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1.
Acta otorrinolaringol. esp ; 70(6): 348-357, nov.-dic. 2019. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-184880

RESUMO

Antecedentes y objetivo: El objetivo del estudio ha sido describir los resultados del tratamiento de sinusitis fúngica invasiva con cirugía endoscópica nasal en una población oncológica pediátrica con inmunosupresión e informar sobre la seguridad, la eficacia y las complicaciones del procedimiento. Métodos: Se realizó un estudio retrospectivo de la totalidad de los pacientes con diagnóstico de sinusitis fúngica invasiva operados en la Unidad Nacional de Oncología Pediátrica entre los años 2012 y 2016. Los datos tomados de su historial médico incluyeron: características epidemiológicas, diagnóstico oncológico, datos hematológicos, síntomas, estudios tomográficos, intervenciones quirúrgicas, resultados de enfermedad y cultivos, medicamentos recibidos, complicaciones, evolución y supervivencia. Los datos fueron analizados utilizando estadística descriptiva, las variables continuas con medidas de tendencia central y las variables categóricas de forma porcentual. Resultados: Se identificó a 18 pacientes, 7 de sexo masculino y 11 de sexo femenino. El promedio de edad fue de 12 años, 13 tuvieron diagnóstico de leucemia linfoide aguda y 5 de leucemia mieloide aguda; 17 pacientes presentaron neutropenia severa en el momento del diagnóstico. El agente etiológico más frecuentemente identificado fue Aspergillus en 13 pacientes. En 16 pacientes (89%) se controló la enfermedad con cirugía endoscópica nasal. Diez pacientes fallecieron por causas no relacionadas a lo largo del estudio. Discusión y conclusiones: La sinusitis fúngica invasiva es una enfermedad cuya incidencia va en aumento entre pacientes con inmunosupresión y debe de considerarse una urgencia médica debido a su alta mortalidad. El diagnóstico se basa en un alto índice de sospecha en pacientes con factores predisponentes (leucemia, neutropenia, fiebre persistente, sonda nasogástrica) y la evaluación endoscópica nasal. El tratamiento médico antifúngico y cirugía endoscópica nasal agresiva está indicado independientemente del estado del paciente para disminuir la carga fúngica y la alta mortalidad asociada. El tratamiento debe de ser suministrado por un equipo multidisciplinario que incluye pediatría, hemato-oncología, infectología y otorrinolaringología


Background and objective: to describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population. Methods: retrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival. Results: 18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study. Discussion and conclusions: Invasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient's condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Sinusite/diagnóstico , Sinusite/cirurgia , Imunossupressão , Endoscopia/métodos , Avaliação de Resultado de Intervenções Terapêuticas , Estudos Retrospectivos , Neutropenia/complicações , Aspergillus/isolamento & purificação , Micoses/complicações , Febre/etiologia , Seios Paranasais/diagnóstico por imagem , Complicações Pós-Operatórias
2.
Medicine (Baltimore) ; 98(50): e18242, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852090

RESUMO

BACKGROUND: Graves ophthalmopathy (GO) is one of the remaining enigmas in thyroidology. Glucocorticoids (GCs) are strongly recommended but their effects are not completely satisfactory and adverse reactions can occur. Tripterygium glycosides (TG) is a promising component extracted from Tripterygium wilfordii Hook F (TwHF), and numerous patients with GO have benefited from it. However, its practical application value is still unclear. The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of TG for patients with GO. METHODS: By retrieving the PubMed, Embase, the Cochrane Library, CNKI, VIP, CBM, and WanFang Databases, the open published randomized controlled trials (RCTs) related to TG in the treatment of GO were collected. And inclusion and exclusion criteria were established. The Cochrane bias risk assessment tool conducts the evaluation of included studies, and meta-analysis was performed using Revman 5.3 software. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019131915. RESULTS: A total of 19 trials (involving 1517 GO patients) were included in this review with generally acceptable validity of included RCTs. TG therapy brought about a significantly higher efficacy rate compared with non-TG treatments (RR: 1.40; 95% CI: 1.31-1.49). Subgroup meta-analysis showed that TG with or without immunosuppressive therapies were all better than controls: with GC (RR: 1.36; 95% CI: 1.27-1.46), with multiple intensification of immunosuppressive therapies (RR: 1.91; 95% CI: 1.37-2.67), with no immunosuppressive therapies (RR: 1.39; 95% CI:1.21-1.59); the dosage of TG for 15-60 mg/d (RR: 1.41; 95% CI: 1.30-1.53) were better compared with for ≥90 mg/d (RR: 1.47; 95% CI: 1.29-1.68); the course of treatment for ≤3 months (RR: 1.43; 95% CI: 1.33-1.52) was better than controls, but when >3 months (RR: 1.15; 95% CI: 0.94-1.41) there was no significant differences. After treatment, the degree of exophthalmus (SMD: -2.55; 95% CI: -2.93 to 2.17), the recurrence rate of 1 year (RR: 0.45; 95% CI: 0.27-0.74), and adverse reactions rate (RR: 0.32; 95% CI: 0.20-0.53) were all lower, while the CAS was no obvious gap in 2 groups (SMD: 0.08; 95% CI: -0.60 to 0.75). CONCLUSIONS: This review found that TG has some advantages in treating GO, especially in improving clinical efficacy and reducing adverse reactions. Nevertheless, large sample, multi-center, reasonable design, and high quality clinical studies are still needed for further verification.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Glicosídeos/uso terapêutico , Oftalmopatia de Graves/tratamento farmacológico , Imunossupressão/métodos , Tripterygium , Humanos
3.
Anticancer Res ; 39(11): 5953-5962, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704820

