1
|
Campos CFC, Olivo CR, Martins MDA, Tempski PZ. Physicians' attention to patients' communication cues can improve patient satisfaction with care and perception of physicians' empathy. Clinics (Sao Paulo) 2024; 79:100377. [PMID: 38703716 DOI: 10.1016/j.clinsp.2024.100377] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/25/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The pathway that links good communication skills and better health outcomes is still unclear. However, it is known that the way that physicians and patients communicate with each other has direct consequences on more "proximal outcomes", such as perceptions of physician empathy and patient satisfaction. However, which specific communication skills lead to those patient outcomes is still unknown. In this study, the authors aimed to analyze which specific patient and physician communication skills are correlated to patients' satisfaction with care and patient-perceived physician empathy. METHODS The authors classified and quantified verbal and nonverbal communication of second-year internal medicine residents and their patients through video recordings of their consultations. Patients also rated their satisfaction with care and the physician's empathy for them. RESULTS Using a linear regression model, the authors identified that patients' and physicians' expressions of disapproval, physicians' disruptions, and patients' use of content questions negatively correlated to patients' satisfaction and patient-perceived physician empathy. Conversely, patient affective behaviors and the physician's provision of advice/suggestion were positively correlated to at least one of the patient-measured outcomes. CONCLUSION Our findings point to the importance of physicians' attentiveness to patients' communication cues. Training physicians to interpret those cues could help develop more satisfactory and empathic therapeutic relationships.
Collapse
Affiliation(s)
- Carlos Frederico Confort Campos
- The Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Center for Development of Medical Education, Universidade de São Paulo, Sao Paulo, SP, Brazil.
| | - Clarice Rosa Olivo
- Center for Development of Medical Education, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Patricia Zen Tempski
- Center for Development of Medical Education, Universidade de São Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
2
|
Galli TT, de Campos EC, do Nascimento Camargo L, Fukuzaki S, Dos Santos TM, Hamaguchi SSS, Bezerra SKM, Silva FJA, Rezende BG, Dos Santos Lopes FTQ, Olivo CR, Saraiva-Romanholo BM, Prado CM, Leick EA, Bourotte CLM, Benseñor IJM, Lotufo PA, Righetti RF, Tibério IFLC. Effects of environmental exposure to iron powder on healthy and elastase-exposed mice. Sci Rep 2024; 14:9134. [PMID: 38644380 PMCID: PMC11033283 DOI: 10.1038/s41598-024-59573-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 04/12/2024] [Indexed: 04/23/2024] Open
Abstract
Prolonged exposure to iron powder and other mineral dusts can threaten the health of individuals, especially those with COPD. The goal of this study was to determine how environmental exposure to metal dust from two different mining centers in Brazil affects lung mechanics, inflammation, remodeling and oxidative stress responses in healthy and elastase-exposed mice. This study divided 72 male C57Bl/6 mice into two groups, the summer group and the winter group. These groups were further divided into six groups: control, nonexposed (SAL); nonexposed, given elastase (ELA); exposed to metal powder at a mining company (SAL-L1 and ELA-L1); and exposed to a location three miles away from the mining company (SAL-L2 and ELA-L2) for four weeks. On the 29th day of the protocol, the researchers assessed lung mechanics, bronchoalveolar lavage fluid (BALF), inflammation, remodeling, oxidative stress, macrophage iron and alveolar wall alterations (mean linear intercept-Lm). The Lm was increased in the ELA, ELA-L1 and ELA-L2 groups compared to the SAL group (p < 0.05). There was an increase in the total number of cells and macrophages in the ELA-L1 and ELA-L2 groups compared to the other groups (p < 0.05). Compared to the ELA and SAL groups, the exposed groups (ELA-L1, ELA-L2, SAL-L1, and SAL-L2) exhibited increased expression of IL-1β, IL-6, IL-10, IL-17, TNF-α, neutrophil elastase, TIMP-1, MMP-9, MMP-12, TGF-β, collagen fibers, MUC5AC, iNOS, Gp91phox, NFkB and iron positive macrophages (p < 0.05). Although we did not find differences in lung mechanics across all groups, there were low to moderate correlations between inflammation remodeling, oxidative stress and NFkB with elastance, resistance of lung tissue and iron positive macrophages (p < 0.05). Environmental exposure to iron, confirmed by evaluation of iron in alveolar macrophages and in air, exacerbated inflammation, initiated remodeling, and induced oxidative stress responses in exposed mice with and without emphysema. Activation of the iNOS, Gp91phox and NFkB pathways play a role in these changes.
