Primer consenso cubano sobre el uso de terapia convencional y biológica en pacientes con artritis reumatoide / First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis

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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)

Swine spermatozoa trigger aggregated neutrophil extracellular traps leading to adverse effects on sperm function.

In pigs, the number of PMN in uterus lumen increases within few hours after natural or artificial AI resulting in early PMN-derived innate immune reactions. Sperm-NETs formation was recently reported to occur in various mammalian species. Aim of this study was to investigate direct interactions of boar spermatozoa with swine PMN, the release of sperm-mediated NETs, and to assess NET-derived effects on sperm functionality. Sperm-triggered NETs were visualized by SEM- and immunofluorescence analyses. Sperm-mediated NETosis was confirmed by presence of extruded DNA with global histones and NE. Largest sizes of sperm-mediated aggNETs were detected after 5 h thereby resulting in effective massive sperm entrapment. The number of aggNETs increased from 3 h onwards. Kinetic studies of swine sperm-mediated NETosis showed to be a time-dependent cellular process. In addition, number of NETs-entrapped spermatozoa increased at 3 h of exposure whilst few free spermatozoa were detected after 3 h. Anchored NETs also increased from 3 h onwards. The cytotoxicity of NETs was confirmed by diminution of the total motility and the progressive motility. Spermatozoa membrane integrity and function loss exposed to NETs was confirmed from 3 h. Experiments revealed NETs-derived damaging effects on swine spermatozoa in membrane integrity, motility and functionality. We hypothesize that swine sperm-triggered aggNETs might play a critical role in reduced fertility potential in swine reproductive technique. Thus, aggNETs formation needs to be considered in future studies about uterine environment as well as advance of sperm in the porcine female reproductive tract.

Epidemiological survey and risk factor analysis on Eimeria infections in calves and young cattle up to 1 year old in Colombia.

A large-scale cross-sectional epidemiological study was conducted to evaluate prevalence, species diversity, and associated risk factors of Eimeria infections in 55 cattle farms across seven states of Colombia, including subtropical and tropical regions. In total, 1333 fecal samples from young animals (< 1 year of age) were examined at a single sampling date from August 2016 to December 2016. Flotation and McMaster techniques were conducted for parasitological investigation. Excreted Eimeria oocysts were allowed to sporulate in vitro and thereafter identified to species level based on morphological and morphometric characteristics. The overall Eimeria prevalence was 75.5% (1006/1333), with no difference observed between age categories. In total, 13 different Eimeria species were identified. The most prevalent species was E. bovis (33.5%), followed by E. auburnensis (12.5%) and E. zuernii (11.9%). Analysis of extrinsic associated risk factors revealed the floor type, feeding system, watering system, and herd size as significant (p < 0.05) risk factors for Eimeria spp. infections. Based on these data, it can be assumed that bovine coccidiosis infections occur ubiquitously in the country and might play an important role especially in its subclinical form by affecting production parameters in conventional cattle management systems.

Occurrence of endoparasites in wild Antillean manatees (Trichechus manatus manatus) in Colombia.

The recognized impact of parasites in wildlife populations demands surveillance of endangered species like the Antillean manatees (Trichechus manatus manatus) in Colombia. We conducted a parasitological survey in four rescued sea cows in order to document the parasite diversity of this sirenian in the Caribbean wetland of Colombia and contribute to the molecular characterization of its trematodes. The flukes Chiorchis fabaceus, Nudacotyle undicola and the protozoans Eimeria manatus and E. nodulosa were identified in analysed faecal samples. For C. fabaceus and N. undicola, partial regions of ribosomal RNA genes were amplified and sequenced in order to infer their phylogenetic relations. The current study constitutes a new sirenian host (T. manatus manatus) record for the genus Eimeria and the trematode N. undicola.

Fatty and hydroxycarboxylic acid receptors: The missing link of immune response and metabolism in cattle.

Fatty and hydroxycarboxylic acids are one of the main intermediates of energy metabolism in ruminants and critical in the milk production of cattle. High production demands on a dairy farm can induce nutritional imbalances and metabolism disorders, which have been widely associated with the onset of sterile inflammatory processes and increased susceptibility to infections. The literature suggests that short-chain fatty acids (SCFA), long-chain fatty acids (LCFA) and hydroxycarboxylic acids are relevant modulators of the host innate inflammatory response. For instance, increased SCFA and lactate levels are associated with subacute ruminal acidosis (SARA) and the activation of pro-inflammatory processes mediated by diverse leukocyte and vascular endothelial cells. As such, free LCFA and the ketone body ß-hydroxybutyrate are significantly increased in the plasma 1-2 weeks postpartum, coinciding with the time period in which cows are more susceptible to acquiring infectious diseases that the host innate immune system should actively oppose. Today, many of these pro-inflammatory responses can be related to the activation of specific G protein-coupled receptors, including GPR41/FFA3 and GPR43/FFA2 for SCFA; GPR40/FFA1 and GPR120/FFA4 for LCFA, GPR109A/HCA2 for ketone body ß-hydroxybutyrate, and GPR81/HCA1 for lactate, all expressed in different bovine tissues. The activation of these receptors modulates the release of intracellular granules [e.g., metalloproteinase-9 (MMP-9) and lactoferrin], radical oxygen species (ROS) production, chemotaxis, and the production of relevant pro-inflammatory mediators. The article aimed to review the role of natural ligands and receptors and the resulting impact on the host innate immune reaction of cattle and, further, to address the most recent evidence supporting a potential connection to metabolic disorders.