RESUMO

BACKGROUND/AIM: The presence of ascites in ovarian cancer patients is considered a negative prognostic factor. The underlying mechanisms are not clearly understood. MATERIALS AND METHODS: The amount of ascites was evaluated, preferably, using diffusion-weighted MRI at primary diagnosis in a retrospective cohort of 214 women with ovarian cancer, in an ordinal manner (amount of ascites: none, limited, moderate, abundant). In a prospective cohort comprising 45 women with ovarian cancer, IL-10 (interleukin), VEGF (vascular endothelial growth factor), TGF-ß (transforming growth factor) and CCL-2 [chemokine (C-C) motif ligand 2] were measured at diagnosis (and at interval debulking, when available). RESULTS: Gradually increasing amounts of ascites were correlated significantly, even after correction for FIGO stage, with reduced survival (p<0.0001) and stronger immunosuppression (IL10 and VEGF). Neoadjuvant chemotherapy reduced immunosuppression, which was observed as a reduction in CCL-2, IL-10 and VEGF. CONCLUSION: The amount of ascites is an independent predictor of survival and correlates with increased immunosuppression.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ascite/mortalidade , Imunossupressão/mortalidade , Terapia Neoadjuvante/efeitos adversos , Neoplasias Ovarianas/mortalidade , Adenocarcinoma de Células Claras/tratamento farmacológico , Adenocarcinoma de Células Claras/imunologia , Adenocarcinoma de Células Claras/mortalidade , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/imunologia , Adenocarcinoma Mucinoso/mortalidade , Adenocarcinoma Mucinoso/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/etiologia , Ascite/patologia , Cistadenocarcinoma Seroso/tratamento farmacológico , Cistadenocarcinoma Seroso/imunologia , Cistadenocarcinoma Seroso/mortalidade , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/tratamento farmacológico , Neoplasias do Endométrio/imunologia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/patologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
4.
Cancer Immunol Immunother ; 68(12): 1935-1947, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31641795

RESUMO

BACKGROUND: Due to the strong tumoricidal activities of activated natural killer T (NKT) cells, invariant NKT cell-based immunotherapy has shown promising clinical efficacy. However, suppressive factors, such as regulatory T cells (Tregs), may be obstacles in the use of NKT cell-based cancer immunotherapy for advanced cancer patients. Here, we investigated the suppressive effects of Tregs on NKT cells and the underlying mechanisms with the aim to improve the antitumor activities of NKT cells. METHODS: Peripheral blood samples were obtained from healthy donors, patients with benign tumors, and patients with head and neck squamous cell carcinoma (HNSCC). NKT cells, induced with α-galactosylceramide (α-GalCer), and monocyte-derived dendritic cells (DCs) were co-cultured with naïve CD4+ T cell-derived Tregs to investigate the mechanism of the Treg suppressive effect on NKT cell cytotoxic function. The functions and phenotypes of NKT cells were evaluated with flow cytometry and cytometric bead array. RESULTS: Treg suppression on NKT cell function required cell-to-cell contact and was mediated via impaired DC maturation. NKT cells cultured under Treg-enriched conditions showed a decrease in CD4- NKT cell frequency, which exert strong tumoricidal responsiveness upon α-GalCer stimulation. The same results were observed in HNSCC patients with significantly increased effector Tregs. CONCLUSION: Tregs exert suppressive effects on NKT cell tumoricidal function by inducing more CD4- NKT cell anergy and less CD4+ NKT cell anergy. Both Treg depletion and NKT cell recovery from the anergy state may be important for improving the clinical efficacy of NKT cell-based immunotherapy in patients with advanced cancers.


