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1.
Trends Immunol ; 45(6): 442-453, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38782625

RESUMO

Activated CD8+ T cells directly kill target cells. Therefore, the regulation of their function is central to avoiding immunopathology. Mechanisms that curb effector functions in CD4+ and CD8+ T cells are mostly shared, yet important differences occur. Here, we focus on the control of CD8+ T cell activity and discuss the importance of a poorly understood aspect of tolerance that directly impairs engagement of target cells: the downregulation of CD8. We contextualize this process and propose that it represents a key element during CD8+ T cell modulation.


Assuntos
Linfócitos T CD8-Positivos , Tolerância Imunológica , Animais , Humanos , Linfócitos T CD4-Positivos/imunologia , Antígenos CD8/metabolismo , Antígenos CD8/imunologia , Linfócitos T CD8-Positivos/imunologia , Regulação para Baixo/imunologia , Ativação Linfocitária/imunologia
2.
ACS ES T Water ; 3(12): 3730-3735, 2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38094916

RESUMO

In the context of the European Union (EU) Drinking Water Directive, freshwater mussels (Order Unionoida: Bivalvia) can help us face the challenges of safe drinking water provisions for all citizens in the EU. Specifically, the implementation of high frequency noninvasive (HFNI) valvometers allows the early detection of eventual pollution events in drinking water treatment plants. Currently real-time behavioral analysis is deployed in a number of EU countries, and we foresee a bright future as new technological advances are developed concerning HFNI valvometers.

3.
Pharmaceuticals (Basel) ; 16(8)2023 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-37631063

RESUMO

Bacteria resistance to antibiotics is a concerning global health problem; in this context, methicillin-resistant Staphylococcus aureus (MRSA) is considered as a high priority by the World Health Organization. Furthermore, patients with a positive result for COVID-19 received early antibiotic treatment, a fact that potentially encourages the increase in antibiotic resistance. Therefore, there is an urgency to develop new drugs with molecular mechanisms different from those of the actual treatments. In this context, enzymes from the shikimate pathway, a route absent in humans, such as dehydroquinate dehydratase (DHQD), are considered good targets. In this work, a computer-aided drug design strategy, which involved exhaustive virtual screening and molecular dynamics simulations with MM-PBSA analysis, as well as an in silico ADMETox characterization, was performed to find potential noncovalent inhibitors of DHQD from MRSA (SaDHQD). After filtering the 997 million compounds from the ZINC database, 6700 compounds were submitted to an exhaustive virtual screening protocol. From these data, four molecules were selected and characterized (ZINC000005753647 (1), ZINC000001720488 (2), ZINC000082049768 (3), and ZINC000644149506 (4)). The results indicate that the four potential inhibitors interacted with residues important for substrate binding and catalysis, with an estimated binding free energy like that of the enzyme's substrate. Their ADMETox-predicted properties suggest that all of them support the structural characteristics to be considered good candidates. Therefore, the four compounds reported here are excellent option to be considered for future in vitro studies to design new SaDHQD noncovalent inhibitors and contribute to the search for new drugs against MRSA.

4.
Arthritis Rheumatol ; 75(6): 961-972, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36575804

RESUMO

OBJECTIVE: Variants in STAT4 are associated with systemic lupus erythematosus (SLE) and other autoimmune diseases. We undertook this study to investigate how disease-associated variants affect STAT4 expression, in particular in CD4+ T cells where STAT4 plays an essential role. METHODS: We compared Th1 differentiation between naive CD4+ T cells from healthy donors homozygous for the risk (R/R) or nonrisk (NR/NR) alleles. We analyzed epigenetic marks in STAT4 and evaluated the relevance of its third intron, assessed the consequences of Stat4 overexpression in vivo in mice, and analyzed the effects of the STAT4 genotype in patients with lupus nephritis. RESULTS: Naive CD4+ T cells from NR/NR healthy donors down-regulated STAT4 in response to interleukin-12 (IL-12). In contrast, cells from R/R healthy donors maintained high levels. R/R cells exhibited a higher abundance of transcriptionally active STAT4 and increased interferon-γ production. Accordingly, R/R healthy donors exhibited a stronger induction of local active enhancer marks. Genetic editing confirmed the presence of a negative regulatory region in the STAT4 third intron, where most of the SLE-associated STAT4 single-nucleotide polymorphisms (SNPs) are located. In vivo forced expression demonstrated that increases in Stat4 levels in T cells enhanced glomerulonephritis in mice. Accordingly, the R/R genotype was associated with suboptimal response to treatment and with worse clinical outcomes in patients with proliferative lupus nephritis. CONCLUSION: The SLE-associated STAT4 haplotype correlates with an abnormal IL-12-mediated STAT4 transcriptional regulation. Carriers of the risk variant exhibit exaggerated CD4+ proinflammatory capacities that, in the context of SLE, contribute to more severe disease. R/R patients may benefit from blockade of the IL-12/STAT4 pathway.


