Clinical and immunological allergy assessment in cancer patients.

Cancer is associated with immunodeficiency, while allergies result from immune system hyperactivity mediated by cytokines and immunoglobulins. The purpose of this study was to determine the relationship between immune environment of specific cancers and allergies, emphasizing cytokines related to Th1 and Th2 responses associated with IgE. 80 adults were distributed into two groups: control (n = 20) and cancer (n = 60), distributed in three subgroups (n = 20), head and neck, stomach, and prostate cancers. This study compared Th1 (IL-2) and Th2 (IL-4) parameters, anti-inflammatory, pro-inflammatory, or regulatory profile regarding both IgE levels and reported allergies, by means of clinical manifestations and IgE, IL-1ß, IL-2, IL-4, IL-17, and TGF-ß serum concentration. Clinically allergies were observed in 50% of the control group and in 20% of the cancer group (p = 0.009). IL-2 cytokine and TGF-ß concentrations were higher in the patients with cancer as compared to the control (p < 0.005). However, there were IL-4, IL-17, and IL-1ß decreases in the patients with cancer (p < 0.05). No correlation was observed between the cytokines studied and IgE and clinically proven allergies in both investigated groups. There was an inverse association between cancer and clinical allergy manifestations. In head and neck, stomach, and prostate cancers, an immunosuppressive serum tumor environment was predominant. There was no difference in cytokines related to Th1 and Th2 parameters in relation to IgE. No correlation was found between clinically proved allergies and immunity markers related to the same allergens.

Imunoterapia no câncer - inibidores do checkpoint imunológico / Immunotherapy and immune checkpoint inhibitors in cancer

O objetivo deste trabalho é fazer uma revisão atual do tratamento de alguns tipos de câncer com imunoterapia e inibidores do checkpoint imunológico. As fontes de dados incluíram artigos originais, revisões e publicações indexados nos bancos de dados PubMed, MEDLINE, LILACS, SciELO e publicações online nos últimos 20 anos. Os checkpoints imunológicos normalmente impedem o organismo de montar uma resposta imune contra células normais. Alguns tipos de câncer podem adquirir estes checkpoints de tal forma que estas células tumorais não são reconhecidas pelo sistema imune, e isto impede que ele seja ativado. A inibição dos checkpoints imunológicos pode melhorar a sobrevida de pacientes com malignidades avançadas. Isto inclui melanoma maligno, carcinoma renal, linfoma e câncer pulmonar de células não pequenas. Uma extraordinária quantidade de investigações pré-clínicas e clínicas estão explorando o potencial terapêutico das moléculas coestimulatórias positivas e negativas. Aqui, nós revisamos o estado atual do nosso conhecimento dos mecanismos co-estimulatórios da célula T e a inibição dos checkpoints, primariamente do CTLA-4 e do PD-1.

This paper aims to review current treatment of some types of cancer with immunotherapy and immune checkpoint inhibitors. Data sources included original articles, reviews and related texts published over the past 20 years in PubMed, MEDLINE, LILACS and SciELO databases and other online publications. Immune checkpoints normally prevent the body from developing an immune response against healthy cells. Some types of cancer may acquire these checkpoints so that the tumor cells are not recognized by the immune system, preventing it from being activated. Immune checkpoint inhibitors may improve the survival of some patients with advanced malignant tumors, including malignant melanoma, renal cell carcinoma, lymphoma and non-small cell lung cancer. An extraordinary amount of preclinical and clinical investigation is exploring the therapeutic potential of negative and positive costimulatory molecules. Herein, we review the current status of our understanding of T-cell costimulatory mechanisms and checkpoint inhibitors, primarily of CTLA-4 and PD-1.

Biomarcadores e imunobiológicos na asma / Biomarkers and immunobiological agents in asthma

A maioria dos asmáticos é bem controlada com o uso de corticosteroides inalados e beta-agonistas de ação prolongada; contudo, uma proporção de pacientes não responde a esta terapia, e mantém controle limitado da doença. Este grupo experimenta exacerbações frequentes, e requer admissão hospitalar. O desenvolvimento de novos agentes biológicos e biomarcadores da doença abre novas avenidas para o tratamento. Nós revisamos as últimas informações pertinentes aos biomarcadores e agentes biológicos, e demonstramos como os pacientes podem ser identificados e se beneficiar destes tratamentos. As fontes de dados incluíram artigos originais, revisões e publicações indexados nos bancos de dados PubMed, MEDLINE, LILACS, SciELO e publicações on-line, nos últimos 15 anos. As informações mais recentes da medicina personalizada com análise genética e biomarcadores da inflamação Th2 permitiram identificar fenótipos de asma que incluem um fenótipo T2 alto. Estudos recentes dirigidos para IgE, IL-5, IL-13, IL-17 e para os receptores de cadeias alfa de IL-4 mostraram alguma eficácia em alguns pacientes fenotipados. Para aqueles sem evidência de inflamação Th2, nenhuma terapia específica foi identificada. A disponibilidade de biomarcadores e agentes bioterapêuticos que são dirigidos para IgE, interleucinas IL-5, IL-4, IL-13 e IL-17, são uma excitante modalidade de medicina molecular. Contudo, estes agentes bioterapêuticos somente são efetivos quando dirigidos para pacientes com fenótipos de asma específicos.

