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Siqueira NSN, Pascoal LB, Rodrigues BL, de Castro MM, Martins ASC, Araújo DOS, Gomes LEM, Camargo MG, Ayrizono MDLS, Leal RF. Ferric carboxymaltose for anemia in Crohn’s disease patients at a tertiary center: A retrospective observational cohort study. World J Clin Cases 2023; 11:2740-2752. [PMID: 37214580 PMCID: PMC10198098 DOI: 10.12998/wjcc.v11.i12.2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/20/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Although the gastrointestinal tract is the most affected by Crohn’s disease (CD), the condition triggers other consequent manifestations, and iron deficiency anemia (IDA) is one of the most common. Intravenous (IV) iron replacement is currently available through several drugs, such as ferric hydroxide sucrose and ferric carboxymaltose (FCM). However, the clinical management of these conditions can be challenging.
AIM To elucidate the drug’s effectiveness, the present study analyzed, through medical records, the clinical and epidemiological data of a cohort of patients with active CD who received IV FCM for the IDA treatment.
METHODS This retrospective observational study included 25 patients with active CD, severe anemia, and refractory to previous conventional treatments. Patients were evaluated two times: During the last treatment with ferric hydroxide sucrose and treatment with FCM.
RESULTS After treatment with FCM, parameters of IDA assessment significantly improved, serum hemoglobin (Hb) levels increased in 93% of patients (P < 0.0001), and in 44%, there was an increase of ≥ 2 g/dL in a single application. In addition, 86% of the patients showed an increase in serum iron (P < 0.0001) and ferritin (P = 0.0008) and 50% in transferrin saturation (P = 0.01). The serum iron levels at baseline showed a negative association with the ileal and colonic CD and use of biologics and a positive association with patients who developed CD later in life after the age of 40 (A3) and with a stenosing (B2) and fistulizing (B3) phenotype. The values of Hb and hematocrit after ferric hydroxide sucrose treatment remained similar to those found before treatment.
CONCLUSION This study demonstrated that FCM is an important therapeutic strategy for treating IDA in CD patients, achieving satisfactory results in refractory cases.
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Affiliation(s)
- Natália Souza Nunes Siqueira
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Livia Bitencourt Pascoal
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Bruno Lima Rodrigues
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Marina Moreira de Castro
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Alan Sidnei Corrêa Martins
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Dante Orsetti Silva Araújo
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Luis Eduardo Miani Gomes
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Michel Gardere Camargo
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (Unicamp), Campinas 13083-878, São Paulo, Brazil
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de Negreiros LMV, Pascoal LB, Genaro LM, Silva JF, Rodrigues BL, Camargo MG, Martinez CAR, Coy CSR, Ayrizono MDLS, Fagundes JJ, Leal RF. Pouchitis: insight into the pathogenesis and clinical aspects. Am J Transl Res 2022; 14:4406-4425. [PMID: 35958439 PMCID: PMC9360866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
Ulcerative colitis (UC) is a chronic intestinal inflammatory disease and familial adenomatous polyposis (FAP) is an autosomal dominant inherited disease. Both diseases, despite being different, may require the same surgical procedure: proctocolectomy with ileal pouch-anal anastomosis (IPAA). The main complication after this procedure is pouch inflammation (pouchitis). This inflammatory complication can affect up to 60 percent of patients who receive IPAA for UC, and a very small percentage of the FAP patients. The purpose of this review was to determine the current molecular mechanisms in its pathogenesis and detail the risk factors involved in pouchitis, its diagnosis, and treatment.
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Affiliation(s)
- Leandro Minatel Vidal de Negreiros
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Lívia Bitencourt Pascoal
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Lívia Moreira Genaro
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Julian Furtado Silva
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Bruno Lima Rodrigues
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Michel Gardere Camargo
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Carlos Augusto Real Martinez
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Cláudio Saddy Rodrigues Coy
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - João José Fagundes
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp) Campinas, Brazil
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Pascoal LB, Palma BB, Chaim FHM, de Castro MM, Damázio TA, Franceschini APMDF, Milanski M, Velloso LA, Leal RF. New translational and experimental insights into the role of pro-resolving lipid mediators in inflammatory bowel disease. World J Exp Med 2022; 12:1-15. [PMID: 35096550 PMCID: PMC8771592 DOI: 10.5493/wjem.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/21/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
The resolution of inflammation is an active process, guided by specialized pro-resolution lipid mediators (SPMs). These mediators originate from polyunsaturated fatty acids, such as omega-3. Sufficient evidence suggests that the beneficial effects attributed to omega-3 are, at least in part, the result of the immunomodulatory action of the SPMs, which act systemically by overcoming inflammation and repairing tissue damage, without suppressing the immune response. Recent studies suggest that an imbalance in the synthesis and/or activity of these compounds may be associated with the pathogenesis of several inflammatory conditions, such as inflammatory bowel disease (IBD). Thus, this review highlights the advances made in recent years with regard to the endo-genous synthesis and the biological role of lipoxins, resolvins, protectins, and maresins, as well as their precursors, in the regulation of inflammation; and provides an update on the participation of these mediators in the development and evolution of IBD and the therapeutic approaches that these immunomodulating substances are involved in this context.
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Affiliation(s)
- Lívia Bitencourt Pascoal
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
| | - Bruna Biazon Palma
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
| | - Fabio Henrique Mendonça Chaim
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
| | - Marina Moreira de Castro
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
| | - Tiago Andrade Damázio
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
| | - Ana Paula Menezes de Freitas Franceschini
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
| | - Marciane Milanski
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
| | - Lício Augusto Velloso
- Laboratory of Cell Signaling, School of Medical Sciences, University of Campinas, Campinas 13083-864, São Paulo, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas 13083-878, São Paulo, Brazil
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Menta PLR, Andrade MER, de Castro LF, Trindade LM, Dias MTS, Miyamoto JÉ, Dos Santos RM, Cassali GD, Leal RF, Ribeiro APB, Grimaldi R, Ignacio-Souza LM, Torsoni MA, Torsoni AS, Cardoso VN, Milanski M. Interesterified palm oil increases intestinal permeability, promotes bacterial translocation, alters inflammatory parameters and tight-junction protein genic expression in Swiss mice. Food Res Int 2022; 151:110897. [PMID: 34980418 DOI: 10.1016/j.foodres.2021.110897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/16/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
High-fat diets seem to have a negative influence on the development of obesity and the processes associated with low-grade chronic systemic inflammation. In recent years, partial hydrogenated oil, rich in trans isomers, has been associated with deleterious health effects. It has been replaced by interesterified fat (IF). However, there is no evidence whether IF ingestion can exert adverse effects on the intestinal mucosa. Thus, this study aimed to evaluate the effect of IF on the intestinal mucosa of male Swiss mice fed a normal or high-fat diet, focusing on its effects on intestinal permeability and bacterial translocation and its possible damage to the intestinal epithelium. The animals were divided into 4 groups: Control (C) and Interesterified Control (IC) groups (10 En% lipids from unmodified fat or interesterified fat, respectively) and High Fat (HF) and Interesterified High Fat (IHF) groups (45 En% lipids from unmodified fat or interesterified fat, respectively). Compare to C, the IC, HF, and IHF groups presented flattened epithelium, a shorter villi length and a lower percentage of goblet cells, less mucin 2, an increased oxidative stress and more inflammatory cells, higher IL-1β, IL-17, and IL-23 levels. These groups also presented increased intestinal permeability and gene expression of the protein claudin 2, while JAM-A and claudin 1 gene expression was reduced. IC and IHF increased IL-6 levels while reducing occludin expression. In addition, the IC group also presented a mucosa with lesions of low intensity in the ileum, an increased mucin 5ac, TNF-α levels, and reduced occludin expression in the distal jejunum. Moreover, there was a significant increase in bacterial translocation in the IC group to blood, liver, and lungs, while HF and IHF groups presented bacterial translocation which was restricted to the mesenteric lymph nodes. In summary, our results supported the hypothesis that IF added to a normolipidic diet can be considered harmful or even worse when compared to a HF.
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Affiliation(s)
- Penélope Lacrísio Reis Menta
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil.
| | - Maria Emília Rabelo Andrade
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lívia Furquim de Castro
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Luísa Martins Trindade
- Department of Food, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Melissa Tainan Silva Dias
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Josiane Érica Miyamoto
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Raisa Magno Dos Santos
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Geovanni Dantas Cassali
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Raquel Franco Leal
- Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil; IBD Research Laboratory, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | | | - Renato Grimaldi
- School of Food Engineering, University of Campinas, UNICAMP, Campinas, Brazil
| | - Letícia Martins Ignacio-Souza
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Marcio Alberto Torsoni
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Adriana Souza Torsoni
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil
| | - Valbert Nascimento Cardoso
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marciane Milanski
- School of Applied Sciences, University of Campinas, UNICAMP, Limeira, SP, Brazil; Obesity and Comorbidities Research Center, University of Campinas, UNICAMP, Campinas, SP, Brazil.
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Fucilini LMP, Genaro LM, Sousa DCE, Coy CSR, Leal RF, Ayrizono MDLS. EPIDEMIOLOGICAL PROFILE AND CLINICAL CHARACTERISTICS OF INFLAMMATORY BOWEL DISEASES IN A BRAZILIAN REFERRAL CENTER. Arq Gastroenterol 2021; 58:483-490. [PMID: 34909854 DOI: 10.1590/s0004-2803.202100000-87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The increase in the incidence and prevalence rates of inflammatory bowel disease (IBD) is evident in many newly industrialized countries in Asia, Africa, Eastern Europe, and the American continent. In Brazil, records are still scarce, and further studies on this topic are needed. OBJECTIVE To evaluate the epidemiological profile and clinical characteristics of patients with IBD who were followed up at a reference service in the state of São Paulo. METHODS We retrospectively analyzed the medical records of patients with IBD who were followed up in a Brazilian Referral Center. RESULTS A total of 625 patients was evaluated, 416 with Crohn's disease (CD), 190 with ulcerative colitis (UC), and 19 with indeterminate colitis. The average age of the patients was 31.6 years, with a homogeneous distribution between males and females patients. In patients with CD, the most predominant Montreal classification was A2, L3, and B1, with 44.8% of patients presenting with perianal disease; in UC, it was E2, and S0. The main extraintestinal manifestation was rheumatologic, followed by cutaneous and ophthalmic lesions. The majority of patients (85.4%) used some type of medication, the most frequent being aminosalicylates in patients with UC and biological therapy in patients with CD. Regarding surgeries, in CD, a significant percentage of patients underwent some type of surgical procedure, unlike the UC patients, including fistulotomies and placement of seton, derivative ostomies, enterectomy, ileocecectomy/right colectomy, total or partial colectomy, and strictureplasty. Only 195 (31.2%) patients lived in the city of Campinas, while 443 (70.9%) were from the 7th Regional Health Department (RHD), which corresponds to the macro-region of Campinas. CONCLUSION In this study, most patients came from the 7th RHD of Campinas; the patients were young, with no predominance of either sex; there was a higher frequency of patients with CD (66.6%). Most of them (85.4%) were undergoing pharmacological treatment, and a significant percentage of CD patients had undergone surgery.
