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Tang K, Rajeh A, Shaw KS, Nguyen N, Wan G, Hashemi KB, Castillo RL, Kwatra SG, LeBoeuf NR, Vleugels RA, Semenov YR. De novo autoimmune connective tissue disease and mortality in patients treated with anti-PD-1 and anti-PD-L1 therapy: a population-level cohort study. Br J Dermatol 2024:ljae184. [PMID: 38676955 DOI: 10.1093/bjd/ljae184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 04/29/2024]
Abstract
Using a population-level cohort analysis, our study demonstrates that though rare, de novo autoimmune cutaneous connective tissue disorders (AiCTD) in the setting of immune checkpoint inhibitors (ICI) are not associated with a greater risk of mortality and are overall approaching a statistically significant decrease in mortality when compared to ICI-treated patients without cutaneous immune-related adverse events. These findings are significant and highly relevant to dermatologists and oncologists caring for ICI recipients as it adds to the limited information on development of cutaneous AiCTD following ICI administration, for which enhanced understanding is critical to improving the care for this challenging patient population.
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Affiliation(s)
- Kimberly Tang
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ahmad Rajeh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharina S Shaw
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nga Nguyen
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guihong Wan
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kimberly B Hashemi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rochelle L Castillo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole R LeBoeuf
- Dana Farber Cancer Institute, Department of Dermatology, Boston, MA, USA
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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2
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Chen GF, Shaw KS, Xu S, Hashemi KB, Castillo RL, Vleugels RA, Cohen JM. Depression in patients with Raynaud's phenomenon: A case-control study in the National Institutes of Health's All of Us Research Program. J Am Acad Dermatol 2024; 90:857-859. [PMID: 38128831 DOI: 10.1016/j.jaad.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | - Katharina S Shaw
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suzanne Xu
- Yale School of Medicine, New Haven, Connecticut
| | - Kimberly B Hashemi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rochelle L Castillo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
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3
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Shaw KS, Reusch DB, Castillo RL, Hashemi KB, Sundel R, Dedeoglu F, Vleugels RA. Rapid Improvement in Recalcitrant Cutaneous Juvenile Dermatomyositis With Anifrolumab Treatment. JAMA Dermatol 2024; 160:237-238. [PMID: 37950917 DOI: 10.1001/jamadermatol.2023.4744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
This case report describes a 14-year-old girl with juvenile dermatomyositis who presented with a 6-year history of a pruritic, photosensitive eruption involving her face, neck, trunk, and extremities and was successfully treated with anifrolumab.
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Affiliation(s)
- Katharina S Shaw
- Section of Dermatology, Department of Dermatology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Diana B Reusch
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rochelle L Castillo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Kimberly B Hashemi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert Sundel
- Rheumatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Fatma Dedeoglu
- Rheumatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
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4
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Castillo RL, Sidhu I, Dolgalev I, Chu T, Prystupa A, Subudhi I, Yan D, Konieczny P, Hsieh B, Haberman RH, Selvaraj S, Shiomi T, Medina R, Girija PV, Heguy A, Loomis CA, Chiriboga L, Ritchlin C, Garcia-Hernandez MDLL, Carucci J, Meehan SA, Neimann AL, Gudjonsson JE, Scher JU, Naik S. Spatial transcriptomics stratifies psoriatic disease severity by emergent cellular ecosystems. Sci Immunol 2023; 8:eabq7991. [PMID: 37267384 PMCID: PMC10502701 DOI: 10.1126/sciimmunol.abq7991] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023]
Abstract
Whereas the cellular and molecular features of human inflammatory skin diseases are well characterized, their tissue context and systemic impact remain poorly understood. We thus profiled human psoriasis (PsO) as a prototypic immune-mediated condition with a high predilection for extracutaneous involvement. Spatial transcriptomics (ST) analyses of 25 healthy, active lesion, and clinically uninvolved skin biopsies and integration with public single-cell transcriptomics data revealed marked differences in immune microniches between healthy and inflamed skin. Tissue-scale cartography further identified core disease features across all active lesions, including the emergence of an inflamed suprabasal epidermal state and the presence of B lymphocytes in lesional skin. Both lesional and distal nonlesional samples were stratified by skin disease severity and not by the presence of systemic disease. This segregation was driven by macrophage-, fibroblast-, and lymphatic-enriched spatial regions with gene signatures associated with metabolic dysfunction. Together, these findings suggest that mild and severe forms of PsO have distinct molecular features and that severe PsO may profoundly alter the cellular and metabolic composition of distal unaffected skin sites. In addition, our study provides a valuable resource for the research community to study spatial gene organization of healthy and inflamed human skin.