Most asthmatic individuals are well managed with inhaled corticosteroids and prolonged-action beta-agonists; however, some patients are unresponsive to therapy and attain limited disease control. The latter group experiences frequent exacerbations requiring hospital admission. The development of new biological agents and disease biomarkers has provided novel avenues for treatment. We review the latest information regarding biomarkers and biological agents and demonstrate how potential patients may be identified for treatment. Data sources included original articles, reviews, and published works indexed in PubMed, MEDLINE, LILACS, SciELO, and other online databases over the past 15 years. The latest findings from personalized medicine with genetic analysis and clinical biomarkers of Th2 inflammation have allowed the identification of asthma phenotypes including a T2-high phenotype. Recent studies targeting IgE, IL-5, IL- 13, IL-17, and the IL4 receptor alpha chain have shown some efficacy in phenotyped patients. For those without evidence of Th2 inflammation, no specific therapies have been identified. The availability of biomarkers and biotherapeutic agents targeting IgE, IL-5, IL-4, IL-13, and IL-17 is an exciting advance in molecular medicine. However, those biotherapeutic agents are effective only when used in patients with specific asthma phenotypes.

Medicina de precisão na asma / Precision medicine in asthma

O objetivo deste trabalho é fazer uma revisão atual de uma medicina de precisão personalizada e dirigida para fenótipos e endótipos de asma. As fontes de dados incluíram artigos originais, revisões e publicações indexadas nos bancos de dados PubMed, MEDLINE, LILACS, SciELO e publicadas on line nos últimos 20 anos. Os resultados mostram que a asma tem sido considerada uma doença única por anos, e que estudos mais recentes cada vez mais focam na sua heterogeneidade. Esta heterogeneidade resulta em que a asma contém múltiplos fenótipos ou grupos de características consistentes. Um endótipo é um subtipo desta doença, definido por um distinto mecanismo fisiopatológico, e é associado a um biomarcador. Múltiplos modificadores da resposta imune estão sendo avaliados na asma denominada T2 alta, bloqueando as interleucinas IL-5, IL-13, imunoglobulina E e outras vias. Assim, muitas destas terapias visando a asma T2 alta têm demonstrado melhor eficácia quando certos biomarcadores estão elevados, especialmente os eosinófilos. Já o tipo de asma T2 baixo, que não apresenta biomarcadores precisos, é geralmente diagnosticada pela ausência de biomarcadores para T2 alta. Estes pacientes tendem a ter mais resistência a tratamento com esteroides e o desenvolvimento de novas terapias são muito menos apreciáveis do que as com o tipo T2 alto. As conclusões são que a disponibilidade de agentes bioterapêuticos dirigidos especificamente a IgE, IL-5 e IL-13 é uma excitante evolução da medicina molecular. Contudo, estes agentes bioterapêuticos somente são efetivos quando dirigidos a fenótipos específicos de asma.

The objective of this study was to conduct an updated review of the role of personalized phenotype-endotype driven precision medicine in asthma. Sources of data included original articles, reviews and other publications indexed in PubMed, MEDLINE, LILACS, and SciELO and published online over the last 20 years. The results showed that asthma has been considered as a single disease for years, and more recent studies have increasingly focused on its heterogeneity. This heterogeneity has promoted the concept that asthma consists of multiple phenotypes or consistent groupings of characteristics. An endotype is a subtype of a condition, defined by a distinct pathophysiological mechanism and linked to a biomarker. Several immune response modifiers have been evaluated in T2-high asthma geared at blocking interleukins IL-5, IL-13, immunoglobulin E, and other pathways. Thus, many of the T2-high asthma therapies available have shown improved effectiveness when certain biomarkers are elevated, especially eosinophils. Conversely, T2-low asthma does not currently have any readily available point-of-care biomarkers, and therefore is often diagnosed based on the absence of T2-high biomarkers. These patients tend to present greater resistance to steroids, and the development of therapies has lagged behind that observed for T2-high asthma. In conclusion, the availability of biotherapeutic agents specifically targeted at IgE, IL-5, and IL-13 is an exciting vindication of molecular medicine. However, these biotherapeutic agents are only effective when targeted at specific asthma phenotypes.