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Affiliation(s)
| | | | | | | | - Raquel Franco Leal
- Universidade de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
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Genaro LM, Gomes LEM, Franceschini APMDF, Ceccato HD, de Jesus RN, Lima AP, Nagasako CK, Fagundes JJ, Ayrizono MDLS, Leal RF. Anti-TNF therapy and immunogenicity in inflammatory bowel diseases: a translational approach. Am J Transl Res 2021; 13:13916-13930. [PMID: 35035733 PMCID: PMC8748125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
Inflammatory bowel diseases are chronic illnesses that involve intestinal inflammation and are usually diagnosed as Crohn's disease or ulcerative colitis. As these diseases do not have a cure, the goal of treatment is to induce and maintain remission. Monoclonal antibodies have been recognized as the most advanced therapy to avoid complications and reduce the need for surgical approaches. However, although their effectiveness has been proven by several studies, they can trigger the immune system, induce the occurrence of immunogenicity, which may lead to the loss of response and treatment failure. The purpose of this review is to determine what are the main mechanisms involved in IBD; to assess the recommended treatments; to explore the mechanisms of immunogenicity. We also try to explain the detection and describe the existing advances that make possible the clinical application of these approaches.
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Affiliation(s)
- Lívia Moreira Genaro
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Luís Eduardo Miani Gomes
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Ana Paula Menezes de Freitas Franceschini
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Hugo Dugolin Ceccato
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Rafael Nascimento de Jesus
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Amanda Pereira Lima
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Cristiane Kibune Nagasako
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - João José Fagundes
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP)Campinas, Brazil
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Mello JDC, Gomes LEM, Silva JF, Siqueira NSN, Pascoal LB, Martinez CAR, Ayrizono MDLS, Leal RF. The role of chemokines and adipokines as biomarkers of Crohn's disease activity: a systematic review of the literature. Am J Transl Res 2021; 13:8561-8574. [PMID: 34539979 PMCID: PMC8430066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Crohn's disease (CD) is an inflammatory bowel disease (IBD) that affects the gastrointestinal tract and can have a major impact on the patient's quality of life and social/professional activities. Asymptomatic patients, or those with mild symptoms, experience the active disease with subclinical manifestation. Systematic review (SR) was performed to look for evidence for the role of chemokines and adipokines as markers for CD activity. METHODS This SR was conducted by searching published studies in international and regional databases up till July, 2020. CD patients were adults with the disease in activity or remission. All adipokines and chemokines were considered for the analysis and the Rayyan QCRI system was used. RESULTS In total, 20 studies were included. Six addressed chemokines and eight adipokines as potential biomarkers of CD activity. CXCL8 was the most studied chemokine (8 studies) and the results were controversial, with 62.5% showing a significant association with CD activity. CXCL10 was investigated by 4 studies and 50% identified it as a potential biomarker. CCL2, CCL11, CCL26 and CXCL1 were examined by 2 articles each. CXCL8 (P=0.002/P=0.001) and CXCL1 (P<0.001) presented the lowest? P value, which qualifies them as potential markers of disease activity. All the adipokines were tested in peripheral blood but 44.4% were also tested in intestinal mucosa, while the percentage in the chemokines' studies was 76.9% in peripheral blood, 46.1% in intestinal mucosa and 7.6% in urine sample respectively. CONCLUSION The development of disease activity biomarkers for CD is becoming relevant for clinical practice. Chemokines and adipokines have the potential to signalize CD activity, but validation in larger cohorts of patients, preferable multicenter studies are still needed.
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Affiliation(s)
- Juliana Delgado Campos Mello
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
| | - Luis Eduardo Miani Gomes
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
| | - Julian Furtado Silva
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
| | - Natalia Souza Nunes Siqueira
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
| | - Lívia Bitencourt Pascoal
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
| | - Carlos Augusto Real Martinez
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP) Campinas, Brazil
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Tilio MSGD, Arias LB, Camargo MG, Oliveira PSPD, Panzetti NV, Ayrizono MDLS, Leal RF, Fagundes JJ, Coy CSR. Quality of life in patients with ileal pouch for ulcerative colitis. Journal of Coloproctology 2021. [DOI: 10.1016/j.jcol.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical procedure for the treatment of ulcerative colitis (UC) and is associated with the prospect of cure. Experience gained over the years has demonstrated the occurrence of a high number of complications as well as bowel disorders that can compromise quality of life (QoL).
Objective evaluate QoL in patients with IPAA for ulcerative colitis.
Patients and methods the Inflammatory Bowel Disease Questionnaire (IBDQ) was used to assess QoL in patients with IPAA after its validation in Portuguese.
Results thirty-one patients submitted to IPAA by the same group of professionals were evaluated. QoL was classified as regular in all domains evaluated (intestinal and systemic symptoms and emotional and social aspects). There were no differences in relation to gender, type of pouch or postoperative time. However, elderly patients showed a tendency toward lower scores. Having a professional activity was associated with higher scores in systemic symptoms and social aspects (p < 0.05). Patients with ileostomy showed lower values in the domains of systemic symptoms, emotional and social aspects (p <0.05).
Conclusion in all domains assessed, patients with IPAA for UC had QoL classified as regular. Ileostomy and lack of professional activity negatively influenced QoL.
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Affiliation(s)
| | - Larissa Berbert Arias
- Coloproctology Group, Discipline of Digestive System Diseases (DDSD), FCM-UNICAMP, Campinas, SP, Brazil
| | - Michel Gardere Camargo
- Coloproctology Group, Discipline of Digestive System Diseases (DDSD), FCM-UNICAMP, Campinas, SP, Brazil
| | | | - Nathalia Vieira Panzetti
- Coloproctology Group, Discipline of Digestive System Diseases (DDSD), FCM-UNICAMP, Campinas, SP, Brazil
| | | | - Raquel Franco Leal
- Coloproctology Group, Discipline of Digestive System Diseases (DDSD), FCM-UNICAMP, Campinas, SP, Brazil
| | - João José Fagundes
- Coloproctology Group, Discipline of Digestive System Diseases (DDSD), FCM-UNICAMP, Campinas, SP, Brazil
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9
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Pascoal LB, Rodrigues PB, Genaro LM, Gomes ABDSP, Toledo-Teixeira DA, Parise PL, Bispo-Dos-Santos K, Simeoni CL, Guimarães PV, Buscaratti LI, Elston JGDA, Marques-Souza H, Martins-de-Souza D, Ayrizono MDLS, Velloso LA, Proenca-Modena JL, Moraes-Vieira PMM, Mori MAS, Farias AS, Vinolo MAR, Leal RF. Microbiota-derived short-chain fatty acids do not interfere with SARS-CoV-2 infection of human colonic samples. Gut Microbes 2021; 13:1-9. [PMID: 33550892 PMCID: PMC7889267 DOI: 10.1080/19490976.2021.1874740] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Microbiota-derived molecules called short-chain fatty acids (SCFAs) play a key role in the maintenance of the intestinal barrier and regulation of immune response during infectious conditions. Recent reports indicate that SARS-CoV-2 infection changes microbiota and SCFAs production. However, the relevance of this effect is unknown. In this study, we used human intestinal biopsies and intestinal epithelial cells to investigate the impact of SCFAs in the infection by SARS-CoV-2. SCFAs did not change the entry or replication of SARS-CoV-2 in intestinal cells. These metabolites had no effect on intestinal cells' permeability and presented only minor effects on the production of anti-viral and inflammatory mediators. Together our findings indicate that the changes in microbiota composition of patients with COVID-19 and, particularly, of SCFAs do not interfere with the SARS-CoV-2 infection in the intestine.
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Affiliation(s)
- Lívia Bitencourt Pascoal
- Laboratory of Immunoinflammation, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil,Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Patrícia Brito Rodrigues
- Laboratory of Immunoinflammation, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Lívia Moreira Genaro
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Daniel Augusto Toledo-Teixeira
- Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Pierina Lorencini Parise
- Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Karina Bispo-Dos-Santos
- Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Camila Lopes Simeoni
- Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Paula Veri Guimarães
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Lucas Ildefonso Buscaratti
- Brazilian Laboratory on Silencing Technologies (Blast), Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - João Gabriel De Angeli Elston
- Brazilian Laboratory on Silencing Technologies (Blast), Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Henrique Marques-Souza
- Brazilian Laboratory on Silencing Technologies (Blast), Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Daniel Martins-de-Souza
- Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, Brazil,Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Maria De Lourdes Setsuko Ayrizono
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Lício Augusto Velloso
- Laboratory of Cell Signaling, School of Medical Sciences,University of Campinas (UNICAMP), Campinas, Brazil,Obesity and Comorbidities Research Center (OCRC), University of Campinas (UNICAMP), Campinas, Brazil
| | - José Luiz Proenca-Modena
- Laboratory of Emerging Viruses, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil,Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, Brazil
| | - Pedro Manoel Mendes Moraes-Vieira
- Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, Brazil,Laboratory of Immunometabolism, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcelo Alves Silva Mori
- Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, Brazil,Laboratory of Aging Biology, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Alessandro Santos Farias
- Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, Brazil,Autoimmune Research Laboratory, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marco Aurélio Ramirez Vinolo
- Laboratory of Immunoinflammation, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil,Experimental Medicine Research Cluster (EMRC), University of Campinas (UNICAMP), Campinas, Brazil,Marco Aurélio RamirezVinolo Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil; Laboratory of Immunoinflammation, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil,Obesity and Comorbidities Research Center (OCRC), University of Campinas (UNICAMP), Campinas, Brazil,CONTACT Raquel Franco Leal
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10
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de Castro MM, Pascoal LB, Steigleder KM, Siqueira BP, Corona LP, Ayrizono MDLS, Milanski M, Leal RF. Role of diet and nutrition in inflammatory bowel disease. World J Exp Med 2021; 11:1-16. [PMID: 33585174 PMCID: PMC7852575 DOI: 10.5493/wjem.v11.i1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) are closely linked to nutrition. The latest research indicates that diet and nutrition are significantly involved in the etiopathogenesis of the disease, although their specific role throughout its clinical course still remains unclear. This study reviewed how diet and nutrition are associated with IBD development and management. Even though specific diets have been shown to bring about positive outcomes, there is currently no scientific consensus regarding an appropriate diet that would benefit all IBD patients. We suggest that individualized dietary recommendations are of the greatest importance and that diets should be planned to provide individual IBD patients with specific nutrient requirements while keeping all the clinical aspects of the patients in mind. Further research is clearly necessary to investigate nutritional factors involved in IBD development and, especially, to evaluate the applications of the diets during the course of the disease.
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Affiliation(s)
- Marina Moreira de Castro
- IBD Research Laboratory, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Lívia Bitencourt Pascoal
- IBD Research Laboratory, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Karine Mariane Steigleder
- IBD Research Laboratory, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Beatriz Piatezzi Siqueira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas (UNICAMP), Limeira 13484-350, São Paulo, Brazil
| | - Ligiana Pires Corona
- Laboratory of Nutritional Epidemiology, School of Applied Sciences, University of Campinas (UNICAMP), Limeira 13484-350, São Paulo, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- IBD Research Laboratory, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Marciane Milanski
- IBD Research Laboratory, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Raquel Franco Leal
- IBD Research Laboratory, Colorectal Surgery Unit, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
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11
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Rodrigues BL, Mazzaro MC, Nagasako CK, Ayrizono MDLS, Fagundes JJ, Leal RF. Assessment of disease activity in inflammatory bowel diseases: Non-invasive biomarkers and endoscopic scores. World J Gastrointest Endosc 2020; 12:504-520. [PMID: 33362904 PMCID: PMC7739141 DOI: 10.4253/wjge.v12.i12.504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
Inflammatory bowel diseases (IBD) comprise two major forms: Crohn's disease and ulcerative colitis. The diagnosis of IBD is based on clinical symptoms combined with results found in endoscopic and radiological examinations. In addition, the discovery of biomarkers has significantly improved the diagnosis and management of IBD. Several potential genetic, serological, fecal, microbial, histological and immunological biomarkers have been proposed for IBD, and they have been evaluated for clinical routine and clinical trials. Ileocolonoscopy, especially with biopsy collection, has been considered the standard method to diagnose IBD and to assess clinical activity of the disease, but it is limited to the colon and terminal ileum and is considered invasive. For this reason, non-invasive biomarkers are necessary for this type of chronic inflammatory disease, which affects mostly young individuals, as they are expected to have a long follow-up.
