Residential Greenness, Lifestyle, and Vitamin D: A Longitudinal Cohort of South Asian Origin and Caucasian Ethnicity Women Living in the South of the UK

The global population is at risk of vitamin D deficiency due to low exposure to sunlight and low intake of the vitamin through diet. The aim of this study was to investigate in women the association between vitamin D status and parathyroid hormone (PTH), ultraviolet radiation, lifestyle, ethnicity, social conditions, and residential greenness. A 1-year longitudinal study assessed vitamin D status in 309 women living at latitude 51°14' N. Blood samples were taken four times throughout the year for analysis of 25(OH)D and serum PTH concentration. After each seasonal visit, the individuals completed 4-day diet diaries and used two dosimeter badges for 1 week to estimate weekly UVR exposure. A questionnaire was applied to provide information about lifestyle and their ethnicity. Residential greenness was measured by Normalized Difference Vegetation Index (NDVI), within a 1000 m radius around each participant's home address. Women living in greener spaces were more likely to have improved vitamin D status (RR: 1.51; 95%CI: 1.13-2.02), as well as those who were more exposed to UVR (RR: 2.05; 95%CI: 1.44-2.92). Our results provide an insight into the connection between residential greenness, lifestyle, and vitamin D status comparing two ethnicities in a country with a temperate climate and with a high degree of urbanization.

Natural Environments in University Campuses and Students' Well-Being

Most recent university campuses follow the North American model, built on city limits or countryside, with large separate buildings in open green spaces. Studies suggest that the prevalence and severity of mental health issues among university students has been increasing over the past decade in most countries. University services were created to face this growing problem, however individual-based interventions have limited effects on mental health and well-being of a large population. Our aim was to verify if and how the natural environment in campuses is focused on programs to cope with the issue of mental health and well-being among students. A systematic review of literature was undertaken with search in Scopus and LILACS with the keywords "green areas" AND "well-being" AND "Campus", following PRISMA guidelines. As a result, 32 articles were selected. Research on the topic is recent, mostly in the USA, Bulgaria, and China. Most studies used objective information on campuses' greenness and/or university students' perception. Mental health was usually measured by validated scores. Findings of all the studies indicated positive association between campus greenery and well-being of students. We conclude that there is a large potential for use of university campuses in programs and as sites for students' restoration and stress relief.

Outdoor airborne allergens: Characterization, behavior and monitoring in Europe

Aeroallergens or inhalant allergens, are proteins dispersed through the air and have the potential to induce allergic conditions such as rhinitis, conjunctivitis, and asthma. Outdoor aeroallergens are found predominantly in pollen grains and fungal spores, which are allergen carriers. Aeroallergens from pollen and fungi have seasonal emission patterns that correlate with plant pollination and fungal sporulation and are strongly associated with atmospheric weather conditions. They are released when allergen carriers come in contact with the respiratory system, e.g. the nasal mucosa. In addition, due to the rupture of allergen carriers, airborne allergen molecules may be released directly into the air in the form of micronic and submicronic particles (cytoplasmic debris, cell wall fragments, droplets etc.) or adhered onto other airborne particulate matter. Therefore, aeroallergen detection strategies must consider, in addition to the allergen carriers, the allergen molecules themselves. This review article aims to present the current knowledge on inhalant allergens in the outdoor environment, their structure, localization, and factors affecting their production, transformation, release or degradation. In addition, methods for collecting and quantifying aeroallergens are listed and thoroughly discussed. Finally, the knowledge gaps, challenges and implications associated with aeroallergen analysis are described.

Designing an automatic pollen monitoring network for direct usage of observations to reconstruct the concentration fields

We consider several approaches to a design of a regional-to-continent-scale automatic pollen monitoring network in Europe. Practical challenges related to the arrangement of such a network limit the range of possible solutions. A hierarchical network is discussed, highlighting the necessity of a few reference sites that follow an extended observations protocol and have corresponding capabilities. Several theoretically rigorous approaches to a network design have been developed so far. However, before starting the process, a network purpose, a criterion of its performance, and a concept of the data usage should be formalized. For atmospheric composition monitoring, developments follow one of the two concepts: a network for direct representation of concentration fields and a network for model-based data assimilation, inverse problem solution, and forecasting. The current paper demonstrates the first approach, whereas the inverse problems are considered in a follow-up paper. We discuss the approaches for the network design from theoretical and practical standpoints, formulate criteria for the network optimality, and consider practical constraints for an automatic pollen network. An application of the methodology is demonstrated for a prominent example of Germany's pollen monitoring network. The multi-step method includes (i) the network representativeness and (ii) redundancy evaluation followed by (iii) fidelity evaluation and improvement using synthetic data.

Impact of Structural GLA Protein Changes on Peripheral GLA Activity and Substrate Accumulation in Fabry Disease Patients

INTRODUCTION

Fabry disease is an X-linked lysosomal storage disorder caused by pathogenic variants in the GLA gene, leading to decreased/absent α-galactosidase activity. In clinical practice, enzyme activity and substrate/byproduct accumulation play a role in diagnosis and disease-monitoring biomarkers. However, interpreting biomarker levels is not straightforward and can change according to the underlying GLA protein abnormality.

OBJECTIVE

Our goals were to understand how disrupting specific protein regions changes biomarker behaviour and to establish specific patterns for individual variants.

METHODOLOGY

We analysed data from the Biochemical Genetics Laboratory regarding GLA variants, GLA enzyme activity (in dried blood spots, plasma or white blood cells), plasma LysoGb3 accumulation, and urinary Gb3 excretion. We assessed correlations, trends, and potential predictor models of biomarker behaviour.

RESULTS

We assessed 169 hemizygous male and 255 heterozygous female patients. For both groups, substrate accumulation correlates inversely with GLA activity. Variants affecting residues buried within the protein core or the active site were associated with more severe biomarker changes, while those affecting residues that establish disulfide bonds or are glycosylated were similar to other variants. For each non-truncating variant, we also established specific profiles of biomarker behaviour. Finally, we also designed predictor models of biomarker behaviour based on structural variant information. This study provides the groundwork for the impact of GLA protein variation on GLA activity and substrate accumulation.