Assuntos
Neoplasias de Cabeça e Pescoço/imunologia , Células T Matadoras Naturais/imunologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Linfócitos T Reguladores/imunologia , Idoso , Idoso de 80 Anos ou mais , Células Cultivadas , Anergia Clonal , Citotoxicidade Imunológica , Feminino , Humanos , Vigilância Imunológica , Imunossupressão , Masculino , Pessoa de Meia-Idade
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1160-1162, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657345

RESUMO

OBJECTIVE: Sepsis includes a highly diverse and dynamic mixture of systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS). In the past, drugs produced to block the early inflammatory response had little effect on reversing the development of sepsis. Recent studies have shown that the mortality and prognosis of patients are significantly correlated with the immunosuppression of sepsis and the overexpression of co-inhibitory molecules. Programmed death-1 (PD-1) is a recently focused co-inhibitory molecule, which can regulate the functions of a variety of immune cells and participate in innate immunity and acquired immunity. It has important value in risk stratification and prognosis prediction of patients with sepsis, and can be used as one of the intervention targets for immune regulation in sepsis in the future. The role of PD-1 signaling pathway in immunosuppression and its effect on patients' prognosis is reviewed in this article, providing new directions for the treatment of sepsis.


Assuntos
Sepse , Síndrome de Resposta Inflamatória Sistêmica , Humanos , Imunidade Inata , Imunossupressão , Transdução de Sinais
7.
Adv Exp Med Biol ; 1186: 141-170, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31654389

RESUMO

Developing successful surgical strategies to deliver cell therapeutics to the back of the eye is an essential pillar to success for stem cell-based applications in blinding retinal diseases. Within this chapter, we have attempted to gather all key considerations during preclinical animal trials.Guidance is provided for choices on animal models, options for immunosuppression, as well as anesthesia. Subsequently we cover surgical strategies for RPE graft delivery, both as suspension as well as in monolayers in small rodents, rabbits, pigs, and nonhuman primate. A detailed account is given in particular on animal variations in vitrectomy and subretinal surgery, which requires a considerable learning curve, when transiting from human to animal. In turn, however, many essential subretinal implantation techniques in large-eyed animals are directly transferrable to human clinical trial protocols.A dedicated subchapter on photoreceptor replacement provides insights on preparation of suspension as well as sheet grafts, to subsequently outline the basics of subretinal delivery via both the transscleral and transvitreal route. In closing, a future outlook on vision restoration through retinal cell-based therapeutics is presented.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos , Retina , Doenças Retinianas , Epitélio Pigmentado da Retina , Animais , Humanos , Imunossupressão , Modelos Animais , Células Fotorreceptoras/citologia , Retina/cirurgia , Doenças Retinianas/cirurgia , Doenças Retinianas/terapia , Epitélio Pigmentado da Retina/cirurgia
8.
Magy Onkol ; 63(3): 246-255, 2019 09 18.
Artigo em Húngaro | MEDLINE | ID: mdl-31533145

RESUMO

Therapy with immune checkpoint inhibitors (ICPis) has become widespread in medical oncology, becoming part of the routine treatment for various malignancies. These antibodies induce an anti-cancer immune activation by blocking the natural immunosuppression, which is supposed to protect the human body's healthy cells from destruction by the immune system, caused also by cancers, and as a result, allow the immune system to take part in destroying malignant cells. However, the immune activation created by these molecules is not selective against cancer tissues, therefore adverse events associated to these therapies are similar to the signs and symptoms of autoimmune diseases. Common adverse events affect the skin, liver, lungs, gastrointestinal and endocrine systems, less frequently the heart and the nervous system, occasionally causing life-threatening complications. Therapy of these adverse events requires rapid diagnosis and adequate treatment in the form of various immunosuppressants.