Collapse
Affiliation(s)
| | | | | | - Silvia Fukuzaki
- Faculdade de Medicina (FMUSP), São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Renato Fraga Righetti
- Faculdade de Medicina (FMUSP), São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Iolanda Fátima Lopes Calvo Tibério
- Faculdade de Medicina (FMUSP), São Paulo, Brazil.
- University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, 01246-903 - Laboratory LIM20, Brazil.
| |
Collapse
|
3
|
Suehiro CL, Souza NTS, da Silva EB, Cruz MM, Laia RM, de Oliveira Santos S, Santana-Novelli FPR, de Castro TBP, Lopes FD, Pinheiro NM, de FátimaLopes Calvo Tibério I, Olivo CR, Alonso-Vale MI, Prado MAM, Prado VF, de Toledo-Arruda AC, Prado CM. Aerobic exercise training engages cholinergic signaling to improve emphysema induced by cigarette smoke exposure in mice. Life Sci 2022; 301:120599. [DOI: 10.1016/j.lfs.2022.120599] [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] [Received: 09/22/2021] [Revised: 04/16/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
|
4
|
Olivo CR, Castro TBP, Riane A, Regonha T, Rivero DHRF, Vieira RP, Saraiva-Romanholo BM, Lopes FDTQS, Tibério IFLC, Martins MA, Prado CM. The effects of exercise training on the lungs and cardiovascular function of animals exposed to diesel exhaust particles and gases. Environ Res 2022; 203:111768. [PMID: 34339693 DOI: 10.1016/j.envres.2021.111768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/02/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
Air pollution has been identified as one of the main environmental risks to health. Since exercise training seems to act as an anti-inflammatory modulator, our hypothesis is that exercise training prevents damage to respiratory and cardiovascular function caused by diesel exhaust particle (DEP) exposure. This study aimed to evaluate whether aerobic exercise training prior to DEP exposure prevents inflammatory processes in the pulmonary and cardiovascular systems. Therefore, BALB/C male mice were or were not submitted to a 10-week exercise training protocol (5×/week, 1 h/d), and after four weeks, they were exposed to DEP in a chamber with 24 μg/m3 PM2.5 or filtered air. Heart rate variability, lung mechanics and bronchoalveolar lavage fluid, cytokines and polymorphonuclear cells in the lung parenchyma were evaluated. Exposure to DEPs reduced heart rate variability and the elastance of the respiratory system and increased the number of cells in bronchoalveolar lavage fluid, as well as macrophages, neutrophils and lymphocytes, the density of polymorphonuclear cells and the proportion of collagen fibres in the lung parenchyma. Additionally, DEP-exposed animals showed increased expression of IL-23 and IL-12p40 (proinflammatory cytokines) and inducible nitric oxide synthase. Exercise training avoided the increases in all these inflammatory parameters, except the elastance of the respiratory system, the amount of collagen fibres and the expression of inducible nitric oxide synthase. Additionally, trained animals showed increased expression of the anti-inflammatory cytokine IL-1ra. Although our data showed a reduction in proinflammatory markers and an increase in markers of the anti-inflammatory pathway, these changes were not sufficient to prevent damage to the lung and cardiovascular function induced by DEPs. Based on these data, we propose that aerobic exercise training prevents the lung inflammatory process induced by DEPs, although it was not sufficient to avoid chronic damage, such as a loss of lung function or cardiovascular events.
Collapse
Affiliation(s)
- C R Olivo
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Institute of Medical Assistance to the State Public Servant (IAMSPE), Sao Paulo, Brazil; University City of Sao Paulo (UNICID), Sao Paulo, Brazil; Department of Bioscience, Universidade Federal de São Paulo, São Paulo, 11015-020, Brazil.