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Affiliation(s)
- Rochelle L. Castillo
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Ikjot Sidhu
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
| | - Igor Dolgalev
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
- Translational Immunology Center, NYU Langone Health, NY, NY 10016
| | - Tinyi Chu
- Computational and Systems Biology program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, NY, NY 10065
| | - Aleksandr Prystupa
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Applied Bioinformatics Laboratories, NYU Langone Health, NY, NY 10016
| | - Ipsita Subudhi
- Department of Pathology, NYU Langone Health, NY, NY 10016
| | - Di Yan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | | | - Brandon Hsieh
- Department of Pathology, NYU Langone Health, NY, NY 10016
| | - Rebecca H. Haberman
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | | | - Tomoe Shiomi
- Center for Biospecimen Research and Development, NYU Langone Health, NY, NY 10016
| | - Rhina Medina
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Parvathy Vasudevanpillai Girija
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Adriana Heguy
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Genome Technology Center, NYU Langone Health, NY, NY 10016
| | | | - Luis Chiriboga
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Center for Biospecimen Research and Development, NYU Langone Health, NY, NY 10016
| | - Christopher Ritchlin
- Allergy, Immunology and Rheumatology Division, Center of Musculoskeletal Research, University of Rochester Medical School, Rochester NY 14642
| | - Maria De La Luz Garcia-Hernandez
- Allergy, Immunology and Rheumatology Division, Center of Musculoskeletal Research, University of Rochester Medical School, Rochester NY 14642
| | - John Carucci
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Shane A. Meehan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Andrea L. Neimann
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
| | - Johann E. Gudjonsson
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, NYU Langone Health, NY, NY 10016
- NYU Psoriatic Arthritis Center, NYU Langone Health, NY, NY 10016
| | - Shruti Naik
- Department of Pathology, NYU Langone Health, NY, NY 10016
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, NY, NY 10016
- Perlmutter Cancer Center, NYU Langone Health, NY, NY 10016
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Castillo RL, Yan D, Ashhurst AS, Elliott A, Angioni MM, Scher JU, Naik S, Neimann A, Byrne SN, Payne RJ, FitzGerald O, Pennington SR, Cauli A, Chandran V. GRAPPA 2020 Research Award Recipients. J Rheumatol 2022; 49:55-56. [DOI: 10.3899/jrheum.211335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
At the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) annual meeting, a summary of the research conducted by the recipients of the 2020 GRAPPA Research Awards was presented by the awardees. The summary of the 4 presentations is provided here.
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Abstract
Precision medicine, which recognizes and upholds the uniqueness of each individual patient and the importance of discerning these inter-individual differences on a molecular scale in order to provide truly personalized medical care, is a revolutionary approach that relies on the discovery of clinically-relevant biomarkers derived from the massive amounts of data generated by epigenomic, genomic, transcriptomic, proteomic, microbiomic, and metabolomic studies, collectively known as multi-omics. If harnessed and mined appropriately with the help of ever-evolving computational and analytic methods, the collective data from omics studies has the potential to accelerate delivery of targeted medical treatment that maximizes benefit, minimizes harm, and eliminates the “fortune-telling” inextricably linked to the prevailing trial-and-error approach. For a disease such as dermatomyositis (DM), which is characterized by remarkable phenotypic heterogeneity and varying degrees of multi-organ involvement, an individualized approach that incorporates big data derived from multi-omics studies with the results of currently available serologic, histopathologic, radiologic, and electrophysiologic tests, and, most importantly, with clinical findings obtained from a thorough history and physical examination, has immense diagnostic, therapeutic, and prognostic value. In this review, we discuss omics-based research studies in DM and describe their practical applications and promising roles in guiding clinical decisions and optimizing patient outcomes.