The production of nitric oxide, IL-6, and TNF-alpha in palmitate-stimulated PBMNCs is enhanced through hyperglycemia in diabetes.

We examined nitric oxide (NO), IL-6, and TNF-α secretion from cultured palmitate-stimulated PBMNCs or in the plasma from type 2 diabetes mellitus (T2MD) patients or nondiabetic (ND) controls. Free fatty acids (FFA) have been suggested to induce chronic low-grade inflammation, activate the innate immune system, and cause deleterious effects on vascular cells and other tissues through inflammatory processes. The levels of NO, IL-6, TNF-α, and MDA were higher in supernatant of palmitate stimulated blood cells (PBMNC) or from plasma from patients. The results obtained in the present study demonstrated that hyperglycemia in diabetes exacerbates in vitro inflammatory responses in PBMNCs stimulated with high levels of SFA (palmitate). These results suggest that hyperglycemia primes PBMNCs for NO, IL-6, and TNF-alpha secretion under in vitro FFA stimulation are associated with the secretion of inflammatory biomarkers in diabetes. A combined therapy targeting signaling pathways activated by hyperglycemia in conjunction with simultaneous control of hyperglycemia and hypertriglyceridemia would be suggested for controlling the progress of diabetic complications.

ß-Carotene, α-tocopherol and ascorbic acid: differential profile of antioxidant, inflammatory status and regulation of gene expression in human mononuclear cells of diabetic donors.

BACKGROUND: Diabetic patients are exposed to increased oxidative stress due to several mechanisms, mainly hyperglycaemia. Pathological processes, such as those in type 1 diabetes, include diminished activity of the antioxidant defense system(s) or excessive oxidative generation resulting in an oxidative/antioxidant imbalance and development of oxidative stress. METHODS: The purpose of this study was to evaluate the production of reactive oxygen species (ROS) (chemiluminescence) and reduction capacity (MTT dye reduction), the expression of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase subunits, superoxide dismutase and catalase using quantitative reverse-transcriptase polymerase chain reaction, and the levels of cytokines [interleukin (IL)-6, tumour necrosis factor-α, IL-8, IL-10 and IL-4] by sandwich enzyme-linked immunosorbent assay in mononuclear cells from non-diabetic and diabetic donors treated with a vitamin complex (ascorbic acid, ß-carotene and α-tocopherol) in two different concentrations ([A] = ascorbic acid = 0.08 µM, α-tocopherol = 0.04 µM, ß-carotene = 0.0008 µM and [20A] = ascorbic acid = 1.6 µM, α-tocopherol = 0.82 µM, ß-carotene = 0.016 µM). RESULTS: Concentration [A] was antioxidant reducing ROS production, expression of NADPH oxidase subunits and pro-inflammatory cytokines while raising the expression of antioxidant enzymes and reducing pro-inflammatory cytokines in both groups. Concentration [20A] was pro-oxidant by raising ROS production, NADPH oxidase subunits and pro-inflammatory cytokines and reducing antioxidant enzymes and anti-inflammatory cytokines in the non-diabetic group but antioxidant in cells of type 1 diabetic patients by raising antioxidant enzymes and anti-inflammatory cytokines and reducing pro-inflammatory cytokines. CONCLUSION: The vitamin complex has a dual effect, pro-oxidant and antioxidant, being also dose dependent with different profiles of cells of non-diabetic and type 1 diabetic patients.

Suppressive effect of aqueous humor from person with type 2 diabetes with or without retinopathy on reactive oxygen species generation.

