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Fagundes MDC, Bianco T, Nunes DP, Ostroski TKD, Bridi GDP, Kawassaki AM, Barbas CSV, Mendonça LO, Barros SF, Kalil J, Shum AK, Escuissato DL. Twenty-year-old patient with polyarthritis since childhood showing cysts and ground glass attenuation on HRCT. Thorax 2024; 79:384-385. [PMID: 38195643 DOI: 10.1136/thorax-2023-220798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024]
Affiliation(s)
| | - Thais Bianco
- Department of Radiology, Universidade Federal do Parana Hospital de Clinicas, Curitiba, Brazil
| | - Daniella Porfírio Nunes
- Department of Pneumology, Universidade Federal do Parana Hospital de Clinicas, Curitiba, Brazil
| | | | | | | | | | - Leonardo Oliveira Mendonça
- Division of Clinical Immunology and Allergy, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil
- Laboratory of Immunology (LIM-19), Universidade de Sao Paulo Instituto do Coracao, Sao Paulo, Brazil
| | - Samar Freschi Barros
- Division of Clinical Immunology and Allergy, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil
- Laboratory of Immunology (LIM-19), Universidade de Sao Paulo Instituto do Coracao, Sao Paulo, Brazil
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil
- Laboratory of Immunology (LIM-19), Universidade de Sao Paulo Instituto do Coracao, Sao Paulo, Brazil
| | - Anthony K Shum
- Department of Pulmonary and Critical Care, University of California, San Francisco, California, USA
| | - Dante Luiz Escuissato
- Department of Radiology, Universidade Federal do Parana Hospital de Clinicas, Curitiba, Brazil
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Marin MLC, Rached MR, Monteiro SM, Kalil J, Abrao MS, Coelho V. Soluble MICA in endometriosis pathophysiology: Impairs NK cell degranulation and effector functions. Am J Reprod Immunol 2024; 91:e13830. [PMID: 38454570 DOI: 10.1111/aji.13830] [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: 08/10/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
PROBLEM Endometriosis exhibits several immune dysfunctions, including deficient natural killer (NK) cell cytotoxicity. MICA (MHC class I chain-related molecule A) is induced by biological stress and soluble MICA (sMICA) negatively modulates the expression of the activating receptor, NKG2D, reducing NK cells activities. We investigated the involvement of soluble MICA in NK cell-deficient activity in endometriosis. METHODS OF STUDY sMICA levels (serum and peritoneal fluid-PF) were evaluated by ELISA. Circulating NK cell subsets quantification and its NKG2D receptor expression, NK cell cytotoxicity and CD107a, IFN-γ and IL-10 expressions by NK cells stimulated with K562 cells were determined by flow cytometry. RESULTS We found higher sMICA levels (serum and PF) in endometriosis, especially in advanced and deep endometriosis. Endometriosis presented lower percentages of CD56dim CD16+ cytotoxic cells and impaired NK cell responses upon stimulation, resulting in lower CD107a and IFN-γ expressions, and deficient NK cell cytotoxicity. NK cell stimulation in the MICA-blocked condition (mimicking the effect of sMICA) showed decreased cytotoxicity in initial endometriosis stages and the emergence of a negative correlation between CD107a expression and sMICA levels. CONCLUSIONS We suggest that soluble MICA is a potential player in endometriosis pathophysiology with involvement in disease progression and severity, contributing to NK cell impaired IFN-γ response and degranulation. NK cell compartment exhibits multiple perturbations, including quantitative deficiency and impaired cytotoxicity, contributing to inadequate elimination of ectopic endometrial tissue.
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Affiliation(s)
- Maria Lucia Carnevale Marin
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Investigaçao Medica 19 (LIM-19), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marici Rached Rached
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sandra Maria Monteiro
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jorge Kalil
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Investigaçao Medica 19 (LIM-19), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto de Investigacao em Imunologia, Instituto Nacional de Ciencia e Tecnologia (iii-INCT), Sao Paulo, SP, Brazil
- Divisao de Imunologia Clinica e Alergia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mauricio Simoes Abrao
- Divisao de Imunologia Clinica e Alergia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Departamento de Ginecologia, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil
| | - Verônica Coelho
- Laboratorio de Imunologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto de Investigacao em Imunologia, Instituto Nacional de Ciencia e Tecnologia (iii-INCT), Sao Paulo, SP, Brazil
- Divisao de Imunologia Clinica e Alergia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Kallás EG, Cintra MAT, Moreira JA, Patiño EG, Braga PE, Tenório JCV, Infante V, Palacios R, de Lacerda MVG, Batista Pereira D, da Fonseca AJ, Gurgel RQ, Coelho ICB, Fontes CJF, Marques ETA, Romero GAS, Teixeira MM, Siqueira AM, Barral AMP, Boaventura VS, Ramos F, Elias Júnior E, Cassio de Moraes J, Covas DT, Kalil J, Precioso AR, Whitehead SS, Esteves-Jaramillo A, Shekar T, Lee JJ, Macey J, Kelner SG, Coller BAG, Boulos FC, Nogueira ML. Live, Attenuated, Tetravalent Butantan-Dengue Vaccine in Children and Adults. N Engl J Med 2024; 390:397-408. [PMID: 38294972 DOI: 10.1056/nejmoa2301790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Butantan-Dengue Vaccine (Butantan-DV) is an investigational, single-dose, live, attenuated, tetravalent vaccine against dengue disease, but data on its overall efficacy are needed. METHODS In an ongoing phase 3, double-blind trial in Brazil, we randomly assigned participants to receive Butantan-DV or placebo, with stratification according to age (2 to 6 years, 7 to 17 years, and 18 to 59 years); 5 years of follow-up is planned. The objectives of the trial were to evaluate overall vaccine efficacy against symptomatic, virologically confirmed dengue of any serotype occurring more than 28 days after vaccination (the primary efficacy end point), regardless of serostatus at baseline, and to describe safety up to day 21 (the primary safety end point). Here, vaccine efficacy was assessed on the basis of 2 years of follow-up for each participant, and safety as solicited vaccine-related adverse events reported up to day 21 after injection. Key secondary objectives were to assess vaccine efficacy among participants according to dengue serostatus at baseline and according to the dengue viral serotype; efficacy according to age was also assessed. RESULTS Over a 3-year enrollment period, 16,235 participants received either Butantan-DV (10,259 participants) or placebo (5976 participants). The overall 2-year vaccine efficacy was 79.6% (95% confidence interval [CI], 70.0 to 86.3) - 73.6% (95% CI, 57.6 to 83.7) among participants with no evidence of previous dengue exposure and 89.2% (95% CI, 77.6 to 95.6) among those with a history of exposure. Vaccine efficacy was 80.1% (95% CI, 66.0 to 88.4) among participants 2 to 6 years of age, 77.8% (95% CI, 55.6 to 89.6) among those 7 to 17 years of age, and 90.0% (95% CI, 68.2 to 97.5) among those 18 to 59 years of age. Efficacy against DENV-1 was 89.5% (95% CI, 78.7 to 95.0) and against DENV-2 was 69.6% (95% CI, 50.8 to 81.5). DENV-3 and DENV-4 were not detected during the follow-up period. Solicited systemic vaccine- or placebo-related adverse events within 21 days after injection were more common with Butantan-DV than with placebo (58.3% of participants, vs. 45.6%). CONCLUSIONS A single dose of Butantan-DV prevented symptomatic DENV-1 and DENV-2, regardless of dengue serostatus at baseline, through 2 years of follow-up. (Funded by Instituto Butantan and others; DEN-03-IB ClinicalTrials.gov number, NCT02406729, and WHO ICTRP number, U1111-1168-8679.).
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Affiliation(s)
- Esper G Kallás
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Monica A T Cintra
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José A Moreira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Elizabeth G Patiño
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Patricia Emilia Braga
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Juliana C V Tenório
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Vanessa Infante
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Palacios
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Marcus Vínicius Guimarães de Lacerda
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dhelio Batista Pereira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Allex Jardim da Fonseca
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Queiroz Gurgel
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ivo Castelo-Branco Coelho
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Cor Jesus Fernandes Fontes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ernesto T A Marques
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Gustavo Adolfo Sierra Romero
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauro Martins Teixeira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - André M Siqueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Aldina Maria Prado Barral
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Viviane Sampaio Boaventura
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fabiano Ramos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Erivaldo Elias Júnior
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José Cassio de Moraes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dimas T Covas
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jorge Kalil
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alexander Roberto Precioso
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Stephen S Whitehead
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alejandra Esteves-Jaramillo
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Tulin Shekar
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jung-Jin Lee
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Julieta Macey
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Sabrina Gozlan Kelner
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Beth-Ann G Coller
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fernanda Castro Boulos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauricio L Nogueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
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4
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Sunderraj A, Cunha LM, Avila M, Alexandria S, Ferreira AM, de Oliveira-da Silva LC, Ribeiro ALP, Nunes MDCP, Sabino EC, Landay A, Kalil J, Chevillard C, Cunha-Neto E, Feinstein MJ. Parasite DNA and Markers of Decreased Immune Activation Associate Prospectively with Cardiac Functional Decline over 10 Years among Trypanosoma cruzi Seropositive Individuals in Brazil. Int J Mol Sci 2023; 25:44. [PMID: 38203212 PMCID: PMC10779141 DOI: 10.3390/ijms25010044] [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: 09/07/2023] [Revised: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Parasitemia and inflammatory markers are cross-sectionally associated with chronic Chagas cardiomyopathy (CCC) among patients with Trypanosoma cruzi. However, the prospective association of the parasite load and host immune response-related characteristics with CCC (that is, progressors) among T. cruzi seropositive individuals has only been partially defined. In a cohort of T. cruzi seropositive patients in Montes Claros and São Paulo, Brazil who were followed over 10 years, we identified the association of a baseline T. cruzi parasite load and systemic markers of inflammation with a decline in cardiac function and/or the presence of cardiac congestion 10 years later. The progressors (n = 21) were individuals with a significant decline in the left ventricular ejection fraction and/or elevated markers of cardiac congestion after 10 years. The controls (n = 31) had normal markers of cardiac function and congestion at the baseline and at the follow-up. They were matched with the progressors on age, sex, and genetic ancestry. The progressors had higher mean parasite loads at the baseline than the controls (18.3 vs. 0.605 DNA parasite equivalents/20 mL, p < 0.05). Of the 384 inflammation-related proteins analyzed, 47 differed significantly at a false discovery rate- (FDR-) corrected p < 0.05 between the groups. There were 44 of these 47 proteins that were significantly higher in the controls compared to in the progressors, including the immune activation markers CCL21, CXCL12, and HCLS1 and several of the tumor necrosis factor superfamily of proteins. Among the individuals who were seropositive for T. cruzi at the baseline and who were followed over 10 years, those with incident CCC at the 10-year marker had a comparatively higher baseline of T. cruzi parasitemia and lower baseline markers of immune activation and chemotaxis. These findings generate the hypothesis that the early impairment of pathogen-killing immune responses predisposes individuals to CCC, which merits further study.
