Comprehensive Proteomic Profiling of Pressure Ulcers in Patients with Spinal Cord Injury Identifies a Specific Protein Pattern of Pathology.

Objective: Severe pressure ulcers (PUs) do not respond to conservative wound therapy and need surgical repair. To better understand the pathogenesis and to advance on new therapeutic options, we focused on the proteomic analysis of PU, which offers substantial opportunities to identify significant changes in protein abundance during the course of PU formation in an unbiased manner. Approach: To better define the protein pattern of this pathology, we performed a proteomic approach in which we compare severe PU tissue from spinal cord injury (SCI) patients with control tissue from the same patients. Results: We found 76 proteins with difference in abundance. Of these, 10 proteins were verified as proteins that define the pathology: antithrombin-III, alpha-1-antitrypsin, kininogen-1, alpha-2-macroglobulin, fibronectin, apolipoprotein A-I, collagen alpha-1 (XII) chain, haptoglobin, apolipoprotein B-100, and complement factor B. Innovation: This is the first study to analyze differential abundance protein of PU tissue from SCI patients using high-throughput protein identification and quantification by tandem mass tags followed by liquid chromatography tandem mass spectrometry. Conclusion: Differential abundance proteins are mainly involved in tissue regeneration. These proteins might be considered as future therapeutic options to enhance the physiological response and permit cellular repair of damaged tissue.

[Recommendations of the Study Group for Metabolic Alterations/Secretariat for the National AIDS Plan (GEAM/SPNS) on the management of metabolic and morphologic alterations in patients with HIV infection]. / Recomendaciones de GEAM/SPNS sobre el tratamiento de las alteraciones metabólicas y morfológicas en el paciente con infección por VIH.

OBJECTIVE: To provide an update of the metabolic and morphologic alterations in patients infected with HIV with an in-depth analysis of their clinical management and treatment. METHODS: These recommendations were agreed by consensus by a committee of experts in metabolic alterations and HIV patient care, under the auspices of the Secretariat for the National AIDS Plan. To do this, the latest clinical, epidemiological and physiopathological advances described in studies published in the scientific literature and/or presented in congresses were reviewed. RESULTS: The most frequent metabolic alterations in HIV patients and in antiretroviral treatment (ART) are dyslipidemia with an atherogenic profile and alterations in carbohydrate metabolism/insulin resistance. A high prevalence of cardiovascular risk factors, especially smoking, has been described. The same criteria for their management as those used in the general population have been employed, with specific nuances. Diet and exercise should be the first therapeutic recommendation. In patients with dyslipidemia who require drug treatment, statins and/or fibrates are indicated. Glitazones have demonstrated efficacy in the treatment of insulin resistance. The approach to anomalous fat distribution continues to be controversial. The main approaches at present are a switch of ART, reparative surgery, psychological support and lifestyle changes. Lactic acidosis is an infrequent but highly serious complication, and the first step is withdrawal of ART. In bone metabolism alterations, prevention and early detection are essential, especially in children and perimenopausal women. Sexual dysfunction is a frequent problem in both men and women; because the causes are highly varied, treatment should be individualized. CONCLUSIONS: The prevalence of metabolic and morphologic alterations has increased since the introduction of highly active antiretroviral treatment (HAART). Knowledge of the various aspects involved in their diagnosis and treatment is essential for the appropriate care of patients with HIV infection.