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Affiliation(s)
- Rochelle L Castillo
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
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Abstract
Dermatomyositis (DM) is a strikingly heterogenous disease characterized by a broad and ever-evolving spectrum of cutaneous manifestations that transcend the classic “hallmarks” defined by Peter and Bohan in 1975. Despite the increasing preponderance and ubiquity of autoantibody, radiologic, and electrophysiologic testing, the diagnosis of DM still hinges largely on prompt detection of cutaneous manifestations of this condition. While pathognomonic cutaneous features of DM are more readily recognizable, many patients present with subtle and/or atypical skin manifestations, and diagnosis of DM may require clinician identification of these cutaneous clues. In this review, we highlight several of the lesser-known skin manifestations of DM, specifically, panniculitis, diffuse subcutaneous edema, erythroderma, calcinosis, ulceration, flagellate erythema, Wong-type DM, gingival telangiectasias, and the ovoid palatal patch. We describe the clinical and histopathologic presentation of these cutaneous findings. While manifesting less frequently than the heliotrope rash, Gottron’s papules, and Gottron’s sign, these cutaneous clues are equally important for clinicians to recognize in order to facilitate timely diagnosis and early intervention.
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Affiliation(s)
- Rochelle L Castillo
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
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Eusebio-Alpapara KMV, Castillo RL, Dofitas BL. Gabapentin for uremic pruritus: a systematic review of randomized controlled trials. Int J Dermatol 2019; 59:412-422. [PMID: 31777066 DOI: 10.1111/ijd.14708] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/05/2019] [Accepted: 10/20/2019] [Indexed: 12/01/2022]
Abstract
Uremic pruritus is one of the most prevalent and bothersome dermatologic symptoms in patients with end-stage renal disease. Some studies suggest a possible neuropathic cause of uremic pruritus. Gabapentin, an anticonvulsant, may control pruritus with neuropathic origin. The objectives of this study were to assess the efficacy of gabapentin in reducing pruritus scores of patients with uremic pruritus and evaluate its safety among dialysis patients. Meta-analysis of randomized controlled trials, using gabapentin as treatment for uremic pruritus among hemodialysis patients was included and analyzed using Review Manager Version 5.1.4 software. Seven out of 17 screened articles were included, with a total of 315 participants. Meta-analysis of the incidence of improved pruritus scores after treatment from four studies (n = 171) showed that treatment with gabapentin decreased the severity of uremic pruritus as compared to the placebo (risk ratio = 0.18; 95% confidence interval: 0.09, 0.33; I2 = 4%: P =< 0.00001). Six studies (n = 290) presented with incidence of adverse drug events such as dizziness, drowsiness, and somnolence. In the pooled analysis, treatment with gabapentin was associated with a higher incidence of adverse drug events compared to the comparator drugs, but the results were not significant (risk ratio = 1.3, 95% confidence interval: 0.81, 2.11; P = 0.28, I2 = 37%). The results of this systematic review suggest that gabapentin is efficacious and safe in improving uremic pruritus among dialysis patients.
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Affiliation(s)
- Kathleen May V Eusebio-Alpapara
- Section of Dermatology, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Rochelle L Castillo
- Section of Dermatology, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Belen L Dofitas
- Section of Dermatology, Department of Medicine, University of the Philippines, Philippine General Hospital, Manila, Philippines
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Castillo RL, Silva CY, Frez MLF. Bullous pemphigoid presenting as a malar rash. Indian J Dermatol Venereol Leprol 2016; 80:80-2. [PMID: 24448138 DOI: 10.4103/0378-6323.125482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rochelle L Castillo
- Department of Medicine, Section of Dermatology Clinic, Philippine General Hospital, Manila, Philippines
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Castillo RL, Carrasco Loza R, Romero-Dapueto C. Pathophysiological Approaches of Acute Respiratory Distress syndrome: Novel Bases for Study of Lung Injury. Open Respir Med J 2015; 9:83-91. [PMID: 26312099 PMCID: PMC4541465 DOI: 10.2174/1874306401509010083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 12/22/2022] Open
Abstract
Experimental approaches have been implemented to research the lung damage related-mechanism. These models show in animals pathophysiological events for acute respiratory distress syndrome (ARDS), such as neutrophil activation, reactive oxygen species burst, pulmonary vascular hypertension, exudative edema, and other events associated with organ dysfunction. Moreover, these approaches have not reproduced the clinical features of lung damage. Lung inflammation is a relevant event in the develop of ARDS as component of the host immune response to various stimuli, such as cytokines, antigens and endotoxins. In patients surviving at the local inflammatory states, transition from injury to resolution is an active mechanism regulated by the immuno-inflammatory signaling pathways. Indeed, inflammatory process is regulated by the dynamics of cell populations that migrate to the lung, such as neutrophils and on the other hand, the role of the modulation of transcription factors and reactive oxygen species (ROS) sources, such as nuclear factor kappaB and NADPH oxidase. These experimental animal models reproduce key components of the injury and resolution phases of human ALI/ARDS and provide a methodology to explore mechanisms and potential new therapies.