Regional report on Angiostrongylus vasorum in Colombia: Genetic similarity to European lineage.

The canine lungworm Angiostrongylus vasorum is considered neglected in South America and was only sporadically reported in dogs and wildlife. Gastropods act as obligatory intermediate hosts for this parasitosis. We here analysed Achatina fulica (African giant snail) populations from 5 regions of Colombia for A. vasorum infections. In total, 609 snails were collected from the departments Antioquia, Valle del Cauca and Putumayo. Angiostrongylus vasorum-infected A. fulica were found in all departments with a total prevalence of 3.9%. Larvae originating from Putumayo were molecularly characterized and identified as the European lineage of A. vasorum. This regional report shows for the first time the presence of A. vasorum in intermediate hosts in Colombia and the European genotype in South America.

Butyric acid stimulates bovine neutrophil functions and potentiates the effect of platelet activating factor.

Increased short-chain fatty acid (SCFA) production is associated with subacute ruminal acidosis (SARA) and activation of inflammatory processes. In humans and rodents, SCFAs modulate inflammatory responses in the gut via free fatty acid receptor 2 (FFA2). In bovines, butyric acid is one of the most potent FFA2 agonists. Its expression in bovine neutrophils has recently been demonstrated, suggesting a role in innate immune response in cattle. This study aimed to evaluate if butyric acid modulates oxidative and non-oxidative functions or if it can potentiate other inflammatory mediators in bovine neutrophils. Our results showed that butyric acid can activate bovine neutrophils, inducing calcium (Ca(2+)) influx and mitogen-activated protein kinase (MAPK) phosphorylation, two second messengers involved in FFA2 activation. Ca(2+) influx induced by butyric acid was dependent on the extracellular and intracellular Ca(2+) source and phospholipase C (PLC) activation. Butyric acid alone had no significant effect on reactive oxygen species (ROS) production and chemotaxis; however, a priming effect on platelet-activating factor (PAF), a potent inflammatory mediator, was observed. Butyric acid increased CD63 expression and induced the release of neutrophil granule markers matrix metalloproteinase-9 (MMP-9) and lactoferrin. Finally, we observed that butyric acid induced neutrophil extracellular trap (NET) formation without affecting cellular viability. These findings suggest that butyric acid, a component of the ruminal fermentative process, can modulate the innate immune response of ruminants.

Calcium influx, a new potential therapeutic target in the control of neutrophil-dependent inflammatory diseases in bovines.

Neutrophils are the first line of defense against pathogens in bovines; however, they are also one of the most aggressive cells during the inflammatory process, causing injury in surrounding tissues. At present, anti-inflammatory drugs are limited in acute diseases, such as pneumonia, mastitis and endometritis, because neutrophils are mostly insensitive. One of the earliest events during neutrophil activation is the increase in intracellular calcium concentration. The calcium movement is attributed to the release from intracellular stores and influx through the calcium channels in the plasma membrane, a process called store operated calcium entry (SOCE). Recently, several calcium influx blockers have been shown to have strong effects on bovine neutrophils, and this suggests that the manipulation of this pathway can be useful in the control of neutrophil functions during acute inflammatory processes. In this paper, we will review the role of calcium influx as a potential anti-inflammatory target and summarize the most recent evidences for this in bovine neutrophils.

Induction of reactive oxygen species in bovine neutrophils is CD11b, but not dectin-1-dependent.