CONCLUSION

This knowledge is of extreme relevance for diagnostic labs and clinicians, as some genetic variants are challenging to interpret regarding pathogenicity. Assessing whether biomarker changes are in the expected range for a specific variant may help diagnostic evaluation. This study also contributes to recognising non-disease-causing variants, considering their overall biochemical impact, and providing a comparative reference for biomarker discovery studies. In the future, the correlation of these findings with disease severity may be of great relevance for diagnosis and monitoring progression.

New Insights into the Dermocosmetic Potential of the Red Seaweed Gelidium corneum

This work addresses the potential of the red seaweed Gelidium corneum as a source of bioactive ingredients for skin health and wellness in response to the growing awareness regarding the significance of sustainable strategies in developing new nature-based dermocosmetic products. Hydroalcoholic extracts from the dried biomass were subjected to sequential liquid-liquid partitions, affording five different fractions (F1-F5). Their cosmetic potential was assessed through a set of in vitro assays concerning their antioxidant, photoprotective, and healing properties. Additionally, their cytotoxicity in HaCaT cells and their capacity to induce inflammation in RAW 264.7 cells were also evaluated. As a proof-of-concept, O/W emulsions were prepared, and emulsion stability was assessed by optical microscopy, droplet size analysis, centrifugation tests, and rheology analysis. Furthermore, in vivo tests were conducted with the final formulation to assess its antioxidant capacity. At subtoxic concentrations, the most lipophilic fraction has provided photoprotection against UV light-induced photooxidation in HaCaT cells. This was conducted together with the aqueous fraction, which also displayed healing capacities. Regarding the physical and stability assays, the best performance was achieved with the formulation containing 1% aqueous extract, which exhibited water retention and antioxidant properties in the in vivo assay. In summary, Gelidium corneum displayed itself as a potential source of bioactive ingredients with multitarget properties for dermatological use.

Design and Characterization of an Ethosomal Gel Encapsulating Rosehip Extract

Rising environmental awareness drives green consumers to purchase sustainable cosmetics based on natural bioactive compounds. The aim of this study was to deliver Rosa canina L. extract as a botanical ingredient in an anti-aging gel using an eco-friendly approach. Rosehip extract was first characterized in terms of its antioxidant activity through a DPPH assay and ROS reduction test and then encapsulated in ethosomal vesicles with different percentages of ethanol. All formulations were characterized in terms of size, polydispersity, zeta potential, and entrapment efficiency. Release and skin penetration/permeation data were obtained through in vitro studies, and cell viability was assessed using an MTT assay on WS1 fibroblasts. Finally, ethosomes were incorporated in hyaluronic gels (1% or 2% w/v) to facilitate skin application, and rheological properties were studied. Rosehip extract (1 mg/mL) revealed a high antioxidant activity and was successfully encapsulated in ethosomes containing 30% ethanol, having small sizes (225.4 ± 7.0 nm), low polydispersity (0.26 ± 0.02), and good entrapment efficiency (93.41 ± 5.30%). This formulation incorporated in a hyaluronic gel 1% w/v showed an optimal pH for skin application (5.6 ± 0.2), good spreadability, and stability over 60 days at 4 °C. Considering sustainable ingredients and eco-friendly manufacturing technology, the ethosomal gel of rosehip extract could be an innovative and green anti-aging skincare product.

The Effect of Sunlight Exposure on Vitamin D Status in Countries of Low and High Latitudes: A Systematic Literature Review

PURPOSE OF THE REVIEW

To conduct a systematic review of studies to investigate the association between climate and vitamin D in humans.

RECENT FINDINGS

There is growing interest in the association between the environment and vitamin D, but robust methods to understand this relationship are lacking. Studies focus mainly on seasonality and latitude. Research quantifying sunlight exposure necessary for adequate vitamin D synthesis in people with darker skin color and those people living at low latitudes are scarce, as are studies in urban populations that may have limited opportunity for sunlight exposure. There are gaps regarding values and timing of exposure to UV radiation required for adequate vitamin D synthesis considering skin color, geography, climate, and local irradiation. Nature-based solutions (NbS) that can mitigate climate change will become increasingly important for preventing hypovitaminosis D. For example, tree-shaded spaces might encourage more participation in outside activities and thereby favor vitamin D synthesis by the skin.

Perceptions of change in the environment caused by the COVID-19 pandemic: Implications for environmental policy

COVID-19 lockdown measures have impacted the environment with both positive and negative effects. However, how human populations have perceived such changes in the natural environment and how they may have changed their daily habits have not been yet thoroughly evaluated. The objectives of this work were to investigate (1) the social perception of the environmental changes produced by the COVID-19 pandemic lockdown and the derived change in habits in relation to i) waste management, energy saving, and sustainable consumption, ii) mobility, iii) social inequalities, iv) generation of noise, v) utilization of natural spaces, and, vi) human population perception towards the future, and (2) the associations of these potential new habits with various socio-demographic variables. First, a SWOT analysis identified strengths (S), weaknesses (W), opportunities (O), and threats (T) generated by the pandemic lockdown measures. Second, a survey based on the aspects of the SWOT was administered among 2370 adults from 37 countries during the period from February to September 2021. We found that the short-term positive impacts on the natural environment were generally well recognized. In contrast, longer-term negative effects arise, but they were often not reported by the survey participants, such as greater production of plastic waste derived from health safety measures, and the increase in e-commerce use, which can displace small storefront businesses. We were able to capture a mismatch between perceptions and the reported data related to visits to natural areas, and generation of waste. We found that age and country of residence were major contributors in shaping the survey participants ´answers, which highlights the importance of government management strategies to address current and future environmental problems. Enhanced positive perceptions of the environment and ecosystems, combined with the understanding that livelihood sustainability, needs to be prioritized and would reinforce environmental protection policies to create greener cities. Moreover, new sustainable jobs in combination with more sustainable human habits represent an opportunity to reinforce environmental policy.