AIM: To evaluate the antioxidant capacity and concentrations of vascular endothelial growth factor (VEGF) and interleukin 6 (IL-6) in aqueous humor from patients with type 2 diabetes mellitus (T2DM) with or without retinopathy. METHODS: Aqueous humor was obtained during elective cataract surgery from T2DM patients with or without retinopathy and from healthy subjects. Reducing response was evaluated by MTT dye reduction and the generation of reactive oxygen species (ROS) was determined by chemiluminescence assay. Granulocytes were treated with phorbol dibutyrate (PDB)-stimulated. Cytokines were quantified by ELISA. RESULTS: Antioxidant capacity of aqueous humor from patients with retinopathy was greater (P<0.05) than that of healthy controls or persons with diabetes without retinopathy. ROS production in PDB (protein kinase C activator)-stimulated granulocytes from T2DM patients with or without retinopathy was inhibited by autologous aqueous humor. Concentrations of VEGF and IL-6 were similar in aqueous humor from healthy controls and from patients without retinopathy, but lower (P<0.05) than those from T2DM patients with retinopathy. Plasma levels of VEGF and IL-6 were similar (P>0.05) in healthy controls and in T2DM patients with and without retinopathy. CONCLUSION: Aqueous humor from T2DM patients with retinopathy exhibits elevated antioxidant activity with significant suppressive effect on ROS production and enhanced levels of locally secreted VEGF and IL-6 in comparison with T2DM patients without retinopathy. These results suggest an inflammatory profile in the absence of typical oxidative stress for T2DM patients with retinopathy, possibly resulting from the compensatory antioxidant response detected in the aqueous humor improving the ocular redox state.

Oxidative stress and interleukin-6 secretion during the progression of type 1 diabetes.

OBJECTIVE: To evaluate inflammatory, oxidizing, and reducing responses during the progression of type 1 diabetes mellitus (T1DM) in patients without chronic complications. SUBJECTS AND METHODS: Plasma antioxidant status, reactive oxygen species (ROS), and interleukin-6 (IL-6) were measured in 42 patients with T1DM and in 24 healthy subjects. RESULTS: Significant increases were detected in the median values of ROS and IL-6 in patients with T1DM compared with healthy subjects (ROS ~ 4,836 vs. 2,036 RLU/min, respectively; P < .05: IL-6 ~ 14.2 vs. 9.7 pg/mL, respectively; P = .002). No significant between-group differences (P > 0.05) were observed in oxidizing responses or in IL-6 concentrations when diabetic patients were grouped according to time after diagnosis (0 - 10, 10 - 20 and > 20 years). Plasma antioxidant responses were similar in patients with T1DM and in healthy subjects. CONCLUSIONS: Our results demonstrate that oxidizing and inflammatory responses are increased at the onset of T1DM, but remain unchanged during disease progression. These findings suggest that functional changes involved in diabetic complications may commence in the first years after diagnosis.

Oxidative stress and interleukin-6 secretion during the progression of type 1 diabetes / Estresse oxidativo e secreção de interleucina-6 durante a progressão do diabetes tipo 1

OBJECTIVE: To evaluate inflammatory, oxidizing, and reducing responses during the progression of type 1 diabetes mellitus (T1DM) in patients without chronic complications. SUBJECTS AND METHODS: Plasma antioxidant status, reactive oxygen species (ROS), and interleukin-6 (IL-6) were measured in 42 patients with T1DM and in 24 healthy subjects. RESULTS: Significant increases were detected in the median values of ROS and IL-6 in patients with T1DM compared with healthy subjects (ROS ~ 4,836 vs. 2,036 RLU/min, respectively; P < .05: IL-6 ~ 14.2 vs. 9.7 pg/mL, respectively; P = .002). No significant between-group differences (P > 0.05) were observed in oxidizing responses or in IL-6 concentrations when diabetic patients were grouped according to time after diagnosis (0 - 10, 10 - 20 and > 20 years). Plasma antioxidant responses were similar in patients with T1DM and in healthy subjects. CONCLUSIONS: Our results demonstrate that oxidizing and inflammatory responses are increased at the onset of T1DM, but remain unchanged during disease progression. These findings suggest that functional changes involved in diabetic complications may commence in the first years after diagnosis.

OBJETIVO: Avaliar as respostas inflamatória, oxidativa e redutora na progressão do diabetes melito tipo 1 (DM1) em pacientes sem complicações crônicas. SUJEITOS E MÉTODOS: Capacidade antioxidante do plasma, espécies reativas de oxigênio (ROS) e interleucina-6 (IL-6) foram avaliadas em 42 pacientes com DM1 e 24 indivíduos saudáveis. RESULTADOS: Aumentos significativos foram detectados nas medianas de ROS e IL-6 em pacientes com DM1 comparados com indivíduos saudáveis (ROS ~ 4.836 vs. 2.036 RLU/min, respectivamente, P < 0,05: IL-6 ~ 14,2 vs. 9,7 pg/mL, respectivamente, P = 0,002). Diferenças não significativas (P > 0,05) foram observadas na resposta oxidante e IL-6 quando os diabéticos foram agrupados de acordo com o tempo após o diagnóstico (0-10, 10-20 e > 20 anos). A resposta antioxidante do plasma foi semelhante em pacientes com DM1 e em indivíduos saudáveis. CONCLUSÕES: Nossos resultados demonstram que as respostas oxidante e inflamatória estão aumentadas desde o início do DM1, mas mantêm-se inalteradas durante a progressão da doença, sugerindo que as mudanças funcionais envolvidas nas complicações diabéticas podem começar nos primeiros anos após o diagnóstico.