Assuntos
Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Animais , Camundongos , Linfócitos T CD4-Positivos/metabolismo , Regulação para Baixo , Haplótipos , Interferon gama/genética , Interleucina-12 , Lúpus Eritematoso Sistêmico/genética , Nefrite Lúpica/genética , Polimorfismo de Nucleotídeo Único , Fator de Transcrição STAT4/genética , Humanos
5.
Conserv Biol ; 37(2): e13994, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36047704

RESUMO

Europe has a long history of human pressure on freshwater ecosystems. As pressure continues to grow and new threats emerge, there is an urgent need for conservation of freshwater biodiversity and its ecosystem services. However, whilst some taxonomic groups, mainly vertebrates, have received a disproportionate amount of attention and funds, other groups remain largely off the public and scientific radar. Freshwater mussels (Bivalvia, Unionida) are an alarming example of this conservation bias and here we point out six conceptual areas that need immediate and long-term attention: knowledge, threats, socioeconomics, conservation, governance and education. The proposed roadmap aims to advance research, policy and education by identifying the most pressing priorities for the short- and long-term conservation of freshwater mussels across Europe.


Assuntos
Bivalves , Ecossistema , Animais , Humanos , Conservação dos Recursos Naturais , Biodiversidade , Água Doce , Europa (Continente)
6.
Proc Natl Acad Sci U S A ; 119(49): e2203454119, 2022 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-36442116

RESUMO

The development of innate lymphoid cell (ILC) transcription factor reporter mice has shown a previously unexpected complexity in ILC hematopoiesis. Using novel polychromic mice to achieve higher phenotypic resolution, we have characterized bone marrow progenitors that are committed to the group 1 ILC lineage. These common ILC1/NK cell progenitors (ILC1/NKP), which we call "aceNKPs", are defined as lineage-Id2+IL-7Rα+CD25-α4ß7-NKG2A/C/E+Bcl11b-. In vitro, aceNKPs differentiate into group 1 ILCs, including NK-like cells that express Eomes without the requirement for IL-15, and produce IFN-γ and perforin upon IL-15 stimulation. Following reconstitution of Rag2-/-Il2rg-/- hosts, aceNKPs give rise to a spectrum of mature ILC1/NK cells (regardless of their tissue location) that cannot be clearly segregated into the traditional ILC1 and NK subsets, suggesting that group 1 ILCs constitute a dynamic continuum of ILCs that can develop from a common progenitor. In addition, aceNKP-derived ILC1/NK cells effectively ameliorate tumor burden in a model of lung metastasis, where they acquired a cytotoxic NK cell phenotype. Our results identify the primary ILC1/NK progenitor that lacks ILC2 or ILC3 potential and is strictly committed to ILC1/NK cell production irrespective of tissue homing.


Assuntos
Imunidade Inata , Interleucina-15 , Animais , Camundongos , Interleucina-15/genética , Células Matadoras Naturais , Perforina , Fatores de Transcrição , Proteínas Repressoras , Proteínas Supressoras de Tumor
7.
Entropy (Basel) ; 24(11)2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36359673

RESUMO

Cryptocurrency markets have attracted many interest for global investors because of their novelty, wide on-line availability, increasing capitalization, and potential profits. In the econophysics tradition, we show that many of the most available cryptocurrencies have return statistics that do not follow Gaussian distributions, instead following heavy-tailed distributions. Entropy measures are applied, showing that portfolio diversification is a reasonable practice for decreasing return uncertainty.