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Affiliation(s)
- Ashwin Sunderraj
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Luisa Marin Cunha
- Faculdade de Ciências Médicas de Santos, UNILUS, Santos 11045-101, Brazil
| | - Matheus Avila
- Faculdade de Ciências Médicas de Santos, UNILUS, Santos 11045-101, Brazil
| | - Shaina Alexandria
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Ariela Mota Ferreira
- Graduate Program in Health Sciences, State University of Montes Claros, Montes Claros 39401-089, Brazil;
| | | | - Antonio L. P. Ribeiro
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil; (A.L.P.R.); (M.d.C.P.N.)
| | - Maria do Carmo Pereira Nunes
- Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil; (A.L.P.R.); (M.d.C.P.N.)
| | - Ester C. Sabino
- Institute of Tropical Medicine, University of São Paulo, São Paulo 05403-000, Brazil; (L.C.d.O.-d.S.)
| | - Alan Landay
- Division of Geriatrics and Gerontology, Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil;
| | - Christophe Chevillard
- Institut MarMaRa, TAGC Theories and Approaches of Genomic Complexity, Aix Marseille Université, 13385 Marseille, France;
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil;
| | - Matthew J. Feinstein
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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5
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Marra AR, Sampaio VS, Ozahata MC, Lopes R, Brito AF, Bragatte M, Kalil J, Miraglia JL, Malheiro DT, Guozhang Y, Teich VD, Victor EDS, Pinho JRR, Cypriano A, Vieira LW, Polonio M, de Oliveira SM, Ricardo VCV, Maezato AM, Callado GY, Schettino GDPP, de Oliveira KG, Santana RAF, Malta FDM, Amgarten D, Boechat AL, Kobayashi T, Perencevich E, Edmond MB, Rizzo LV. Risk factors for long coronavirus disease 2019 (long COVID) among healthcare personnel, Brazil, 2020-2022. Infect Control Hosp Epidemiol 2023; 44:1972-1978. [PMID: 37272468 PMCID: PMC10755155 DOI: 10.1017/ice.2023.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/26/2023] [Accepted: 04/01/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine risk factors for the development of long coronavirus disease 2019 (COVID-19) in healthcare personnel (HCP). METHODS We conducted a case-control study among HCP who had confirmed symptomatic COVID-19 working in a Brazilian healthcare system between March 1, 2020, and July 15, 2022. Cases were defined as those having long COVID according to the Centers for Disease Control and Prevention definition. Controls were defined as HCP who had documented COVID-19 but did not develop long COVID. Multiple logistic regression was used to assess the association between exposure variables and long COVID during 180 days of follow-up. RESULTS Of 7,051 HCP diagnosed with COVID-19, 1,933 (27.4%) who developed long COVID were compared to 5,118 (72.6%) who did not. The majority of those with long COVID (51.8%) had 3 or more symptoms. Factors associated with the development of long COVID were female sex (OR, 1.21; 95% CI, 1.05-1.39), age (OR, 1.01; 95% CI, 1.00-1.02), and 2 or more SARS-CoV-2 infections (OR, 1.27; 95% CI, 1.07-1.50). Those infected with the SARS-CoV-2 δ (delta) variant (OR, 0.30; 95% CI, 0.17-0.50) or the SARS-CoV-2 o (omicron) variant (OR, 0.49; 95% CI, 0.30-0.78), and those receiving 4 COVID-19 vaccine doses prior to infection (OR, 0.05; 95% CI, 0.01-0.19) were significantly less likely to develop long COVID. CONCLUSIONS Long COVID can be prevalent among HCP. Acquiring >1 SARS-CoV-2 infection was a major risk factor for long COVID, while maintenance of immunity via vaccination was highly protective.
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Affiliation(s)
- Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | | | | | - Rafael Lopes
- Instituto Todos Pela Saúde, São Paulo, São Paulo, Brazil
| | | | | | - Jorge Kalil
- Instituto Todos Pela Saúde, São Paulo, São Paulo, Brazil
| | | | | | - Yang Guozhang
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | | | | | - Adriana Cypriano
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Miria Polonio
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Deyvid Amgarten
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Eli Perencevich
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
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6
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Giavina-Bianchi P, Cua E, Risso K, Mondain V, Vissian A, Joie C, Pouletty P, Gineste P, Ehrlich HJ, Kalil J. ABX464 (obefazimod) for patients with COVID-19 at risk for severe disease: miR-AGE, a randomized, double-blind placebo-controlled trial. J Allergy Clin Immunol Glob 2023; 2:100140. [PMID: 37781656 PMCID: PMC10509999 DOI: 10.1016/j.jacig.2023.100140] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 10/03/2023]
Abstract
Background ABX464 (obefazimod) is a small molecule that upregulates a single microRNA (miR-124) in immune cells and reduces the production of various inflammatory cytokines and chemokines. Objective We assessed the efficacy and safety of the standard of care (SoC) plus oral obefazimod (SoC plus ABX464), 50 mg once daily, versus the SoC plus placebo for prevention of severe acute respiratory syndrome in patients with coronavirus disease 2019 (COVID-19) who are at risk for severe disease. Methods Eligible patients for this phase 2/3 double-blind, placebo-controlled miR-AGE study were randomized (2:1) into 2 groups: SoC-ABX464 (n = 339) and SoC-placebo (n = 170). The primary end point was the percentage of patients who did not require use of high-flow oxygen or invasive or noninvasive mechanical ventilation within 28 days. The safety analyses included patients who had been randomly assigned and had received at least 1 dose of the study treatment. Results At the time of the interim analysis, obefazimod showed no benefit over placebo when added to the SoC; the study enrollment was stopped for futility. The evaluation of the safety of obefazimod in 505 patients showed significantly more treatment-emergent adverse events in the SoC-ABX464 group than in the SoC-placebo group (P = .007). Frequently reported AEs in the SoC-ABX464 group included headache (14.6%), abdominal pain (9.6%), diarrhea (9.0%), back pain (6.9%), and nausea (6.0%). No treatment-related changes in laboratory parameters were reported. Conclusion For patients who have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and are at risk for severe COVID-19, obefazimod, 50 mg, provided no benefit over placebo when added to the SoC, although it did have a good safety profile (comparable to that reported in many therapeutic areas).
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Affiliation(s)
- Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, Clinical Medicine Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo (FMUSP), Brazil
| | - Eric Cua
- CHU de Nice - Hôpital Archet 1, Nice, France
| | | | | | | | | | | | | | | | - Jorge Kalil
- Clinical Immunology and Allergy Division, Clinical Medicine Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo (FMUSP), Brazil
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7
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Nunes JPS, Roda VMDP, Andrieux P, Kalil J, Chevillard C, Cunha-Neto E. Inflammation and mitochondria in the pathogenesis of chronic Chagas disease cardiomyopathy. Exp Biol Med (Maywood) 2023; 248:2062-2071. [PMID: 38235691 PMCID: PMC10800136 DOI: 10.1177/15353702231220658] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Chagas disease (CD), caused by the protozoan parasite Trypanosoma cruzi, is a neglected disease affecting around 6 million people. About 30% of CD patients develop chronic Chagas disease cardiomyopathy (CCC), an inflammatory cardiomyopathy that occurs decades after the initial infection, while most infected patients (60%) remain asymptomatic in the so-called indeterminate form (IF). Death results from heart failure or arrhythmia in a subset of CCC patients. Myocardial fibrosis, inflammation, and mitochondrial dysfunction are involved in the arrhythmia substrate and triggering events. Survival in CCC is worse than in other cardiomyopathies, which may be linked to a Th1-T cell rich myocarditis with abundant interferon (IFN)-γ and tumor necrosis factor (TNF)-α, selectively lower levels of mitochondrial energy metabolism enzymes in the heart, and reduced levels of high-energy phosphate, indicating poor adenosine triphosphate (ATP) production. IFN-γ and TNF-α signaling, which are constitutively upregulated in CD patients, negatively affect mitochondrial function in cardiomyocytes, recapitulating findings in CCC heart tissue. Genetic studies such as whole-exome sequencing (WES) in nuclear families with multiple CCC/IF cases has disclosed rare heterozygous pathogenic variants in mitochondrial and inflammatory genes segregating in CCC cases. In this minireview, we summarized studies showing how IFN-γ and TNF-α affect cell energy generation, mitochondrial health, and redox homeostasis in cardiomyocytes, in addition to human CD and mitochondria. We hypothesize that cytokine-induced mitochondrial dysfunction in genetically predisposed patients may be the underlying cause of CCC severity and we believe this mechanism may have a bearing on other inflammatory cardiomyopathies.
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Affiliation(s)
- João Paulo Silva Nunes
- Laboratory of Immunology, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, 05403-900 São Paulo, Brazil
- Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, Brazil
- Institute for Investigation in Immunology (III), Instituto Nacional de Ciência e Tecnologia (INCT), 05403-900 São Paulo, Brazil
| | - Vinicius Moraes de Paiva Roda
- Laboratory of Immunology, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, 05403-900 São Paulo, Brazil
- Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, Brazil
| | - Pauline Andrieux
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) U1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, 13288 Marseille, France
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, 05403-900 São Paulo, Brazil
- Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, Brazil
- Institute for Investigation in Immunology (III), Instituto Nacional de Ciência e Tecnologia (INCT), 05403-900 São Paulo, Brazil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) U1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, 13288 Marseille, France
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor), Faculdade de Medicina da Universidade de São Paulo, 05403-900 São Paulo, Brazil
- Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, 01246-903 São Paulo, Brazil
- Institute for Investigation in Immunology (III), Instituto Nacional de Ciência e Tecnologia (INCT), 05403-900 São Paulo, Brazil
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8
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Sampaio VS, Lopes R, Ozahata MC, Nakaya HI, Sousa E, Araújo JD, Bragatte MA, Brito AF, Grespan RMZ, Capuani MLD, Domingues HH, Pellini ACG, Mateos SDOG, Conde MTRP, Eudes Leal F, Sabino E, Simão M, Kalil J. Thinking out of the box: revisiting health surveillance based on medical records. Antimicrob Steward Healthc Epidemiol 2023; 3:e185. [PMID: 38028896 PMCID: PMC10654951 DOI: 10.1017/ash.2023.451] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/12/2023] [Indexed: 12/01/2023]
Abstract
Despite the considerable advances in the last years, the health information systems for health surveillance still need to overcome some critical issues so that epidemic detection can be performed in real time. For instance, despite the efforts of the Brazilian Ministry of Health (MoH) to make COVID-19 data available during the pandemic, delays due to data entry and data availability posed an additional threat to disease monitoring. Here, we propose a complementary approach by using electronic medical records (EMRs) data collected in real time to generate a system to enable insights from the local health surveillance system personnel. As a proof of concept, we assessed data from São Caetano do Sul City (SCS), São Paulo, Brazil. We used the "fever" term as a sentinel event. Regular expression techniques were applied to detect febrile diseases. Other specific terms such as "malaria," "dengue," "Zika," or any infectious disease were included in the dictionary and mapped to "fever." Additionally, after "tokenizing," we assessed the frequencies of most mentioned terms when fever was also mentioned in the patient complaint. The findings allowed us to detect the overlapping outbreaks of both COVID-19 Omicron BA.1 subvariant and Influenza A virus, which were confirmed by our team by analyzing data from private laboratories and another COVID-19 public monitoring system. Timely information generated from EMRs will be a very important tool to the decision-making process as well as research in epidemiology. Quality and security on the data produced is of paramount importance to allow the use by health surveillance systems.