Neutrophils play a key role in initiating an innate immune response, being the first type of immune cell arriving at the site of injury or infection. These cells are able to mount a direct anti-bactericidal response by the production of reactive oxygen or reactive nitrogen species (ROS/RNS). An important component of the host innate immune response is recognition of pathogen-associated molecular patterns (PAMPs) by pattern recognition receptors (PRRs). Toll-like receptors (TLRs) are an important family of PRRs and, are a key component in activation of innate immune mechanisms. In the present study we described the presence of mRNA transcripts for TLR1, TLR2, TLR4, TLR6, TLR7 and TLR10 in bovine neutrophils. In contrast, the presence of mRNA transcripts for TLR3 varied between animals, whereas no transcripts were detected for TLR5, TLR8, TLR9 or the C-type lectin receptor dectin-1 in neutrophils isolated from bovine blood. Additionally, zymosan, a dectin-1/TLR2 ligand, induced ROS, but not RNS production in a CD11b-, but not dectin-1-dependent manner. This effect was dependent on Store Operated Calcium Entry (SOCE), and partially inhibited using monoclonal antibodies to CD11b. Taken together, our data describe the presence of specific PRRs transcripts in the mRNA isolated from bovine neutrophil and show a CD11b-/Ca(2+) dependent ROS production by these cells.

[Intestinal geohelminthosis in man and domestic animals in the riverside sections of the Valdivia River Basin, Chile]. / Geohelmintosis intestinales en el hombre y animales domésticos de sectores ribereños de la cuenca del río Valdivia, Chile.

In March-October 1987 were analyzed 1295 coprological specimens in a sample of the human population who lives in riverside localities in the Valdivia River Basin, Chile. A 23.6% of examined persons presented infection by one or more helminth species. The prevalence of infection by Ascaris lumbricoides, Trichuris trichiura and Trichostrongylidae gen. sp. were 15.5, 12.7 and 0.2%, respectively. The prevalence of human ascariosis and trichuriosis were greater in pre-school and school children. The sex of the host and prevalence of geohelminthosis did not show any relationship. Prevalences of ascariosis and trichuriosis were higher in persons from houses with no sanitary fecal and water disposal. Over 35% and 20.7% of family groups showed infection by A. lumbricoides and T. trichiura, respectively in over 40% of the members of each group. Fecal samples from domestic mammals revealed the following prevalences rates for helminth infections: in dogs 19.0 and 15.2% for Toxocara canis and Uncinaria stenocephala respectively, in cats 65.1% for Toxocara cati, and in pigs 25.4 and 3.2% for Ascaris suum and Trichuris suis respectively. Some of these species are clearly demonstrated agents of zoonoses.

[Blastocystosis and other intestinal protozoan infections in human riverside communities of the Valdivia River basin, Chile]. / Blastocistosis y otras infecciones por protozoos intestinales en comunidades humanas ribereñas de la cuenca del Río Valdivia, Chile.

Between March and October 1987, the prevalence of infection by Blastocystis hominis and other intestinal protozoan, their relationship with the age and sex of the hosts, and the percentage of infected persons in family groups were determined in riverside communities of Valdivia River Basin, Chile. One or more intestinal protozoan species were determined in 72.5% of the examined persons. The prevalence was greater for B. hominis (61.8%). The prevalences of B. hominis, Endolimax nana and Entamoeba coli were greater in relation to the age of the host. The sex of the host and prevalence of infections by B. hominis and other species of intestinal protozoans did not show association. Prevalence of B. hominis was greater in persons from houses with no sanitary faeces disposal. Over 60% of the members of family groups showed infection by B. hominis in 53.1% of the groups compared to 2.4%-21.8% of infections by other protozoan species. Faecal samples of 45 pigs revealed 22.2% of infection by Blastocystis.

[Epidemiology of diphyllobothriasis in the Valdivia river basin, Chile]. / Epidemiología de la difilobotriasis en la cuenca del Río Valdivia, Chile.

In the Valdivia (Chile) river basin 1,295 inhabitants of 6 riverside districts were examined between March and October 1987 and showed a 1.2% of prevalence by Diphyllobothrium in the districts of Riñihue and Las Huellas. Prevalence of 5.3% and 9.8% respectively were registered in dogs of the districts of Riñihue and Malihue. No cat or pig infection was observed in the different districts. The parasites recovered after the treatment were identified as Diphyllobothrium latum. Human infection by D. latum in the districts affected results from the consumption of smoked or insufficiently cooked fish. The investigation of 1,450 fish (4 exotic species and 11 autochthonous ones), caught in the Valdivia river basin in 1986 and 1987, showed the existence of plerocercoids of D. latum and/or Diphyllobothrium dendriticum in Salmo gairdneri and Salmo trutta among exotic fish and in some autochthonous species. Prevalence and mean intensity in the infection of fish as well as the degree of aggregation in the infrapopulations varied in the different districts. Some species of fish would act as intermediary hosts and others as paratenic hosts in the life cycles of Diphyllobothrium spp. in the Valdivia river basin. An improvement in the conditions of basic sanitation, in sanitary education and in the treatment of infected persons is proposed as a means for the control of diphyllobothriasis in the districts affected.