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Affiliation(s)
- Bruno Lima Rodrigues
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Márcia Carolina Mazzaro
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Cristiane Kibune Nagasako
- Department of Gastroenterology, Gastrocenter, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - João José Fagundes
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
| | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, Gastrocenter, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-878, São Paulo, Brazil
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12
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Portovedo M, Reginato A, Miyamoto JÉ, Simino LA, Hakim MP, Campana M, Leal RF, Ignácio-Souza LM, Torsoni MA, Magnan C, Le Stunff H, Torsoni AS, Milanski M. Lipid excess affects chaperone-mediated autophagy in hypothalamus. Biochimie 2020; 176:110-116. [PMID: 32623049 DOI: 10.1016/j.biochi.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/09/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 01/15/2023]
Abstract
Obesity is a major health problem worldwide. Overweight and obesity directly affect health-related quality of life and also have an important economic impact on healthcare systems. In experimental models, obesity leads to hypothalamic inflammation and loss of metabolic homeostasis. It is known that macroautophagy is decreased in the hypothalamus of obese mice but the role of chaperone-mediated autophagy is still unknown. In this study, we aimed to investigate the role of hypothalamic chaperone-mediated autophagy in response to high-fat diet and also the direct effect of palmitate on hypothalamic neurons. Mice received chow or high-fat diet for 3 days or 1 week. At the end of the experimental protocol, chaperone-mediated autophagy in hypothalamus was investigated, as well as cytokines expression. In other set of experiments, neuronal cell lines were treated with palmitic acid, a saturated fatty acid. We show that chaperone-mediated autophagy is differently regulated in response to high-fat diet intake for 3 days or 1 week. Also, when hypothalamic neurons are directly exposed to palmitate there is activation of chaperone-mediated autophagy. High-fat diet causes hypothalamic inflammation concomitantly to changes in the content of chaperone-mediated autophagy machinery. It remains to be studied the direct role of inflammation and lipids itself on the activation of chaperone-mediated autophagy in the hypothalamus in vivo and also the neuronal implications of chaperone-mediated autophagy inhibition in response to obesity.
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Affiliation(s)
- M Portovedo
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - A Reginato
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - J É Miyamoto
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - L A Simino
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - M P Hakim
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - M Campana
- Université de Paris, BFA, UMR 8251, CNRS, F-75013, Paris, France
| | - R F Leal
- IBD Research Laboratory, Colorectal Surgery Unit, Department of Surgery, School of Medical Sciences, UNICAMP, Campinas, 13083-878, Brazil
| | - L M Ignácio-Souza
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - M A Torsoni
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - C Magnan
- Université de Paris, BFA, UMR 8251, CNRS, F-75013, Paris, France
| | - H Le Stunff
- Université de Paris, BFA, UMR 8251, CNRS, F-75013, Paris, France
| | - A S Torsoni
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil
| | - M Milanski
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences, UNICAMP, Limeira, 13484-350, Brazil.
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13
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de Castro MM, Corona LP, Pascoal LB, Miyamoto JÉ, Ignacio-Souza LM, de Lourdes Setsuko Ayrizono M, Torsoni MA, Torsoni AS, Leal RF, Milanski M. Dietary Patterns Associated to Clinical Aspects in Crohn's Disease Patients. Sci Rep 2020; 10:7033. [PMID: 32341416 PMCID: PMC7184619 DOI: 10.1038/s41598-020-64024-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Diet is an important factor in both the pathogenesis and in the clinical course of Crohn's disease (CD). However, data on dietary patterns of CD patients are rather limited in the literature. This cross-sectional study included 60 patients with CD, aged 18-60 years. Dietary intake was assessed using a validated food frequency questionnaire to measure food consumption patterns by principal component analysis (PCA). Multiple regression analysis was performed to investigate the association between dietary patterns and clinical and demographic variables. Three dietary patterns were identified: "Traditional + FODMAP" was associated with symptoms, gender, previous surgeries, and duration of the disease. "Fitness style" was positively associated with physical activity and negatively associated with body mass index and smoking. "Snacks and processed foods" was positively associated with duration of the disease and negatively associated with age. According to the weekly food consumption analysis, patients with active disease consumed less coffee and tea. We found significant associations between the three dietary patterns and the variables, but not with the stage of the disease. Prospective studies are necessary to determine the effects of food consumption patterns on the clinical course of CD.
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Affiliation(s)
- Marina Moreira de Castro
- School of Applied Sciences, University of Campinas (UNICAMP), Limeira, Brazil
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ligiana Pires Corona
- School of Applied Sciences, University of Campinas (UNICAMP), Limeira, Brazil
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | | | | | | | | | - Raquel Franco Leal
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marciane Milanski
- School of Applied Sciences, University of Campinas (UNICAMP), Limeira, Brazil.
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
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14
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da Silva-Maia JK, Batista ÂG, Cazarin CBB, Soares ES, Bogusz Junior S, Leal RF, da Cruz-Höfling MA, Maróstica Junior MR. Aqueous Extract of Brazilian Berry ( Myrciaria jaboticaba) Peel Improves Inflammatory Parameters and Modulates Lactobacillus and Bifidobacterium in Rats with Induced-Colitis. Nutrients 2019; 11:nu11112776. [PMID: 31731626 PMCID: PMC6893622 DOI: 10.3390/nu11112776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/29/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022] Open
Abstract
Natural compounds could be a complementary alternative to inflammatory bowel disease (IBD) management. This study determined the effects of an aqueous extract of Myrciaria jaboticaba peel (EJP) (50 g L-1) on 2,4,6-trinitrobenzenesulfonic acid-induced colitis. Wistar rats were randomized into five groups: HC-healthy control, CC-colitis control, DC-drug control, SJ-short-term treatment with EJP, and LJ-long-term treatment with EJP. The EJP treatments reduced body weight loss, stool consistency score, and spleen enlargement. Gut microbiota was modulated through increased Lactobacillus and Bifidobacterium counts after EJP treatment. Short-chain fatty acids were also higher in the EJP treatment groups. The antioxidant enzyme activities were greater than CC or DC controls. Myeloperoxidase activity (LJ), inducible nitric oxide synthase (LJ/SJ), and intercellular adhesion molecule (SJ) levels were lower than in the CC group. EJP decreased histological scoring, mucosal thickness, and preserved the crypts and histological structure. Therefore, EJP showed beneficial effects and could be potentially used as an adjuvant in IBD treatment.
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Affiliation(s)
- Juliana Kelly da Silva-Maia
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Rio Grande do Norte, Rua das Artes—Lagoa Nova, Natal, RN 59075-000, Brazil
- Department of Food and Nutrition, School of Food Engineering, University of Campinas, Rua Monteiro Lobato, Campinas, SP 13083-862, Brazil
- Correspondence: (J.K.d.S.-M.); (M.R.M.J.); Tel.: +55-8432153135 (J.K.d.S.-M.); +55-19-35214078 (M.R.M.J.)
| | - Ângela Giovana Batista
- Department of Food and Nutrition, School of Food Engineering, University of Campinas, Rua Monteiro Lobato, Campinas, SP 13083-862, Brazil
- Department of Food and Nutrition, Federal University of Santa Maria—UFSM—Campus Palmeira das Missões, Av. Independência, nº 3751, Palmeira das Missões, RS CEP 98300-000, Brazil
| | - Cinthia Baú Betim Cazarin
- Department of Food and Nutrition, School of Food Engineering, University of Campinas, Rua Monteiro Lobato, Campinas, SP 13083-862, Brazil
| | - Edilene Siqueira Soares
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, SP 13083-862, Brazil
| | - Stanislau Bogusz Junior
- São Carlos Institute of Chemistry (IQSC), University of São Paulo (USP), São Carlos, SP 13566-590, Brazil
| | - Raquel Franco Leal
- School of Medical Sciences, University of Campinas, Campinas, SP 13083-862, Brazil
| | - Maria Alice da Cruz-Höfling
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, SP 13083-862, Brazil
| | - Mário Roberto Maróstica Junior
- Department of Food and Nutrition, School of Food Engineering, University of Campinas, Rua Monteiro Lobato, Campinas, SP 13083-862, Brazil
- Correspondence: (J.K.d.S.-M.); (M.R.M.J.); Tel.: +55-8432153135 (J.K.d.S.-M.); +55-19-35214078 (M.R.M.J.)
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15
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Gomes LEM, da Silva FAR, Pascoal LB, Ricci RL, Nogueira G, Camargo MG, de Lourdes Setsuko Ayrizono M, Fagundes JJ, Leal RF. Authors' Reply - Comments: Serum levels of infliximab in Brazilian patients with Crohn's disease: what are the reasons for differences from previous studies? Clinics (Sao Paulo) 2019; 74:e1517. [PMID: 31576921 PMCID: PMC6751365 DOI: 10.6061/clinics/2019/e1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Luis Eduardo Miani Gomes
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Francesca Aparecida Ramos da Silva
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Lívia Bitencourt Pascoal
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Renato Lazarin Ricci
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Guilherme Nogueira
- Laboratorio de Sinalizacao Celular, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Michel Gardere Camargo
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Maria de Lourdes Setsuko Ayrizono
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - João José Fagundes
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Raquel Franco Leal
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
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16
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Zaltman C, Amarante H, Brenner MM, Costa MHM, Flores C, Leal RF, Grain JFDS, Zeroncio M. Crohn's disease - treatment with biological medication. ACTA ACUST UNITED AC 2019; 65:554-567. [PMID: 31066809 DOI: 10.1590/1806-9282.65.4.554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
- Cyrla Zaltman
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil
| | - Heda Amarante
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil
| | - Marta Machado Brenner
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil
| | - Marcia Henriques Magalhaes Costa
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil
| | - Cristina Flores
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil
| | - Raquel Franco Leal
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil
| | - Jair Francisco de Santana Grain
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil
| | - Marco Zeroncio
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil
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Maurer LH, Cazarin CBB, Quatrin A, Minuzzi NM, Costa EL, Morari J, Velloso LA, Leal RF, Rodrigues E, Bochi VC, Júnior MRM, Emanuelli T. Grape peel powder promotes intestinal barrier homeostasis in acute TNBS-colitis: A major role for dietary fiber and fiber-bound polyphenols. Food Res Int 2019; 123:425-439. [PMID: 31284994 DOI: 10.1016/j.foodres.2019.04.068] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 10/19/2018] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel diseases are characterized by impaired intestinal barrier function. This study aimed to evaluate the effects of grape peel powder (GPP) and its bioactive rich-fractions on the barrier function and colonic injury in a model of colitis induced by 2,4,6 trinitrobenzene sulfonic acid (TNBS). Wistar rats received diets supplemented with either GPP (8%), extractable polyphenols (EP), non-extractable polyphenols-rich fraction (NEP-F), or polyphenols-poor, fiber-rich fraction (F) from grapes at amounts equivalent to the GPP group during 15 days before and for 7 days after colitis induction. NEP-F has decreased the extension of colonic lesion but the other grape peel bioactive fractions did not protect against macroscopic or microscopic colonic damage, EP diet increased macroscopic colonic damage. GPP, EP, and NEP-F reduced claudin-2 mRNA expression, whereas GPP and F fraction increased occludin and ZO-1 mRNA expression. All experimental diets reduced the colitis-triggered increase of MMP-9 mRNA expression. Colitis reduced by 30% the production of cecal short-chain fatty acids (SCFA). GPP and NEP-F completely protected against this effect, whereas F fraction was ineffective. Only GPP and NEP-F were able to decrease the upregulation of GRP94 mRNA triggered by colitis. Dietary fiber seems to reestablish the intestinal barrier function, whereas fiber-bound phenolics were able to restore cecal metabolism to produce beneficial metabolites like SCFA and to reduce the activation of the unfolded protein response.