High doses of in vitro beta-carotene, alpha-tocopherol and ascorbic acid induce oxidative stress and secretion of IL-6 in peripheral blood mononuclear cells from healthy donors.

BACKGROUND: Oxidative stress represents an imbalance between the production and manifestation of reactive oxygen species (ROS) and a biological system's ability to readily detoxify the reactive intermediates or repair the resulting damage. Our objective was to verify the existence of an in vitro dual effect of alpha-tocopherol, beta-carotene and ascorbic acid in peripheral blood mononuclear cells (PBMNC) of healthy donors and the inflammatory capacity by IL-6 production. METHODS: PBMNC were incubated with two concentrations of vitamin complex: [A] = Ascorbic Acid = 0.08µM, α- tocopherol = 0.04µM, ß-carotene = 0.0008 µM and [20A] = Ascorbic Acid = 1.6µM, α-tocopherol = 0.82µM, ß-carotene = 0.016µM. Oxidizing and reducing response were measured by chemiluminescence and MTT assays, respectively. IL-6 production was measured by sandwich ELISA. RESULTS: Ours results demonstrated that PBMNC (from 20-39-year-old donors) incubated with vitamins activated free radical production only in [20A] concentration. However, in the age groups of 40-59 and 60-80 years old, there was a significant reduction and activation of the oxidizing response with both concentrations, respectively. The inflammatory profile showed an elevation of IL-6 production in pro-oxidant and a decrease in antioxidant conditions. Correlation between ROS production and IL-6 releasing was observed. CONCLUSIONS: With this experiment we concluded that vitamins can exert an antioxidant effect and a pro-oxidant effect according to their concentration, and could be an inductor of an inflammatory process in vitro generating severe complications to the body in cellular levels.

Ascorbic acid, alpha-tocopherol, and beta-carotene reduce oxidative stress and proinflammatory cytokines in mononuclear cells of Alzheimer's disease patients.

OBJECTIVES: The in vitro effect of a vitamin complex in generating and reducing oxidative species in peripheral blood mononuclear cells (PBMNC) and plasma of patients with Alzheimer's disease (AD) and healthy subjects (HS) was evaluated. METHODS: Two concentrations of a vitamin complex ([A] and [20A]) with ascorbic acid, alpha-tocopherol, and beta-carotene were incubated with either mononuclear cells or plasma. The generation of oxidizing species was measured in a luminol-dependent chemiluminescence assay and the reducing response by the MTT dye reduction assay. The levels of cytokines (interleukin [IL]-1ß, IL-6, and IL-4) were measured by sandwich enzyme-linked immunosorbent assay. RESULTS: Our results demonstrated that the increase in the vitamin complex concentration reduced the reactive oxygen species (ROS) production and enhanced cellular reduction capacity in cells of AD patients in concentration [20A]. Plasma reduction capacity rose significantly for both groups (AD and HS). Concentration [A] did not alter the IL-1ß production, increased IL-4 production in both groups and lowered IL-6 production in AD cells. Concentration [20A] increased pro-inflammatory cytokines (IL-1ß and IL-6) and decreased IL-4 production by PBMNC of HS leading to a pro-inflammatory status. DISCUSSION: The antioxidant vitamin complex was effective in reducing oxidative stress in PBMNC of AD patients by lowering ROS production, improving cellular antioxidant capacities and modifying cytokine induced inflammation.

Role PKA and p38 MAPK on ROS production in neutrophil age-related: Lack of IL-10 effect in older subjects.