8.
Front Immunol ; 13: 981479, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36263033

RESUMO

Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide, and is largely refractory to current immunotherapeutic interventions. The lack of efficacy of existing cancer immunotherapies in CRC reflects the complex nature of the unique intestinal immune environment, which serves to maintain barrier integrity against pathogens and harmful environmental stimuli while sustaining host-microbe symbiosis during homeostasis. With their expression by barrier epithelial cells, the cytokines interleukin-25 (IL-25) and IL-33 play key roles in intestinal immune responses, and have been associated with inappropriate allergic reactions, autoimmune diseases and cancer pathology. Studies in the past decade have begun to uncover the important roles of IL-25 and IL-33 in shaping the CRC tumour immune microenvironment, where they may promote or inhibit tumorigenesis depending on the specific CRC subtype. Notably, both IL-25 and IL-33 have been shown to act on group 2 innate lymphoid cells (ILC2s), but can also stimulate an array of other innate and adaptive immune cell types. Though sometimes their functions can overlap they can also produce distinct phenotypes dependent on the differential distribution of their receptor expression. Furthermore, both IL-25 and IL-33 modulate pathways previously known to contribute to CRC tumorigenesis, including angiogenesis, tumour stemness, invasion and metastasis. Here, we review our current understanding of IL-25 and IL-33 in CRC tumorigenesis, with specific focus on dissecting their individual function in the context of distinct subtypes of CRC, and the potential prospects for targeting these pathways in CRC immunotherapy.


Assuntos
Neoplasias Colorretais , Interleucina-33 , Humanos , Interleucina-17/metabolismo , Imunidade Inata , Neoplasias Colorretais/metabolismo , Linfócitos/metabolismo , Carcinogênese , Transformação Celular Neoplásica/genética , Citocinas , Microambiente Tumoral
9.
Sci Immunol ; 7(72): eabn0175, 2022 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-35658010

RESUMO

Interleukin-25 (IL-25) and group 2 innate lymphoid cells (ILC2s) defend the host against intestinal helminth infection and are associated with inappropriate allergic reactions. IL-33-activated ILC2s were previously found to augment protective tissue-specific pancreatic cancer immunity. Here, we showed that intestinal IL-25-activated ILC2s created an innate cancer-permissive microenvironment. Colorectal cancer (CRC) patients with higher tumor IL25 expression had reduced survival and increased IL-25R-expressing tumor-resident ILC2s and myeloid-derived suppressor cells (MDSCs) associated with impaired antitumor responses. Ablation of IL-25 signaling reduced tumors, virtually doubling life expectancy in an Apc mutation-driven model of spontaneous intestinal tumorigenesis. Mechanistically, IL-25 promoted intratumoral ILC2s, which sustained tumor-infiltrating MDSCs to suppress antitumor immunity. Therapeutic antibody-mediated blockade of IL-25 signaling decreased intratumoral ILC2s, MDSCs, and adenoma/adenocarcinoma while increasing antitumor adaptive T cell and interferon-γ (IFN-γ)-mediated immunity. Thus, the roles of innate epithelium-derived cytokines IL-25 and IL-33 as well as ILC2s in cancer cannot be generalized. The protumoral nature of the IL-25-ILC2 axis in CRC highlights this pathway as a potential therapeutic target against CRC.


Assuntos
Proteína da Polipose Adenomatosa do Colo/genética , Interleucina-33 , Células Supressoras Mieloides , Carcinogênese , Humanos , Imunidade Inata , Interleucina-17 , Interleucina-33/genética , Linfócitos , Mutação , Microambiente Tumoral
10.
Biol Rev Camb Philos Soc ; 97(5): 1967-1998, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35770724