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Affiliation(s)
- Vanderson S. Sampaio
- Instituto Todos pela Saúde, São Paulo, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Amazonas State University, Manaus, Brazil
| | | | | | - Helder I. Nakaya
- Instituto Todos pela Saúde, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Erick Sousa
- Instituto Todos pela Saúde, São Paulo, Brazil
- Telehealth Group, School of Medicine, Federal University of Goiás, Goiás, Brazil
| | | | - Marcelo A.S. Bragatte
- Instituto Todos pela Saúde, São Paulo, Brazil
- Capixaba Institute for Teaching, Research and Innovation in Health (ICEPi), Espírito Santo, Brazil
| | | | - Regina Maura Zettoni Grespan
- Municipal University of São Caetano do Sul, São Caetano do Sul, São Paulo, Brazil
- Secretary of Health of The Municipality of São Caetano do Sul, São Paulo, Brazil
| | | | | | | | | | | | - Fabio Eudes Leal
- Municipal University of São Caetano do Sul, São Caetano do Sul, São Paulo, Brazil
| | - Ester Sabino
- Instituto Todos pela Saúde, São Paulo, Brazil
- Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Jorge Kalil
- Instituto Todos pela Saúde, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Laboratory of Clinical Immunology and Allergy-LIM60/University of Sao Paulo School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil
- Laboratory of Immunology, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil
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9
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Damiano RF, Rocca CCDA, Serafim ADP, Loftis JM, Talib LL, Pan PM, Cunha-Neto E, Kalil J, de Castro GS, Seelaender M, Guedes BF, Nagahashi Marie SK, de Souza HP, Nitrini R, Miguel EC, Busatto G, Forlenza OV. Cognitive impairment in long-COVID and its association with persistent dysregulation in inflammatory markers. Front Immunol 2023; 14:1174020. [PMID: 37287969 PMCID: PMC10242059 DOI: 10.3389/fimmu.2023.1174020] [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: 02/25/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Objective To analyze the potential impact of sociodemographic, clinical and biological factors on the long-term cognitive outcome of patients who survived moderate and severe forms of COVID-19. Methods We assessed 710 adult participants (Mean age = 55 ± 14; 48.3% were female) 6 to 11 months after hospital discharge with a complete cognitive battery, as well as a psychiatric, clinical and laboratory evaluation. A large set of inferential statistical methods was used to predict potential variables associated with any long-term cognitive impairment, with a focus on a panel of 28 cytokines and other blood inflammatory and disease severity markers. Results Concerning the subjective assessment of cognitive performance, 36.1% reported a slightly poorer overall cognitive performance, and 14.6% reported being severely impacted, compared to their pre-COVID-19 status. Multivariate analysis found sex, age, ethnicity, education, comorbidity, frailty and physical activity associated with general cognition. A bivariate analysis found that G-CSF, IFN-alfa2, IL13, IL15, IL1.RA, EL1.alfa, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, Follow-up C-Reactive Protein, and Follow-up D-Dimer were significantly (p<.05) associated with general cognition. However, a LASSO regression that included all follow-up variables, inflammatory markers and cytokines did not support these findings. Conclusion Though we identified several sociodemographic characteristics that might protect against cognitive impairment following SARS-CoV-2 infection, our data do not support a prominent role for clinical status (both during acute and long-stage of COVID-19) or inflammatory background (also during acute and long-stage of COVID-19) to explain the cognitive deficits that can follow COVID-19 infection.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Jennifer M. Loftis
- Research & Development Service, VA Portland Health Care System, Portland, OR, United States
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Leda Leme Talib
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Pedro Mário Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Edecio Cunha-Neto
- Departamento de Cínica Médica, Universidade de São Paulo FMUSP, São Paulo, SP, Brazil
- Institute for Investigation in Immunology/National Institutes for Science and Technology (iii/INCT), São Paulo, Brazil
| | - Jorge Kalil
- Departamento de Cínica Médica, Universidade de São Paulo FMUSP, São Paulo, SP, Brazil
- Institute for Investigation in Immunology/National Institutes for Science and Technology (iii/INCT), São Paulo, Brazil
| | - Gabriela Salim de Castro
- Cancer Metabolism Research Group, Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Bruno F. Guedes
- Departamento de Neurologia, Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | | | - Ricardo Nitrini
- Departamento de Neurologia, Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Euripedes Constantino Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Geraldo Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Melo A, de Carvalho LM, Ferriani VPL, Cavalcanti A, Appenzeller S, Oliveira VR, Neto HC, Rosário NA, de Oliveira Poswar F, Guimaraes MX, Kokron CM, Maia RE, Silva GD, Keller G, Ferreira MD, Vasconcelos DM, Toledo-Barros MAM, Barros SF, Neto NSR, Krieger MH, Kalil J, Mendonça LO. A brazilian nationwide multicenter study on deficiency of deaminase-2 (DADA2). Adv Rheumatol 2023; 63:23. [PMID: 37217999 DOI: 10.1186/s42358-023-00303-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. PATIENTS AND METHODS This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. RESULTS Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. CONCLUSION The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).
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Affiliation(s)
- Adriana Melo
- Division of Clinical Immunology and Allergy, Hospital das Clínicas da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana Martins de Carvalho
- Division of Pediatric Rheumatology Department of Pediatrics, Clinical Hospital of Ribeirão Preto Medical School, Universidade de São Paulo, São Paulo, Brazil
| | - Virginia Paes Leme Ferriani
- Division of Pediatric Rheumatology Department of Pediatrics, Clinical Hospital of Ribeirão Preto Medical School, Universidade de São Paulo, São Paulo, Brazil
| | - André Cavalcanti
- Department of Pediatrics, Hospital das Clínicas da Universidade Federal de Pernambuco, Universidade Federal de Pernambuco, Pernambuco, Brazil
| | - Simone Appenzeller
- Department of Pediatric Rheumatology, Universidade de Campinas, São Paulo, Brazil
| | | | - Herberto Chong Neto
- Division of Allergy and Immunology, Complexo Hospital de Clínicas, Federal University of Paraná, Paraná, Brazil
| | - Nelson Augusto Rosário
- Division of Allergy and Immunology, Complexo Hospital de Clínicas, Federal University of Paraná, Paraná, Brazil
| | | | | | - Cristina Maria Kokron
- Division of Clinical Immunology and Allergy, Hospital das Clínicas da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Rayana Elias Maia
- Division of Genetics, Universidade Federal de Campina Grande, Campina Grande, Paraíba, Brazil
| | - Guilherme Diogo Silva
- Department of Neurology; Hospital das Cl?nicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriel Keller
- Department of Neurology; Hospital das Cl?nicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio Domingues Ferreira
- Department of Dermatology; Ambulatory for cutaneous manifestations of Primary Immunodeficiencies; Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Dewton Moraes Vasconcelos
- Department of Dermatology; Ambulatory for cutaneous manifestations of Primary Immunodeficiencies; Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Myrthes Anna Maragna Toledo-Barros
- Division of Clinical Immunology and Allergy, Hospital das Clínicas da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Samar Freschi Barros
- Laboratory for Medical Investigation (LIM-19) - LIM-19; Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil
| | - Nilton Salles Rosa Neto
- Department of Internal Medicine, Universidade de Santo Amaro-UNISA, São Paulo, Brazil
- Center for Rare and Immunological Disorders, Hospital 9 de Julho - Rede DASA, São Paulo, Brazil
| | - Marta Helena Krieger
- ANDAI (Associação Nacional de Doenças Autoinflamatórias - Brazilian Association for Autoinflammatory Diseases), São Paulo, Brazil
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, Hospital das Clínicas da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Laboratory for Medical Investigation (LIM-19) - LIM-19; Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Oliveira Mendonça
- Division of Clinical Immunology and Allergy, Hospital das Clínicas da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
- Laboratory for Medical Investigation (LIM-19) - LIM-19; Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil.
- Center for Rare and Immunological Disorders, Hospital 9 de Julho - Rede DASA, São Paulo, Brazil.
- Division of Immunology and Allergy, Center for Rare and Immunological Disorders, DASA- Hospital, 9 de Julho Rua Peixoto Gomide, 285, 01409001, São Paulo, Brazil.
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Nunez FA, Castro ACH, Daher IP, Cunha-Neto E, Kalil J, Boscardin SB, Lanfredi AJC, de Oliveira VL, Alves WA. ZnO-Based Electrochemical Immunosensor to Assess Vaccine-Induced Antibody-Mediated Immunity against Wild-Type and Gamma SARS-CoV-2 Strains. Biosensors (Basel) 2023; 13:371. [PMID: 36979583 PMCID: PMC10046366 DOI: 10.3390/bios13030371] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
The evaluation of serological responses to COVID-19 is crucial for population-level surveillance, developing new vaccines, and evaluating the efficacy of different immunization programs. Research and development of point-of-care test technologies remain essential to improving immunity assessment, especially for SARS-CoV-2 variants that partially evade vaccine-induced immune responses. In this work, an impedimetric biosensor based on the immobilization of the recombinant trimeric wild-type spike protein (S protein) on zinc oxide nanorods (ZnONRs) was employed for serological evaluation. We successfully assessed its applicability using serum samples from spike-based COVID-19 vaccines: ChAdOx1-S (Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech). Overall, the ZnONRs/ spike-modified electrode displayed accurate results for both vaccines, showing excellent potential as a tool for assessing and monitoring seroprevalence in the population. A refined outcome of this technology was achieved when the ZnO immunosensor was functionalized with the S protein from the P.1 linage (Gamma variant). Serological responses against samples from vaccinated individuals were acquired with excellent performance. Following studies based on traditional serological tests, the ZnONRs/spike immunosensor data reveal that ChAdOx1-S vaccinated individuals present significantly less antibody-mediated immunity against the Gamma variant than the BNT162b2 vaccine, highlighting the great potential of this point-of-care technology for evaluating vaccine-induced humoral immunity against different SARS-CoV-2 strains.
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Affiliation(s)
- Freddy A. Nunez
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Paulo 09210-580, Brazil
| | - Ana C. H. Castro
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Paulo 09210-580, Brazil
| | - Isabela P. Daher
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-900, Brazil
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, São Paulo 05508-900, Brazil
| | - Edecio Cunha-Neto
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-900, Brazil
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-900, Brazil
| | - Jorge Kalil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-900, Brazil
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-900, Brazil
| | - Silvia B. Boscardin
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, São Paulo 05508-900, Brazil
| | - Alexandre J. C. Lanfredi
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, São Paulo 09210-580, Brazil
| | - Vivian L. de Oliveira
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Paulo 09210-580, Brazil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-900, Brazil
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 05403-900, Brazil
| | - Wendel A. Alves
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, São Paulo 09210-580, Brazil
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Hunsberger S, Ellenberg SS, Joffe S, Babiker A, Fix A, Griffin MR, Kalil J, Levine MM, Makgoba MW, Moore RH, Tsiatis AA, Whitley R. Monitoring Multiple U.S. Government-Supported Covid-19 Vaccine Trials. NEJM Evid 2023; 2:EVIDctcs2200301. [PMID: 38320019 DOI: 10.1056/evidctcs2200301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Monitoring U.S. Government-Supported Covid-19 Vaccine TrialsOperation Warp Speed was a partnership created to accelerate the development of Covid-19 vaccines. The National Institutes of Health oversaw one data and safety monitoring board to review/monitor all Operation Warp Speed trials. This article describes the challenges faced in monitoring these trials and provides ideas for future similar endeavors.
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Affiliation(s)
- Sally Hunsberger
- National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Susan S Ellenberg
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Steven Joffe
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Abdel Babiker
- Medical Research Council Clinical Trials Unit, University College London, London
| | - Alan Fix
- Center for Vaccine Innovation and Access, PATH, Washington, D.C
| | | | - Jorge Kalil
- Faculdade de Medicina, Universidade de São Paulo, São Paulo
| | | | | | - Reneé H Moore
- Dornsife School of Public Health, Drexel University, Philadelphia
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Figo DD, Cordeiro Macedo PR, Gadermaier G, Remuzgo C, Castro FFM, Kalil J, Galvão CES, Santos KS. IgE and IgG4 Epitopes of Dermatophagoides and Blomia Allergens before and after Sublingual Immunotherapy. Int J Mol Sci 2023; 24:ijms24044173. [PMID: 36835585 PMCID: PMC9958541 DOI: 10.3390/ijms24044173] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Sublingual immunotherapy (SLIT) is used worldwide to treat house dust mites (HDM) allergy. Epitope specific immunotherapy with peptide vaccines is used far less, but it is of great interest in the treatment of allergic reactions, as it precludes the drawbacks of allergen extracts. The ideal peptide candidates would bind to IgG, blocking IgE-binding. To better elucidate IgE and IgG4 epitope profiles during SLIT, sequences of main allergens, Der p 1, 2, 5, 7, 10, 23 and Blo t 5, 6, 12, 13, were included in a 15-mer peptide microarray and tested against pooled sera from 10 patients pre- and post-1-year SLIT. All allergens were recognized to some extent by at least one antibody isotype and peptide diversity was higher post-1-year SLIT for both antibodies. IgE recognition diversity varied among allergens and timepoints without a clear tendency. Der p 10, a minor allergen in temperate regions, was the molecule with more IgE-peptides and might be a major allergen in populations highly exposed to helminths and cockroaches, such as Brazil. SLIT-induced IgG4 epitopes were directed against several, but not all, IgE-binding regions. We selected a set of peptides that recognized only IgG4 or were able to induce increased ratios of IgG4:IgE after one year of treatment and might be potential targets for vaccines.