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Affiliation(s)
- R L Castillo
- Programa de Fisiopatología, Facultad de Medicina, Universidad de Chile, Chile
| | - R Carrasco Loza
- Departamento de Medicina, Hospital del Salvador, Santiago, Chile; Laboratorio de Investigación Biomédica, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - C Romero-Dapueto
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
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Álvarez P, Carrasco R, Romero-Dapueto C, Castillo RL. Transfusion-Related Acute Lung Injured (TRALI): Current Concepts. Open Respir Med J 2015; 9:92-6. [PMID: 26312100 PMCID: PMC4541453 DOI: 10.2174/1874306401509010092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 02/01/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI. A common theme among the experimental TRALI models is the central importance of neutrophils in mediating the early immune response, and lung vascular injury. Central clinical symptoms are dyspnea, tachypnea, tachycardia, cyanosis and pulmonary secretions, altogether with other hemodynamic alterations, such as hypotension and fever. Complementary to these clinical findings, long-term validated animal models for TRALI should allow the determination of the cellular targets for TRALI-inducing alloantibodies as well as delineation of the underlying pathogenic molecular mechanisms, and key molecular mediators of the pathology. Diagnostic criteria have been established and preventive measures have been implemented. These actions have contributed to the reduction in the overallnumber of fatalities. However, TRALI still remains a clinical problem. Any complication suspected of TRALI should immediately be reported.
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Affiliation(s)
- P Álvarez
- Unidad de Paciente Crítico, Hospital Metropolitano La Florida, Santiago, Chile ; Facultad de Medicina, Universidad Finis Terrae, Chile
| | - R Carrasco
- Departamento de Medicina, Universidad de Chile, Hospital Salvador, Santiago, Chile
| | - C Romero-Dapueto
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - R L Castillo
- Programa de Fisiopatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Álvarez P, Tapia L, Mardones LA, Pedemonte JC, Farías JG, Castillo RL. Cellular mechanisms against ischemia reperfusion injury induced by the use of anesthetic pharmacological agents. Chem Biol Interact 2014; 218:89-98. [PMID: 24835546 DOI: 10.1016/j.cbi.2014.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/20/2014] [Accepted: 04/28/2014] [Indexed: 12/15/2022]
Abstract
Ischemia-reperfusion (IR) cycle in the myocardium is associated with activation of an injurious cascade, thus leading to new myocardial challenges, which account for up to 50% of infarct size. Some evidence implicates reactive oxygen species (ROS) as a probable cause of myocardial injury in prooxidant clinical settings. Damage occurs during both ischemia and post-ischemic reperfusion in animal and human models. The mechanisms that contribute to this damage include the increase in cellular calcium (Ca(2+)) concentration and induction of ROS sources during reperfusion. Pharmacological preconditioning, which includes pharmacological strategies that counteract the ROS burst and Ca(2+) overload followed to IR cycle in the myocardium, could be effective in limiting injury. Currently widespread evidence supports the use of anesthetics agents as an important cardioprotective strategy that act at various levels such as metabotropic receptors, ion channels or mitochondrial level. Their administration before a prolonged ischemic episode is known as anesthetic preconditioning, whereas when given at the very onset of reperfusion, is termed anesthetic postconditioning. Both types of anesthetic conditioning reduce, albeit not to the same degree, the extent of myocardial injury. This review focuses on cellular and pathophysiological concepts on the myocardial damage induced by IR and how anesthetic pharmacological agents commonly used could attenuate the functional and structural effects induced by oxidative stress in cardiac tissue.
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Affiliation(s)
- P Álvarez
- Critical Care Unit, Hospital Clínico Metropolitano La Florida, Santiago, Chile; Faculty of Medicine, University Finis Terrae, Chile; Pathophysiology Program, Faculty of Medicine, University of Chile, Chile
| | - L Tapia
- Pathophysiology Program, Faculty of Medicine, University of Chile, Chile; Emergency Unit, Clínica Dávila, Santiago, Chile
| | - L A Mardones
- Pathophysiology Program, Faculty of Medicine, University of Chile, Chile
| | - J C Pedemonte
- Anesthesia Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J G Farías
- Departamento de Ingeniería Química, Facultad de Ingeniería y Ciencias, Universidad de la Frontera, Casilla 54-D, Temuco, Chile
| | - R L Castillo
- Pathophysiology Program, Faculty of Medicine, University of Chile, Chile.
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