| | - T B P Castro
- Institute of Medical Assistance to the State Public Servant (IAMSPE), Sao Paulo, Brazil
| | - A Riane
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - T Regonha
- University City of Sao Paulo (UNICID), Sao Paulo, Brazil
| | - D H R F Rivero
- Department of Clinical Medicine (LIM 05), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - R P Vieira
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (LABPEI), Sao Jose dos Campos, SP, Brazil
| | - B M Saraiva-Romanholo
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Institute of Medical Assistance to the State Public Servant (IAMSPE), Sao Paulo, Brazil; University City of Sao Paulo (UNICID), Sao Paulo, Brazil
| | - F D T Q S Lopes
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - I F L C Tibério
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - M A Martins
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - C M Prado
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Department of Bioscience, Universidade Federal de São Paulo, São Paulo, 11015-020, Brazil
| |
Collapse
|
5
|
Felix SN, Agondi RC, Aun MV, Olivo CR, de Almeida FM, Amorim TS, Cezario JC, Giavina-Bianchi P, Tiberio IDFLC, de Martins MDA, Romanholo BMS. Clinical, functional and inflammatory evaluation in asthmatic patients after a simple short-term educational program: a randomized trial. Sci Rep 2021; 11:18267. [PMID: 34521963 PMCID: PMC8440547 DOI: 10.1038/s41598-021-97846-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/08/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023] Open
Abstract
This study aimed to evaluate the clinical evolution, functional parameters and inflammatory activity of asthma in patients who submitted to an educational intervention. 58 adult patients over 18 years of age with partly controlled and uncontrolled asthma were randomized into an intervention group (IG) (N = 32) and a control group (CG) (N = 26) and evaluated for 12 weeks. The Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), Asthma Quality Life Questionnaire (AQLQ) and Beck Depression Inventory (BDI) questionnaires were applied. Spirometry, exhaled nitric oxide (NO), exhaled breath condensate (EBC) and induced sputum (IS), measurement of the peak flow and symptoms were performed. The IG patients received an educational activity for 30 min applied by a nurse. Statistical analysis: analysis of variance with repeated intragroup measures. IG presented a decreased number of eosinophils in IS and IL-17A in EBC, an increase in the percentage of FEV1 before and after bronchodilator and an improvement in quality of life compared to the CG. There was an improvement in depression levels and a decrease in IL-4 and IL-5 in the IS and in the EBC in both groups. Our results suggest that an educational intervention can bring benefits concerning the control of inflammation, lung function alterations, quality of life and levels of depression in asthmatic patients. Registration: ClinicalTrials.gov; NCT03655392.
Collapse
Affiliation(s)
- Soraia Nogueira Felix
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil.
| | - Rosana Câmara Agondi
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Vivolo Aun
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Clarice Rosa Olivo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, Brazil
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Francine Maria de Almeida
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Pedro Giavina-Bianchi
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Milton de Arruda de Martins
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Beatriz Mangueira Saraiva Romanholo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil.
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, Brazil.
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| |
Collapse
|
6
|
Moreira AR, Pereira de Castro TB, Kohler JB, Ito JT, de França Silva LE, Lourenço JD, Almeida RR, Santana FR, Brito JM, Rivero DHRF, Vale MICA, Prado CM, Câmara NOS, Saldiva PHN, Olivo CR, Lopes FDTQDS. Chronic exposure to diesel particles worsened emphysema and increased M2-like phenotype macrophages in a PPE-induced model. PLoS One 2020; 15:e0228393. [PMID: 32004356 PMCID: PMC6993960 DOI: 10.1371/journal.pone.0228393] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic exposure to ambient levels of air pollution induces respiratory illness exacerbation by increasing inflammatory responses and apoptotic cells in pulmonary tissues. The ineffective phagocytosis of these apoptotic cells (efferocytosis) by macrophages has been considered an important factor in these pathological mechanisms. Depending on microenvironmental stimuli, macrophages can assume different phenotypes with different functional actions. M1 macrophages are recognized by their proinflammatory activity, whereas M2 macrophages play pivotal roles in responding to microorganisms and in efferocytosis to avoid the progression of inflammatory conditions. To verify how exposure to air pollutants interferes with macrophage polarization in emphysema development, we evaluated the different macrophage phenotypes in a PPE- induced model with the exposure to diesel exhaust particles. C57BL/6 mice received intranasal instillation of porcine pancreatic elastase (PPE) to induce emphysema, and the control groups received saline. Both groups were exposed to diesel exhaust particles or filtered air for 60 days according to the groups. We observed that both the diesel and PPE groups had an increase in alveolar enlargement, collagen and elastic fibers in the parenchyma and the number of macrophages, lymphocytes and epithelial cells in BAL, and these responses were exacerbated in animals that received PPE instillation prior to exposure to diesel exhaust particles. The same response pattern was found inCaspase-3 positive cell analysis, attesting to an increase in cell apoptosis, which is in agreement with the increase in M2 phenotype markers, measured by RT-PCR and flow cytometry analysis. We did not verify differences among the groups for the M1 phenotype. In conclusion, our results showed that both chronic exposure to diesel exhaust particles and PPE instillation induced inflammatory conditions, cell apoptosis and emphysema development, as well as an increase in M2 phenotype macrophages, and the combination of these two factors exacerbated these responses. The predominance of the M2-like phenotype likely occurred due to the increased demand for efferocytosis. However, M2 macrophage activity was ineffective, resulting in emphysema development and worsening of symptoms.