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Affiliation(s)
- Luana Haselein Maurer
- Graduate Program on Food Science and Technology, Center of Rural Sciences, Federal University of Santa Maria, 97105-900 Santa Maria, Rio Grande do Sul, Brazil; Federal Institute of Education, Science, and Technology Farroupilha, 97555-000 Alegrete, Rio Grande do Sul, Brazil
| | - Cinthia Baú Betim Cazarin
- School of Food Engineering, Department of Food and Nutrition, University of Campinas, Campinas, São Paulo 13083-862, Brazil
| | - Andréia Quatrin
- Federal Institute of Education, Science, and Technology Farroupilha, 97555-000 Alegrete, Rio Grande do Sul, Brazil
| | - Natália Machado Minuzzi
- Integrated Center for Laboratory Analysis Development (NIDAL), Department of Food Technology and Science, Center of Rural Sciences, Federal University of Santa Maria, 97105-900 Santa Maria, Rio Grande do Sul, Brazil
| | - Eduarda Lasch Costa
- Integrated Center for Laboratory Analysis Development (NIDAL), Department of Food Technology and Science, Center of Rural Sciences, Federal University of Santa Maria, 97105-900 Santa Maria, Rio Grande do Sul, Brazil
| | - Joseane Morari
- School of Medical Sciences, Laboratory of Cell Signaling, University of Campinas, Campinas, São Paulo 13084-970, Brazil
| | - Lício Augusto Velloso
- School of Medical Sciences, Laboratory of Cell Signaling, University of Campinas, Campinas, São Paulo 13084-970, Brazil
| | - Raquel Franco Leal
- School of Medical Sciences, Department of Surgery, University of Campinas, Campinas, São Paulo 13083-887, Brazil
| | - Eliseu Rodrigues
- Federal University of Rio Grande do Sul, Institute of Food Science and Technology, 91501-970 Porto Alegre, RS, Brazil
| | - Vivian Caetano Bochi
- Federal University of Health Sciences of Porto Alegre, Department of Nutrition, 90050-170 Porto Alegre, RS, Brazil
| | - Mário Roberto Maróstica Júnior
- School of Food Engineering, Department of Food and Nutrition, University of Campinas, Campinas, São Paulo 13083-862, Brazil
| | - Tatiana Emanuelli
- Graduate Program on Food Science and Technology, Center of Rural Sciences, Federal University of Santa Maria, 97105-900 Santa Maria, Rio Grande do Sul, Brazil; Integrated Center for Laboratory Analysis Development (NIDAL), Department of Food Technology and Science, Center of Rural Sciences, Federal University of Santa Maria, 97105-900 Santa Maria, Rio Grande do Sul, Brazil.
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18
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Gomes LEM, da Silva FAR, Pascoal LB, Ricci RL, Nogueira G, Camargo MG, de Lourdes Setsuko Ayrizono M, Fagundes JJ, Leal RF. Serum Levels of Infliximab and Anti-Infliximab Antibodies in Brazilian Patients with Crohn's Disease. Clinics (Sao Paulo) 2019; 74:e824. [PMID: 30994711 PMCID: PMC6445154 DOI: 10.6061/clinics/2019/e824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/28/2018] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the quantitative serum level of infliximab (IFX) as well as the detection of anti-infliximab antibodies (ATIs) in patients with Crohn's disease (CD). METHOD Forty patients with CD under treatment at a tertiary center in southeastern Brazil were evaluated. Their use of infliximab was continuous and regular. We analyzed and compared the differences in the IFX and ATI levels between the patients with active CD (CDA) and those with CD in remission (CDR). RESULTS There was no difference in the IFX level between the CDA and CDR groups (p>0.05). Eighty percent of all patients had IFX levels above the therapeutic concentration (6-10 μg/mL). Two (9%) of the 22 patients with active disease and four (22.2%) of the 18 patients in remission had undetectable levels of IFX. Four (66.6%) of the six patients with undetectable levels of IFX had positive ATI levels; three of these patients were in remission, and one had active disease. In addition, the other two patients with undetectable levels of IFX presented ATI levels close to positivity (2.7 and 2.8 AU/ml). None of the patients with therapeutic or supratherapeutic IFX levels had positive ATI levels. CONCLUSIONS The undetectable levels of IFX correlated with the detection of ATIs, which was independent of disease activity. Immunogenicity was not the main factor for the loss of response to IFX in our study, and the majority of patients in both groups (CDA and CDR) had supratherapeutic levels of IFX.
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Affiliation(s)
- Luis Eduardo Miani Gomes
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Francesca Aparecida Ramos da Silva
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Lívia Bitencourt Pascoal
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Renato Lazarin Ricci
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Guilherme Nogueira
- Laboratorio de Sinalizacao Celular, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Michel Gardere Camargo
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Maria de Lourdes Setsuko Ayrizono
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - João José Fagundes
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
| | - Raquel Franco Leal
- Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
- Corresponding author. E-mail:
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19
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Morelli U, Magna LA, Rodrigues Coy CS, Franco Leal R, de Lourdes Setsuko Ayrizono M. Endoanal ultrasound for perianal Crohn's disease: is there correlation with fecal incontinence? Chirurgia (Bucur) 2018. [DOI: 10.23736/s0394-9508.18.04810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Lomazi EA, de Negreiros LMV, Magalhães PVVS, Togni RDCS, de Paiva NM, Ribeiro AF, Leal RF. Intestinal paracoccidioidomycosis resembling Crohn's disease in a teenager: a case report. J Med Case Rep 2018; 12:108. [PMID: 29706133 PMCID: PMC5925842 DOI: 10.1186/s13256-018-1641-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/15/2018] [Accepted: 03/02/2018] [Indexed: 12/11/2022] Open
Abstract
Background Differential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn’s disease. Case presentation We report a case of a 13-year-old Caucasian boy with abdominal pain for 1.5 years associated with nausea, diarrhea, and weight loss of 10 kg. He presented increased C-reactive protein and an increased erythrocyte sedimentation rate. A colonoscopy showed deep serpiginous ulcers throughout his entire colon and rectum, which suggested Crohn’s disease. He received one dose of infliximab, which is an anti-tumor necrosis factor-α, and showed no improvement. After the second dose, he got worse and started to have bloody diarrhea. A new colonoscopy was performed and pathological examination revealed ulcerative chronic inflammation with non-caseating granulomas and fungal structures (budding forms) compatible with Paracoccidioides brasiliensis. He underwent intravenously administered and then orally administered trimethoprim-sulfamethoxazole treatment. Due to drug intolerance, he was treated with amphotericin B and itraconazole, then he showed clinical improvement and mucosal healing with good outcome. Conclusion Paracoccidioidomycosis must be part of the differential diagnosis of inflammatory bowel diseases in endemic areas and must be excluded before starting immunosuppressive therapy.
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Affiliation(s)
| | - Leandro Minatel Vidal de Negreiros
- Inflammatory Bowel Disease Research Laboratory, University of Campinas, UNICAMP, João Lopes Vieira Street, no 108, 61, Tower 2, Campinas, Sao Paulo, 13087-734, Brazil
| | | | | | - Nielce Maria de Paiva
- Inflammatory Bowel Disease Research Laboratory, University of Campinas, UNICAMP, João Lopes Vieira Street, no 108, 61, Tower 2, Campinas, Sao Paulo, 13087-734, Brazil
| | | | - Raquel Franco Leal
- Inflammatory Bowel Disease Research Laboratory, University of Campinas, UNICAMP, João Lopes Vieira Street, no 108, 61, Tower 2, Campinas, Sao Paulo, 13087-734, Brazil.
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21
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Paiva NM, Pascoal LB, Negreiros LMV, Portovedo M, Coope A, Ayrizono MDLS, Coy CSR, Milanski M, Leal RF. Ileal pouch of ulcerative colitis and familial adenomatous polyposis patients exhibit modulation of autophagy markers. Sci Rep 2018; 8:2619. [PMID: 29422639 PMCID: PMC5805688 DOI: 10.1038/s41598-018-20938-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/26/2018] [Indexed: 12/13/2022] Open
Abstract
Total retocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgery of choice for patients with ulcerative colitis (UC) that are refractory to clinical treatment. Pouchitis is one of the most common complications after this procedure. Defects in autophagy have been reported in inflammatory bowel diseases. However, there are no studies on the IP. Therefore, we studied markers for autophagy in the IP mucosa of UC and FAP patients comparing them to controls with a normal distal ileum. Sixteen patients with IP in "J" shape, asymptomatic and with endoscopically normal IP were evaluated. The control group consisted of eight patients with normal colonoscopy. There was a significant decrease in the transcriptional levels of ATG5, MAP1LC3A and BAX in the FAP group. There was also a decrease in the protein level of Beclin-1 in the UC and FAP compared to the control group. Although the LC3II levels by immunoblot were higher in the UC group, LC3/p62 co-localization were lower in the immunofluorescence analysis in the UC and FAP compared to the control group. Corroborating these results, there was an increase of p62 by immunoblot in the UC group. These findings indicated a modulation of macroautophagy markers in the IP, which may explain the mucosa inflammation predisposition.
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Affiliation(s)
- Nielce Maria Paiva
- IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Lívia Bitencourt Pascoal
- IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Leandro Minatel Vidal Negreiros
- IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Mariana Portovedo
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Andressa Coope
- IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Maria de Lourdes Setsuko Ayrizono
- IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Claudio Saddy Rodrigues Coy
- IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Marciane Milanski
- Laboratory of Metabolic Disorders, Faculty of Applied Sciences University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Raquel Franco Leal
- IBD Research Laboratory, Coloproctology Unit, Surgery Department University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil.