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Affiliation(s)
- Daniele Danella Figo
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
| | - Priscilla Rios Cordeiro Macedo
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Servico de Imunologia Clinica e Alergia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, 5020 Salzburg, Austria
| | - Cesar Remuzgo
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
| | - Fábio Fernandes Morato Castro
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Servico de Imunologia Clinica e Alergia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
- Instituto Nacional de Ciencia e Tecnologia de Investigação em Imunologia (iii-INCT), Sao Paulo 05403-900, Brazil
| | - Jorge Kalil
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Instituto Nacional de Ciencia e Tecnologia de Investigação em Imunologia (iii-INCT), Sao Paulo 05403-900, Brazil
| | - Clovis Eduardo Santos Galvão
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Servico de Imunologia Clinica e Alergia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Keity Souza Santos
- LIM-19, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Laboratorio de Imunologia, INCOR, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-900, Brazil
- Departamento de Clinica Medica, Disciplina de Imunologia Clinica e Alergia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Instituto Nacional de Ciencia e Tecnologia de Investigação em Imunologia (iii-INCT), Sao Paulo 05403-900, Brazil
- Correspondence:
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Argolo P, Motta A, Kalil J, Agondi R. Total Serum Ige And Severity Of Chronic Spontaneous Urticaria. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.447] [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: 02/05/2023]
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Franco G, Menechino N, Lopes LN, Pitchon A, Lima F, Marinho AK, Grecco O, Toledo-Barros M, Kalil J, Kokron C. Description of COVID-19 infection in 92 patients with primary or secondary immunodeficiency followed at the Immunodeficiency Outpatient Clinic of a tertiary hospital. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.611] [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: 02/05/2023]
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Lopes LN, Menechino N, Kalil J, Marinho AK. Events Supposedly Attributable to Vaccination or Immunization after COVID-19 vaccines in children. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.313] [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: 02/05/2023]
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Xavier de Medeiros G, de Carvalho Pereira Ferreira L, Magawa JY, Kuramoto A, Sasahara GL, Ferreira M, Toledo Barros MM, Kalil J, Barreto Berselli Marinho AK, Cunha-Neto E, Santos KS, Kokron C. Immune Responses Of CVID Patients To COVID-19 Vaccines. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.077] [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: 02/05/2023]
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Oliveira JR, Ruiz CMR, Machado RRG, Magawa JY, Daher IP, Urbanski AH, Schmitz GJH, Arcuri HA, Ferreira MA, Sasahara GL, de Medeiros GX, Júnior RCVS, Durigon EL, Boscardin SB, Rosa DS, Schechtman D, Nakaya HI, Cunha-Neto E, Gadermaier G, Kalil J, Coelho V, Santos KS. Immunodominant antibody responses directed to SARS-CoV-2 hotspot mutation sites and risk of immune escape. Front Immunol 2023; 13:1010105. [PMID: 36685521 PMCID: PMC9849925 DOI: 10.3389/fimmu.2022.1010105] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Considering the likely need for the development of novel effective vaccines adapted to emerging relevant CoV-2 variants, the increasing knowledge of epitope recognition profile among convalescents and afterwards vaccinated with identification of immunodominant regions may provide important information. Methods We used an RBD peptide microarray to identify IgG and IgA binding regions in serum of 71 COVID-19 convalescents and 18 vaccinated individuals. Results We found a set of immunodominant RBD antibody epitopes, each recognized by more than 30% of the tested cohort, that differ among the two different groups and are within conserved regions among betacoronavirus. Of those, only one peptide, P44 (S415-429), recognized by 68% of convalescents, presented IgG and IgA antibody reactivity that positively correlated with nAb titers, suggesting that this is a relevant RBD region and a potential target of IgG/IgA neutralizing activity. Discussion This peptide is localized within the area of contact with ACE-2 and harbors the mutation hotspot site K417 present in gamma (K417T), beta (K417N), and omicron (K417N) variants of concern. The epitope profile of vaccinated individuals differed from convalescents, with a more diverse repertoire of immunodominant peptides, recognized by more than 30% of the cohort. Noteworthy, immunodominant regions of recognition by vaccinated coincide with mutation sites at Omicron BA.1, an important variant emerging after massive vaccination. Together, our data show that immune pressure induced by dominant antibody responses may favor hotspot mutation sites and the selection of variants capable of evading humoral response.
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Affiliation(s)
- Jamille Ramos Oliveira
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Investigação em Imunologia–Instituto Nacional de Ciências e Tecnologia – instituto de investigação em imunologia - Instituto Nacional de Ciências e Tecnologia (iii-INCT), São Paulo, Brazil
| | - Cesar Manuel Remuzgo Ruiz
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
| | | | - Jhosiene Yukari Magawa
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Investigação em Imunologia–Instituto Nacional de Ciências e Tecnologia – instituto de investigação em imunologia - Instituto Nacional de Ciências e Tecnologia (iii-INCT), São Paulo, Brazil
| | - Isabela Pazotti Daher
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Investigação em Imunologia–Instituto Nacional de Ciências e Tecnologia – instituto de investigação em imunologia - Instituto Nacional de Ciências e Tecnologia (iii-INCT), São Paulo, Brazil
| | - Alysson Henrique Urbanski
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gabriela Justamante Händel Schmitz
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
| | - Helen Andrade Arcuri
- Centro de Estudos de Insetos Sociais, Departamento de Biologia, Instituto de Biociências de Rio Claro, Universidade Estadual Paulista, Rio Claro, SP, Brazil
| | - Marcelo Alves Ferreira
- Laboratório de Biologia Celular, Laboratório de Investigação Médica 59 (LIM59), Departamento de Patologia, Faculdade de Medicina Faculdade de Medicina da Universidade de São Paulo (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Greyce Luri Sasahara
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
| | - Giuliana Xavier de Medeiros
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Roberto Carlos Vieira Silva Júnior
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
| | - Edison Luiz Durigon
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
- Plataforma Científica Pasteur-USP, São Paulo, SP, Brazil
| | - Silvia Beatriz Boscardin
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniela Santoro Rosa
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo (UNIFESP/EPM, São Paulo, SP, Brazil
| | - Deborah Schechtman
- Departamento de Bioquímica, instituto de Química, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Helder I. Nakaya
- Plataforma Científica Pasteur-USP, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Edecio Cunha-Neto
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Investigação em Imunologia–Instituto Nacional de Ciências e Tecnologia – instituto de investigação em imunologia - Instituto Nacional de Ciências e Tecnologia (iii-INCT), São Paulo, Brazil
| | - Gabriele Gadermaier
- Department of Biosciences and Medical Biology, Paris Lodron University Salzburg, Salzburg, Brazil
| | - Jorge Kalil
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Investigação em Imunologia–Instituto Nacional de Ciências e Tecnologia – instituto de investigação em imunologia - Instituto Nacional de Ciências e Tecnologia (iii-INCT), São Paulo, Brazil
| | - Verônica Coelho
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Investigação em Imunologia–Instituto Nacional de Ciências e Tecnologia – instituto de investigação em imunologia - Instituto Nacional de Ciências e Tecnologia (iii-INCT), São Paulo, Brazil
| | - Keity Souza Santos
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratório de Imunologia, LIM19, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP) São Paulo da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Investigação em Imunologia–Instituto Nacional de Ciências e Tecnologia – instituto de investigação em imunologia - Instituto Nacional de Ciências e Tecnologia (iii-INCT), São Paulo, Brazil
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Agondi RC, Argôlo PN, Mousinho-Fernandes M, Gehlen B, Kalil J, Motta AA. Multiple comorbidities in patients with long-lasting chronic spontaneous urticaria. An Bras Dermatol 2023; 98:93-96. [PMID: 36319512 PMCID: PMC9837631 DOI: 10.1016/j.abd.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Rosana Câmara Agondi
- Clinical Immunology and Allergy Division, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil,Laboratory of Immunology (LIM19), Instituto do Coração (InCor), Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil,Corresponding author.
| | - Paula Natassya Argôlo
- Clinical Immunology and Allergy Division, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mariana Mousinho-Fernandes
- Clinical Immunology and Allergy Division, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruna Gehlen
- Clinical Immunology and Allergy Division, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jorge Kalil
- Clinical Immunology and Allergy Division, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil,Laboratory of Immunology (LIM19), Instituto do Coração (InCor), Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antonio Abílio Motta
- Clinical Immunology and Allergy Division, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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20
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Kalil J, Krzywon L, Zlotnik O, Chaudhury P, Metrakos P. Tumor volume reduction surgery improves survival for colorectal liver metastases. HPB (Oxford) 2023; 25:S72-S73. [DOI: 10.1016/j.hpb.2023.05.142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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21
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de Castro MV, Silva MVR, Soares FB, Cória VR, Naslavsky MS, Scliar MO, Castelli EC, de Oliveira JR, de Medeiros GX, Sasahara GL, Santos KS, Cunha-Neto E, Kalil J, Zatz M. Corrigendum: Follow-up of young adult monozygotic twins after simultaneous critical coronavirus disease 2019: a case report. Front Med (Lausanne) 2023; 10:1185833. [PMID: 37188090 PMCID: PMC10177390 DOI: 10.3389/fmed.2023.1185833] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fmed.2022.1008585.].
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Affiliation(s)
- Mateus V. de Castro
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Monize V. R. Silva
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Flávia B. Soares
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Vivian R. Cória
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Michel S. Naslavsky
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Marilia O. Scliar
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Erick C. Castelli
- Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Jamile R. de Oliveira
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Giuliana X. de Medeiros
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Greyce L. Sasahara
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Keity S. Santos
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia—Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia—Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Jorge Kalil
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia—Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
- *Correspondence: Mayana Zatz
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22
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Mendonça LO, dos Reis Chuster AP, Dorna MB, Barros SF, Alves JB, Gonçalves VL, Yang AC, Kalil J, Toledo-Barros MAM, Kokron CM. Underlying IPEX syndrome in a patient with idiopathic juvenile arthritis and vitiligo. Allergy Asthma Clin Immunol 2022; 18:105. [PMID: 36503523 PMCID: PMC9743487 DOI: 10.1186/s13223-022-00740-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND IPEX syndrome is an X-linked inborn error of immunity clinically characterized by the triad of: enteropathy, polyendocrinopathy and eczema. However many other clinical presentations lacking the triad above described have been reported what underpin the need of careful clinical suspicion, immunological evaluation and genetic sequencing. CASE PRESENTATION Here we report a case of a Brazilian boy with severe eczema as the first and only presentation requiring cyclosporin therapy. Progressive and cumulative symptoms of arthritis and enteropathy lead to the suspicion of an inborn error of immunity. Peripheral FOXP3 expression was normal (CD127-/CD4+/CD25+/FOXP3+-396 cells-63%) and a pathogenic mutation in FOXP3 gene (c.1150G>A; p.Ala384Thr), confirmed the diagnosis of IPEX syndrome. CONCLUSIONS IPEX syndrome should be suspected in patients presenting with severe eczema associated or not with other autoimmune/hyper inflammatory diseases in life. Our study also reinforces that FOXP3 expression by flowcytometry seems not to be a good screening method, and genetic sequencing is mandatory even in those with high suspicion and normal peripheral FOXP3 expression.
