equally with a male to female ratio of 1.0, and its onset can occur at any age, but the diagnosis is most commonly observed in the range of 20 to 40 years of age. CD diminishes quality of life, interferes with social activities, traumatizes due to the stigma of incontinence, fistulae, strictures, and colostomies, and in severe cases, affects survival when compared to the general population. Symptoms fluctuate between periods of remission and activity in which complications such as fistulas, strictures, and the need for bowel resection, surgery, and colostomy implantation make up the most severe aspects of the disease. CD can be progressive and the complications recurrent despite treatment with anti-inflammatory drugs, corticosteroids, immunosuppressants, and biological agents. However, over time many patients become refractory without treatment alternatives, and in this scenario, hematopoietic stem cell transplantation (HSCT) has emerged as a potential treatment option. The rationale for the use of HSCT for CD is anchored in animal studies and human clinical trials where HSCT could reset a patient's immune system by eliminating disease-causing effector cells and upon immune recovery increase regulatory and suppressive immune cells. Autologous HSCT using a non-myeloablative regimen of cyclophosphamide and anti-thymocyte globulin without CD34+ selection has been to date the most common transplant conditioning regimen adopted. In this review we will address the current situation regarding CD treatment with HSCT and emphasize the medical, ethical, and legal aspects that permeate the procedure in Brazil.

Hematopoietic stem cell transplantation for Crohn's disease: Gaps, doubts and perspectives.

Crohn's disease (CD) is an inflammatory bowel disease that can affect any site of the digestive system. It occurs due to an immunological imbalance and is responsible for intestinal mucosal lesions and complications such as fistulas and stenoses. Treatment aims to stabilize the disease, reducing the symptoms and healing intestinal lesions. Surgical procedures are common in patients. Cell therapy was initially used to treat this disease in patients who also suffered from lymphoma and leukemia and were considered to be good candidates for autologous and allogeneic transplantation. After transplantation, an improvement was also observed in their CD. In 2003, the procedure began to be used to treat the disease itself, and several case series and randomized studies have been published since then; this approach currently comprises a new option in the treatment of CD. However, considerable doubt along with significant gaps in our knowledge continue to exist in relation to cell therapy for CD. Cell therapy is currently restricted to the autologous modality of hematopoietic stem cell transplantation and, experimentally, to mesenchymal stromal cells to directly treat lesions of the anal mucosa. This article presents the supporting claims for transplantation as well as aspects related to the mobilization regime, conditioning and perspectives of cell therapy.

Meiotic behavior of 18 species from eight families of terrestrial heteroptera.

Insects of the suborder Heteroptera are known for their odor, for being pests, or for being disease carriers. To gain better insight into the cytogenetic characteristics of heteropterans, 18 species of terrestrial Heteroptera belonging to eight families were studied. The presence of heteropycnotic corpuscles during prophase I, terminal or interstitial chiasmas, telomeric associations between chromosomes, ring disposals of autosomes during metaphase, and late migrations of the sex chromosomes during anaphase were analyzed. These features showed identical patterns to other species of Heteroptera previously described in the literature. Another studied characteristic was chromosome complements. The male chromosome complements observed were 2n = 12 chromosomes [10A + XY, Galgupha sidae (Amyot & Serville) (Corimelaenidae) and Pachycoris torridus (Scopoli) (Scutelleridae)]; 2n = 13 [10A + 2m + X0, Harmostes serratus (Fabricius), Harmostes apicatus (Stål), Jadera haematoloma (Herrich-Schaeffer), Jadera sanguinolenta (Fabricius), Jadera sp. (Rhopalidae)], and Neomegalotomus parvus (Westwood) (Alydidae); 2n = 13 [12A + X0, Stenocoris furcifera (Westwood) (Alydidae); 2n = 14 [12A + XY, Dictyla monotropidia (Stål) (Tingidae)]; 2n = 19 [18A + X0, Acanonicus hahni (Stål) (Coreidae)]; 2n = 21 [18A + 2m + X0, Acanthocephala sp. (Dallas) (Coreidae)]; 2n = 27 [24A + 2m + X0, Anisoscelis foliacea marginella (Dallas) (Coreidae)]; 2n = 18 [16A + XY, Oncopeltus fasciatus (Dallas) (Lygaeidae)]; 2n = 17 [14A + X1X2Y, Oxycarenus hyalinipennis (Costa) (Lygaeidae)]; 2n = 16 [12A + 2m + XY, Pachybrachius bilobatus (Say) (Lygaeidae)]; 2n = 26 [24A + XY, Atopozelus opsinus (Elkins) (Reduviidae)]; and 2n = 27 [24A + X1X2Y, Doldina carinulata (Stål) (Reduviidae)]. The diversity of the cytogenetic characteristics of Heteroptera was reflected in the 18 studied species. Thus, this study extends the knowledge of these characteristics, such as the variations related to chromosome complements, sex chromosome systems, and meiotic behavior.

Morphological aspects of the testes of 18 species of terrestrial of Heteroptera from Northwestern Sao Paulo (Brazil) / Aspectos testiculares de 18 especies terrestres de Heteroptera do Noroeste de Sao Paulo (Brasil)

The Heteroptera are known for their odour, for being pests or for being disease carriers. However, they are still not extensively studied, perhaps because they form a very large group. Therefore, with the aim of enhancing the knowledge of the morphology of the testes of this insect order, we collected and analysed 18 species of terrestrial Heteroptera from the northwestern part of São Paulo. The analysis of these species revealed some differences between the testicles of these species, including their shape (elongated, oval, round or pecten), the morphology of the testicular lobes (elongated and paired side by side or united in a single region), the colours of the peritoneal sheath that surrounds the lobes (red, orange, yellow or translucent), and the number of testicular lobes (one, two, four, five, six or seven). Because the aspects analysed were highly variable, our study suggests a need for further analysis of Heteropteran testicular morphological differences.

Os Heteroptera são organismos conhecidos pelo seu odor, por serem pragas ou por serem transmissores de doenças, contudo, eles ainda são pouco estudados, talvez por formarem um grupo muito grande. Portanto, com o objetivo de ampliarmos as informações dos aspectos testiculares deste grupo analisamos 18 espécies de Heteroptera terrestres pertencentes a oito famílias que foram coletadas no Noroeste Paulista. Através das análises dessas espécies foi observado diferenças testiculares quanto: a sua forma (alongadas; ovalados; forma de concha, denominada pecten; ou arredondados); a morfologia dos lobos (alongados e pareados lado a lado ou unidos em uma única região, na forma de um “ofiuroide”); às cores da bainha peritoneal (alaranjada, amarelada, avermelhada ou transparente); ao número de lobos testiculares (um, dois, quatro, cinco, seis, sete). Devido aos aspectos analisados serem muito variáveis, nosso estudo sugere um aprofundamento maior na questão que envolve as diferenças morfológicas testiculares.