Short-Term Exposure of Dactylis glomerata Pollen to Atmospheric Gaseous Pollutants Is Related to an Increase in IgE Binding in Patients with Grass Pollen Allergies

The concentrations of nitrogen dioxide (NO₂) and tropospheric ozone (O₃) in urban and industrial site atmospheres are considered key factors associated with pollen-related respiratory allergies. This work studies the effects of NO₂ and O₃ on the protein expression profile and IgE binding in patients with grass allergies to Dactylis glomerata pollen extracts. Pollens were collected during the flowering season and were exposed to NO₂ and O₃ in a controlled environmental chamber. The amount of soluble protein was examined using the Bradford method, and the protein expression profile and antigenic properties were analysed using the immunoblotting and enzyme-linked immunosorbent assay (ELISA), respectively. Our results showed apparent inter-sera differences concerning the number and intensity of IgE reactivity, with the most prominent at bands of 55 kDa, 35, 33, and 13 kDa. In the 13 kDa band, both gases tend to induce an increase in IgE binding, the band at 33 kDa showed a tendency towards a reduction, particularly pollen exposed to O₃. Reactive bands at 55 and 35 kDa presented an increase in the IgE binding pattern for all the patient sera samples exposed to NO₂, but the samples exposed to O₃ showed an increase in some sera and in others a decrease. Regarding the ELISA results, out of the 21 tested samples, only 9 showed a statistically significant increase in total IgE reactivity after pollen exposure to the pollutants. Our study revealed that although airborne pollen allergens might be affected by air pollution, the possible impacts on allergy symptoms might vary depending on the type of pollutant and the patient's sensitisation profile.

Positive predictive value of the crusade score for bleeding events in patients with acute coronary syndromes on dual antiplatelet therapy with acetylsalicylic acid and clopidogrel

Introduction

Crusade score (CS) quantifies intrahospital major bleeding (IHMB) risk in patients admitted with acute coronary syndrome (ACS). Hemorrhagic risk after ACS increases with age, although, it's not considered in score estimation.

Purpose

Evaluate CS ability to predict IHBM risk according to different patient ages (higher or lower than 75 years) admitted with ACS diagnosis and submitted to double antiagreggation therapy with acetylsalicylic acid and Clopidogrel.

Methods

A retrospective study based on the Portuguese National Registry of ACS, including patients (pts) hospitalized with ACS and treated with double antiagreggation therapy with acetylsalicylic acid (AAS) and clopidogrel between October 2010 and January 2021 (n=8401). Were excluded patients submitted to coronary artery bypass grafting, with ticagrelor or prasugrel switch to clopidogrel during hospitalization.

Patients were divided into two groups according to their age (above or below 75 years) and then subdivided in 5 groups according to CS category of IHBM risk estimation: very low (CS ≤20, 3,1% risk predicted by the score), low (21 ≤ CS≤30, 5,5%), moderate (31 ≤ CS≤40, 8,6%), high (41 ≤ CS≤50, 11,9%) and very high risk (CS≥51, 19,5%). Then, the incidence of IHMB observed in each group during hospitalization (mean 5 days) was compared to the IHBM risk predicted by the CS.

Results

The IHMB rate was 1.78%, significantly lower than predicted by the Crusade score (7.1%, p<0.001). Bleeding rates in each group of patients (above or below 75 years and according to CS calculation are depicted in Figure 1. CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years (see Figure 2).

Conclusion

As shown in different literature, crusade score overestimate bleeding risk after ACS compared to real-life cohorts. Despite the same trend observed in our cohort of patients, in this retrospective study, CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years in patients submitted to double antiaggregation with AAS and clopidogrel.

Funding Acknowledgement

Type of funding sources: None.

Vitamin D and musculoskeletal health: outstanding aspects to be considered in the light of current evidence

Vitamin D enhances calcium absorption and bone mineralisation, promotes maintenance of muscle function, and is crucial for musculoskeletal health. Low vitamin D status triggers secondary hyperparathyroidism, increases bone loss, and leads to muscle weakness. The primary physiologic function of vitamin D and its metabolites is maintaining calcium homeostasis for metabolic functioning, signal transduction, and neuromuscular activity. A considerable amount of human evidence supports the well-recognised contribution of adequate serum 25-hydroxyvitamin D concentrations for bone homeostasis maintenance and prevention and treatment strategies for osteoporosis when combined with adequate calcium intake. This paper aimed to review the literature published, mainly in the last 20 years, on the effect of vitamin D and its supplementation for musculoskeletal health in order to identify the aspects that remain unclear or controversial and therefore require further investigation and debate. There is a clear need for consistent data to establish realistic and meaningful recommendations of vitamin D status that consider different population groups and locations. Moreover, there is still a lack of consensus on thresholds for vitamin D deficiency and optimal status as well as toxicity, optimal intake of vitamin D, vitamin D supplement alone as a strategy to prevent fractures and falls, recommended sun exposure at different latitudes and for different skin pigmentations, and the extra skeletal effects of vitamin D.

Potential Transformation of Contaminated Areas into Public Parks: Evidence from São Paulo, Brazil

Waste-contaminated areas have been reused and requalified environmentally across the globe, aiming to reintegrate them into urban dynamics with new functions such as public parks. This practice has attracted the attention of public health and environmental control agencies due to the scarcity of free areas and vacant spaces for creation of green areas, and d the need for more sustainable planning guidelines in large cities. The present work aimed to study processes of requalification of waste-contaminated areas for transformation in parks, using as study two cases located in the city of São Paulo, Brazil. Method: Documentary research in environmental agencies, literature review and field visit. Results: In the two cases the process of requalification was unequal, with emphasis on three aspects: the actors involved in the case, the role of civil society and the action of the Public Prosecutor's Office of the State of São Paulo. Thus, it becomes evident that successful cases of waste-contaminated areas in the city of São Paulo are linked to the direct support of these aspects complemented with the private sector. Furthermore, a consensus is necessary among the public authorities regarding the laws of contaminated areas versus environmental damage full repair in the process of requalification.