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Affiliation(s)
- Leonardo Oliveira Mendonça
- grid.11899.380000 0004 1937 0722Division of Clinical Immunology and Allergy, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de São Paulo, Department of Internal Medicine, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 8th floor, São Paulo, 05403-000 Brazil ,grid.11899.380000 0004 1937 0722Laboratory for Immunological Investigation (LIM-19), Heart Institute, University of São Paulo, São Paulo, Brazil ,Division of Clinical Immunology and Allergy, Center for Rare and Immunological Disorders, DASA - Hospital 9 de Julho, São Paulo, Brazil
| | - Adriana Pitchon dos Reis Chuster
- grid.11899.380000 0004 1937 0722Division of Clinical Immunology and Allergy, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de São Paulo, Department of Internal Medicine, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 8th floor, São Paulo, 05403-000 Brazil
| | - Mayra Barros Dorna
- grid.11899.380000 0004 1937 0722Division of Allergy and Immunology, Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Samar Freschi Barros
- grid.11899.380000 0004 1937 0722Laboratory for Immunological Investigation (LIM-19), Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Janaina Baptista Alves
- grid.11899.380000 0004 1937 0722Laboratory for Immunological Investigation (LIM-19), Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Victor Lucas Gonçalves
- grid.11899.380000 0004 1937 0722Department of Surgical Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ariana Campos Yang
- grid.11899.380000 0004 1937 0722Division of Clinical Immunology and Allergy, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de São Paulo, Department of Internal Medicine, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 8th floor, São Paulo, 05403-000 Brazil
| | - Jorge Kalil
- grid.11899.380000 0004 1937 0722Division of Clinical Immunology and Allergy, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de São Paulo, Department of Internal Medicine, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 8th floor, São Paulo, 05403-000 Brazil ,grid.11899.380000 0004 1937 0722Laboratory for Immunological Investigation (LIM-19), Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Myrthes Anna Maragna Toledo-Barros
- grid.11899.380000 0004 1937 0722Division of Clinical Immunology and Allergy, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de São Paulo, Department of Internal Medicine, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 8th floor, São Paulo, 05403-000 Brazil
| | - Cristina Maria Kokron
- grid.11899.380000 0004 1937 0722Division of Clinical Immunology and Allergy, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de São Paulo, Department of Internal Medicine, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 8th floor, São Paulo, 05403-000 Brazil
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23
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de Castro MV, Silva MVR, Naslavsky MS, Scliar MO, Nunes K, Passos-Bueno MR, Castelli EC, Magawa JY, Adami FL, Moretti AIS, de Oliveira VL, Boscardin SB, Cunha-Neto E, Kalil J, Jouanguy E, Bastard P, Casanova JL, Quiñones-Vega M, Sosa-Acosta P, Guedes JDS, de Almeida NP, Nogueira FCS, Domont GB, Santos KS, Zatz M. Correction: The oldest unvaccinated Covid-19 survivors in South America. Immun Ageing 2022; 19:61. [PMID: 36476248 PMCID: PMC9727865 DOI: 10.1186/s12979-022-00319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mateus V. de Castro
- grid.11899.380000 0004 1937 0722Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo Brazil
| | - Monize V. R. Silva
- grid.11899.380000 0004 1937 0722Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo Brazil
| | - Michel S. Naslavsky
- grid.11899.380000 0004 1937 0722Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo Brazil ,grid.11899.380000 0004 1937 0722Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo Brazil
| | - Marilia O. Scliar
- grid.11899.380000 0004 1937 0722Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo Brazil ,grid.11899.380000 0004 1937 0722Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo Brazil
| | - Kelly Nunes
- grid.11899.380000 0004 1937 0722Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo Brazil ,grid.11899.380000 0004 1937 0722Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo Brazil
| | - Maria Rita Passos-Bueno
- grid.11899.380000 0004 1937 0722Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo Brazil ,grid.11899.380000 0004 1937 0722Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo Brazil
| | - Erick C. Castelli
- grid.410543.70000 0001 2188 478XDepartment of Pathology, School of Medicine, UNESP - São Paulo State University, Botucatu, São Paulo Brazil
| | - Jhosiene Y. Magawa
- grid.411074.70000 0001 2297 2036Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil ,grid.11899.380000 0004 1937 0722Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil ,grid.11899.380000 0004 1937 0722Departamento de Clínica Médica, Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Flávia L. Adami
- grid.11899.380000 0004 1937 0722Laboratory of Antigen Targeting to Dendritic Cells, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana I. S. Moretti
- grid.411074.70000 0001 2297 2036Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Vivian L. de Oliveira
- grid.411074.70000 0001 2297 2036Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Silvia B. Boscardin
- grid.11899.380000 0004 1937 0722Laboratory of Antigen Targeting to Dendritic Cells, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Edecio Cunha-Neto
- grid.11899.380000 0004 1937 0722Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil ,grid.11899.380000 0004 1937 0722Departamento de Clínica Médica, Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- grid.411074.70000 0001 2297 2036Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil ,grid.11899.380000 0004 1937 0722Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Emmanuelle Jouanguy
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France
| | - Paul Bastard
- grid.412134.10000 0004 0593 9113Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France ,grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France
| | - Jean-Laurent Casanova
- grid.10988.380000 0001 2173 743XImagine Institute, University of Paris, Paris, France ,grid.134907.80000 0001 2166 1519St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY USA
| | - Mauricio Quiñones-Vega
- grid.8536.80000 0001 2294 473XProteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XLaboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia Sosa-Acosta
- grid.8536.80000 0001 2294 473XProteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XLaboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jéssica de S. Guedes
- grid.8536.80000 0001 2294 473XProteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XLaboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natália P. de Almeida
- grid.8536.80000 0001 2294 473XProteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XLaboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fábio C. S. Nogueira
- grid.8536.80000 0001 2294 473XProteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ,grid.8536.80000 0001 2294 473XLaboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto B. Domont
- grid.8536.80000 0001 2294 473XProteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Keity S. Santos
- grid.411074.70000 0001 2297 2036Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil ,grid.11899.380000 0004 1937 0722Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil ,grid.11899.380000 0004 1937 0722Departamento de Clínica Médica, Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- grid.11899.380000 0004 1937 0722Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo Brazil ,grid.11899.380000 0004 1937 0722Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo Brazil
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24
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Szor RS, Fernandes F, Lino AMM, Mendonça LO, Seguro FS, Feitosa VA, Castelli JB, Jorge LB, de Oliveira Alves LB, de Menezes Neves PDM, de Oliveira Souza E, Cavalcante LB, Malheiros D, Kalil J, Martinez GA, Rocha V. Systemic amyloidosis journey from diagnosis to outcomes: a twelve-year real-world experience of a single center in a middle-income country. Orphanet J Rare Dis 2022; 17:425. [PMID: 36471404 PMCID: PMC9724300 DOI: 10.1186/s13023-022-02584-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Systemic amyloidosis is caused by the deposition of misfolded protein aggregates in tissues, leading to progressive organ dysfunction and death. Epidemiological studies originate predominantly from high-income countries, with few data from Latin America. Due to the non-specific clinical manifestations, diagnosing amyloidosis is often challenging and patients experience a long journey and delay in diagnosis. This study aimed to assess clinical and laboratory characteristics, the diagnostic journey, and outcomes of patients with biopsy-proven systemic amyloidosis diagnosed between 2009 and 2020 at a university referral center in a middle-income Latin American country. Patients´ medical records were retrospectively reviewed. RESULTS One hundred and forty-three patients were included. The median age at diagnosis was 60 years and 54% were male. Until the diagnosis, most of the patients (52%) were seen by at least 3 specialists, the main ones being: general practitioners (57%), nephrologists (45%), and cardiologists (38%). The most common manifestations were renal (54%) and cardiac (41%) disorders, and cachexia was seen in 36% of patients. In 72% of the cases, ≥ 2 biopsies were required until the final diagnosis. The median time from symptoms onset to diagnosis was 10.9 months, and most patients (75%) had ≥ 2 organs involved. The following subtypes were identified: AL (68%), ATTR (13%), AA (8%), AFib (4%), and inconclusive (7%). Median OS was 74.3 months in the non-AL subgroup and 18.5 months in AL. Among AL patients, those with advanced cardiac stage had the worst outcome [median OS 8.6 months versus 52.3 for stage III versus I-II, respectively (p < 0.001)]. AL subtype, cardiac involvement, and ECOG ≥ 2 were identified as independent risk factors for reduced survival. CONCLUSIONS Systemic amyloidosis is still an underdiagnosed condition and the delay in its recognition leads to poor outcomes. Medical education, better diagnostic tools, improvement in access to therapies, and establishment of referral centers may improve patient outcomes in middle-income countries.
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Affiliation(s)
- Roberta Shcolnik Szor
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | - Fabio Fernandes
- grid.11899.380000 0004 1937 0722Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Angelina Maria Martins Lino
- grid.11899.380000 0004 1937 0722Divisão de Neurologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Oliveira Mendonça
- grid.11899.380000 0004 1937 0722Departamento de Imunologia Clínica e Alergia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Salles Seguro
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | - Valkercyo Araujo Feitosa
- grid.11899.380000 0004 1937 0722Divisão de Nefrologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Jussara Bianchi Castelli
- grid.11899.380000 0004 1937 0722Laboratório de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil ,grid.466673.6Grupo Fleury, São Paulo, Brazil
| | - Lecticia Barbosa Jorge
- grid.11899.380000 0004 1937 0722Divisão de Nefrologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Lucas Bassolli de Oliveira Alves
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | | | - Evandro de Oliveira Souza
- grid.11899.380000 0004 1937 0722Divisão de Gastroenterologia e Hepatologia Clínica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Livia Barreira Cavalcante
- grid.11899.380000 0004 1937 0722Divisão de Anatomia Patológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Denise Malheiros
- grid.11899.380000 0004 1937 0722Divisão de Anatomia Patológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- grid.11899.380000 0004 1937 0722Departamento de Imunologia Clínica e Alergia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Gracia Aparecida Martinez
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil
| | - Vanderson Rocha
- grid.11899.380000 0004 1937 0722Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP CEP 01246-000 Brazil ,grid.4991.50000 0004 1936 8948Department of Hematology, Churchill Hospital, Oxford University, Oxford, UK
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Mendonça LO, Toledo-Barros MAM, Leal VNC, Roa MEGV, Cambuí RAG, Toledo E, Barros SF, de Oliveira AM, Rivitti-Machado MC, Francescantonio ICM, Grumach AS, de Oliveira Penido N, Castro FFM, Kalil J, Pontillo A. In-vitro NLRP3 functional test assists the diagnosis of cryopyrin-associated periodic syndrome (CAPS) patients: A Brazilian cooperation. Clin Immunol 2022; 245:109159. [DOI: 10.1016/j.clim.2022.109159] [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: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
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Korenblik R, van Zon JFJA, Olij B, Heil J, Dewulf MJL, Neumann UP, Olde Damink SWM, Binkert CA, Schadde E, van der Leij C, van Dam RM, van Baardewijk LJ, Barbier L, Binkert CA, Billingsley K, Björnsson B, Andorrà EC, Arslan B, Baclija I, Bemelmans MHA, Bent C, de Boer MT, Bokkers RPH, de Boo DW, Breen D, Breitenstein S, Bruners P, Cappelli A, Carling U, Robert MCI, Chan B, De Cobelli F, Choi J, Crawford M, Croagh D, van Dam RM, Deprez F, Detry O, Dewulf MJL, Díaz-Nieto R, Dili A, Erdmann JI, Font JC, Davis R, Delle M, Fernando R, Fisher O, Fouraschen SMG, Fretland ÅA, Fundora Y, Gelabert A, Gerard L, Gobardhan P, Gómez F, Guiliante F, Grünberger T, Grochola LF, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess G, Hilal MA, Hoffmann M, Iezzi R, Imani F, Inmutto N, James S, Borobia FJG, Jovine E, Kalil J, Kingham P, Kollmar O, Kleeff J, van der Leij C, Lopez-Ben S, Macdonald A, Meijerink M, Korenblik R, Lapisatepun W, Leclercq WKG, Lindsay R, Lucidi V, Madoff DC, Martel G, Mehrzad H, Menon K, Metrakos P, Modi S, Moelker A, Montanari N, Moragues JS, Navinés-López J, Neumann UP, Nguyen J, Peddu P, Primrose JN, Olde Damink SWM, Qu X, Raptis DA, Ratti F, Ryan S, Ridouani F, Rinkes IHMB, Rogan C, Ronellenfitsch U, Serenari M, Salik A, Sallemi C, Sandström P, Martin ES, Sarría L, Schadde E, Serrablo A, Settmacher U, Smits J, Smits MLJ, Snitzbauer A, Soonawalla Z, Sparrelid E, Spuentrup E, Stavrou GA, Sutcliffe R, Tancredi I, Tasse JC, Teichgräber U, Udupa V, Valenti DA, Vass D, Vogl TJ, Wang X, White S, De Wispelaere JF, Wohlgemuth WA, Yu D, Zijlstra IJAJ. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open 2022; 6:6844022. [PMID: 36437731 PMCID: PMC9702575 DOI: 10.1093/bjsopen/zrac141] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase. RESULTS Eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients). CONCLUSION Based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
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Affiliation(s)
- Remon Korenblik
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
| | - Jasper F J A van Zon
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bram Olij
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,GROW—Department of Surgery, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Heil
- Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maxime J L Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands,Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Aachen, Germany,NUTRIM—Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Christoph A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Erik Schadde
- Department of General, Visceral and Transplant Surgery, Klinik Hirslanden, Zurich, Switzerland,Department of General, Visceral and Transplant Surgery, Hirslanden Klink St. Anna Luzern, Luzern, Switzerland
| | | | - Ronald M van Dam
- Correspondence to: R. K., Universiteigssingel 50 (room 5.452) 6229 ER Maastricht, The Netherlands (e-mail: ); R. M. v. D., Maastricht UMC+, Dept. of Surgery, Level 4, PO Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail: )
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de Castro MV, Silva MVR, Naslavsky MS, Scliar MO, Nunes K, Passos-Bueno MR, Castelli EC, Magawa JY, Adami FL, Moretti AIS, de Oliveira VL, Boscardin SB, Cunha-Neto E, Kalil J, Jouanguy E, Bastard P, Casanova JL, Quiñones-Vega M, Sosa-Acosta P, Guedes JDS, de Almeida NP, Nogueira FCS, Domont GB, Santos KS, Zatz M. The oldest unvaccinated Covid-19 survivors in South America. Immun Ageing 2022; 19:57. [PMID: 36384671 PMCID: PMC9666972 DOI: 10.1186/s12979-022-00310-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although older adults are at a high risk of severe or critical Covid-19, there are many cases of unvaccinated centenarians who had a silent infection or recovered from mild or moderate Covid-19. We studied three Brazilian supercentenarians, older than 110 years, who survived Covid-19 in 2020 before being vaccinated. RESULTS Despite their advanced age, humoral immune response analysis showed that these individuals displayed robust levels of IgG and neutralizing antibodies (NAbs) against SARS-CoV-2. Enrichment of plasma proteins and metabolites related to innate immune response and host defense was also observed. None presented autoantibodies (auto-Abs) to type I interferon (IFN). Furthermore, these supercentenarians do not carry rare variants in genes underlying the known inborn errors of immunity, including particular inborn errors of type I IFN. CONCLUSION These observations suggest that their Covid-19 resilience might be a combination of their genetic background and their innate and adaptive immunity.