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22
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Dotti I, Mora-Buch R, Ferrer-Picón E, Planell N, Jung P, Masamunt MC, Leal RF, Martín de Carpi J, Llach J, Ordás I, Batlle E, Panés J, Salas A. Alterations in the epithelial stem cell compartment could contribute to permanent changes in the mucosa of patients with ulcerative colitis. Gut 2017; 66:2069-2079. [PMID: 27803115 PMCID: PMC5749340 DOI: 10.1136/gutjnl-2016-312609] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE UC is a chronic inflammatory disease of the colonic mucosa. Growing evidence supports a role for epithelial cell defects in driving pathology. Moreover, long-lasting changes in the epithelial barrier have been reported in quiescent UC. Our aim was to investigate whether epithelial cell defects could originate from changes in the epithelial compartment imprinted by the disease. DESIGN Epithelial organoid cultures (EpOCs) were expanded ex vivo from the intestinal crypts of non-IBD controls and patients with UC. EpOCs were induced to differentiate (d-EpOCs), and the total RNA was extracted for microarray and quantitative real-time PCR (qPCR) analyses. Whole intestinal samples were used to determine mRNA expression by qPCR, or protein localisation by immunostaining. RESULTS EpOCs from patients with UC maintained self-renewal potential and the capability to give rise to differentiated epithelial cell lineages comparable with control EpOCs. Nonetheless, a group of genes was differentially regulated in the EpOCs and d-EpOCs of patients with UC, including genes associated with antimicrobial defence (ie, LYZ, PLA2G2A), with secretory (ie, ZG16, CLCA1) and absorptive (ie, AQP8, MUC12) functions, and with a gastric phenotype (ie, ANXA10, CLDN18 and LYZ). A high rate of concordance was found in the expression profiles of the organoid cultures and whole colonic tissues from patients with UC. CONCLUSIONS Permanent changes in the colonic epithelium of patients with UC could be promoted by alterations imprinted in the stem cell compartment. These changes may contribute to perpetuation of the disease.
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Affiliation(s)
- Isabella Dotti
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Rut Mora-Buch
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Elena Ferrer-Picón
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Núria Planell
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain,Bioinformatics Platform, CIBERehd, Barcelona, Spain
| | - Peter Jung
- Oncology Program, Institute for Research in Biomedicine (IRB), Barcelona, Spain,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - M Carme Masamunt
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Raquel Franco Leal
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain,IBD Research Laboratory, Surgery Department, Universidade Estadual de Campinas, Campinas, Sao Paulo, Brazil
| | - Javier Martín de Carpi
- Department of Gastroenterology, Hepatology and Pediatric Nutrition, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Ingrid Ordás
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Eduard Batlle
- Oncology Program, Institute for Research in Biomedicine (IRB), Barcelona, Spain,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Julián Panés
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Azucena Salas
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
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23
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Planell N, Masamunt MC, Leal RF, Rodríguez L, Esteller M, Lozano JJ, Ramírez A, Ayrizono MDLS, Coy CSR, Alfaro I, Ordás I, Visvanathan S, Ricart E, Guardiola J, Panés J, Salas A. Usefulness of Transcriptional Blood Biomarkers as a Non-invasive Surrogate Marker of Mucosal Healing and Endoscopic Response in Ulcerative Colitis. J Crohns Colitis 2017; 11:1335-1346. [PMID: 28981629 PMCID: PMC5881703 DOI: 10.1093/ecco-jcc/jjx091] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Ulcerative colitis [UC] is a chronic inflammatory disease of the colon. Colonoscopy remains the gold standard for evaluating disease activity, as clinical symptoms are not sufficiently accurate. The aim of this study is to identify new accurate non-invasive biomarkers based on whole-blood transcriptomics that can predict mucosal lesions and response to treatment in UC patients. METHODS Whole-blood samples were collected for a total of 152 UC patients at endoscopy. Blood RNA from 25 UC individuals and 20 controls was analysed using microarrays. Genes that correlated with endoscopic activity were validated using real-time polymerase chain reaction in an independent group of 111 UC patients, and a prediction model for mucosal lesions was evaluated. Responsiveness to treatment was assessed in a longitudinal cohort of 16 UC patients who started anti-tumour necrosis factor [TNF] therapy and were followed up for 14 weeks. RESULTS Microarray analysis identified 122 genes significantly altered in the blood of endoscopically active UC patients. A significant correlation with the degree of endoscopic activity was observed in several genes, including HP, CD177, GPR84, and S100A12. Using HP as a predictor of endoscopic disease activity, an accuracy of 67.3% was observed, compared with 52.4%, 45.2%, and 30.3% for C-reactive protein, erythrocyte sedimentation rate, and platelet count, respectively. Finally, at 14 weeks of treatment, response to anti-TNF therapy induced alterations in blood HP, CD177, GPR84, and S100A12 transcripts that correlated with changes in endoscopic activity. CONCLUSIONS Transcriptional changes in UC patients are sensitive to endoscopic improvement and appear to be an effective tool to monitor patients over time.
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Affiliation(s)
- Núria Planell
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain,Bioinformatics Platform, CIBER-EHD, Barcelona, Spain
| | - M Carme Masamunt
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain
| | - Raquel Franco Leal
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain,IBD Research Laboratory, Surgery Department, University of Campinas, Sao Paulo, Brazil
| | - Lorena Rodríguez
- Department of Gastroenterology, Hospital Universitari de Bellvitge-Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Miriam Esteller
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain
| | - Juan J Lozano
- Bioinformatics Platform, CIBER-EHD, Barcelona, Spain
| | - Anna Ramírez
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain
| | | | | | - Ignacio Alfaro
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain
| | - Ingrid Ordás
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain
| | | | - Elena Ricart
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain
| | - Jordi Guardiola
- Department of Gastroenterology, Hospital Universitari de Bellvitge-Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Julián Panés
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain
| | - Azucena Salas
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBER-EHD, Barcelona, Spain,Corresponding author: Azucena Salas, Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona 080036, Spain. Tel.: +34-932272436;
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Sobrado CW, Leal RF, Sobrado LF. THERAPIES FOR CROHN'S DISEASE: a clinical update. Arq Gastroenterol 2016; 53:206-11. [PMID: 27438429 DOI: 10.1590/s0004-28032016000300016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/09/2016] [Indexed: 01/22/2023]
Abstract
The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.
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Affiliation(s)
- Carlos Walter Sobrado
- Disciplina de Coloproctologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brasil
| | - Raquel Franco Leal
- Departamento de Cirurgia, Unidade de Coloproctologia, Universidade de Campinas (UNICAMP), Brasil
| | - Lucas Faraco Sobrado
- Disciplina de Coloproctologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brasil
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25
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Andrade VAD, Coy CSR, Leal RF, Fagundes JJ, Martinez CAR, Ayrizono MDLS. NEOADJUVANT THERAPY AND SURGERY FOR RECTAL CANCER. Comparative study between partial and complete pathological response. Arq Gastroenterol 2016; 53:163-8. [PMID: 27438421 DOI: 10.1590/s0004-28032016000300008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/28/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The approach of locally advanced extra-peritoneal rectal adenocarcinoma implies a treatment with neoadjuvant chemoradiotherapy associated with total mesorectal excision surgery. However, the tumors respond variably to this neoadjuvant therapy, and the mechanisms for response are not completely understood. OBJECTIVE Evaluate the variables related to the complete tumor response and the outcomes of patients who underwent surgery, comparing those with partial tumor regression and those with total remission of rectal lesion, at the pathological examination. METHODS Retrospective analysis of medical records of 212 patients operated between 2000 and 2010, in which 182 (85.9%) obtained partial remission at neoadjuvant therapy (Group 1) and 30 (14.1%), total remission (Group 2). RESULTS No difference was found between the groups in relation to gender, ethnicity, age, tumor distance from the anal verge, occurrence of metastases and synchronous lesions on preoperative staging, dose of radiotherapy and performed surgery. In Group 2, was verified high rate of complete remission when the time to surgery after neoadjuvant therapy was equal or less than 8 weeks (P=0.027), and a tendency of lower levels of pretreatment carcinoembryonic antigen (P=0.067). In pathological analysis, the Group 1 presented in relation to Group 2, more affected lymph nodes (average 1.9 and 0.5 respectively; P=0.003), more angiolymphatic (19.2% and 3.3%; P=0.032) and perineural involvement (15.4% and 0%; P=0.017) and greater number of lymph nodes examined (16.3 and 13.6; P=0.023). In the late follow-up, Group 1 also had lower overall survival than Group 2 (94.1 months and 136.4 months respectively; P=0.02) and disease-free survival (85.5 months and 134.6 months; P=0.004). There was no statistical difference between Group 2 and Group 1 in local recurrence (15% and 3.4%, respectively) and distant metastasis (28% and 13.8%, respectively). CONCLUSION In this study, the only factor associated with complete remission of rectal adenocarcinoma was the time between neoadjuvant therapy and surgery. This group of patients had less affected lymph nodes, less angiolymphatic and perineural involvement, a longer overall and disease-free survival, but no significant statistical difference was observed in local recurrence and distant metastasis. Although the complete pathologic remission was associated with better prognosis, this not implied in the cure of the disease for all patients.
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Mukai N, Pinheiro LV, Ayrizono MDLS, Barreiro GC, Kharmandayan P, Akinaga MH, Bento AM, Martinez CAR, de Carvalho RB, Ward M, Coy CSR, Leal RF. Mucinous adenocarcinoma associated with chronic suppurative hidradenitis: Report of a case and review of the literature. Int J Surg Case Rep 2016; 26:12-6. [PMID: 27424105 PMCID: PMC4949808 DOI: 10.1016/j.ijscr.2016.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/27/2016] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 02/08/2023] Open
Abstract
Mucinous adenocarcinoma associated with suppurative hidradenitis is extremely rare. Magnetic resonance imaging findings help in the diagnosis of mucinous adenocarcinoma. The surgery is highly complex, and even in a tertiary hospital, complications may occur.
Introduction Chronic suppurative hidradenitis (CSH) is a benign condition that can affect the perineal region and often leads to the formation of abscesses and fistulas. It is rare for CSH to undergo malignant degeneration into mucinous adenocarcinoma. Presentation of case We report a case of a 55-year-old male patient with perineal CSH who suffered worsening long-term pain despite multiple surgical procedures to alleviate his symptoms. Pelvic magnetic resonance imaging (MRI) showed multiloculated cystic lesion on the left side wall of the distal rectum with gluteal extension. Pathological examination revealed mucinous adenocarcinoma. The patient underwent an abdominoperineal resection (APR) of the rectum with cutaneous muscle flap reconstruction. Although histopathological sections showed clear margins, the tumor recurred 6 months following surgery. Discussion Perineal mucinous adenocarcinoma arising in a patient with CSH is an extremely rare condition. This diagnosis is often difficult, due to the paucity of signs of malignant degeneration as well as the rarity of the disease itself. Surgical resection of the lesions is a well-established approach. In this case, diagnosing the tumor at such a late stage likely compromised his outcome. Conclusion Malignant degeneration to mucinous adenocarcinoma must be suspected in patients with a history of long-term CSH. In such cases, local biopsies and a radiological examination, such as MRI can help in the diagnosis.
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Affiliation(s)
- Natalia Mukai
- Coloproctology Unit, Department of Surgery, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil
| | - Lílian Vital Pinheiro
- Coloproctology Unit, Department of Surgery, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil
| | | | | | - Paulo Kharmandayan
- Plastic Surgery Unit, Department of Surgery, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil
| | - Mariana Hanayo Akinaga
- Plastic Surgery Unit, Department of Surgery, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil
| | - Adriano Mesquita Bento
- Plastic Surgery Unit, Department of Surgery, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil
| | | | - Rita Barbosa de Carvalho
- Department of Pathology, Gastrocenter, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil
| | - Marc Ward
- University of Chicago Medical Center, Chicago, IL, United States
| | | | - Raquel Franco Leal
- Coloproctology Unit, Department of Surgery, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil.