Differential Quercus spp. pollen-particulate matter interaction is dependent on geographical areas

Particulate matter (PM) and pollen interaction, either airborne or at the respiratory mucosa needs further clarification, as allergic reaction intensification can be related to the PM physical characteristics and toxicity. This study aimed to investigate the physical-chemical properties of PM that can adhere to the pollen wall during its transport or inhalation, using Quercus spp. as a model, in three Portuguese cities with different geographical locations, meteorological influence and urbanization levels. Possible sources were evaluated through air masses trajectory analysis using the HYSPLIT model and correlation with meteorological factors. The sampling was performed using a 7-days Hirst-type volumetric sampler, and the pollen grains were observed using a Field Emission Electron Probe Microanalyser for PM analysis. A secondary electron image of each pollen grain was taken, to determine the adhered particles characteristics and energy dispersive x-ray spectroscopy (EDS) spectra were obtained for individual particles. A total of 484 pollen grains was observed, with 7683 particles counted and 1914 EDS spectra analyzed. The particle's equivalent diameter ranged from 0.3-16 μm, with most having a diameter < 3 μm. For the three cities, there were significant differences in the number of particles per pollen and the % area occupied by the particles. Particles adhered were mainly Si-rich, but variations in other dominant groups were observed. For Évora and Guarda, Ca-rich, SO-rich were second and third more representative, while Porto were Organic and Cl-rich. Metals&Oxides were found in all cities with the highest number in Porto. P-rich particles were only found in Évora. Sea salt particles were observed in Évora, coincide with air mass trajectories possible carrying them from the Mediterranean Sea. In conclusion, the PM physical characteristics are similar between the studied cities, however, the dominant chemical composition is different, certainly impacting the exposome influence and pollen-allergy intensification towards the same pollen type and concentration.

Association between vitamin D status and lifestyle factors in Brazilian women: Implications of Sun Exposure Levels, Diet, and Health

BACKGROUND

Vitamin D deficiency has been documented to be prevalent, even in low latitude regions; and this may be related to sun exposure behaviors. The aim of the current study was to assess the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and lifestyle-related factors in a sample of Brazilian women living at latitude 21º 8' S.

METHODS

A cross-sectional study was undertaken in 101 women aged 35 years or older in July 2019 to assess the association between 25(OH)D concentration and level of exposure to ultraviolet radiation (UVR), smoking habits, alcohol consumption, and physical activity levels. Age, body mass index (BMI), and postmenopausal status were investigated.

FINDINGS

According to the slope coefficient for individual daily UVR levels, the concentration of 25(OH)D increased by 5 nmol / L for each extra Standard Erythema Dose of UVR, regardless of age and BMI (p < 0·001). Postmenopausal women had a significantly higher mean concentration of 25(OH)D (p = 0·01), higher UVR exposure (p = 0·01) and lower BMI (p = 0·005) compared with younger women, independent of other confounders including smoking, alcohol, occupation and physical activity.

INTERPRETATION

Although postmenopausal women from Brazil had higher mean concentrations of 25(OH)D than younger women, more studies are necessary to understand how sun exposure and lifestyle variables interfere with these levels. These findings have important public health implications since they suggest that vitamin D deficiency in older age is not inevitable.

FUNDING

This study was funded by an award received by Universities Global Partnership Network - UGPN. KVSS and SLO receive scholarship from CAPES, Brazilian Ministry of Education. HR receives a productivity grant from CNPq.

Long-term commuting times and air quality relationship to COVID-19 in São Paulo

The Coronavirus Disease 2019 (COVID-19) epidemic is an unprecedented global health crisis and the effects may be related to environmental and socio-economic factors. In São Paulo, Brazil, the first death occurred in March 2020 and since then the numbers have grown to 175 new deaths per day in April 2021, positioning the city as the epicenter of the number of cases and deaths in Brazil. São Paulo is one of the largest cities in the world with more than 12 million inhabitants, a fleet of about 8 million vehicles and frequent pollutant concentrations above recommended values. Social inequalities are evident in the municipality, similarly to other cities in the world. This paper focuses on transportation activities related to air pollution and associated with cardiovascular and respiratory diseases especially on people who developed comorbidities during their whole life. This study relates travel trip data to air quality analysis and expanded to COVID-19 disease. This work studied the relationship of deaths in São Paulo due to COVID-19 with demographic density, with family income, with the use of public transport and with atmospheric pollution for the period between March 17th, 2020 and April 29th, 2021. The main results showed that generally passenger kilometers traveled, commuting times and air quality related diseases increase with residential distance from the city center, and thus, with decreasing residential density. PM_2.5 concentrations are positively correlated with COVID-19 deaths, regions with high urban densities have higher numbers of deaths and long-distance frequent trips can contribute to spread of the disease.

Global Perspective of the Vitamin D Status of African-Caribbean Populations: A Systematic Review and Meta-analysis

BACKGROUND/OBJECTIVES

Vitamin D deficiency remains a global public health issue, particularly in minority ethnic groups. This review investigates the vitamin D status (as measured by 25(OH)D and dietary intake) of the African-Caribbean population globally.

SUBJECTS/METHODS

A systematic review was conducted by searching key databases (PUBMED, Web of Science, Scopus) from inception until October 2019. Search terms included 'Vitamin D status' and 'African-Caribbean'. A random effects and fixed effects meta-analysis was performed by combining means and standard error of the mean.

RESULT

The search yielded 19 papers that included n = 5670 African-Caribbean participants from six countries. A meta-analysis found this population to have sufficient (>50 nmol/L) 25(OH)D levels at 67.8 nmol/L, 95% CI (57.9, 7.6) but poor dietary intake of vitamin D at only 3.0 µg/day, 95% CI (1.67,4.31). For those living at low latitudes 'insufficient' (as defined by study authors) 25(OH)D levels were found only in participants with type 2 diabetes and in those undergoing haemodialysis. Suboptimal dietary vitamin D intake (according to the UK recommended nutrient intake of 10 µg/day) was reported in all studies at high latitudes. Studies at lower latitudes, with lower recommended dietary intakes (Caribbean recommended dietary intake: 2.5 µg/day) found 'sufficient' intake in two out of three studies.

CONCLUSIONS

25(OH)D sufficiency was found in African-Caribbean populations at lower latitudes. However, at higher latitudes, 25(OH)D deficiency and low dietary vitamin D intake was prevalent.