RESUMO

Identification of ecosystem services, i.e. the contributions that ecosystems make to human well-being, has proven instrumental in galvanising public and political support for safeguarding biodiversity and its benefits to people. Here we synthesise the global evidence on ecosystem services provided and disrupted by freshwater bivalves, a heterogenous group of >1200 species, including some of the most threatened (in Unionida) and invasive (e.g. Dreissena polymorpha) taxa globally. Our systematic literature review resulted in a data set of 904 records from 69 countries relating to 24 classes of provisioning (N = 189), cultural (N = 491) and regulating (N = 224) services following the Common International Classification of Ecosystem Services (CICES). Prominent ecosystem services included (i) the provisioning of food, materials and medicinal products, (ii) knowledge acquisition (e.g. on water quality, past environments and historical societies), ornamental and other cultural contributions, and (iii) the filtration, sequestration, storage and/or transformation of biological and physico-chemical water properties. About 9% of records provided evidence for the disruption rather than provision of ecosystem services. Synergies and trade-offs of ecosystem services were observed. For instance, water filtration by freshwater bivalves can be beneficial for the cultural service 'biomonitoring', while negatively or positively affecting food consumption or human recreation. Our evidence base spanned a total of 91 genera and 191 species, dominated by Unionida (55% of records, 76% of species), Veneroida (21 and 9%, respectively; mainly Corbicula spp.) and Myoida (20 and 4%, respectively; mainly Dreissena spp.). About one third of records, predominantly from Europe and the Americas, related to species that were non-native to the country of study. The majority of records originated from Asia (35%), with available evidence for 23 CICES classes, as well as Europe (29%) and North America (23%), where research was largely focused on 'biomonitoring'. Whilst the earliest record (from 1949) originated from North America, since 2000, annual output of records has increased rapidly in Asia and Europe. Future research should focus on filling gaps in knowledge in lesser-studied regions, including Africa and South America, and should look to provide a quantitative valuation of the socio-economic costs and benefits of ecosystem services shaped by freshwater bivalves.


Assuntos
Bivalves , Ecossistema , Animais , Biodiversidade , Água Doce , Humanos , Qualidade da Água
11.
Nat Rev Rheumatol ; 18(4): 232-244, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35075294

RESUMO

Adaptive immune responses rely on the proliferation of T lymphocytes able to recognize and eliminate pathogens. The magnitude and duration of the expansion of activated T cell clones are finely regulated to minimize immunopathology and avoid autoimmunity. In patients with rheumatic autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis, activated lymphocytes survive and exert effector functions for prolonged periods, defying the mechanisms that normally curb their capacities during acute and chronic infections. Here, we review the molecular mechanisms that limit the duration of immune responses in health and discuss the factors that alter such regulation in the setting of systemic lupus erythematosus and rheumatoid arthritis. We highlight defects that could contribute to the development and progression of autoimmune disease and describe how chronic inflammation can alter the regulation of activated lymphocyte survival, promoting its perpetuation. These concepts might contribute to the understanding of the mechanisms that underlie the chronicity of inflammation in the context of autoimmunity.


Assuntos
Artrite Reumatoide , Doenças Autoimunes , Lúpus Eritematoso Sistêmico , Doenças Reumáticas , Autoimunidade , Sobrevivência Celular , Humanos , Inflamação , Linfócitos T
12.
JAMA ; 326(20): 2031-2042, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34762106