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Leal RF, Planell N, Kajekar R, Lozano JJ, Ordás I, Dotti I, Esteller M, Masamunt MC, Parmar H, Ricart E, Panés J, Salas A. Identification of inflammatory mediators in patients with Crohn's disease unresponsive to anti-TNFα therapy. Gut 2015; 64:233-42. [PMID: 24700437 DOI: 10.1136/gutjnl-2013-306518] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anti-tumour necrosis factor α (TNFα) therapy effectively induces and maintains remission in Crohn's disease (CD). Up to 40% of patients, however, fail to respond to anti-TNFα. OBJECTIVE To identify the mechanisms underlying the persistence of mucosal lesions in patients who fail to respond to anti-TNFα therapy. DESIGN An observational study based on whole-genome transcriptional analysis was carried out using intestinal biopsy specimens from patients with CD receiving (n=12) or not (n=10) anti-TNFα therapy. The transcriptional signature of responders was compared with that of non-responders after anti-TNFα therapy. Controls with non-inflammatory bowel disease (non-IBD) (n=17) were used for comparisons. Genes of interest were validated by real-time RT-PCR in an independent cohort of patients with CD receiving (n=17) or not (n=16) anti-TNFα and non-IBD controls (n=7). RESULTS We confirmed that response to anti-TNFα is accompanied by significant regulation of a large number of genes, including IL1B, S100A8, CXCL1, which correlated with endoscopic activity. Remarkably, patients who failed to respond to anti-TNFα showed a mixed signature, maintaining increased expression of IL1B, IL17A and S100A8, while showing significant modulation of other genes commonly upregulated in active CD, including IL6 and IL23p19. CONCLUSIONS Our results show that anti-TNFα therapy significantly downregulates a subset of inflammatory genes even in patients who fail to achieve endoscopic remission, suggesting that these genes may not be dominant in driving inflammation in non-responders. On the other hand, we identified IL1B and IL17A as genes that remained altered in non-responders, pointing to potentially more relevant targets for modulating mucosal damage in refractory patients.
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Affiliation(s)
- Raquel Franco Leal
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain Postdoctoral CAPES fellow, Brazil
| | - Núria Planell
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain Bioinformatics Platform, CIBERehd, Barcelona, Spain
| | - Radhika Kajekar
- Hoffmann-La Roche, Nutley, New Jersey, USA Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Ingrid Ordás
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Isabella Dotti
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Miriam Esteller
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - M Carme Masamunt
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Harsukh Parmar
- Hoffmann-La Roche, Nutley, New Jersey, USA EMD Serono Research & Development Institute, Boston, Massachusetts, USA
| | - Elena Ricart
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Julián Panés
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
| | - Azucena Salas
- Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain
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Dias CB, Milanski M, Portovedo M, Horita V, Ayrizono MDLS, Planell N, Coy CSR, Velloso LA, Meirelles LR, Leal RF. Defective apoptosis in intestinal and mesenteric adipose tissue of Crohn's disease patients. PLoS One 2014; 9:e98547. [PMID: 24887376 PMCID: PMC4041748 DOI: 10.1371/journal.pone.0098547] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/05/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) is associated with complex pathogenic pathways involving defects in apoptosis mechanisms. Recently, mesenteric adipose tissue (MAT) has been associated with CD ethiopathology, since adipose thickening is detected close to the affected intestinal area. However, the potential role of altered apoptosis in MAT of CD has not been addressed. AIMS To evaluate apoptosis in the intestinal mucosa and MAT of patients with CD. METHODS Samples of intestinal mucosa and MAT from patients with ileocecal CD and from non-inflammatory bowel diseases patients (controls) were studied. Apoptosis was assessed by TUNEL assay and correlated with the adipocytes histological morphometric analysis. The transcriptional and protein analysis of selected genes and proteins related to apoptosis were determined. RESULTS TUNEL assay showed fewer apoptotic cells in CD, when compared to the control groups, both in the intestinal mucosa and in MAT. In addition, the number of apoptotic cells (TUNEL) correlated significantly with the area and perimeter of the adipose cells in MAT. Transcriptomic and proteomic analysis reveal a significantly lower transcript and protein levels of Bax in the intestinal mucosa of CD, compared to the controls; low protein levels of Bax were found localized in the lamina propria and not in the epithelium of this tissue. Furthermore, higher level of Bcl-2 and low level of Caspase 3 were seen in the MAT of CD patients. CONCLUSION The defective apoptosis in MAT may explain the singular morphological characteristics of this tissue in CD, which may be implicated in the pathophysiology of the disease.
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Affiliation(s)
- Cilene Bicca Dias
- Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
- Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
- Doctoral CAPES fellowship, Post graduate Program in Surgery Sciences, Faculty of Medical School, University of Campinas, Sao Paulo, Brazil
| | - Marciane Milanski
- Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Mariana Portovedo
- Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Vivian Horita
- Department of Pathology, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | | | - Núria Planell
- Department of Gastroenterology and Bioinformatics Platform, CIBERehd, Barcelona, Spain
| | - Cláudio Saddy Rodrigues Coy
- Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | - Lício Augusto Velloso
- Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
| | | | - Raquel Franco Leal
- Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
- Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
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Camargo MG, Fagundes JJ, Leal RF, Ayrizono MDLS, Rossi DHDG, Oliveira PDSP, Chung WF, Lee HD, Coy CSR. Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats. Acta Cir Bras 2014; 28:783-7. [PMID: 24316746 DOI: 10.1590/s0102-86502013001100007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/18/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS Forty rats, weighing from 300 to 350 g (321.29 ± 11.3 1g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3 ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3 ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.
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Rodrigues VS, Milanski M, Fagundes JJ, Torsoni AS, Ayrizono MLS, Nunez CEC, Dias CB, Meirelles LR, Dalal S, Coy CSR, Velloso LA, Leal RF. Serum levels and mesenteric fat tissue expression of adiponectin and leptin in patients with Crohn's disease. Clin Exp Immunol 2013; 170:358-64. [PMID: 23121676 DOI: 10.1111/j.1365-2249.2012.04660.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Crohn's disease (CD) is characterized by inflammation and an aetiology that is still unknown. Hypertrophy of mesenteric fat is a reflection of disease activity, as this fat covers the entire length of the affected area. Adipocytes synthesize leptin and adiponectin, adipocytokines responsible for pro- and anti-inflammatory effects. Therefore, we evaluated serum levels of adiponectin and leptin, as well as mesenteral expression of adiponectin in active CD and those in remission. Sixteen patients with ileocaecal CD followed at the Outpatient Clinic, Coloproctology Unit of University of Campinas Clinical Hospital, participated in the study. Analysis of serum adiponectin and leptin by enzyme-linked immunosorbent assay was performed in patients with active CD (ACD group), remission CD (RCD group) and in six healthy controls. Ten patients with active ileocaecal CD (FCD group) and eight patients with non-inflammatory disease selected for surgery were also studied. The specimens were snap-frozen and the expression of adiponectin was determined by immunoblot of protein extracts. Serum C-reactive protein levels were higher in the ACD group when compared to the others and no difference of body mass index was observed between the groups. Serum adiponectin was lower in the ACD group when compared to control, but no differences were seen when comparing the ACD and RCD groups. Mesenteric adiponectin expression was lower in the FCD group when compared to the FC group. Serum leptin was similar in all groups. The lower levels of serum and mesenteric adiponectin in active CD suggest a defective regulation of anti-inflammatory pathways in CD pathogenesis.
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Affiliation(s)
- V S Rodrigues
- Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Sao Paulo, Brazil
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Santos JOM, Miyajima N, Carvalho R, Leal RF, Ayrizomo MDLS, Coy CSR. Feasibility of endoscopic submucosal dissection for gastric and colorectal lesions: Initial experience from the Gastrocentro--UNICAMP. Clinics (Sao Paulo) 2013; 68:141-6. [PMID: 23525307 PMCID: PMC3584284 DOI: 10.6061/clinics/2013(02)oa04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/17/2012] [Accepted: 10/10/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Endoscopic submucosal dissection is a technique developed in Japan for en bloc resection with a lower rate of recurrence. It is considered technically difficult and performed only in specialized centers. This study sought to report the initial experience from the Gastrocentro--Campinas State University for the treatment of gastric and colorectal lesions by endoscopic submucosal dissection. MATERIALS AND METHODS The guidelines of the Japanese Association of Gastric Cancer were used as evaluative criteria. For colorectal lesions, the recommended standards proposed by Uraoka et al. and Saito et al. were employed. The practicability of the method, the development of complications and histological analysis of the specimens were evaluated. RESULTS Sixteen patients underwent endoscopic submucosal dissection from June 2010 to April 2011; nine patients were treated for gastric lesions, and seven were treated for colorectal lesions. The average diameter of the gastric lesions was 28.6 mm, and the duration of resection was 103 min without complications. All lesions presented lesion-free margins. Of the seven colorectal tumors, four were located in the rectum and three were located in the colon. The average size was 26 mm, and the average procedure time was 163 min. Two complications occurred during the rectal resection procedures: perforation, which was treated with an endoscopic clip, and controlled bleeding. One of the lesions presented a compromised lateral margin without relapse after 90 days. Depth margins were all free of lesions. CONCLUSION Endoscopic submucosal dissection at our institution achieved high success rates, with few complications in preliminary procedures. The procedure also made appropriate lesion staging possible.
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Leal RF, Silva PVVT, Ayrizono MDLS, Fagundes JJ, Amstalden EMI, Coy CSR. Desmoid tumor in patients with familial adenomatous polyposis. Arq Gastroenterol 2011; 47:373-8. [PMID: 21225148 DOI: 10.1590/s0004-28032010000400010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 05/12/2010] [Indexed: 01/16/2023]
Abstract
CONTEXT Desmoid tumors constitute one of the most important extraintestinal manifestations of familial adenomatous polyposis. The development of desmoids is responsible for increasing morbidity and mortality rates in cases of familial adenomatous polyposis. OBJECTIVES To evaluate the occurrence of desmoid tumors in familial adenomatous polyposis cases following prophylactic colectomy and to present patient outcome. METHODS Between 1984 and 2008, 68 patients underwent colectomy for familial adenomatous polyposis at the School of Medical Sciences Teaching Hospital, University of Campinas, SP, Brazil. Desmoid tumors were found in nine (13.2%) of these patients, who were studied retrospectively by consulting their medical charts with respect to clinical and surgical data. RESULTS Of nine patients, seven (77.8%) were submitted to laparotomy for tumor resection. Median age at the time of surgery was 33.9 years (range 22-51 years). Desmoid tumors were found in the abdominal wall in 3/9 cases (33.3%) and in an intra-abdominal site in the remaining six cases (66.7%). Median time elapsed between ileal pouch-anal anastomosis and diagnosis of desmoid tumor was 37.5 months (range 14-60 months), while the median time between colectomy with ileorectal anastomosis and diagnosis was 63.7 months (range 25-116 months). In 6/9 (66.7%) patients with desmoid tumors, the disease was either under control or there was no evidence of tumor recurrence at a follow-up visit made a mean of 63.1 months later (range 12-240 months). CONCLUSIONS Desmoid tumors were found in 13.2% of cases of familial adenomatous polyposis following colectomy; therefore, familial adenomatous polyposis patients should be followed-up and surveillance should include abdominal examination to detect signs and symptoms. Treatment options include surgery and clinical management with antiestrogens, antiinflammatory drugs or chemotherapy.