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Affiliation(s)
- Mateus V de Castro
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Monize V R Silva
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Michel S Naslavsky
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marilia O Scliar
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Kelly Nunes
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Maria Rita Passos-Bueno
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Erick C Castelli
- Department of Pathology, School of Medicine, UNESP - São Paulo State University, Botucatu, São Paulo, Brazil
| | - Jhosiene Y Magawa
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
- Departamento de Clínica Médica, Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Flávia L Adami
- Laboratory of Antigen Targeting to Dendritic Cells, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana I S Moretti
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Vivian L de Oliveira
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Silvia B Boscardin
- Laboratory of Antigen Targeting to Dendritic Cells, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
- Departamento de Clínica Médica, Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Emmanuelle Jouanguy
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Imagine Institute, University of Paris, Paris, France
| | - Paul Bastard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Necker Hospital for Sick Children, Paris, France
- Imagine Institute, University of Paris, Paris, France
| | - Jean-Laurent Casanova
- Imagine Institute, University of Paris, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Mauricio Quiñones-Vega
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia Sosa-Acosta
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jéssica de S Guedes
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natália P de Almeida
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fábio C S Nogueira
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Proteomics (LabProt), Institute of Chemistry, LADETEC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto B Domont
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Keity S Santos
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia-Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
- Departamento de Clínica Médica, Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, São Paulo, Brazil.
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, São Paulo, Brazil.
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Castelli EC, de Castro MV, Naslavsky MS, Scliar MO, Silva NSB, Pereira RN, Ciriaco VAO, Castro CFB, Mendes-Junior CT, Silveira EDS, de Oliveira IM, Antonio EC, Vieira GF, Meyer D, Nunes K, Matos LRB, Silva MVR, Wang JYT, Esposito J, Cória VR, Magawa JY, Santos KS, Cunha-Neto E, Kalil J, Bortolin RH, Hirata MH, Dell’Aquila LP, Razuk-Filho A, Batista-Júnior PB, Duarte-Neto AN, Dolhnikoff M, Saldiva PHN, Passos-Bueno MR, Zatz M. MUC22, HLA-A, and HLA-DOB variants and COVID-19 in resilient super-agers from Brazil. Front Immunol 2022; 13:975918. [PMID: 36389712 PMCID: PMC9641602 DOI: 10.3389/fimmu.2022.975918] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 06/22/2022] [Accepted: 09/15/2022] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Although aging correlates with a worse prognosis for Covid-19, super elderly still unvaccinated individuals presenting mild or no symptoms have been reported worldwide. Most of the reported genetic variants responsible for increased disease susceptibility are associated with immune response, involving type I IFN immunity and modulation; HLA cluster genes; inflammasome activation; genes of interleukins; and chemokines receptors. On the other hand, little is known about the resistance mechanisms against SARS-CoV-2 infection. Here, we addressed polymorphisms in the MHC region associated with Covid-19 outcome in super elderly resilient patients as compared to younger patients with a severe outcome. METHODS SARS-CoV-2 infection was confirmed by RT-PCR test. Aiming to identify candidate genes associated with host resistance, we investigated 87 individuals older than 90 years who recovered from Covid-19 with mild symptoms or who remained asymptomatic following positive test for SARS-CoV-2 as compared to 55 individuals younger than 60 years who had a severe disease or died due to Covid-19, as well as to the general elderly population from the same city. Whole-exome sequencing and an in-depth analysis of the MHC region was performed. All samples were collected in early 2020 and before the local vaccination programs started. RESULTS We found that the resilient super elderly group displayed a higher frequency of some missense variants in the MUC22 gene (a member of the mucins' family) as one of the strongest signals in the MHC region as compared to the severe Covid-19 group and the general elderly control population. For example, the missense variant rs62399430 at MUC22 is two times more frequent among the resilient super elderly (p = 0.00002, OR = 2.24). CONCLUSION Since the pro-inflammatory basal state in the elderly may enhance the susceptibility to severe Covid-19, we hypothesized that MUC22 might play an important protective role against severe Covid-19, by reducing overactive immune responses in the senior population.
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Affiliation(s)
- Erick C. Castelli
- Department of Pathology, School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
- Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Mateus V. de Castro
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Michel S. Naslavsky
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Marilia O. Scliar
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Nayane S. B. Silva
- Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Raphaela N. Pereira
- Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Viviane A. O. Ciriaco
- Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Camila F. B. Castro
- Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
- Centro Universitário Sudoeste Paulista, Avaré, Brazil
| | - Celso T. Mendes-Junior
- Departamento de Química, Faculdade de Filosofa, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Etiele de S. Silveira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Iuri M. de Oliveira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Eduardo C. Antonio
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gustavo F. Vieira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratório de Saúde Humana In Silico, Programa de Pós-Graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, Brazil
| | - Diogo Meyer
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Kelly Nunes
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Larissa R. B. Matos
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Monize V. R. Silva
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Jaqueline Y. T. Wang
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Joyce Esposito
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Vivian R. Cória
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Jhosiene Y. Magawa
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia, Instituto Nacional de Ciências e Tecnologia-iii (INCT), São Paulo, Brazil
| | - Keity S. Santos
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia, Instituto Nacional de Ciências e Tecnologia-iii (INCT), São Paulo, Brazil
| | - Edecio Cunha-Neto
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia, Instituto Nacional de Ciências e Tecnologia-iii (INCT), São Paulo, Brazil
| | - Jorge Kalil
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia, Instituto Nacional de Ciências e Tecnologia-iii (INCT), São Paulo, Brazil
| | - Raul H. Bortolin
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Mário Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Amaro N. Duarte-Neto
- Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marisa Dolhnikoff
- Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo H. N. Saldiva
- Department of Pathology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Rita Passos-Bueno
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
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Souza BD, Ferreira MA, Kalil J, Giavina-Bianchi P, Agondi RC. Development, validation and application of a questionnaire to qualify the indoor environmental exposure of patients with respiratory allergy. J Asthma 2022; 60:1191-1201. [PMID: 36264019 DOI: 10.1080/02770903.2022.2138432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: Environmental control includes measures to prevent exposure to common aeroallergens in an individual's home. Questionnaires are part of the clinical practice of health assessment, and are also widely used in research. Our aim was to develop and validate a questionnaire to identify possible sources of aeroallergens present in the indoor environment. Methods: This study describes the development, validation and application of a questionnaire. For content validation the Content Validation Index and Ordinal Cronbach's Alpha Index have been used; Polychoric Correlations for the agreement between judges; and an Exploratory Factor Analysis for the structure of the questionnaire, while for reliability assessment, Intraclass Correlation Coefficient has been applied. Results: Twenty-one doctors participated as judges to validate the questionnaire, which 204 patients answered. The Content Validity Index for all the questions on the "Clarity" aspect was 0.846 ± 0.152 and on the "Relevance" aspect, 0.954 ± 0.080. Cronbach's alpha coefficient for the "Clarity" aspect was 0.88 with a 95% confidence intervals (CI) and the "Relevance" aspect, 0.94 with a 95% CI. The average Intraclass Correlation Coefficient was 0.94 and all the F tests were highly significant. Conclusions: The questionnaire developed by our group was considered valid and reliable, and is capable of portraying the home environment without the need for a personal visit to the patient's home. This questionnaire would be a good tool to use in research or during patient consultations to assess the patient's home environment, as this latter assessment is essential for the management of patients with respiratory allergies.
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Affiliation(s)
- Bárbara de Souza
- Clinical Immunology and Allergy Division, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | - Jorge Kalil
- Clinical Immunology and Allergy Division, University of Sao Paulo School of Medicine, São Paulo, Brazil.,Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Rosana Câmara Agondi
- Clinical Immunology and Allergy Division, University of Sao Paulo School of Medicine, São Paulo, Brazil.,Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
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Lima FMS, Toledo-Barros M, Alves VAF, Duarte MIS, Takakura C, Bernardes-Silva CF, Marinho AKBB, Grecco O, Kalil J, Kokron CM. Liver disease accompanied by enteropathy in common variable immunodeficiency: Common pathophysiological mechanisms. Front Immunol 2022; 13:933463. [PMID: 36341360 PMCID: PMC9632424 DOI: 10.3389/fimmu.2022.933463] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/30/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Common variable immunodeficiency (CVID) is one of the inborn errors of immunity that have the greatest clinical impact. Rates of morbidity and mortality are higher in patients with CVID who develop liver disease than in those who do not. The main liver disorder in CVID is nodular regenerative hyperplasia (NRH), the cause of which remains unclear and for which there is as yet no treatment. The etiology of liver disease in CVID is determined by analyzing the liver injury and the associated conditions. The objective of this study was to compare CVID patients with and without liver–spleen axis abnormalities in terms of clinical characteristics, as well as to analyze liver and duodenal biopsies from those with portal hypertension (PH), to elucidate the pathophysiology of liver injury. Patients were divided into three groups: Those with liver disease/PH, those with isolated splenomegaly, and those without liver–spleen axis abnormalities. Clinical and biochemical data were collected. Among 141 CVID patients, 46 (32.6%) had liver disease/PH; 27 (19.1%) had isolated splenomegaly; and 68 (48.2%) had no liver–spleen axis abnormalities. Among the liver disease/PH group, patients, even those with mild or no biochemical changes, had clinical manifestations of PH, mainly splenomegaly, thrombocytopenia, and esophageal varices. Duodenal celiac pattern was found to correlate with PH (p < 0.001). We identified NRH in the livers of all patients with PH (n = 11). Lymphocytic infiltration into the duodenal mucosa also correlated with PH. Electron microscopy of liver biopsy specimens showed varying degrees of lymphocytic infiltration and hepatocyte degeneration, which is a probable mechanism of lymphocyte-mediated cytotoxicity against hepatocytes and enterocytes. In comparison with the CVID patients without PH, those with PH were more likely to have lymphadenopathy (p < 0.001), elevated β2-microglobulin (p < 0.001), low B-lymphocyte counts (p < 0.05), and low natural killer-lymphocyte counts (p < 0.05). In CVID patients, liver disease/PH is common and regular imaging follow-up is necessary. These patients have a distinct immunological phenotype that may predispose to liver and duodenal injury from lymphocyte-mediated cytotoxicity. Further studies could elucidate the cause of this immune-mediated mechanism and its treatment options.