Collapse
Affiliation(s)
- Alyne Riani Moreira
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Thamyres Barros Pereira de Castro
- Institute of Medical Assistance to the State Public Servant (IAMSPE), Sao Paulo, Brazil
- University City of Sao Paulo (UNICID), Sao Paulo, Brazil
| | - Júlia Benini Kohler
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Juliana Tiyaki Ito
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Juliana Dias Lourenço
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Rafael Ribeiro Almeida
- Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
- Heart Institute (InCor) School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Jose Mara Brito
- Department of Pathology (LIM 5), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Carla Máximo Prado
- Department of Bioscience, Federal University of Sao Paulo, Santos, Sao Paulo, Brazil
| | - Niels Olsen Saraiva Câmara
- Department of Immunology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
- Department of Clinical Medicine (LIM 16), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Department of Medicine, Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Clarice Rosa Olivo
- Department of Clinical Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Institute of Medical Assistance to the State Public Servant (IAMSPE), Sao Paulo, Brazil
- University City of Sao Paulo (UNICID), Sao Paulo, Brazil
| | | |
Collapse
|
7
|
Barbosa AP, Lourenço JD, Junqueira JJM, Larissa Emidio de França S, Martins JS, Oliveira Junior MC, Begalli I, Velosa APP, Olivo CR, Bastos TB, Jorgetti V, Rodolfo de Paula V, Teodoro WR, Lopes FD. The deleterious effects of smoking in bone mineralization and fibrillar matrix composition. Life Sci 2020; 241:117132. [DOI: 10.1016/j.lfs.2019.117132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/31/2019] [Accepted: 11/29/2019] [Indexed: 12/17/2022]
|
8
|
Fernandes P, de Mendonça Oliveira L, Brüggemann TR, Sato MN, Olivo CR, Arantes-Costa FM. Physical Exercise Induces Immunoregulation of TREG, M2, and pDCs in a Lung Allergic Inflammation Model. Front Immunol 2019; 10:854. [PMID: 31156611 PMCID: PMC6532549 DOI: 10.3389/fimmu.2019.00854] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/02/2019] [Indexed: 01/12/2023] Open
Abstract
The benefits of moderate aerobic physical exercise for allergic asthma are well-known, particularly that of the anti-inflammatory effect that occurs by reducing Th2 responses and lung remodeling. However, the mechanisms of this immunoregulation are still under investigation. In this study, we investigated the possible immunoregulatory mechanisms of lung inflammation induced by moderate aerobic exercise in an experimental asthma model. BALB/c mice were distributed into Control, Exercise (EX), OVA, and OEX groups. OVA and OEX groups were sensitized with ovalbumin (OVA) on days 0, 14, 21, 28, and 42 and were challenged with OVA aerosol three times a week from days 21 to 51. The EX and OEX groups underwent moderate aerobic physical exercise from days 21 to 51 (5 d/w, 1 h/d). The mice were euthanized on day 52. We evaluated pulmonary cytokine production, serum immunoglobulin levels, and the inflammatory cell profile in lung and mediastinal lymph nodes. OVA mice showed increased expression of IL-4, IL-6, IL-10, and TGF-β and decreased macrophage type 2 (M2) recruitment. Physical exercise did not affect the increased antibody production of IgG2a, IgG1, or IgE induced by OVA. Of note, physical exercise alone markedly increased production of anti-inflammatory cytokines such as IL-10 and TGF-β. Physical exercise in OVA-mice also increased the recruitment of M2 in the lungs, as well as the influx and activation of regulatory T cells (Tregs) and CD4 and CD8 lymphocytes. In the draining lymph nodes, it was also observed that physical exercise increased the activation of CD4 T cells, regardless of the presence of OVA. Notably, physical exercise decreased common dendritic cells' (cDCs; pro-inflammatory) expression of co-stimulatory molecules such as CD80, CD86, and ICOSL in the draining lymph nodes, as well as increased ICOSL in plasmacytoid dendritic cells (pDCs; anti-inflammatory). Together, these findings show that physical exercise modulates pulmonary allergic inflammation by increasing Treg and M2 recruitment, as well as pDCs activation, which leads to an increase in anti-inflammatory cytokines and a decrease in pro-inflammatory cells and mediators.