Assuntos
Antineoplásicos/efeitos adversos , Doenças Autoimunes/induzido quimicamente , Doenças Autoimunes/prevenção & controle , Imunossupressão , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Doenças Autoimunes/imunologia , Humanos
9.
Magy Onkol ; 63(3): 257-260, 2019 09 18.
Artigo em Húngaro | MEDLINE | ID: mdl-31533146

RESUMO

The immune checkpoint inhibitors (ICI) opened a new era in anticancer treatment. This type of treatment is beneficial for a subset of patients who had a restricted success in the past. However, manipulation of the immune system may lead to the flare up of preexisting autoimmune diseases, requiring intervention. Furthermore, immune suppression strongly influences the outcome of ICI treatment. The ICI treatment of cancer patients with autoimmune disease is a complex task: pre-treatment assessment of the patients, early management of flare ups, and introduction of effective immune suppression is required to achieve the best outcome.


Assuntos
Doenças Autoimunes/complicações , Doenças Autoimunes/prevenção & controle , Imunoterapia/métodos , Neoplasias/complicações , Neoplasias/terapia , Doenças Autoimunes/imunologia , Humanos , Imunossupressão/métodos , Neoplasias/imunologia
10.
Lancet ; 394(10205): 1274-1285, 2019 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-31533905

RESUMO

The main goal of treatment for type 1 diabetes is to control glycaemia with insulin therapy to reduce disease complications. For some patients, technological approaches to insulin delivery are inadequate, and allogeneic islet transplantation is a safe alternative for those patients who have had severe hypoglycaemia complicated by impaired hypoglycaemia awareness or glycaemic lability, or who already receive immunosuppressive drugs for a kidney transplant. Since 2000, intrahepatic islet transplantation has proven efficacious in alleviating the burden of labile diabetes and preventing complications related to diabetes, whether or not a previous kidney transplant is present. Age, body-mass index, renal status, and cardiopulmonary status affect the choice between pancreas or islet transplantation. Access to transplantation is limited by the number of deceased donors and the necessity of immunosuppression. Future approaches might include alternative sources of islets (eg, xenogeneic tissue or human stem cells), extrahepatic sites of implantation (eg, omental, subcutaneous, or intramuscular), and induction of immune tolerance or encapsulation of islets.


Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Células Secretoras de Insulina/transplante , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressão , Resultado do Tratamento
11.
Nervenarzt ; 90(10): 1055-1066, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31538208

RESUMO

Myasthenia gravis (MG) is an autoimmune disorder caused by antibodies against acetylcholine receptors (AChR) or other structural proteins of the neuromuscular junction. This diminishes cholinergic transmission, thus leading to exercise-induced fatigue and sometimes manifest muscle weakness, including the bulbar and ocular musculature. Whereas ocular MG is as a rule initially symptomatically treated with acetylcholine esterase inhibitors, generalized MG requires long-term immunosuppression. The thymus plays a particular role in the pathophysiology of AChR antibody-positive MG, which can also manifest as a paraneoplastic disorder in the context of a thymoma. This article reviews the basic and advanced treatment options of the different disease subtypes including plasma exchange and immunoglobulins for treatment in a myasthenic crisis. Recently, clinical approval of eculizumab, a complement inhibitor, enriched the pharmacological armamentarium for AChR antibody-positive MG patients not appropriately responding to immunosuppression alone.


Assuntos
Miastenia Gravis , Anticorpos Monoclonais Humanizados/uso terapêutico , Humanos , Imunoglobulinas/uso terapêutico , Imunossupressão , Miastenia Gravis/imunologia , Miastenia Gravis/terapia , Troca Plasmática , Timo/imunologia , Timo/patologia
12.
Z Rheumatol ; 78(10): 940-946, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31538231

RESUMO

Patients under immunosuppressive treatment have a much higher risk for severe infections and sepsis. The morbidity and mortality of severe infections in critically ill patients are high but the prognosis is not different from immunocompetent patients if diagnosed early and treated adequately, especially in high volume centers. A high level of clinical alertness for infectious complications is essential for rapid and adequate diagnosis and treatment. The established principles for treatment of sepsis are also valid for immunocompromized patients, i.e. rapid initiation of antibiotic treatment, focal control and rapid supportive treatment according to the current guidelines on sepsis. In patients with the corresponding clinical signs and not responding to initial empirical treatment, opportunistic infections as rare causes of sepsis have to be taken into account. To prevent development or selection of resistance due to broad spectrum treatment, the empirical treatment should always focus on the specific pathogen detected.