BACKGROUND: There is a large increase in the number of elderly people in modern societies. This demographic phenomenon has been paralleled by an epidemic of chronic diseases and inflammatory processes usually associated with advanced age. OBJECTIVE: We studied the role of protein kinase A (PKA), protein kinase B (Akt/PKB) and p38 mitogen-activated protein kinase (p38 MAPK) signaling pathways in ROS produced by neutrophils induced by pro-interferon-gamma (IFN-gamma) or anti-inflammatory interleukin 10 (IL-10) cytokines age-related. METHODS: The ROS generation was studied in healthy subjects in age ranging from 20 to 80 years old divided in five age groups: (20-39), (40-49), (50-59), (60-69) and (70-80) years old. ROS production was quantified in a luminol-dependent chemiluminescence assay and the results were expressed as relative light units/min). RESULTS: ROS production in human neutrophil was activated by IFN-gamma in all the groups studied. This activation was down-regulated by IL-10. The inhibitory effect of IL-10 on 20-49 years old group was reversed by the pre-treatment with H89 (PKA inhibitor) but not with PD169316 (p38 MAPK inhibitor). This differential effect of IL-10 associated with age was not observed with the neutrophil pre-treatment with Akt/PKB or NADPH-oxidase inhibitor (DPI). Lack of IL-10 effect on ROS production was observed in older subjects (50-80 years old). The effect of IL-10 showed a significant inhibition of ROS production similar to those got with PD169316 alone as compared to that of p38 MAPK. CONCLUSION: The results suggest that inhibitory effect of the ROS production mediated by IL-10 depends on PKA for the younger and the lack effect on the elderly is p38 MAPK dependent.

cAMP activates the generation of reactive oxygen species and inhibits the secretion of IL-6 in peripheral blood mononuclear cells from type 2 diabetic patients.

Peripheral blood mononuclear cells (PBMNC) from patients with type 2 diabetes (DM2) have generated higher levels of reactive oxygen species (ROS) that were higher than those in cells from healthy individuals. In the presence of a cAMP-elevating agent, ROS production was significantly activated in PBMNC from DM2 patients but it was inhibited in cells from healthy subjects. Higher levels of IL-6 has been detected in the supernatant of PBMNC cultures from DM2 patients in comparison with healthy controls. When cells were cultured in the presence of a cAMP-elevating agent, the level of IL-6 decreased has by 46% in the supernatant of PBMNC from DM2 patients but it remained unaltered in controls. No correlations between ROS and IL-6 levels in PBMNC from DM2 patients or controls have been observed. Secretions of IL-4 or IFNgamma by PBMNC from patients or controls have not been affected by the elevation of cAMP. cAMP elevating agents have activated the production of harmful reactive oxidant down modulated IL-6 secretion by these cells from DM2 patients, suggesting an alteration in the metabolic response possibly due to hyperglicemia. The results suggest that cAMP may play an important role in the pathogenesis of diabetes.

Efeitos do tratamento com corticosteróide nasal e controle do ambiente em crianças com rinite alérgica e asma / Effect of nasal topical corticosteroid and allergen avoidance in children with allergic rhinitis and bronchial asthma

Objetivos: A exposição domiciliar a níveis altos de alérgenos do ambiente tem sido relacionada à rinite alérgica e asma e uma intervenção global de controle do ambiente, bem como o uso de corticosteróide tópico nasal, pode ajudar a melhorar as duas patologias. O estudo teve como objetivo primário determinar os efeitos clínicos deste tratamento e como objetivo secundário verificar a redução dos alérgenos ambientais e a redução da asma destes pacientes. Casuística e Métodos: Trinta e seis crianças com rinite alérgica persistente e asma leve persistente foram alocadas randomicamente para um grupo de tratamento com medidas globais para controle do ambiente e um grupo controle sem estas medidas. Além disto, ambos os grupos usaram triancinolona nasal continuamente pelo período de estudo. Observamos durante um período de seis meses, por ensaio duplo cego, se esta intervenção bi facetada teve algum efeito, primariamente, na redução dos sintomas clínicos e secundariamente no nível de alérgenos do ambiente e nas provas de função pulmonar. Resultados: Desfecho favorável foi observado no grupo de tratamento em relação aos sintomas clínicos e nas medidas do pico de fluxo expiratório em associação à redução dos níveis de alérgenos do ambiente. As medidas do VEFl não melhoraram e houve também desfecho favorável, porém menos acentuado, nos mesmos parâmetros no grupo controle. Conclusão: Os resultados indicam que medidas globais de controle do ambiente e o uso simultâneo de corticosteróide intranasal em pacientes com rinite alérgica persistente e asma leve persistente têm impacto positivo sobre a asma.