Collapse
Affiliation(s)
- Paula Fernandes
- Laboratory of Experimental Therapeutics LIM20, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Laboratory of Medical Investigation LIM56, Division of Clinical Dermatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Thayse Regina Brüggemann
- Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Maria Notomi Sato
- Laboratory of Medical Investigation LIM56, Division of Clinical Dermatology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Clarice Rosa Olivo
- Laboratory of Experimental Therapeutics LIM20, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.,University City of São Paulo (UNICID)/Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo, Brazil
| | - Fernanda Magalhães Arantes-Costa
- Laboratory of Experimental Therapeutics LIM20, Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.,Department of Medicine, Center of Development of Medical Education, CEDEM, School of Medicine, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
9
|
Rodrigues R, Olivo CR, Lourenço JD, Riane A, Cervilha DADB, Ito JT, Martins MDA, Lopes FDTQDS. A murine model of elastase- and cigarette smoke-induced emphysema. J Bras Pneumol 2017; 43:95-100. [PMID: 28538775 PMCID: PMC5474371 DOI: 10.1590/s1806-37562016000000179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/31/2016] [Indexed: 12/04/2022] Open
Abstract
Objective: To describe a murine model of emphysema induced by a combination of exposure to cigarette smoke (CS) and instillation of porcine pancreatic elastase (PPE). Methods: A total of 38 C57BL/6 mice were randomly divided into four groups: control (one intranasal instillation of 0.9% saline solution); PPE (two intranasal instillations of PPE); CS (CS exposure for 60 days); and CS + PPE (two intranasal instillations of PPE + CS exposure for 60 days). At the end of the experimental protocol, all animals were anesthetized and tracheostomized for calculation of respiratory mechanics parameters. Subsequently, all animals were euthanized and their lungs were removed for measurement of the mean linear intercept (Lm) and determination of the numbers of cells that were immunoreactive to macrophage (MAC)-2 antigen, matrix metalloproteinase (MMP)-12, and glycosylated 91-kDa glycoprotein (gp91phox) in the distal lung parenchyma and peribronchial region. Results: Although there were no differences among the four groups regarding the respiratory mechanics parameters assessed, there was an increase in the Lm in the CS + PPE group. The numbers of MAC-2-positive cells in the peribronchial region and distal lung parenchyma were higher in the CS + PPE group than in the other groups, as were the numbers of cells that were positive for MMP-12 and gp91phox, although only in the distal lung parenchyma. Conclusions: Our model of emphysema induced by a combination of PPE instillation and CS exposure results in a significant degree of parenchymal destruction in a shorter time frame than that employed in other models of CS-induced emphysema, reinforcing the importance of protease-antiprotease imbalance and oxidant-antioxidant imbalance in the pathogenesis of emphysema.