RESUMO

IMPORTANCE: No therapy has been shown to reduce the risk of serious adverse outcomes in patients with nonalcoholic steatohepatitis (NASH). OBJECTIVE: To investigate the long-term relationship between bariatric surgery and incident major adverse liver outcomes and major adverse cardiovascular events (MACE) in patients with obesity and biopsy-proven fibrotic NASH without cirrhosis. DESIGN, SETTING, AND PARTICIPANTS: In the SPLENDOR (Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk) study, of 25 828 liver biopsies performed at a US health system between 2004 and 2016, 1158 adult patients with obesity were identified who fulfilled enrollment criteria, including confirmed histological diagnosis of NASH and presence of liver fibrosis (histological stages 1-3). Baseline clinical characteristics, histological disease activity, and fibrosis stage of patients who underwent simultaneous liver biopsy at the time of bariatric surgery were balanced with a nonsurgical control group using overlap weighting methods. Follow-up ended in March 2021. EXPOSURES: Bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy) vs nonsurgical care. MAIN OUTCOMES AND MEASURES: The primary outcomes were the incidence of major adverse liver outcomes (progression to clinical or histological cirrhosis, development of hepatocellular carcinoma, liver transplantation, or liver-related mortality) and MACE (a composite of coronary artery events, cerebrovascular events, heart failure, or cardiovascular death), estimated using the Firth penalized method in a multivariable-adjusted Cox regression analysis framework. RESULTS: A total of 1158 patients (740 [63.9%] women; median age, 49.8 years [IQR, 40.9-57.9 years], median body mass index, 44.1 [IQR, 39.4-51.4]), including 650 patients who underwent bariatric surgery and 508 patients in the nonsurgical control group, with a median follow-up of 7 years (IQR, 4-10 years) were analyzed. Distribution of baseline covariates, including histological severity of liver injury, was well-balanced after overlap weighting. At the end of the study period in the unweighted data set, 5 patients in the bariatric surgery group and 40 patients in the nonsurgical control group experienced major adverse liver outcomes, and 39 patients in the bariatric surgery group and 60 patients in the nonsurgical group experienced MACE. Among the patients analyzed with overlap weighting methods, the cumulative incidence of major adverse liver outcomes at 10 years was 2.3% (95% CI, 0%-4.6%) in the bariatric surgery group and 9.6% (95% CI, 6.1%-12.9%) in the nonsurgical group (adjusted absolute risk difference, 12.4% [95% CI, 5.7%-19.7%]; adjusted hazard ratio, 0.12 [95% CI, 0.02-0.63]; P = .01). The cumulative incidence of MACE at 10 years was 8.5% (95% CI, 5.5%-11.4%) in the bariatric surgery group and 15.7% (95% CI, 11.3%-19.8%) in the nonsurgical group (adjusted absolute risk difference, 13.9% [95% CI, 5.9%-21.9%]; adjusted hazard ratio, 0.30 [95% CI, 0.12-0.72]; P = .007). Within the first year after bariatric surgery, 4 patients (0.6%) died from surgical complications, including gastrointestinal leak (n = 2) and respiratory failure (n = 2). CONCLUSIONS AND RELEVANCE: Among patients with NASH and obesity, bariatric surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident major adverse liver outcomes and MACE.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Cirrose Hepática/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/cirurgia , Adulto , Biópsia , Peso Corporal , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/etiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Fígado/patologia , Cirrose Hepática/etiologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pontuação de Propensão , Estudos Retrospectivos
13.
Surg Endosc ; 35(9): 4903-4917, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34279710

RESUMO

BACKGROUND: Gastroesophageal Reflux Disease (GERD) is an extremely common condition with several medical and surgical treatment options. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of GERD with an emphasis on evaluating different surgical techniques. METHODS: Literature reviews were conducted for 4 key questions regarding the surgical treatment of GERD in both adults and children: surgical vs. medical treatment, robotic vs. laparoscopic fundoplication, partial vs. complete fundoplication, and division vs. preservation of short gastric vessels in adults or maximal versus minimal dissection in pediatric patients. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed. RESULTS: The panel provided seven recommendations for adults and children with GERD. All recommendations were conditional due to very low, low, or moderate certainty of evidence. The panel conditionally recommended surgical treatment over medical management for adults with chronic or chronic refractory GERD. There was insufficient evidence for the panel to make a recommendation regarding surgical versus medical treatment in children. The panel suggested that once the decision to pursue surgical therapy is made, adults and children with GERD may be treated with either a robotic or a laparoscopic approach, and either partial or complete fundoplication based on surgeon-patient shared decision-making and patient values. In adults, the panel suggested either division or non-division of the short gastric vessels is appropriate, and that children should undergo minimal dissection during fundoplication. CONCLUSIONS: These recommendations should provide guidance with regard to surgical decision-making in the treatment of GERD and highlight the importance of shared decision-making and patient values to optimize patient outcomes. Pursuing the identified research needs may improve future versions of guidelines for the treatment of GERD.