Global Health and Planetary Health: perspectives for a transition to a more sustainable world post COVID-19

The manuscript discusses interfaces between academic and practical fields of Global Health and Planetary Health, shedding light on some critical perspectives of cumulative and synergistic causes of global crises, and effects on health and food security, on human rights, on migration, and on environment. Concepts of Global Health and Planetary Health and the path for the Sustainable Development Goals -SDG in the context of the Syndemy of Global Crisis, in particular the COVID-19 pandemic, are presented. COVID-19 lessons highlight challenges of infectious diseases and pandemics of the crisis of food insecurity, and of climate emergency. The manuscript advocates for an innovative approach that simultaneously broader awareness of the interconnected problems and of their complex causes and calls for emancipatory knowledge to face urgent challenges for a transdisciplinary research agenda aiming to tackle enormous planetary problems brought by the Anthropocene. It calls for practical solutions, with examples of some nature-based. It highlights the need of a collective reflection on a viable path to promote changes for a more sustainable, equitable, and adaptive future, bridging gaps from Global and Planetary Health.

Complying with the Guideline for Quality and Equivalence for Topical Semisolid Products: The Case of Clotrimazole Cream

Semisolids constitute a significant proportion of topical pharmaceutical dosage forms available on the market, with creams being considered profitable systems for releasing active substances into the skin. This work aimed at the development of a generic Clotrimazole topical cream, based on the assumptions that assist the development of such formulations. First, the critical parameters to obtain a final formulation as similar as possible to the reference product were defined. Then, the percentages of cetyl palmitate and octyldodecanol were identified as critical variables and chosen for optimization in further studies. A "quality by design" approach was then used to identify the effect of process variability on the structural and functional similarity (Q3) of the generic product qualitatively (Q1) and quantitatively (Q2). A two-factor central composite orthogonal design was applied and eleven different formulations were developed and subjected to physicochemical characterization and product performance studies. The results were used to estimate the influence of the two variables in the variation of the responses, and to determine the optimum point of the tested factors, using a design space approach. Finally, an optimized formulation was obtained and analysed in parallel with the reference. The obtained results agreed with the prediction of the chemometric analysis, validating the reliability of the developed multivariate models. The in vitro release and permeation results were similar for the reference and the generic formulations, supporting the importance of interplaying microstructure properties with product performance and stability. Lastly, based on quality targets and response constraints, optimal working conditions were successfully achieved.

Conhecimentos, atitudes e práticas de agricultores familiares brasileiros sobre a exposição aos agrotóxicos

Resumo O artigo discute conhecimentos, atitudes e práticas (CAP) de agricultores familiares brasileiros a respeito dos impactos na saúde e no ambiente gerados pelo uso de agrotóxicos. Trata-se de um estudo transversal misto, realizado em 2014 em São José de Ubá, RJ. A pesquisa é composta por uma etapa qualitativa, baseada em observações em campo e entrevistas com 25 participantes sobre CAP, no que se refere ao uso de agrotóxicos. A etapa quantitativa abrange avaliação sociodemográfica e de exposição aos agrotóxicos de 78 agricultores. Apesar de reconhecerem parcialmente os perigos dos agrotóxicos, os agricultores enfrentam os riscos da exposição e comumente adotam práticas laborais inadequadas. Fatores como a carência de apoio técnico e treinamento laboral, baixa escolaridade, dificuldade de compreensão das orientações de bulas e rótulos dos agrotóxicos, valor elevado e desconforto causado pelo equipamento de proteção individual (EPI), além da crença da dependência do uso de agrotóxicos, explicam parcialmente as atitudes não seguras. É preciso promover práticas agrícolas mais sustentáveis, fortalecer o apoio técnico e treinamento laboral, melhorar a comunicação e o gerenciamento dos riscos e reduzir as desigualdades de gênero entre os agricultores brasileiros, como a forma mais eficaz e imediata de prevenir os agravos relacionados ao trabalho com agrotóxicos.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

OBJECTIVE:

To explore the association of occupational pesticide exposure with acute and mental health symptoms.

METHODS:

Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios.

RESULTS:

Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment.

CONCLUSIONS:

Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Towards sustainable valorisation of Acacia melanoxylon biomass: Characterization of mature and juvenile plant tissues

In Mediterranean area, Acacia melanoxylon biomass is an abundant waste material from non-native and invasive tree species control actions, requiring suitable disposal. Valorisation of such biomass residues requires its complete characterization to best approach the full potential of each plant material that could suit specific applications. This study compares mature and juvenile A. melanoxylon plant tissues (wood and bark) from two stands in different locations, regarding their chemical characteristics and organic growing media properties, such as mineral content and phytotoxicity effect for Lepidium sativum seeds. Juvenile bark (JB) showed greater total extractives (29%) extracted using solvents of increasing polarity (dichloromethane, ethanol, and water), followed by mature bark (MB) (21%). MB revealed the highest lignin content (>50%) suggesting material resistance to microbial biodegradation in horticultural applications. High barks phenolic content proved to be phytotoxic for cress seeds (null JB root index), although the toxic substances may be removed. After 1 week, ageing effect reduced MB phytototoxicity (root index > 60%) improving seed performance. Bark presented more mineral elements availability than wood. Wood high cellulose (>50%), low extractive (<9%) and moderate total lignin (<30%) contents can be attractive for pulp production, while bark growth medium profile may potentiate its application for horticultural uses. The future research on novel uses of A. melanoxylon plant residues can result in economic benefits that may alleviate management costs.

COVID-19 Response in Latin America

Effective management of a pandemic due to a respiratory virus requires public health capacity for a coordinated response for mandatory restrictions, large-scale testing to identify infected individuals, capacity to isolate infected cases and track and test contacts, and health services for those infected who require hospitalization. Because of contextual and socioeconomic factors, it has been hard for Latin America to confront this epidemic. In this article, we discuss the context and the initial responses of eight selected Latin American countries, including similarities and differences in public health, economic, and fiscal measures, and provide reflections on what worked and what did not work and what to expect moving forward.