Collapse
Affiliation(s)
- Rubia Rodrigues
- . Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Clarice Rosa Olivo
- . Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Juliana Dias Lourenço
- . Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Alyne Riane
- . Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Juliana Tiyaki Ito
- . Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Milton de Arruda Martins
- . Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | |
Collapse
|
10
|
da Silva RA, Almeida FM, Olivo CR, Saraiva-Romanholo BM, Perini A, Martins MA, Carvalho CRF. Comparison of the Effects of Aerobic Conditioning Before and After Pulmonary Allergic Inflammation. Inflammation 2014; 38:1229-38. [DOI: 10.1007/s10753-014-0090-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Muniz BP, Victor JR, de Mendonça Oliveira L, de Lima Lira AA, Perini A, Olivo CR, Arantes-Costa FM, Martins MA, da Silva Duarte AJ, Sato MN. Tolerogenic microenvironment in neonatal period induced by maternal immunization with ovalbumin. Immunobiology 2014; 219:377-84. [PMID: 24582301 DOI: 10.1016/j.imbio.2014.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 10/22/2013] [Revised: 12/05/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
Maternal immunization with allergens, such as ovalbumin (OVA), can inhibit the development of an allergic response in offspring. The regulatory mechanisms seem to be mediated by maternal antibodies (MatAbs) and factors generated by the maternal-fetal interface. The aim of this study was to verify the pathways of inhibitory Ab transference after maternal immunization with OVA and the effect of the offspring's dendritic cells (DCs) on the generation of regulatory T (Treg) cells. We verified that preconceptional OVA immunization induces high levels of proinflammatory and regulatory cytokines in the amniotic fluid, allowing the transference of high levels of anti-OVA IgG1 Abs to the offspring. Using an adoptive nursing protocol, we verified that maternal immunization leads to MatAb transference by the placental route and by breastfeeding contribute to the inhibition of anaphylactic IgE and IgG1 Ab responses in immunized offspring. We observed that maternal immunization decreased eosinophil numbers in recovered bronchoalveolar lavage fluid and in the lung tissue, whereas with a lack of control of airway responsiveness to methacholine. Maternal immunization induced in young offspring a decreased percentage of CD11c+ DCs expressing MHC class II and CD40 molecules. Moreover, DCs from both groups of offspring when pulsed with OVA, were able to induce Treg cells in vitro. Similarly, OVA immunization at the neonatal stage increased the frequency of Treg cells, regardless of the mother's immunization status. These findings emphasize that maternal immunization leads to a complex interaction of regulatory factors, with MatAbs, DCs and Treg cells affecting the tolerance of offspring during an allergic response.
Collapse
Affiliation(s)
- Bruno Pacola Muniz
- Laboratory of Medical Investigation, LIM 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Jefferson Russo Victor
- Laboratory of Medical Investigation, LIM 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Laboratory of Medical Investigation, LIM 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Aline Aparecida de Lima Lira
- Laboratory of Medical Investigation, LIM 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Adenir Perini
- Department of Medicine, LIM 20, Medical School, University of São Paulo, São Paulo, Brazil
| | - Clarice Rosa Olivo
- Department of Medicine, LIM 20, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Milton Arruda Martins
- Department of Medicine, LIM 20, Medical School, University of São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Laboratory of Medical Investigation, LIM 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Notomi Sato
- Laboratory of Medical Investigation, LIM 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil.
| |
Collapse
|
12
|
Lopes FDTQS, Toledo AC, Olivo CR, Prado CM, Leick EA, Medeiros MC, Santos ABG, Garippo A, Martins MA, Mauad T. A comparative study of extracellular matrix remodeling in two murine models of emphysema. Histol Histopathol 2013; 28:269-76. [PMID: 23275309 DOI: 10.14670/hh-28.269] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A single instillation of porcine pancreatic elastase (PPE) results in significant airspace enlargement on the 28th day after instillation, whereas cigarette smoke (CS) exposure requires 6 months to produce mild emphysema in rodents. Considering that there are differences in the pathogenesis of parenchymal destruction in these different experimental models, it is likely that there may be different patterns of extracellular matrix (ECM) remodeling. To evaluate ECM remodeling, C57BL/6 mice were submitted to either a nasal drop of PPE (PPE 28 Days) or exposed for 6 months to cigarette smoke (CS 6 months). Control groups received either an intranasal instillation of saline solution (Saline 28 Days) or remained without any smoke inhalation for six months (Control 6 months). We measured the mean linear intercept and the volume proportion of collagen type I, collagen type III, elastin and fibrillin. We used emission-scanning confocal microscopy to verify the fiber distribution. Both models induced increased mean linear intercept in relation to the respective controls, being larger in the elastase model in relation to the CS model. In the CS model, emphysema was associated with an increase in the volume proportion of fibrillin, whereas in the PPE model there was an increase in the parenchymal elastin content. In both models, there was an increase in collagen type III, which was higher in the CS-exposed mice. We concluded that ECM remodeling is different in the two most used experimental models of emphysema.