Objectives: Home exposure to high level of house allergens has been shown to be related to rhinitis and asthma and global allergen control as well as intranasal use of corticosteroids can reduce both conditions. The primary purpose of the study was to determine the clinical effect of this treatment e secondarily to verify the reduction of environmental allergens and whether this treatment could reduce asthma. Patients and Methods: Children (36) with clinical persistent rhinitis and mild persistent asthma were randomly allocated to a global house dust avoidance treatment group and a placebo group with no intervention. All patients in both groups used a triancinolone nasal spray continuously throughout the study period. We observed during a period of six months, in a double blind action, whether the intervention and nasal spray had an effect on clinical symptoms and secondarily whether there was any effect on the levels of home antigens on the FEVl and Peak Flow parameters. Results: Significant improvements were seen in the treatment group in symptoms scores and Peak Flow measurements in association with reduction of antigen determination in their homes. FEVl determinations did not improve and a minor improvement in the same parameters was seen in the placebo group. Conclusions: The results indicates that global dust mite avoidance measures and the simultaneously use of intranasal steroid in patients with persistent allergic rhinitis and mild persistent asthma had a positive impact in asthma. .

Estresse oxidativo: revisão da sinalização metabólica no diabetes tipo 1 / Oxidative stress: a review on metabolic signaling in type 1 diabetes

O diabetes melito e suas complicações apresentam origem multifatorial. Mecanismos bioquímicos e patológicos estão associados com hiperglicemia crônica no diabetes e o aumento do estresse oxidativo tem sido postulado com papel central nestas desordens. Evidências sugerem que a lesão celular oxidativa causada pelos radicais livres contribuem para o desenvolvimento das complicações no diabetes tipo 1 (DM1) e a diminuição das defesas antioxidantes (enzimáticas e não-enzimáticas) parecem correlacionar-se com a gravidade das alterações patológicas no DM1. Nesta revisão, relata-se como o estresse oxidativo pode exercer efeitos deletérios no diabetes e são apresentadas as opções terapêuticas em estudo para modulação da injúria vascular.

Diabetic complications appear to be multifactorial process. The biochemical and pathological mechanisms are associated with chronic hyperglycemia of diabetes and the increased oxidative stress which has been postulated to play a central role in these disorders. Accumulating evidence suggests that oxidative cell injury caused by free radicals contributes to the development of type 1 diabetes (DM1) complications and decreased efficiency of antioxidant defenses (both enzymatic and nonenzymatic) seems to correlate with the severity of pathological tissue changes in DM1. In this review, we report as oxidative stress may exert deleterious effects in diabetes, as well as address current strategies in study to down-regulating vascular injury.

Correlation between ROS production and InsP3 released by granulocytes from type 1 diabetic patients in a cAMP-dependent manner.

BACKGROUND: Diabetes is associated with a pro-inflammatory status characterized by an increased production of inflammatory molecules. Reactive oxygen species (ROS) and cAMP elevating agents represent two molecular systems, normally generated during inflammation. These molecules could be responsible for the alteration of signaling pathways. In the present paper we have studied the correlation between ROS generation and inositolpolyphosphates (InsP(1), InsP(2) InsP(3) and InsP(4)) released by granulocytes from Type 1 diabetic patients (DM1) in the presence or in the absence of cyclic AMP-elevating agents. METHODS: The effect of cAMP on ROS production was quantified in a chemoluminescence assay luminol-dependent (RLU/min). InsP(1), InsP(2) InsP(3) and InsP(4) were quantified by inositol-H(3) in a Beta-counter and the results were expressed as count per minute (CPM). RESULTS: The elevation of intracellular level of cAMP inhibited both InsP(3) and ROS production in granulocytes from healthy subjects and activated in the cells from Type 1 diabetic patients. InsP(1), InsP(2) and InsP(4) did not show significant alteration in both studied cells. There was a significant correlation between InsP(3) and ROS in the presence of elevated content of cAMP. This correlation was observed in a 15 minutes reaction for healthy subjects and in 120 minutes for DM1. CONCLUSIONS: The importance of both InsP(3) release and ROS production in an inflammatory process and tissue pathophysiology in Type 1 diabetic patients is still under debate because hyperglycemia accelerates generation of oxidative stress and may play an important role in the development of complications in diabetes. Thus, our results demonstrated alteration in metabolic response in granulocytes from Type 1 diabetic patients and it may be important for the development of therapeutic processes and drugs that interfere with signaling of ROS generation and may contribute to the improvement of the severe complications of diabetes.

Role of inositol 1,4,5-triphosphate and p38 mitogen-activated protein kinase in reactive oxygen species generation by granulocytes in a cyclic AMP-dependent manner: an age-related phenomenon.