Assuntos
Imunossupressão , Sepse , Antibacterianos/uso terapêutico , Estado Terminal , Humanos , Hospedeiro Imunocomprometido , Sepse/diagnóstico , Sepse/tratamento farmacológico
13.
Khirurgiia (Mosk) ; (9): 80-85, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532171

RESUMO

This article discusses the need to implement effective methods for monitoring immune status and rehabilitation of patients after kidney transplantation. Induction of immunological tolerance which allows minimizing or even completely canceling supportive immunosuppressive therapy is one of the key tasks in the field of organ transplantation. Regulatory T-cells (TREGs) play an important role in maintaining immunological homeostasis, including limiting kidney transplant rejection, and potentially contribute to the development of immunological tolerance. At the same time, for the introduction of TREG therapy into clinical practice, it is necessary to overcome a number of unsolved problems, such as induction and cultivation of a sufficient number of TREG cells for therapeutic action as well as reducing the risks associated with TREG conversion to effector lymphocytes or an undesirable non-specific immunosuppressive effect. This review examines both the impact of common post-transplant pharmacological immunosuppression approaches on TREGs and the therapeutic potential of TREG cell cultures in prevention of kidney transplant rejection. The questions of ex vivo TREG manufacturing process and possible threats of applying cell technologies in this branch of transplantology were considered.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Transplante de Rim/efeitos adversos , Linfócitos T Reguladores/imunologia , Rejeição de Enxerto/etiologia , Humanos , Tolerância Imunológica/imunologia , Imunossupressão/métodos , Imunossupressores/uso terapêutico , Transplante de Rim/reabilitação , Imunologia de Transplantes/imunologia
16.
Transplant Proc ; 51(6): 1796-1800, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399165

RESUMO

BACKGROUND: In kidney transplantation, donor recipient human leukocyte antigen (HLA)-DR mismatch signals high immunologic risk and portends inferior outcomes. We compared the impacts of depleting vs non-depleting antibody induction on the outcomes in kidney transplant recipients (KTRs) at different levels of HLA-DR mismatches. METHODS: Using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database, we identified adult KTRs from 2001 to 2015 who received induction therapy with either depleting (thymoglobulin/alemtuzumab) or non-depleting (basiliximab/daclizumab) antibody and were discharged on calcineurin inhibitor/mycophenolic acid maintenance. Patients were then stratified by the number of donor-recipient HLA-DR mismatches (0, 1, 2) in both living donor (LD) and deceased donor (DD) KTRs. Under each HLA-DR mismatch category, long-term outcomes were compared for depleting vs non-depleting induction using a Cox model. RESULTS: A total of 63,821 LD (HLA-DR mismatches: 0, n = 6945 [depleting = 4409, non-depleting = 2536]; 1, n = 19,557 [depleting = 13,558, non-depleting = 6019]; and 2, n = 10,727 [depleting = 7694, non-depleting = 3033]) and 64,922 DD (HLA-DR mismatches: 0, n = 13,915 [depleting = 10,124, non-depleting = 3791]; 1, n = 27,994 [depleting = 20,454, non-depleting = 7540]; and 2, n = 23,013 [depleting = 16,908, non-depleting = 6105]) KTRs were included in the analysis. Adjusted patient death risk was significantly lower in the depleting vs non-depleting antibody induction group among DD kidney recipients (hazard ratio 0.90, 95% CI 0.85-0.96, P = .001) and trended lower among LD kidney recipients (HR 0.88, 95% 0.79-1.01, P = .05) with 2 HLA-DR mismatches. DISCUSSION: Our study found a patient survival benefit associated with the use of perioperative induction with depleting when compared to non-depleting antibody in KTRs with 2 HLA-DR mismatches and maintained on a calcineurin inhibitor/mycophenolic acid regimen.


Assuntos
Incompatibilidade de Grupos Sanguíneos/imunologia , Sobrevivência de Enxerto/imunologia , Antígenos HLA-DR/imunologia , Imunossupressão/métodos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Adulto , Alemtuzumab/uso terapêutico , Anticorpos/imunologia , Soro Antilinfocitário/imunologia , Soro Antilinfocitário/uso terapêutico , Basiliximab/imunologia , Basiliximab/uso terapêutico , Inibidores de Calcineurina/imunologia , Inibidores de Calcineurina/uso terapêutico , Contraindicações de Procedimentos , Daclizumabe/imunologia , Daclizumabe/uso terapêutico , Bases de Dados Factuais , Feminino , Teste de Histocompatibilidade , Humanos , Rim/imunologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/imunologia , Ácido Micofenólico/uso terapêutico , Modelos de Riscos Proporcionais , Resultado do Tratamento
17.
Adv Exp Med Biol ; 1155: 381-390, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31468416