Zika virus syndrome, lack of environmental policies and risks of worsening by cyanobacteria proliferation in a climate change scenario

Almost half of the Brazilian population has no access to sewage collection and treatment. Untreated effluents discharged in waters of reservoirs for human supply favor the flowering of cyanobacteria – and these microorganisms produce toxins, such as saxitoxin, which is a very potent neurotoxin present in reservoirs in the Northeast region. A recent study confirmed that chronic ingestion of neurotoxin-infected water associated with Zika virus infection could lead to a microcephaly-like outcome in pregnant mice. Cyanobacteria benefit from hot weather and organic matter in water, a condition that has been intensified by climate change, according to our previous studies. Considering the new findings, we emphasize that zika arbovirus is widespread and worsened when associated with climate change, especially in middle- or low-income countries with low levels of sanitation coverage.

Air Quality during COVID-19 in Four Megacities: Lessons and Challenges for Public Health

The study described in this manuscript analyzed the effects of quarantine and social distancing policies implemented due to the Coronavirus Disease 2019 (COVID-19) pandemic on air pollution levels in four western megacities: São Paulo in Brazil; Paris in France; and Los Angeles and New York in the United States. The study investigated the levels of four air pollutants-Carbon monoxide (CO), Ozone (O3), Fine Particulate (PM2.5) and Nitrogen dioxide (NO2)-during the month of March 2020, compared to 2015-2019, in the urban air of these metropolitan areas, controlling for meteorological variables. Results indicated reductions in the levels of PM2.5, CO and NO2, with reductions of the latter two showing statistical significance. In contrast, tropospheric ozone levels increased, except in Los Angeles. The beneficial health effects of cleaner air might also help prevent deaths caused by the epidemic of COVID-19 in megacities by diminishing pressure on hospitals and health equipment. Future actions for the re-starting of non-essential economic activities in these cities should take into consideration the overall importance of health for the individual, as well as for societies.

Chemical inhibition of β-glucocerebrosidase does not affect phagocytosis and early containment of Leishmania by murine macrophages

Gaucher disease is a lysosomal storage disease in which a genetic deficiency in β-glucocerebrosidase leads to the accumulation of glycosphingolipids in lysosomes. Macrophages are amongst the cells most severely affected in Gaucher disease patients. One phenotype associated with Gaucher macrophages is the impaired capacity to fight bacterial infections. Here, we investigate whether inhibition of β-glucocerebrosidase activity affects the capacity of macrophages to phagocytose and act on the early containment of human pathogens of the genus Leishmania. Towards our aim, we performed in vitro infection assays on macrophages derived from the bone marrow of C57BL/6 mice. To mimic Gaucher disease, macrophages were incubated with the β-glucocerebrosidase inhibitor, conduritol B epoxide (CBE), prior to contact with Leishmania. This treatment guaranteed that β-glucocerebrosidase was fully inhibited during the contact of macrophages with Leishmania, its enzymatic activity being progressively recovered along the 48 h that followed removal of the inhibitor. Infections were performed with L. amazonensis, L. infantum, or L. major, so as to explore potential species-specific responses in the context of β-glucocerebrosidase inactivation. Parameters of infection, recorded immediately after phagocytosis, as well as 24 and 48 h later, revealed no noticeable differences in the infection parameters of CBE-treated macrophages relative to non-treated controls. We conclude that blocking β-glucocerebrosidase activity during contact with Leishmania does not interfere with the phagocytic capacity of macrophages and the early onset of leishmanicidal responses.

Does Vitamin D play a role in the management of Covid-19 in Brazil?

The study discusses the possible role of adequate vitamin D status in plasma or serum for preventing acute respiratory infections during the Covid-19 pandemic. Our arguments respond to an article, published in Italy, that describes the high prevalence of hypovitaminosis D in older Italian women and raises the possible preventive and therapeutic role of optimal vitamin D levels. Based on literature review, we highlight the findings regarding the protective role of vitamin D for infectious diseases of the respiratory system. However, randomized controlled trials are currently lacking. Adequate vitamin D status is obtained from sun exposure and foods rich in vitamin D. Studies in Brazil have shown that hypovitaminosis D is quite common in spite of high insolation. Authors recommend ecological, epidemiological and randomized controlled trials studies to verify this hypothesis.

Respiratory and Allergic Effects in Children Exposed to Pesticides-A Systematic Review

Pesticide exposure may affect children’s respiratory and allergic health, although results from epidemiological studies have not reached consensus. This review aims to analyze the scientific evidence on respiratory and allergic effects of exposure to agricultural pesticides in children aged up to 12 years old. The databases PubMed, Web of Science, Scielo, and Lilacs were screened to select articles published in English, Spanish, or Portuguese, and 21 articles were included in this review. Most investigations were conducted in North America (mostly in the United States), while no studies conducted in Latin America or Africa were found, despite their intensive use of pesticides. Children are exposed to pesticides through multiple pathways from the prenatal period throughout later developmental stages and may experience several respiratory effects. Most studies (79%) found positive associations with pesticide exposure and children’s respiratory and allergic effects such as asthma, wheezing, coughs, acute respiratory infections, hay fever, rhinitis, eczema, chronic phlegm, and lung function impairments. Contrastingly, 21% of the studies found no associations between pesticide exposure and children’s respiratory health. The vast differences among the characteristics of the studies hamper any comparison of the results. Exposure to pesticides may have several impacts on childhood respiratory health. More studies must be conducted, especially in low- and middle-income countries, preferably with comparable research protocols adapted to local realities. Efforts should be made to develop comprehensive risk mitigation strategies and behavioral interventions to reduce children’s exposure to pesticides used in agriculture and respiratory health effects, and to ensure healthy childhood growth.

Comparison of Parent Questionnaires, Examiner-Led Assessment and Parents' Concerns at 14 Months of Age as Indicators of Later Diagnosis of Autism

Parents participating in a prospective longitudinal study of infants with older siblings with autism completed an autism screening questionnaire and were asked about any concerns relating to their child’s development, and children were administered an interactive assessment conducted by a researcher at 14 months. Scores on the parent questionnaire were highest for children later diagnosed with autism. Parental concerns and scores from the examiner-led assessment distinguished children with later developmental difficulties (both autism and other developmental atypicalities) from those who were developing typically. Children about whom parents expressed concern scored higher on both the questionnaire and the interactive assessment than those without concerns. There were no significant associations between total or individual item scores from the questionnaire and interactive assessment.