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Rocha AA, Leal RF, Ayrizono MDLS, Chung WF, Coy CSR, Lee HD, Fagundes JJ. Hyperbaric oxygen therapy and mechanical resistence of the colonics anastomosis in rats with peritonitis. Acta Cir Bras 2011; 25:368-74. [PMID: 20676497 DOI: 10.1590/s0102-86502010000400013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 04/14/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To analyze the effects of hyperbaric oxygen therapy (HBO) on the mechanical resistance of anastomosis performed in rats' distal colon presenting peritonitis induced by ligature and cecal punction using the Total Energy Rupture biomechanical test (ETR). METHODS It was used 45 rats divided into three groups of 15 animals each. In Control Group (CG), it was performed anastomosis in distal colon without peritonitis. In Peritonitis Group (PG), it was performed anastomosis six hours after the induction of peritonitis by ligature and cecal punction. In Hyperbaric Chamber Group (HCG), it was performed six hours after the induction of peritonitis by ligature and cecal punction. The animals on CG and PG were kept at place air while the animals on HCG were placed on an experimental hyperbaric chamber in order to inhale oxygen at 100%, two absolute atmospheres, for 120 minutes, for four consecutive days. Euthanasia took place on the fifth day of the experiment. All the animals underwent to Total Energy Rupture Biomechanical Resistance test (ETR). Total Energy Rupture was defined as the necessary internal energy stored up to promote the colon rupture after an external traction force imposition. RESULTS The Peritonitis Group presents smaller average ETR than Control Group. There was no statistical difference between Peritonitis Group and Hyberbaric Chamber Group. CONCLUSION Hyperbaric oxygen therapy did not alter the mechanical resistance of anastomosis performed in distal colon of rats under the presence of peritonitis induced by ligature and cecal puncture.
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Affiliation(s)
- Antonio Angelo Rocha
- Post-graduate Program in Surgery, University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Leal RF, Ayrizono MLS, Milanski M, Coope A, Fagundes JJ, Velloso LA, Coy CSR. Activation of signal transducer and activator of transcription-1 (STAT-1) and differential expression of interferon-gamma and anti-inflammatory proteins in pelvic ileal pouches for ulcerative colitis and familial adenomatous polyposis. Clin Exp Immunol 2010; 160:380-5. [PMID: 20345984 PMCID: PMC2883108 DOI: 10.1111/j.1365-2249.2009.04088.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2009] [Indexed: 01/19/2023] Open
Abstract
Pouchitis after total rectocolectomy is the most common complication of ulcerative colitis (UC). The immunological mechanisms involved in the genesis of pouchitis are unclear. Therefore, we evaluated the inflammatory activity in normal ileal pouch mucosa by determining signal transducers and activators of transcription (STAT-1) activation and cytokine expression in patients operated for UC and familial adenomatous polyposis (FAP). Eighteen asymptomatic patients, who underwent total rectocolectomy and J pouch, were evaluated: nine with UC and nine with FAP. The activation of STAT-1 and cytokine expression were determined by immunoblot of total protein extracts from pouch mucosal biopsies. The absence of pouchitis was assessed by clinical, histological and endoscopic parameters, according to the Pouchitis Disease Activity Index. The patients were not receiving any medication. Analysis of variance (anova) and Tukey-Kramer's test were applied. The local ethical committee approved the study and informed consent was signed by all participants. STAT-1 activation was increased in UC when compared to FAP and controls (P < 0.05). Higher levels of interferon (IFN)-gamma expression were observed in UC patients when compared to the control group (P < 0.05), but were similar to FAP. In contrast, cytokine signalling (SOCS-3) and interleukin (IL)-10 expression were similar in all groups (P > 0.05). These findings could explain the higher susceptibility to this inflammatory complication in UC when compared to FAP. A tendency towards increased levels of IFN-gamma and STAT-1 in patients with UC, even without clinical and endoscopic evidence of pouchitis, was observed; studying inflammatory activity in asymptomatic ileal pouches may help understanding of the pathogenesis of pouchitis.
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Affiliation(s)
- R F Leal
- Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil
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Bolzam-Nascimento R, Coy CSR, Pereira YEA, Leal RF, Reis RCM, Mantovani M, Ayrizono MDLS, Chung WF, Fagundes JJ. Influence of omentoplasty on colonic anastomosis in animals submitted to hemorrhagic shock in rats. Acta Cir Bras 2009; 24:233-8. [DOI: 10.1590/s0102-86502009000300013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Accepted: 01/28/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To analyze influence of omentoplasty on anastomosis in descending colon of rats. Rats were submitted to the hypovolemic shock of the hemorrhagic type by the Biomechanical Test of Pressure of Rupture by Liquid Distension (BTPRLD). In addition, establish a type of acute anemia in rats that are provided to the study. METHODS: Comparative study between two groups of animals with ten rats in each one, all submitted to hemorrhagic shock for 30% volemic removal by the carotid artery. An anastomosis was performed in left colon. An anastomosis was performed in the left colon. Group 1 took place anastomosis with Polyvinyl Chloride (P.V.C) film to prevent the adhesions formation on sature line. Group 2 placed the great omentum around the anastomosis. Euthanasia occurred on the fifth day, when the anastomoses were submitted to the biomechanical test of pressure of rupture by liquid distension (BTPRLD). RESULTS: High rupture pressure was gained with omentoplasty group in relation to the group in which anastomosis was protected from adhesions formation. A statistical significance was noted. CONCLUSION: Protection by great omentum has increased the anastomosis resistance of the shocked animals. Also, the proposed hemorrhagic shock type has proven to be useful for this study.
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Ayrizono MDLS, Meirelles LR, Leal RF, Coy CSR, Fagundes JJ, Góes JRN. [Long-term outcomes of ileal pouch after secondary diagnosis of Crohn's disease]. Arq Gastroenterol 2008; 45:204-7. [PMID: 18852947 DOI: 10.1590/s0004-28032008000300007] [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] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 01/18/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Total rectocolectomy and ileal pouch-anal anastomosis is the choice surgical procedure for patients with ulcerative colitis. In cases of Crohn's disease post-operative diagnosis, it can be followed by pouch failure. AIM To evaluate ileal pouch-anal anastomosis long-term outcome in patients with Crohn's disease. METHODS Between February 1983 and March 2007, 151 patients were submitted to ileal pouch-anal anastomosis by Campinas State University Colorectal Unit, Campinas, SP, Brazil, 76 had pre-operative ulcerative colitis diagnosis and 11 had post-operative Crohn's disease diagnosis. Crohn's disease diagnosis was made by histopathological biopsies in nine cases, being one in surgical specimen, two cases in rectal stump, small bowel in two cases, ileal pouch in three and in perianal abscess in one of them. The median age was 30.6 years and eight (72.7%) were female. RESULTS All patients had previous ulcerative colitis diagnosis and in five cases emergency colectomy was done by toxic megacolon. The mean time until of Crohn's disease diagnosis was 30.6 (6-80) months after ileal pouch-anal anastomosis. Ileostomy closure was possible in 10 cases except in one that had ileal pouch fistula, perianal disease and small bowel involvement. In the long-term follow-up, three patients had perineal fistulas and one had also a pouch-vaginal fistula. All of them were submitted to a new ileostomy and one had the pouch excised. Another patient presented pouch-vaginal fistula which was successfully treated by mucosal flap. Three patients had small bowel involvement and three others, pouch involvement. All improved with medical treatment. Presently, the mean follow-up is 76.5 months and all patients are in clinical remission, and four have fecal diversion. The remaining patients have good functional results with 6-10 bowel movements/day. CONCLUSION Crohn's disease diagnosis after ileal pouch-anal anastomosis for ulcerative colitis may be usual and later complications such fistulas and stenosis are common. However, when left in situ ileal pouch is associated with good function.
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Affiliation(s)
- Maria de Lourdes Setsuko Ayrizono
- Grupo de Coloproctologia, Departamento de Cirurgia e Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil.
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Leal RF, Ayrisono MDLS, Coy CSR, Fagundes JJ, Góes JRN. Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar. Arq Gastroenterol 2008; 45:106-10. [DOI: 10.1590/s0004-28032008000200003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 11/21/2007] [Indexed: 01/26/2023]
Abstract
RACIONAL: A retocolectomia total com confecção de reservatório ileal é cirurgia ideal para o tratamento do cólon e reto dos doentes com polipose adenomatosa familiar, no entanto pode estar associada a complicações no pós-operatório imediato e tardio. OBJETIVO: Estudar as complicações pós-operatórias da cirurgia do reservatório ileal na polipose adenomatosa familiar. MÉTODOS: Estudo retrospectivo de 69 doentes com polipose adenomatosa familiar submetidos a cirurgia de reservatório ileal no período de 1984 a 2006, pelo Grupo de Coloproctologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, SP. O seguimento médio pós-operatório foi de 82 (2-280) meses. Dados de interesse: ocorrência de complicações no pós-operatório. RESULTADOS: A morbidade e mortalidade foram de 63,8% e 2,9%, respectivamente. As complicações mais freqüentes foram obstrução intestinal (17,4%), estenose da anastomose (15,9%) e sepse pélvica (10,1%). Outras complicações foram isquemia aguda do reservatório ileal (4,3%), ileíte do reservatório (" pouchitis" ) (2,9%) e fístulas relacionadas ao reservatório (2,9%). CONCLUSÕES: A morbimortalidade foi semelhante à da literatura e aceitável para uma cirurgia complexa como é a do reservatório ileal, realizada em dois tempos operatórios. A obstrução intestinal foi a complicação mais freqüente. Entretanto, isquemia do reservatório, " pouchitis" e sepse pélvica constituíram importantes complicações relacionadas à perda do reservatório ileal.
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Pereira YEA, Fagundes JJ, Morandini RC, Ayrizono MDLS, Nascimento RBD, Leal RF, Góes JRN, Mantovani M, Coy CSR. Hemorrhagic shock influence on colonic anastomoses in rats: evaluation of rupture by liquid distension resistance test. Acta Cir Bras 2008; 23:237-42. [DOI: 10.1590/s0102-86502008000300004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 02/12/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To evaluate the effect of hemorrhagic shock in colonic anastomoses in rats, with a rupture by liquid distension resistance test. METHODS: Wistar lineage rats, averaging 90 days old and weighing from 310 to 380 grams were divided into two groups. In the first group (G1), 10 animals were submitted to colonic anastomoses in normovolemic terms and the second group (G2), of 10 animals, was submitted to colonic anastomoses in hypovolemic conditions. The shock was caused by half milliliter of blood withdrawn, every two minutes, until the value of average 50mmHg arterial pressure or a total volume corresponding 30% withdrawal of volemia was reached. Serum lactate dosages were carried out at the beginning and end of the procedure. The average serum lactate values at the end of the surgery were 1.91 mmol/l in G1 group and 3.69 mmol/l in G2 group (p<0.05). On the fifth postoperative day, the animals were euthanized. The anastomoses were evaluated with a rupture by liquid distension resistance test. RESULTS: In G1, the average value of colonic rupture was 160.7 mmHg whereas in G2 it was 152.1mmHg (p>0.05). CONCLUSION: Hemorrhagic shock, under the established conditions of this study, had no influence on colonic anastomoses in rats evaluated with the rupture by liquid distention resistance test.