BACKGROUND: It is generally agreed that elderly subjects undergo progressive deterioration of their immune responsiveness, which leads to an increased susceptibility to autoimmune processes, neoplasm and inflammation. Thus there is a general consensus that regulation of inflammation results from a balance between pro-inflammatory and anti-inflammatory pathways. OBJECTIVE: The present study aimed to investigate the possible alterations of cyclic AMP/protein kinase A (cAMP/PKA) and p38 mitogen-activated protein kinase (p38 MAPK) pathway signaling (reactive oxygen species (ROS) generation) and inositol 1,4,5-triphosphate (InsP3) production by neutrophils during the aging process. METHODS: Age-induced ROS generation and InsP3 production were studied in healthy subjects ranging in age from 20 to 80 years. The subjects were divided into six age groups: (I) 20-29, (II) 30-39, (III) 40-49, (IV) 50-59, (V) 60-69, and (VI) 70-80 years old. The effect of cAMP, H89 (inhibitor PKA), and PD169316 (inhibitor p38 MAPK) on ROS production was quantified in a luminol-dependent chemiluminescence assay (relative light units/min) and by InsP3 release (cpm). RESULTS: Our results demonstrated a lack of dibutyryl cAMP inhibitory effects on ROS generation and InsP3 production by granulocytes from PKA-dependent 50-year-olds. However, the inhibitory effect of cAMP is restored in neutrophils after the age of 50 years when p38 MAPK signaling is inhibited. CONCLUSIONS: The present study may be important towards a better understanding of the high susceptibility to infections and age-related inflammatory and deregulation diseases. The alteration of cAMP/PKA and p38 MAPK signaling pathways enhances the inflammatory process.

Uso de próteses em cirurgia ginecológica: o estado da arte / Use of protheses in gynecological surgery: state of the art

A escolha de materiais biocompatíveis sintéticos sofreu grande evolução. Os tecidos encontrados hoje no mercado são extremamente atraentes porque reduzem tanto o tempo de operação quanto o desconforto do paciente. Não há incisão adicional, e o tempo de internação hospitalar também é reduzido. Os resultados de operações mostram-se muito promissores utilizando-se estes materiais. São comparáveis aos resultados de cirurgias clássicas em seguimento de curto e longo prazo

Efeito do controle ambiental e corticosteróide nasal em pacientes com rinite alérgica persistente / Effecr of allergen avoidance and nasal tropical corticosteroid in patients with persistent allergic rhinitis

Objetivos: O propósito deste estudo foi determinar os níveis dos alérgenos ambientais, promover seu controle agressivo, administrar corticosteróide tópico intranasal em crianças com rinite alérgica persistente e verificar o seu efeito no controle da mesma. Métodos: Estudo clínico aleatório com 62 crianças com rinite alérgica e asma leve persistente (VEF1> 80% do previsto) foi conduzido. Os pacientes foram alocados aleatoriamente para um grupo de tratamento com terapia tópica nasal em combinação com medidas agressivas para controle do ambiente ou um grupo controle com terapia tópica nasal sem estas medidas. Além disto, ambos os grupos usaram triancinoiona tópica nasal continuamente pelo período de estudo. Testamos se esta intervenção e o uso de corticosteróide nasal tiveram algum efeito nos escores de sintomas da rinite, no pico de fluxo inspiratório nasal (PFIN) e no nível de alérgenos ambientais durante período de seis meses. Resultados: Das 62 crianças, 26 não cumpriram os critérios de inclusão e seis tiveram descontinuação do tratamento. Melhora significativa foi observada no grupo de tratamento em relação aos sintomas clínicos e nas medidas do PFIN em associação à redução dos níveis de alérgenos ambientais. Houve também melhora menos acentuada dos sintomas clínicos e das medidas do pico de fluxo inspiratório nasal no grupo controle, mas não houve melhora dos níveis de alérgenos ambientais. Conclusão: Os resultados indicam que medidas agressivas de controle ambientar e o uso simultâneo de corticosteróide tópico nasal em pacientes com rinite alérgica persistente melhoram os sintomas clínicos, o fluxo inspiratório nasal e os níveis de alérgenos ambientais. O uso somente do corticosteróide tópico nasal pode também melhorar menos acentuadamente os sintomas clínicos e a obstrução medida por fluxos inspiratórios nasais.

Ligadura da artéria hipogástrica: alternativa nas hemorragias ginecológicas incontroláveis / Hypogastric artery ligation: alternative in the uncontrollable gynecological hemorrhages

O objetivo deste trabalho é mostrar a importância da ligadura da artéria hipogástrica no tratamento das hemorragias ginecológicas incontroláveis. Os autores fazem uma revisão da base anatômica, fisiopatológica e técnica do método. Além disso, são explicadas as situações nas quais este procedimento deve ser realizado