A High-Throughput BRET Cellular Target Engagement Assay Links Biochemical to Cellular Activity for Bruton's Tyrosine Kinase

Protein kinases are intensely studied mediators of cellular signaling. While traditional biochemical screens are capable of identifying compounds that modulate kinase activity, these assays are limited in their capability of predicting compound behavior in a cellular environment. Here, we aim to bridge target engagement and compound-cellular phenotypic behavior by utilizing a bioluminescence resonance energy transfer (BRET) assay to characterize target occupancy within living cells for Bruton's tyrosine kinase (BTK). Using a diverse chemical set of BTK inhibitors, we determine intracellular engagement affinity profiles and successfully correlate these measurements with BTK cellular functional readouts. In addition, we leveraged the kinetic capability of this technology to gain insight into in-cell target residence time and the duration of target engagement, and to explore a structural hypothesis.

Near-ground effect of height on pollen exposure

The effect of height on pollen concentration is not well documented and little is known about the near-ground vertical profile of airborne pollen. This is important as most measuring stations are on roofs, but patient exposure is at ground level. Our study used a big data approach to estimate the near-ground vertical profile of pollen concentrations based on a global study of paired stations located at different heights. We analyzed paired sampling stations located at different heights between 1.5 and 50 m above ground level (AGL). This provided pollen data from 59 Hirst-type volumetric traps from 25 different areas, mainly in Europe, but also covering North America and Australia, resulting in about 2,000,000 daily pollen concentrations analyzed. The daily ratio of the amounts of pollen from different heights per location was used, and the values of the lower station were divided by the higher station. The lower station of paired traps recorded more pollen than the higher trap. However, while the effect of height on pollen concentration was clear, it was also limited (average ratio 1.3, range 0.7-2.2). The standard deviation of the pollen ratio was highly variable when the lower station was located close to the ground level (below 10 m AGL). We show that pollen concentrations measured at >10 m are representative for background near-ground levels.

Environmental and socioeconomic analysis of malaria transmission in the Brazilian Amazon, 2010-2015

OBJECTIVE

To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon.

METHODS

The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model).

RESULTS

The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19–3.56), 1.73 (95%CI 1.19–2.51) and 1.10 (95%CI 1.03–1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence.

CONCLUSIONS

As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.

Assessment of the potential real pollen related allergenic load on the atmosphere of Porto city

The knowledge of the allergen content in the atmosphere is a useful tool to stablish the risk allergy warnings for the sensitive people. In Portugal the main airborne allergenic pollen come from trees (such as Betula or Olea), grasses or weeds (mainly Urticaceae). The present study sought the quantification of the Bet v 1, Ole e 1, Lol p1 and Par j1-2 aeroallergen concentration as well as how weather variables influence in the pollen and allergen concentration in Porto city. Aerobiological study was carried out by a Hirst-type volumetric sampler for pollen collection and a Burkard Cyclone sampler for the aeroallergens. A regression analysis between pollen and allergens was conducted for the identification the allergenic risk days. High Pollen Allergen Potency in the atmosphere was observed considering the low levels of airborne pollen detected. A significant and positive correlation has been obtained between pollen and aeroallergen values with the temperatures whereas the correlation was negative with relative humidity, rainfall and wind speed. Back trajectory methodology was applied in order to analyse the discordances between pollen and allergen maximum concentrations. The analysis showed that when the pollen and allergen peaks were registered on the same day, air masses always comes from the continent. However, when the peaks do not coincide, the air mass comes from the continent in the case of the pollen peak and from the sea for the allergen peak. This behaviour can be a consequence of the high humidity in the air masses from the sea, which can benefit the allergen release from pollen grains. In our study it was observed that the available traditional information for allergenic Type I patients, corresponding to the amount of pollen grains in the bioaerosol, do not accurately identify the real allergenic load in the air.

Lipid Antigen Presentation by CD1b and CD1d in Lysosomal Storage Disease Patients

The lysosome has a key role in the presentation of lipid antigens by CD1 molecules. While defects in lipid antigen presentation and in invariant Natural Killer T (iNKT) cell response were detected in several mouse models of lysosomal storage diseases (LSD), the impact of lysosomal engorgement in human lipid antigen presentation is poorly characterized. Here, we analyzed the capacity of monocyte-derived dendritic cells (Mo-DCs) from Fabry, Gaucher, Niemann Pick type C and Mucopolysaccharidosis type VI disease patients to present exogenous antigens to lipid-specific T cells. The CD1b- and CD1d-restricted presentation of lipid antigens by Mo-DCs revealed an ability of LSD patients to induce CD1-restricted T cell responses within the control range. Similarly, freshly isolated monocytes from Fabry and Gaucher disease patients had a normal ability to present α-Galactosylceramide (α-GalCer) antigen by CD1d. Gaucher disease patients' monocytes had an increased capacity to present α-Gal-(1-2)-αGalCer, an antigen that needs internalization and processing to become antigenic. In summary, our results show that Fabry, Gaucher, Niemann Pick type C, and Mucopolysaccharidosis type VI disease patients do not present a decreased capacity to present CD1d-restricted lipid antigens. These observations are in contrast to what was observed in mouse models of LSD. The percentage of total iNKT cells in the peripheral blood of these patients is also similar to control individuals. In addition, we show that the presentation of exogenous lipids that directly bind CD1b, the human CD1 isoform with an intracellular trafficking to the lysosome, is normal in these patients.