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Leal RF, Coy CSR, Ayrizono MLS, Fagundes JJ, Milanski M, Saad MJ, Velloso LA, Góes JRN. Differential expression of pro-inflammatory cytokines and a pro-apoptotic protein in pelvic ileal pouches for ulcerative colitis and familial adenomatous polyposis. Tech Coloproctol 2008; 12:33-8. [PMID: 18512010 DOI: 10.1007/s10151-008-0395-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 01/12/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pouchitis after total rectocolectomy is among the most common complications of patients with ulcerative colitis (UC). However, its frequency is quite rare in patients with familial adenomatous polyposis (FAP). We evaluated the inflammatory and pro-apoptotic activity in endoscopically normal mucosa of the ileal pouch in patients with UC and FAP. METHODS Twenty patients (10 with UC and 10 with FAP) with "J" pouch after total proctocolectomy were studied as were 10 normal controls. Biopsies were obtained from the mucosa of the pouch of UC and FAP patients and from the normal ileum of controls. The expression levels of TNF-alpha, IL-1beta, IL-6, IL-8 and phospho-BAD were determined by immunoblotting. Activated NFkappaB was evaluated by immuno-precipitation and immunoblotting for IkappaB kinase beta. RESULTS Patients with UC had higher levels of IL-1beta, IL-6, IL-8 and TNF-alpha than patients with FAP. The level of TNF-alpha was higher in patients with UC than in patients with FAP; both patient groups had TNF-alpha levels higher than controls. Activation of NFkappaB was similar in all three groups. The expression of phospho-BAD was significantly lower in patients with FAP than in patients with UC. CONCLUSIONS As compared with patients with FAP, patients with UC presented increased levels of some pro-inflammatory cytokines, even in the absence of clinical or endoscopic signs of pouchitis. Patients with FAP presented lower levels of pro-inflammatory proteins and of phospho-BAD. These findings may explain the higher rates of progression to pouchitis in UC patients, which could correlate with mucosal atrophy that occurs in inflamed tissue.
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Affiliation(s)
- R F Leal
- Department of Internal Medicine Cellular Signalization Laboratory, Universidade Estadual de Campinas UNICAMP, Campinas, São Paulo, Brazil
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Ayrizono MDLS, Leal RF, Coy CSR, Fagundes JJ, Góes JRN. [Crohn's disease small bowel strictureplasties: early and late results]. Arq Gastroenterol 2007; 44:215-20. [PMID: 18060274 DOI: 10.1590/s0004-28032007000300007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 09/01/2006] [Indexed: 02/05/2023]
Abstract
BACKGROUND Strictureplasty is an alternative surgical procedure for Crohn's disease, particulary in patients with previous resections or many intestinal stenosis. AIM To analyze surgical complications and clinical follow-up in patients submitted to strictureplasty secondary to Crohn's disease. METHODS Twenty-eight patients (57.1% male, mean age 33.3 years, range 16-54 years) with Crohn's disease and intestinal stenosis (small bowel, ileocecal region and ileocolic anastomosis) were submitted to strictureplasty, at one institution, between September 1991 and May 2004. Thirteen patients had previous intestinal resections. The mean follow-up was 58.1 months. A total of 116 strictureplasties were done (94 Heineke-Mikulicz--81%, 15 Finney--13%, seven side-to-side ileocolic strictureplasty--6%). Three patients were submitted to strictureplasty at two different surgical procedures and two in three procedures. RESULTS Regarding to strictureplasty, postoperative complication rate was 25% and mortality was 3.6%. Early local complication rate was 57.1%, with three suture leaks (10.7%) and late complication was present in two patients, both with incisional hernial and enterocutaneous fistulas (28.6%). Patients remained hospitalized during a medium time of 12.4 days. Clinical and surgical recurrence rates were 63% and 41%, respectively. Among the patients submitted to another surgery, two patients had two more operations and one had three. Recurrence rate at strictureplasty site was observed in 3.5%, being Finney technique the commonest one. Presently, 19 patients had been asymptomatic with the majority of them under medical therapy. CONCLUSION Strictureplasties have low complication rates, in spite of having been done at compromised site, with long term pain relief. Considering the clinical course of Crohn's disease, with many patients being submitted to intestinal resections, strictureplasties should be considered as an effective surgical treatment to spare long intestinal resections.
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Leal RF, Ayrizono MDLS, Coy CSR, Callejas-Neto F, Fagundes JJ, Góes JRN. Polipose gastroduodenal em doentes com polipose adenomatosa familiar Pós-Retocolectomia. Arq Gastroenterol 2007; 44:133-6. [DOI: 10.1590/s0004-28032007000200009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 09/05/2006] [Indexed: 11/22/2022]
Abstract
RACIONAL: As manifestações extracólicas, como os pólipos gastroduodenais e o tumor do duodeno, são fatores que influenciam a morbimortalidade dos doentes com polipose adenomatosa familiar no seguimento pós-retocolectomia total. OBJETIVO: Investigar a freqüência destas alterações em doentes com polipose adenomatosa familiar e verificar a eficácia do rastreamento endoscópico. MÉTODO:No período de 1984 a 2005, 62 doentes com polipose adenomatosa familiar pós-retocolectomia foram estudados retrospectivamente pelo Grupo de Coloproctologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, SP. O tempo de seguimento médio pós-operatório foi de 81,9 meses, sendo que em 53 (85,5%) foi possível analisar a ocorrência de pólipos gastroduodenais. RESULTADOS: Dos 53 doentes em seguimento, 27 (50,9%) apresentavam pólipos gastroduodenais. Em 8 (15,4%) os pólipos adenomatosos eram gástricos, 14 (27%) pólipos duodenais e 5 (9,6%) pólipos gástricos e duodenais. Dois doentes (3,8%) desenvolveram adenoma duodenal com displasia de alto grau. E outro (1,9%), adenocarcinoma em papila duodenal. CONCLUSÃO: O rastreamento endoscópico, desta forma, é de grande importância e o objetivo é detectar, o mais precocemente possível, os casos de adenocarcinoma duodenal e pólipos gastroduodenais com displasia de alto grau.
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Leal RF, Ayrizono MLS, Coy CSR, Fagundes JJ, Góes JR. Mucinous adenocarcinoma derived from chronic perianal fistulas: report of a case and review of the literature. Tech Coloproctol 2007; 11:155-7. [PMID: 17510737 DOI: 10.1007/s10151-007-0348-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2005] [Accepted: 05/19/2006] [Indexed: 11/30/2022]
Abstract
Chronic perianal fistulas are a common clinical condition. However, their evolution into adenocarcinoma is rare. We report the case of a 68-year-old man with perineal and perianal chronic fistulas, who developed a perineal mass that extended proximally as a pararectal tumor. Diagnosis was confirmed by magnetic resonance imaging (MRI). Histopathological sections indicated extramucosal mucinous adenocarcinoma. No intestinal lesion was seen at endoscopic examination. The patient underwent abdominal perineal excision of the rectum without neoadjuvant or adjuvant therapy, and had a good postoperative outcome.
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Affiliation(s)
- R F Leal
- Coloproctology Unit, Department of Surgery, Universidade Estadual de Campinas, UNICAMP, Rua Antônio Augusto de Almeida, n. 37 Cidade Universitária, CEP 13084-070, Campinas, São Paulo, Brazil
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Abstract
OBJETIVO: O trauma da veia porta é raro e freqüentemente fatal por causa de exsanguinação e alta incidência de lesões de estruturas adjacentes. Devido às pecualiaridades desta lesão e diferentes condutas propostas na literatura, o objetivo dos autores é relatar a experiência neste tipo de lesão. MÉTODO: Estudo retrospectivo, de janeiro de 1994 e dezembro de 2001, de 1370 pacientes submetidos à laparotomia devido trauma abdominal. Entre esses, 15 pacientes apresentavam lesão da veia porta. As lesões foram classificadas conforme a sua extensão e localização. RESULTADOS: O mecanismo de trauma predominante foi o penetrante. O diagnóstico da lesão foi realizado no intraoperatório. Os procedimentos executados foram: sutura, anastomose término-terminal e ligadura da veia porta. A mortalidade foi de 53,3%. CONCLUSÃO: A lesão da veia porta possui alta taxa de mortalidade e o atendimento adequado está diretamente relacionado à sobrevida.
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Abstract
Introduction: The commitment of the great blood-vessels make up a situation of great complexity and a high rate of the complications and mortality patients with abdominal trauma. The injury of the portal vein matters because of the difficulty on the diagnosis and the approach surgery. Objective: To set the standard on the transverse section of the pancreas looking for a safer surgical access to repair the portal vein injuries. Methods: A quantitative analysis was performed to characterize the anatomical relationship between the portal vein and their tributaries relating them to the pancreas. On these corpses, the measurements of a anatomical triangle were studied. It base was the upper limit of the superior mesenteric vein and the initial portion of the portal vein; the apex, a point located on the upper limit of the confluence of the splenic vein and superior mesenteric vein, situated at the middle line of the superior mesenteric_ vein. Results: The portal vein is formed 3.24cm from the internal border of the duodenal arc at a distance of 1.61cm and 1.07 from the inferior and superior pancreas borders, respectively. Conclusion: The present study allow us to conclude that, to have access to the origin of the portal vein, in case of trauma of this vessel, one should proceed a transverse section of the neck of the pancreas next to the superior mesenteric vein, because its confluence with splenic vein occur, on average, 1.07cm and 1.61cm from the superior and inferior border of the gland, respectively.
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Abstract
OBJETIVO: avaliar a incidência de colelitíase em pacientes submetidos à necropsia no Hospital das Clínicas da UNICAMP e relacioná-la com a ocorrência de outras doenças associadas. MÉTODO: Os autores analisaram a incidência de colelitíase em 2.355 necropsias realizadas pelo Departamento de Anatomia Patológica da UNICAMP, no período de 1975 a 1998, considerando-se somente os casos com idade acima de 10 anos. O teste do qui-quadrado e a "odds ratio" (OR) foram utilizados para análise de correlação com outras afecções. RESULTADOS: A incidência foi de 243 (10,3%) casos de colelitíase; com 110 (7,9%) casos em homens e 133 (13,6%) em mulheres (p=0,00001), resultando numa proporção de 1:1,7. A incidência aumentou com a idade (p<0,000000001) e diferiu, significativamente, entre os grupos raciais estudados, sendo 195 (11,1%) casos em indivíduos da raça branca e 48 (7,8%) em não brancos (p=0,02). Quando relacionada com as demais doenças hepáticas associadas, observou-se que as de maior incidência foram a esteatose, com 33 (13,5%) casos; as neoplasias, com 31 (12,7%); a cirrose, com 30 (12,3%); a hepatite e a congestão crônica do fígado, cada uma com 16 (6,5%) casos, respectivamente. Na análise de correlação verificou-se que as neoplasias, o infarto hepático e a atrofia parda do fígado mostraram associações estatisticamente significantes com a incidência de colelitíase. CONCLUSÕES: Os resultados indicam um aumento progressivo na incidência de colelitíase com a idade, sendo mais incidente na população acima dos 80 anos e, com predomínio, em indivíduos da raça branca.
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