Assuntos
Esofagoplastia , Refluxo Gastroesofágico , Laparoscopia , Adulto , Criança , Fundoplicatura , Refluxo Gastroesofágico/cirurgia , Humanos , Resultado do Tratamento
14.
Front Immunol ; 12: 635862, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33841416

RESUMO

Activation of self-reactive CD8+ T cells induces a peripheral tolerance mechanism that involves loss of CD8 expression. Because genetic deficiency of Fas and Fasl causes the accumulation of double-negative (DN; CD3+ TCR-αß+ CD4- CD8-) T cells that have been proposed to derive from CD8+ cells, we decided to explore the role of Fas and FasL in self-antigen-induced CD8 downregulation. To this end, we quantified Fas and FasL induction by different stimuli and analyzed the effects of Fas/FasL deficiency during a protective immune response and after exposure to self-antigens. Our data describes how Fas and FasL upregulation differs depending on the setting of CD8 T cell activation and demonstrates that Fas/FasL signaling maintains CD8 expression during repetitive antigen stimulation and following self-antigen encounter. Together, our results reveal an unexpected role of Fas/FasL signaling and offer a new insight into the role of these molecules in the regulation of immune tolerance.


Assuntos
Autoantígenos/metabolismo , Antígenos CD8/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Proteína Ligante Fas/metabolismo , Tolerância Imunológica , Ativação Linfocitária , Receptor fas/metabolismo , Transferência Adotiva , Animais , Autoantígenos/imunologia , Antígenos CD8/imunologia , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/transplante , Células Cultivadas , Regulação para Baixo , Proteína Ligante Fas/genética , Proteína Ligante Fas/imunologia , Cinética , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Fenótipo , Transdução de Sinais , Receptor fas/genética , Receptor fas/imunologia
15.
Surg Endosc ; 35(5): 1949-1962, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655443

RESUMO

BACKGROUND: Achalasia is a rare, chronic, and morbid condition with evolving treatment. Peroral endoscopic myotomy (POEM) has gained considerable popularity, but its comparative effectiveness is uncertain. We aim to evaluate the literature comparing POEM to Heller myotomy (HM) and pneumatic dilation (PD) for the treatment of achalasia. METHODS: We conducted a systematic review of comparative studies between POEM and HM or PD. A priori outcomes pertained to efficacy, perioperative metrics, and safety. Internal validity of observational studies and randomized trials (RCTs) was judged using the Newcastle Ottawa Scale and the Cochrane Risk of Bias 2.0 tool, respectively. RESULTS: From 1379 unique literature citations, we included 28 studies comparing POEM and HM (n = 21) or PD (n = 8), with only 1 RCT addressing each. Aside from two 4-year observational studies, POEM follow-up averaged ≤ 2 years. While POEM had similar efficacy to HM, POEM treated dysphagia better than PD both in an RCT (treatment "success" RR 1.71, 95% CI 1.34-2.17; 126 patients) and in observational studies (Eckardt score MD - 0.43, 95% CI - 0.71 to - 0.16; 5 studies; I2 21%; 405 patients). POEM needed reintervention less than PD in an RCT (RR 0.19, 95% CI 0.08-0.47; 126 patients) and HM in an observational study (RR 0.33, 95% CI 0.16, 0.68; 98 patients). Though 6-12 months patient-reported reflux was worse than PD in 3 observational studies (RR 2.67, 95% CI 1.02-7.00; I2 0%; 164 patients), post-intervention reflux was inconsistently measured and not statistically different in measures ≥ 1 year. POEM had similar safety outcomes to both HM and PD, including treatment-related serious adverse events. CONCLUSIONS: POEM has similar outcomes to HM and greater efficacy than PD. Reflux remains a critical outcome with unknown long-term clinical significance due to insufficient data and inconsistent reporting.


Assuntos
Acalasia Esofágica/cirurgia , Miotomia de Heller/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Transtornos de Deglutição/etiologia , Dilatação/efeitos adversos , Dilatação/métodos , Esfíncter Esofágico Inferior/cirurgia , Esofagite Péptica/etiologia , Refluxo Gastroesofágico/etiologia , Miotomia de Heller/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
16.
Surg Endosc ; 35(8): 4095-4123, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33651167