Emigração de médicos brasileiros para os Estados Unidos da América

Resumo Este artigo aborda a mobilidade de médicos pelo mundo a partir de levantamento bibliográfico em base de dados e identifica a escassez de informações referentes aos médicos brasileiros. O objetivo é analisar aspectos que determinam a emigração de médicos brasileiros para os EUA. A metodologia baseia-se em pesquisa bibliográfica, utilizando as palavras-chave “brain drain”, “medical migration”, “physicians migration”, “data migration physicians”; identificação de artigos relacionados à emigração de médicos pelo mundo; elaboração e validação do questionário “Motivos de Emigração”; identificação de médicos que emigraram utilizando a técnica “bola de neve” ; envio do questionário por e-mail aos médicos que emigraram para os EUA; tabulação das respostas encaminhadas; realização de entrevistas por Skype com a finalidade de corroborar e exemplificar os resultados obtidos nos questionários. Inicialmente, os médicos escolhem emigrar por motivos pessoais (família, oportunidades profissionais e, em geral, facilidade do idioma); ao se estabelecerem nos EUA vivenciam uma nova forma de vida, o que os faz permanecer (melhores condições de trabalho, qualidade de vida, família e oportunidades em geral); as causas do não retorno ao Brasil passam a ter motivos externos (insegurança, cenários profissional, político e econômico). Conclui-se que existe um processo emigratório de médicos brasileiros para os EUA e, a princípio, a motivação de emigrar não é bem determinada; o salário não é citado como questão primordial; a presença da família facilita a permanência no país; a fluência na língua inglesa é fundamental; e é necessário recomeçar a vida profissional como um recém-formado em medicina, pois não existe processo de validação de diploma ou de especialidades.

Data on pesticide exposure and mental health screening of family farmers in Brazil

This dataset is part of a risk assessment project that evaluated the human health effects of pesticide exposure in São José de Ubá, State of Rio de Janeiro. This region is one of the greatest tomato producers in Brazil, and pest control is commonly based on the use of pesticides. We interviewed 78 smallholder family farmers about sociodemographic characteristics, pesticide use and exposure, assessed blood cholinesterase as biomarkers (n = 70), and screened all participants for probable common mental disorders through the Self-Reporting Questionnaire (SRQ-20).

Health Diplomacy and Global Health: Latin American perspectives

We will analyze and comment on the book Health Diplomacy and Global Health: Latin American Perspectives, edited by Paulo Marchiori Buss and Sebastián Tobar and published by Editora Fiocruz. Throughout its 653 pages, the book brings prominent national and foreign authors in the field of Health Diplomacy and Global Health, depicting a decade in which Brazil had great international protagonism in the field of Public Health, especially in South-South cooperation, in an innovative and structuring manner. Furthermore, the chapters present theoretical aspects and basic principles of Global Health as a new field of knowledge, in which the country has been developing and sharing scientific production with a Latin American perspective, focused on the pursuit of equity and health for all peoples of the world.

Reliability of Paris Classification for superficial neoplastic gastric lesions improves with training and narrow band imaging

Background and study aims  Paris Classification is used to classify gastrointestinal superficial neoplastic lesions and to predict presence of submucosal invasion. We aimed to evaluate interobserver reliability and agreement for this classification among Western endoscopists. Methods  A total of 54 superficial gastric lesions were independently classified according to Paris classification by eight endoscopists (4 experts and 4 non-experts). Observers were asked to classify two sets of images - first, obtained with high-resolution white light (HR-WL) endoscopy and secondly, with the same HR-WL images paired with images obtained with high-resolution Narrow Band Imaging (HR-NBI) - HR-WL + NBI image group. Results  Overall interobserver reliability when asked to classify in I, II or III was good both using HR-WL images and HR-WL + NBI images (wK of 0.65 and 0.70, respectively). The proportion of agreement for type III lesions was 0.48 for HR-WL images increasing to 0.74 in the HR-WL + NBI group. Interobserver reliability for identification of a IIc component was only moderate (wK 0,47). NBI improves both sensitivity and interobserver reliability among trainees (from wK 0.19 to 0.47). Specificity was higher than sensitivity in predicting submucosal invasion. Conclusion  Overall, the reliability of Paris classification is moderate to good. Training on this classification or its revision and use of technology such as NBI may improve not only reliability and agreement but also accuracy.

Initialization of Single Spin Dressed States using Shortcuts to Adiabaticity

We demonstrate the use of shortcuts to adiabaticity protocols for initialization, read-out, and coherent control of dressed states generated by closed-contour, coherent driving of a single spin. Such dressed states have recently been shown to exhibit efficient coherence protection, beyond what their two-level counterparts can offer. Our state transfer protocols yield a transfer fidelity of ∼99.4(2)% while accelerating the transfer speed by a factor of 2.6 compared to the adiabatic approach. We show bidirectionality of the accelerated state transfer, which we employ for direct dressed state population read-out after coherent manipulation in the dressed state manifold. Our results enable direct and efficient access to coherence-protected dressed states of individual spins and thereby offer attractive avenues for applications in quantum information processing or quantum sensing.

The GM2 ganglioside inhibits iNKT cell responses in a CD1d-dependent manner

Invariant natural killer T (iNKT) cells are a subset of T lymphocytes that recognize lipid antigens presented on CD1d molecules at the surface of antigen-presenting cells. GM2 is a glycosphingolipid abundant in cellular membranes and known to bind CD1d molecules, but the functional consequences of this binding are not completely clarified. Herein, we analyzed the effect of GM2 in iNKT cell activation. We found that culturing antigen-presenting cells or total peripheral blood mononuclear cells with GM2 did not induce activation of human iNKT cells, implying that this lipid is not antigenic for human iNKT cells. To investigate if this lipid could inhibit iNKT cell activation, we simultaneously incubated antigen-presenting cells with GM2 and the iNKT cell antigen α-Galactosylceramide (α-GalCer) and used them to stimulate iNKT cells. We found that GM2 reduced human iNKT cell activation in a dose-dependent manner. An explanation for this effect could be a direct competition of GM2 with antigenic lipids for CD1d binding. This was demonstrated by the use of an antibody (L363) that stains mouse CD1d:α-GalCer complexes, as in the presence of GM2 the amount of CD1d:α-GalCer complexes are reduced. We further explored the consequences of chronic GM2 overload on human iNKT cells by analyzing iNKT cells in patients diagnosed with GM2 gangliosidoses. We found that pediatric patients present a higher frequency of circulating CD4⁺ iNKT cells and concomitant lower frequency of CD4^-CD8^- iNKTs. A lower percentage of iNKT cells expressing the NK marker CD161 was also observed in these patients. In contrast, in two adult patients studied, no differences on iNKT cell phenotype were observed. Altogether, this study uncovers a new role for GM2 in the modulation of iNKT cell activation, thus strengthening the central role of lipid metabolism in iNKT cell biology.