Collapse
Affiliation(s)
- F D T Q S Lopes
- Department of Medicine, School of Medicine, University of Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Anciães AM, Olivo CR, Prado CM, Kagohara KH, Pinto TDS, Moriya HT, Mauad T, Martins MDA, Lopes FDTQDS. Respiratory mechanics do not always mirror pulmonary histological changes in emphysema. Clinics (Sao Paulo) 2011; 66:1797-803. [PMID: 22012054 PMCID: PMC3180141 DOI: 10.1590/s1807-59322011001000020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To verify the accordance of functional and morphometric parameters during the development of emphysema. METHODS BALB/c mice received a nasal drop of either papain or saline solution and were studied after 1, 3, 15, 28, and 40 days. Functional parameters, such as airway resistance, tissue damping, and tissue elastance, were analyzed. To evaluate the structural changes and possible mechanisms involved in this disease, we measured the mean linear intercept, the volume proportions of elastic and collagen fibers, the number of macrophages, the numbers of cells expressing metalloprotease 12 and 8-isoprostane in lung parenchyma. RESULTS We only observed decreases in tissue elastance and tissue damping on the 28th day, with a concomitant increase in the mean linear intercept, indicating the presence of emphysema. However, only the mean linear intercept values remained increased until the 40th day. The volume proportion of collagen fibers was increased from the 15th day to the 40th day, whereas the volume proportion of elastic fibers was only increased on the 40th day. The number of macrophages increased beginning on the 1st day. The expression of metalloproteinase 12 was increased from the 3rd day until the 40th day. However, 8-isoprostane expression was only increased on the 1st and 3rd days. CONCLUSIONS In this study, morphometric parameters were found to be more reliable for detecting the presence of emphysema than the functional parameters measured by respiratory mechanics. Further investigations are necessary to understand how the extracellular matrix remodeling observed in the lung parenchyma could be involved in this process.
Collapse
Affiliation(s)
- Adriana Martins Anciães
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Ramos DS, Olivo CR, Quirino Santos Lopes FDT, Toledo AC, Martins MA, Lazo Osório RA, Dolhnikoff M, Ribeiro W, Vieira RDP. Low-intensity swimming training partially inhibits lipopolysaccharide-induced acute lung injury. Med Sci Sports Exerc 2010; 42:113-9. [PMID: 20010123 DOI: 10.1249/mss.0b013e3181ad1c72] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Aerobic exercise decreases pulmonary inflammation and remodeling in experimental models of allergic asthma. However, the effects of aerobic exercise on pulmonary inflammation of nonallergic origin, such as in experimental models of acute lung injury induced by lipopolysaccharide (LPS), have not been evaluated. OBJECTIVE The present study evaluated the effects of aerobic exercise in a model of LPS-induced acute lung injury. METHODS BALB/c mice were divided into four groups: Control, Aerobic Exercise, LPS, and Aerobic Exercise + LPS. Swimming tests were conducted at baseline and at 3 and 6 wk. Low-intensity swimming training was performed for 6 wk, four times per week, 60 min per session. Intranasal LPS (1 mg x kg(-1) (60 microg per mouse)) was instilled 24 h after the last swimming physical test in the LPS and Aerobic Exercise + LPS mice, and the animals were studied 24 h after LPS instillation. Exhaled nitric oxide, respiratory mechanics, total and differential cell counts in bronchoalveolar lavage, and lung parenchymal inflammation and remodeling were evaluated. RESULTS LPS instillation resulted in increased levels of exhaled nitric oxide (P < 0.001), higher numbers of neutrophils in the bronchoalveolar lavage (P < 0.001) and in the lung parenchyma (P < 0.001), and decreased lung tissue resistance (P < 0.05) and volume proportion of elastic fibers (P < 0.01) compared with the Control group. Swim training in LPS-instilled animals resulted in significantly lower exhaled nitric oxide levels (P < 0.001) and fewer neutrophils in the bronchoalveolar lavage (P < 0.001) and the lung parenchyma (P < 0.01) compared with the LPS group. CONCLUSIONS These results suggest that low-intensity swimming training inhibits lung neutrophilic inflammation, but not remodeling and impaired lung mechanics, in a model of LPS-induced acute lung injury.
Collapse
Affiliation(s)
- Daniel Souza Ramos
- Laboratory of Physiology and Pharmacodynamics, Institute of Research and Development, University of Vale do Paraíba, Săo Paulo, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|