RESUMO

BACKGROUND: Gastroesophageal reflux disease (GERD) has a high worldwide prevalence in adults and children. There is uncertainty regarding medical versus surgical therapy and different surgical techniques. This review assessed outcomes of antireflux surgery versus medical management of GERD in adults and children, robotic versus laparoscopic fundoplication, complete versus partial fundoplication, and minimal versus maximal dissection in pediatric patients. METHODS: PubMed, Embase, and Cochrane databases were searched (2004-2019) to identify randomized control and non-randomized comparative studies. Two independent reviewers screened for eligibility. Random effects meta-analysis was performed on comparative data. Study quality was assessed using the Cochrane Risk of Bias and Newcastle Ottawa Scale. RESULTS: From 1473 records, 105 studies were included. Most had high or uncertain risk of bias. Analysis demonstrated that anti-reflux surgery was associated with superior short-term quality of life compared to PPI (Std mean difference = - 0.51, 95%CI - 0.63, - 0.40, I2 = 0%) however short-term symptom control was not significantly superior (RR = 0.75, 95%CI 0.47, 1.21, I2 = 82%). A proportion of patients undergoing operative treatment continue PPI treatment (28%). Robotic and laparoscopic fundoplication outcomes were similar. Compared to total fundoplication, partial fundoplication was associated with higher rates of prolonged PPI usage (RR = 2.06, 95%CI 1.08, 3.94, I2 = 45%). There was no statistically significant difference for long-term symptom control (RR = 0.94, 95%CI 0.85, 1.04, I2 = 53%) or long-term dysphagia (RR = 0.73, 95%CI 0.52, 1.02, I2 = 0%). Ien, minimal dissection during fundoplication was associated with lower reoperation rates than maximal dissection (RR = 0.21, 95%CI 0.06, 0.67). CONCLUSIONS: The available evidence regarding the optimal treatment of GERD often suffers from high risk of bias. Additional high-quality randomized control trials may further inform surgical decision making in the treatment of GERD.


Assuntos
Refluxo Gastroesofágico , Laparoscopia , Adulto , Criança , Fundoplicatura , Refluxo Gastroesofágico/cirurgia , Humanos , Qualidade de Vida , Resultado do Tratamento
17.
Annu Rev Immunol ; 39: 167-198, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33534604

RESUMO

Type 2 immunity helps protect the host from infection, but it also plays key roles in tissue homeostasis, metabolism, and repair. Unfortunately, inappropriate type 2 immune reactions may lead to allergy and asthma. Group 2 innate lymphoid cells (ILC2s) in the lungs respond rapidly to local environmental cues, such as the release of epithelium-derived type 2 initiator cytokines/alarmins, producing type 2 effector cytokines such as IL-4, IL-5, and IL-13 in response to tissue damage and infection. ILC2s are associated with the severity of allergic asthma, and experimental models of lung inflammation have shown how they act as playmakers, receiving signals variously from stromal and immune cells as well as the nervous system and then distributing cytokine cues to elicit type 2 immune effector functions and potentiate CD4+ T helper cell activation, both of which characterize the pathology of allergic asthma. Recent breakthroughs identifying stromal- and neuronal-derived microenvironmental cues that regulate ILC2s, along with studies recognizing the potential plasticity of ILC2s, have improved our understanding of the immunoregulation of asthma and opened new avenues for drug discovery.


Assuntos
Asma , Hipersensibilidade , Animais , Asma/etiologia , Humanos , Imunidade Inata , Interleucina-13 , Linfócitos
18.
Mucosal Immunol ; 14(1): 26-37, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32457448

RESUMO

Type-2 immunity is characterised by interleukin (IL)-4, IL-5 and IL-13, eosinophilia, mucus production, IgE, and alternatively activated macrophages (AAM). However, despite the lack of neutrophil chemoattractants such as CXCL1, neutrophils, a feature of type-1 immunity, are observed in type-2 responses. Consequently, alternative mechanisms must exist to ensure that neutrophils can contribute to type-2 immune reactions without escalation of deleterious inflammation. We now demonstrate that type-2 immune-associated neutrophil infiltration is regulated by the mouse RNase A homologue, eosinophil-associated ribonuclease 11 (Ear11), which is secreted by AAM downstream of IL-25-stimulated ILC2. Transgenic overexpression of Ear11 resulted in tissue neutrophilia, whereas Ear11-deficient mice have fewer resting tissue neutrophils, whilst other type-2 immune responses are not impaired. Notably, administration of recombinant mouse Ear11 increases neutrophil motility and recruitment. Thus, Ear11 helps maintain tissue neutrophils at homoeostasis and during type-2 reactions when chemokine-producing classically activated macrophages are infrequently elicited.