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Affiliation(s)
- Fabiana Mascarenhas Souza Lima
- Division of Clinical Immunology and Allergy, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- *Correspondence: Fabiana Mascarenhas Souza Lima,
| | - Myrthes Toledo-Barros
- Division of Clinical Immunology and Allergy, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Maria Irma Seixas Duarte
- Laboratory of the Discipline of Pathology of Transmissible Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cleusa Takakura
- Laboratory of the Discipline of Pathology of Transmissible Diseases, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Felipe Bernardes-Silva
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Octavio Grecco
- Division of Clinical Immunology and Allergy, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- iii-Institute for Investigation in Immunology, Instituto Nacional de Ciência e Tecnologia (INCT), Sao Paulo, Brazil
| | - Cristina Maria Kokron
- Division of Clinical Immunology and Allergy, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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31
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de Castro MV, Silva MVR, Soares FB, Cória VR, Naslavsky MS, Scliar MO, Castelli EC, de Oliveira JR, Sasahara GL, Santos KS, Cunha-Neto E, Kalil J, Zatz M. Follow-up of young adult monozygotic twins after simultaneous critical coronavirus disease 2019: A case report. Front Med (Lausanne) 2022; 9:1008585. [PMID: 36250103 PMCID: PMC9558815 DOI: 10.3389/fmed.2022.1008585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background The influence of the host genome on coronavirus disease 2019 (COVID-19) susceptibility and severity is supported by reports on monozygotic (MZ) twins where both were infected simultaneously with similar disease outcomes, including several who died due to the SARS-CoV-2 infection within days apart. However, successive exposures to pathogens throughout life along with other environmental factors make the immune response unique for each individual, even among MZ twins. Case presentation and methods Here we report a case of a young adult monozygotic twin pair, who caught attention since both presented simultaneously severe COVID-19 with the need for oxygen support despite age and good health conditions. One of the twins, who spent more time hospitalized, reported symptoms of long-COVID even 7 months after infection. Immune cell profile and specific responses to SARS-CoV-2 were evaluated as well as whole exome sequencing. Conclusion Although the MZ twin brothers shared the same genetic mutations which may be associated with their increased risk of developing severe COVID-19, their clinical progression was different, reinforcing the role of both immune response and genetics in the COVID-19 presentation and course. Besides, post-COVID syndrome was observed in one of them, corroborating an association between the duration of hospitalization and the occurrence of long-COVID symptoms.
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Affiliation(s)
- Mateus V. de Castro
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Monize V. R. Silva
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Flávia B. Soares
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Vivian R. Cória
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Michel S. Naslavsky
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Marilia O. Scliar
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Erick C. Castelli
- Molecular Genetics and Bioinformatics Laboratory, Experimental Research Unit (Unipex), School of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | - Jamile R. de Oliveira
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Greyce L. Sasahara
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
| | - Keity S. Santos
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia—Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia—Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Jorge Kalil
- Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Imunologia, Instituto do Coração (InCor), LIM 19, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, Brazil
- Instituto de Investigação em Imunologia—Instituto Nacional de Ciências e Tecnologia-iii-INCT, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
- Department of Genetics and Evolutionary Biology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
- *Correspondence: Mayana Zatz,
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Brochet P, Ianni B, Nunes JPS, Frade AF, Teixeira PC, Mady C, Ferreira LRP, Kuramoto A, Pissetti CW, Saba B, Cândido DDS, Dias F, Sampaio M, Marin-Neto JA, Fragata A, Zaniratto RC.F, Siqueira S, Peixoto GDL, Rigaud VOC, Buck P, Almeida RR, Lin-Wang HT, Schmidt A, Martinelli M, Hirata MH, Donadi E, Rodrigues Junior V, Pereira AC, Kalil J, Spinelli L, Cunha-Neto E, Chevillard C. Blood DNA methylation marks discriminate Chagas cardiomyopathy disease clinical forms. Front Immunol 2022; 13:1020572. [PMID: 36248819 PMCID: PMC9558220 DOI: 10.3389/fimmu.2022.1020572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
Chagas disease is a parasitic disease from South America, affecting around 7 million people worldwide. Decades after the infection, 30% of people develop chronic forms, including Chronic Chagas Cardiomyopathy (CCC), for which no treatment exists. Two stages characterized this form: the moderate form, characterized by a heart ejection fraction (EF) ≥ 0.4, and the severe form, associated to an EF < 0.4. We propose two sets of DNA methylation biomarkers which can predict in blood CCC occurrence, and CCC stage. This analysis, based on machine learning algorithms, makes predictions with more than 95% accuracy in a test cohort. Beyond their predictive capacity, these CpGs are located near genes involved in the immune response, the nervous system, ion transport or ATP synthesis, pathways known to be deregulated in CCCs. Among these genes, some are also differentially expressed in heart tissues. Interestingly, the CpGs of interest are tagged to genes mainly involved in nervous and ionic processes. Given the close link between methylation and gene expression, these lists of CpGs promise to be not only good biomarkers, but also good indicators of key elements in the development of this pathology.
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Affiliation(s)
- Pauline Brochet
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Barbara Ianni
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - João P. S. Nunes
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Amanda F. Frade
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Priscila C. Teixeira
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Charles Mady
- Myocardiopathies and Aortic Diseases Unit, Heart Institute, Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ludmila R. P. Ferreira
- RNA Systems Biology Laboratory (RSBL), Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andreia Kuramoto
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Cristina W. Pissetti
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Bruno Saba
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Darlan D. S. Cândido
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Fabrício Dias
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Sampaio
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - José A. Marin-Neto
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Abílio Fragata
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Ricardo C .F. Zaniratto
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sergio Siqueira
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Giselle D. L. Peixoto
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vagner O. C. Rigaud
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paula Buck
- Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rafael R. Almeida
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - André Schmidt
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Martino Martinelli
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mario H. Hirata
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Eduardo Donadi
- School of Medicine of Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | | | - Alexandre C. Pereira
- Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Lionel Spinelli
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute Instituto do Coração(InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Christophe Chevillard
- Aix Marseille Univ, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
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Agondi RC, Menechino N, Marinho AKBB, Kalil J, Giavina-Bianchi P. Worsening of asthma control after COVID-19. Front Med (Lausanne) 2022; 9:882665. [PMID: 36186769 PMCID: PMC9524244 DOI: 10.3389/fmed.2022.882665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 02/26/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSARS-CoV-2 enters lung cells via angiotensin-converting enzyme 2 (ACE2) receptor. Several studies suggest that interleukin-13, an important cytokine involved in T2 inflammation, reduces ACE2 expression, and therefore, asthma would not be a significant risk factor for the development of severe COVID-19. However, several asthma-related risk factors should be valued during the concurrent occurrence of asthma and COVID-19. The purpose of this study was to compare the evolution of asthma in patients who had COVID-19 with those who did not have the disease.MethodsThis was an observational and retrospective study involving asthmatic patients followed up at a tertiary center. Patients were assessed for severity of asthma, atopy, comorbidities, and COVID-19. Worsening of asthma was considered when, during the period of Sept 2020 to Oct 2021, patients referred an increasing of asthma symptoms and a need to increment their maintenance therapy.ResultsThis study included 208 asthmatic patients, the mean age was 52.75 years, 79.81% were atopic asthmatics, and 59 (28.37%) had laboratory-confirmed coronavirus disease. Of all patients infected with the SARS-CoV-2, eleven (18.64%) needed hospitalization and required oxygen supply with an O2 mask. Comparing the worsening of asthma between patients who had COVID-19 and those who had not the disease, there was a statistically significant difference, 33.90 vs. 11.41%, respectively (p < 0.001). There was no statistical significance regarding asthma comorbidities.ConclusionThis study assessed a group of asthmatic patients that had COVID-19, and that although the respiratory symptoms related to COVID-19 were mild to moderate, a subgroup of these asthmatic patients evolved with a chronic worsening of their asthma requiring an increment in asthma medication to control the disease.
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Affiliation(s)
- Rosana Câmara Agondi
- Clinical Immunology and Allergy Division, Department of Medical Clinic, School of Medicine, University of São Pãulo, São Paulo, Brazil
- Laboratory of Immunology (LIM19), School of Medicine, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
- *Correspondence: Rosana Câmara Agondi
| | - Natália Menechino
- Clinical Immunology and Allergy Division, Department of Medical Clinic, School of Medicine, University of São Pãulo, São Paulo, Brazil
| | | | - Jorge Kalil
- Clinical Immunology and Allergy Division, Department of Medical Clinic, School of Medicine, University of São Pãulo, São Paulo, Brazil
- Laboratory of Immunology (LIM19), School of Medicine, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, Department of Medical Clinic, School of Medicine, University of São Pãulo, São Paulo, Brazil
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34
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Brochet P, Ianni BM, Laugier L, Frade AF, Silva Nunes JP, Teixeira PC, Mady C, Ferreira LRP, Ferré Q, Santos RHB, Kuramoto A, Cabantous S, Steffen S, Stolf AN, Pomerantzeff P, Fiorelli AI, Bocchi EA, Pissetti CW, Saba B, Cândido DDS, Dias FC, Sampaio MF, Gaiotto FA, Marin-Neto JA, Fragata A, Zaniratto RCF, Siqueira S, Peixoto GDL, Rigaud VOC, Bacal F, Buck P, Almeida RR, Lin-Wang HT, Schmidt A, Martinelli M, Hirata MH, Donadi EA, Costa Pereira A, Rodrigues Junior V, Puthier D, Kalil J, Spinelli L, Cunha-Neto E, Chevillard C. Epigenetic regulation of transcription factor binding motifs promotes Th1 response in Chagas disease cardiomyopathy. Front Immunol 2022; 13:958200. [PMID: 36072583 PMCID: PMC9441916 DOI: 10.3389/fimmu.2022.958200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023] Open
Abstract
Chagas disease, caused by the protozoan Trypanosoma cruzi, is an endemic parasitic disease of Latin America, affecting 7 million people. Although most patients are asymptomatic, 30% develop complications, including the often-fatal Chronic Chagasic Cardiomyopathy (CCC). Although previous studies have demonstrated some genetic deregulations associated with CCCs, the causes of their deregulations remain poorly described. Based on bulk RNA-seq and whole genome DNA methylation data, we investigated the genetic and epigenetic deregulations present in the moderate and severe stages of CCC. Analysis of heart tissue gene expression profile allowed us to identify 1407 differentially expressed transcripts (DEGs) specific from CCC patients. A tissue DNA methylation analysis done on the same tissue has permitted the identification of 92 regulatory Differentially Methylated Regions (DMR) localized in the promoter of DEGs. An in-depth study of the transcription factors binding sites (TFBS) in the DMRs corroborated the importance of TFBS’s DNA methylation for gene expression in CCC myocardium. TBX21, RUNX3 and EBF1 are the transcription factors whose binding motif appears to be affected by DNA methylation in the largest number of genes. By combining both transcriptomic and methylomic analysis on heart tissue, and methylomic analysis on blood, 4 biological processes affected by severe CCC have been identified, including immune response, ion transport, cardiac muscle processes and nervous system. An additional study on blood methylation of moderate CCC samples put forward the importance of ion transport and nervous system in the development of the disease.