RESUMO

Taurine (2-aminoethanesulfonic acid) has positive effects on the formation of immune systems. In this study, we evaluated the effects of taurine on the development of T lymphocyte subpopulations in thymus of immunosuppresive mice. The immunosuppressed mice model was established by intraperitoneal injection of dexamethasone (Dex) for 7 days. Mice (male, Kunming strain) were randomly divided into three groups, the normal control group (Cont.), the Dex-induced immunosuppressive model group (Dex + PBS), and the taurine intervention group (Dex + TAU). Taurine was administered at a dose of 200 mg/kg for 30 days or until euthanasia. Total cell numbers in the thymi of mice were evaluated by cell count, and the flow cytometry was used to determine the proportion of different cell subsets. Our results showed that the size and weight of thymi of Dex + PBS group were significantly smaller than those of Cont. group, and taurine administration efficiently increased the thymus index. Taurine also significantly increased the number of CD4- CD8- double negative (DN), CD4+ CD8+ double positive (DP), CD4+ single positive (CD4+) and CD8+ SP (CD8+) cells compared with the Dex + PBS group, but did not affect the CD4+/CD8+ cell ratio in thymus of Dex-induced immunoseppressive mice. Our results suggested that taurine has a positive effect on thymus differentiation in Dex-induced immunosuppressive mice.


Assuntos
Diferenciação Celular , Imunossupressão , Subpopulações de Linfócitos T/efeitos dos fármacos , Taurina/farmacologia , Timo/efeitos dos fármacos , Animais , Relação CD4-CD8 , Dexametasona , Citometria de Fluxo , Masculino , Camundongos , Distribuição Aleatória , Subpopulações de Linfócitos T/citologia
19.
Semin Oncol ; 46(3): 254-260, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31383368

RESUMO

The broad use of radiotherapy (RT) in the management of solid human tumors is based on its ability to damage cellular macromolecules, particularly the DNA, effectively inducing growth arrest and cell death locally in irradiated tumor cells. However, bystander effects, such as the transmission of lethal signals between cells via gap junctions or the production of diffusible cytotoxic mediators, can also contribute to the local antineoplastic action of RT. Traditionally, RT has been considered to exert immunosuppressive effects on the host. This idea largely stems from the radiosensitivity of quiescent lymphocytes and on the use of total body irradiation as part of myeloablative conditioning regimens preceding hematopoietic stem cell transplantation. Additionally, the occurrence of the so-called "abscopal effect," where nonirradiated distant lesions display effects of RT response, suggests that RT may also induce tumor immunization. Several RT-induced effects on cancer, immune and stromal cells, contribute to the abscopal effect: (1) induction of "immunogenic cell death", with release of tumor-associated antigens, (2) alterations of cancer cell immunophenotype, and (3) modulation of the tumor microenvironment. Damage and death of cancer cells leads to the surface exposure of immunogenic molecules as well as the release of damage associated molecular patterns such as adenosine triphosphate or High-Mobility-Group-Protein B1, and potentially tumor antigens that activate the innate and adaptive immune systems. Moreover, nuclear release and cytoplasmic sensing of altered nucleic acids via cyclic GMP-AMP Synthase/Stimulator of Interferon Genes is connected to the secretion of cytokines that support innate and adaptive antitumor immunity. As a result of the above, irradiated tumor cells may potentially act as an "in situ vaccine."


Assuntos
Morte Celular/efeitos da radiação , Neoplasias/radioterapia , Tolerância a Radiação/imunologia , Células Estromais/efeitos da radiação , Antígenos de Neoplasias/imunologia , Morte Celular/imunologia , Proteína HMGB1/genética , Proteína HMGB1/imunologia , Humanos , Imunofenotipagem , Imunossupressão , Linfócitos/imunologia , Linfócitos/efeitos da radiação , Neoplasias/imunologia , Células Estromais/imunologia , Microambiente Tumoral/imunologia , Microambiente Tumoral/efeitos da radiação , Irradiação Corporal Total/efeitos adversos
20.
BJOG ; 126(11): 1310-1319, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31410987

RESUMO

Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair. TWEETABLE ABSTRACT: Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.


Assuntos
Sobrevivência de Enxerto/fisiologia , Imunossupressão/métodos , Infertilidade Feminina/cirurgia , Transplante de Órgãos , Doadores de Tecidos , Útero/transplante , Adulto , Feminino , Rejeição de Enxerto , Humanos , Nascimento Vivo , Pessoa de Meia-Idade , Transplante de Órgãos/métodos , Gravidez , Resultado do Tratamento , Adulto Jovem
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