Assuntos
Imunidade Inata , Linfócitos/fisiologia , Ativação de Macrófagos/imunologia , Macrófagos/fisiologia , Infiltração de Neutrófilos/imunologia , Neutrófilos/fisiologia , Ribonucleases/biossíntese , Animais , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Eosinófilos/imunologia , Eosinófilos/metabolismo , Imunomodulação , Imunofenotipagem , Interleucina-13/biossíntese , Pulmão/imunologia , Pulmão/metabolismo , Pulmão/patologia , Camundongos , Camundongos Transgênicos , Ribonucleases/genética
19.
J Environ Manage ; 282: 111528, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33172704

RESUMO

The study of the relationships between freshwater organisms, pollution and public awareness has been little researched. The public's perception of risk from pollution is a fundamental component in determining consumer behavior and promoting healthy habits. For instance, understanding how consumers perceive the risks associated with pollution can help with adoption of safe behaviors to reduce the health hazard associated with pollutant exposure. This study focused on the southeastern United States, a region predicted to be exposed to high mercury stress by increasing mercury deposition and methylation. First, we placed our study region in the world map of regions more prone to suffer from increasing mercury stress in a climate change scenario. Second, mercury levels in fish tissues was quantified by direct mercury analyzer (DMA). Third, we explored human fish consumption habits and risk social perception, including willingness to adapt fish consumption based on two future hypothetical scenarios of mercury stress. From a global perspective, our analysis demonstrates that the southern US is one of five world areas of greatest conservation concern for mercury stress. In this region, the average mono-methyl mercury concentration in fish tissues exceeded the limits considered safe for human consumption. Even though many in the local population were aware of the health hazards associated with fish consumption, only women of reproductive age were willing to adopt safe consumption habits. Altogether, these results show how bringing together field data, social perceptions, and consumption habits can help in designing an adaptive strategy to confront mercury pollution. Although our results are for the United States, other world regions prone to suffer increasing mercury stress have been identified and should be the focus of future studies and prescriptions.


Assuntos
Mercúrio , Animais , Feminino , Peixes , Contaminação de Alimentos/análise , Humanos , Mercúrio/análise , Percepção Social , Sudeste dos Estados Unidos , Estados Unidos
20.
Cell Rep ; 33(13): 108562, 2020 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-33378680

RESUMO

Generating mammalian cells with desired mitochondrial DNA (mtDNA) sequences is enabling for studies of mitochondria, disease modeling, and potential regenerative therapies. MitoPunch, a high-throughput mitochondrial transfer device, produces cells with specific mtDNA-nuclear DNA (nDNA) combinations by transferring isolated mitochondria from mouse or human cells into primary or immortal mtDNA-deficient (ρ0) cells. Stable isolated mitochondrial recipient (SIMR) cells isolated in restrictive media permanently retain donor mtDNA and reacquire respiration. However, SIMR fibroblasts maintain a ρ0-like cell metabolome and transcriptome despite growth in restrictive media. We reprogrammed non-immortal SIMR fibroblasts into induced pluripotent stem cells (iPSCs) with subsequent differentiation into diverse functional cell types, including mesenchymal stem cells (MSCs), adipocytes, osteoblasts, and chondrocytes. Remarkably, after reprogramming and differentiation, SIMR fibroblasts molecularly and phenotypically resemble unmanipulated control fibroblasts carried through the same protocol. Thus, our MitoPunch "pipeline" enables the production of SIMR cells with unique mtDNA-nDNA combinations for additional studies and applications in multiple cell types.


Assuntos
Reprogramação Celular , Fibroblastos/metabolismo , Técnicas de Transferência de Genes , Ensaios de Triagem em Larga Escala/métodos , Mitocôndrias/genética , Mitocôndrias/metabolismo , Mitocôndrias/transplante , Animais , Diferenciação Celular , Linhagem Celular , DNA Mitocondrial/metabolismo , Células HEK293 , Humanos , Células-Tronco Pluripotentes Induzidas/metabolismo , Metaboloma , Camundongos , Camundongos Endogâmicos C57BL , Transcriptoma
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