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Affiliation(s)
- Pauline Brochet
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Barbara Maria Ianni
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Laurie Laugier
- Aix Marseille Université, Génétique et Immunologie des Maladies Parasitaires, Inserm, UMR_906, Marseille, France
| | - Amanda Farage Frade
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - João Paulo Silva Nunes
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Priscila Camillo Teixeira
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Charles Mady
- Myocardiopathies and Aortic Diseases Unit, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ludmila Rodrigues Pinto Ferreira
- RNA Systems Biology Laboratory (RSBL), Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Quentin Ferré
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Ronaldo Honorato Barros Santos
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Andreia Kuramoto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Sandrine Cabantous
- Aix Marseille Université, Génétique et Immunologie des Maladies Parasitaires, Inserm, UMR_906, Marseille, France
| | - Samuel Steffen
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Antonio Noedir Stolf
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Pablo Pomerantzeff
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Alfredo Inacio Fiorelli
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Cristina Wide Pissetti
- Laboratory of Immunology, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Bruno Saba
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Darlan da Silva Cândido
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Fabrício C. Dias
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Marcelo Ferraz Sampaio
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Fabio Antônio Gaiotto
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Surgery, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - José Antonio Marin-Neto
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Abílio Fragata
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - Ricardo Costa Fernandes Zaniratto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Sergio Siqueira
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Giselle De Lima Peixoto
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vagner Oliveira-Carvalho Rigaud
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Heart Failure Unit, Heart Institute Instituto do Coração (InCor) School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando Bacal
- Division of Transplantation, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Paula Buck
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rafael Ribeiro Almeida
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Hui Tzu Lin-Wang
- Laboratório de Investigação Molecular em Cardiologia, Instituto de Cardiologia Dante Pazzanese (IDPC), São Paulo, Brazil
| | - André Schmidt
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Martino Martinelli
- Pacemaker Clinic, Heart Institute Instituto do Coração (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), São Paulo, Brazil
| | - Eduardo Antonio Donadi
- School of Medicine of Ribeirão Preto Faculdade de Medicina de Ribeirão Preto (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Costa Pereira
- Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Denis Puthier
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Lionel Spinelli
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- Aix Marseille Université, CNRS, INSERM, Centre d'Immunologie de Marseille-Luminy, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute Instituto do Coração (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia, INCT, III- Institute for Investigation in Immunology, São Paulo, Brazil
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Christophe Chevillard, ; Edecio Cunha-Neto, ; Lionel Spinelli,
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Fernandes ER, de Souza Apostolico J, Jacintho LC, Carnevale Marin ML, Vieira da Silva Júnior RC, Rodrigues H, Santos KS, Coelho V, Boscardin SB, Kalil J, Cunha-Neto E, Rosa DS. Time-dependent contraction of the SARS-CoV-2–specific T-cell responses in convalescent individuals. Journal of Allergy and Clinical Immunology: Global 2022; 1:112-121. [PMID: 36203479 PMCID: PMC9170273 DOI: 10.1016/j.jacig.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 12/03/2022]
Abstract
Background Adaptive immunity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is decisive for disease control. Delayed activation of T cells is associated with a worse outcome in coronavirus disease 2019 (COVID-19). Although convalescent individuals exhibit solid T-cell immunity, to date, long-term immunity to SARS-CoV-2 is still under investigation. Objectives We aimed to characterize the specific T-cell response on the basis of the in vitro recall of IFN-γ–producing cells to in silico–predicted peptides in samples from SARS-CoV-2 convalescent individuals. Methods The sequence of the SARS-CoV-2 genome was screened, leading to the identification of specific and promiscuous peptides predicted to be recognized by CD4+ and CD8+ T cells. Next, we performed an in vitro recall of specific T cells from PBMC samples from the participants. The results were analyzed according to clinical features of the cohort and HLA diversity. Results Our results indicated heterogeneous T-cell responsiveness among the participants. Compared with patients who exhibited mild symptoms, hospitalized patients had a significantly higher magnitude of response. In addition, male and older patients showed a lower number of IFN-γ–producing cells. Analysis of samples collected after 180 days revealed a reduction in the number of specific circulating IFN-γ–producing T cells, suggesting decreased immunity against viral peptides. Conclusion Our data are evidence that in silico–predicted peptides are highly recognized by T cells from convalescent individuals, suggesting a possible application for vaccine design. However, the number of specific T cells decreases 180 days after infection, which might be associated with reduced protection against reinfection over time.
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De Campos L, Giavina-Bianchi P, Acharya S, Lynch DM, Kalil J, Castells MC. Basophil Activation Test as a Biomarker for Taxanes Anaphylaxis. Front Allergy 2022; 3:787749. [PMID: 35910859 PMCID: PMC9328177 DOI: 10.3389/falgy.2022.787749] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Taxanes are widely used chemotherapy agents, and their administration, despite premedication, is associated with hypersensitivity reactions (HR) in up to 9% of patients, 1% of which are severe. The mechanisms of these reactions are not fully understood. Finding biomarkers for early diagnosis and better understanding the underlying mechanisms of these reactions are key to defining the best treatment strategy for patients. Methods The purpose of this study was to evaluate the effectiveness of the basophil activation test (BAT) to diagnose patients with anaphylactic reactions to taxanes. Patients with anaphylaxis to taxane compounds (n = 15) were assessed through clinical history, skin testing (when possible), and BAT. BAT was performed immediately before rapid drug desensitization or before skin testing using anti-CD123 conjugated (APC-Biolegend), anti-HLADR conjugated (FITC-Biolegend) to gate Basophils and anti-CD63 conjugated (PE-Biolegend), and anti-CD203c conjugated (BV-Biolegend) to assess CD203c and CD63 expression on basophils under taxane stimulation. BAT was also performed in eight healthy volunteers. Results BAT was positive for CD203c in eight out of 15 patients and for CD63 in four out of 15 patients and in two out of eight controls. The sensitivity for CD203c was 53%, the specificity was 87%, and the area under the curve was 0.66 (p = 0.19%). For CD63, these rates were 33%, 87%, and 0.6 (p = 0.4). In a subgroup analysis of patients with positive skin tests (11 patients), CD203c was positive in six patients (sensitivity of 54.5% and specificity of 87.5%), and CD63 was positive in five patients (sensitivity of 45% and specificity of 75%). Conclusions BAT as a diagnostic tool for immediate hypersensitivity reactions to taxanes may be relevant in patients with selected phenotypes and endotypes, especially those with severe reactions or when the diagnosis cannot be established by the skin test. Increased expression of CD203c was more frequent than of CD63 in patients with positive results, and the sensitivity of this biomarker was higher in patient sub-group with positive skin tests, i.e., patients with IgE-mediated endotypes.
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Affiliation(s)
- Lucila De Campos
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA, United States
- *Correspondence: Lucila De Campos
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Shree Acharya
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA, United States
| | - Donna-Marie Lynch
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA, United States
| | - Jorge Kalil
- Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
| | - Mariana C. Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA, United States
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Silveira CGT, Magnani DM, Costa PR, Avelino-Silva VI, Ricciardi MJ, Timenetsky MDCST, Goulart R, Correia CA, Marmorato MP, Ferrari L, Nakagawa ZB, Tomiyama C, Tomiyama H, Kalil J, Palacios R, Precioso AR, Watkins DI, Kallás EG. Plasmablast Expansion Following the Tetravalent, Live-Attenuated Dengue Vaccine Butantan-DV in DENV-Naïve and DENV-Exposed Individuals in a Brazilian Cohort. Front Immunol 2022; 13:908398. [PMID: 35837409 PMCID: PMC9274664 DOI: 10.3389/fimmu.2022.908398] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
An effective vaccine against the dengue virus (DENV) should induce a balanced, long-lasting antibody (Ab) response against all four viral serotypes. The burst of plasmablasts in the peripheral blood after vaccination may reflect enriched vaccine-specific Ab secreting cells. Here we characterize the acute plasmablast responses from naïve and DENV-exposed individuals following immunization with the live attenuated tetravalent (LAT) Butantan DENV vaccine (Butantan-DV). The frequency of circulating plasmablasts was determined by flow cytometric analysis of fresh whole blood specimens collected from 40 participants enrolled in the Phase II Butantan-DV clinical trial (NCT01696422) before and after (days 6, 12, 15 and 22) vaccination. We observed a peak in the number of circulating plasmablast at day 15 after vaccination in both the DENV naïve and the DENV-exposed vaccinees. DENV-exposed vaccinees experienced a significantly higher plasmablast expansion. In the DENV-naïve vaccinees, plasmablasts persisted for approximately three weeks longer than among DENV-exposed volunteers. Our findings indicate that the Butantan-DV can induce plasmablast responses in both DENV-naïve and DENV-exposed individuals and demonstrate the influence of pre-existing DENV immunity on Butantan DV-induced B-cell responses.
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Affiliation(s)
- Cássia G. T. Silveira
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Diogo M. Magnani
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Priscilla R. Costa
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vivian I. Avelino-Silva
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Michael J. Ricciardi
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Raphaella Goulart
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carolina A. Correia
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mariana P. Marmorato
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lilian Ferrari
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Zelinda B. Nakagawa
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Claudia Tomiyama
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Helena Tomiyama
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Palacios
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Alexander R. Precioso
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
- Pediatrics Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - David I. Watkins
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Esper G. Kallás
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
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Diethelm-Varela B, Reyes A, Rosenstein Y, Kalil J, Hill M, Docena G, Anegon I, González PA, Kalergis AM. Federation of Clinical Immunology Societies Goes South 2021: advanced course on molecular and cellular translational immunology. Immunotherapy 2022; 14:839-842. [PMID: 35757836 DOI: 10.2217/imt-2022-0075] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Federation of Clinical Immunology Societies (FOCIS) regularly organizes scientific meetings to foster advances in immunology. A new event of this type is FOCIS Goes South, a course and workshop organized by FOCIS Centers of Excellence (FCEs) from across Latin America, which consists of a course on advanced immunology, a flow cytometry workshop and seminars on cutting-edge research in autoimmunity, tolerance, cancer, infectious diseases and vaccines. Due to the COVID-19 pandemic, the second version of FOCIS Goes South, hosted by the Millennium Institute on Immunology and Immunotherapy in Chile, took place virtually from 15 to 18 November 2021, with more than 950 registered participants. The present article summarizes the key findings and insights discussed at FOCIS Goes South 2021.
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Affiliation(s)
- Benjamin Diethelm-Varela
- Millennium Institute on Immunology & Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Reyes
- Millennium Institute on Immunology & Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yvonne Rosenstein
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jorge Kalil
- Laboratory of Clinical Immunology & Allergy-LIM60/University of São Paulo School of Medicine, São Paulo, Brazil; Institute for Investigation in Immunology-iii-INCT, São Paulo, Brazil; Laboratory of Immunology, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marcelo Hill
- Laboratory of Immunoregulation & Inflammation, Institut Pasteur de Montevideo, Montevideo, Uruguay; Immunobiology Department, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Guillermo Docena
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), CONICET; Universidad Nacional de La Plata, La Plata, Argentina
| | - Ignacio Anegon
- INSERM, UMR 1064- Center for Research in Transplantation & Immunology, Université de Nantes, Nantes, France
| | - Pablo A González
- Millennium Institute on Immunology & Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology & Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Endocrinología, Facultad de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Carvalho-Silva AC, Da Silva Junior AR, Rigaud VOC, Martins WK, Coelho V, Pfrimer IAH, Kalil J, Fonseca SG, Cunha-Neto E, Ferreira LRP. A Major Downregulation of Circulating microRNAs in Zika Acutely Infected Patients: Potential Implications in Innate and Adaptive Immune Response Signaling Pathways. Front Genet 2022; 13:857728. [PMID: 35719399 PMCID: PMC9199004 DOI: 10.3389/fgene.2022.857728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022] Open
Abstract
Zika virus (ZIKV) is an arbovirus mainly transmitted by mosquitos of the genus Aedes. The first cases of ZIKV infection in South America occurred in Brazil in 2015. The infection in humans causes diverse symptoms from asymptomatic to a syndrome-like dengue infection with fever, arthralgia, and myalgia. Furthermore, ZIKV infection during pregnancy is associated with fetal microcephaly and neurological disorders. The identification of host molecular mechanisms responsible for the modulation of different signaling pathways in response to ZIKV is the first step to finding potential biomarkers and therapeutic targets and understanding disease outcomes. In the last decade, it has been shown that microRNAs (miRNAs) are important post-transcriptional regulators involved in virtually all cellular processes. miRNAs present in body fluids can not only serve as key biomarkers for diagnostics and prognosis of human disorders but also contribute to cellular signaling offering new insights into pathological mechanisms. Here, we describe for the first time ZIKV-induced changes in miRNA plasma levels in patients during the acute and recovery phases of infection. We observed that during ZIKV acute infection, among the dysregulated miRNAs (DMs), the majority is with decreased levels when compared to convalescent and control patients. We used systems biology tools to build and highlight biological interactions between miRNAs and their multiple direct and indirect target molecules. Among the 24 DMs identified in ZIKV + patients, miR-146, miR-125a-5p, miR-30-5p, and miR-142-3p were related to signaling pathways modulated during infection and immune response. The results presented here are an effort to open new vistas for the key roles of miRNAs during ZIKV infection.
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Affiliation(s)
- Ana Carolina Carvalho-Silva
- RNA Systems Biology Laboratory (RSBL), Departmento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Programa de Pós-Graduação em Biologia Celular, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Almir Ribeiro Da Silva Junior
- Laboratory of Immunology, Heart Institute (InCor) School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology, iii-INCT (National Institute of Science and Technology), São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Waleska Kerllen Martins
- Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
- Universidade Anhanguera, São Paulo, Brazil
| | - Verônica Coelho
- Laboratory of Immunology, Heart Institute (InCor) School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology, iii-INCT (National Institute of Science and Technology), São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Jorge Kalil
- Laboratory of Immunology, Heart Institute (InCor) School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology, iii-INCT (National Institute of Science and Technology), São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Simone Gonçalves Fonseca
- Institute for Investigation in Immunology, iii-INCT (National Institute of Science and Technology), São Paulo, Brazil
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor) School of Medicine, University of São Paulo, São Paulo, Brazil
- Institute for Investigation in Immunology, iii-INCT (National Institute of Science and Technology), São Paulo, Brazil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ludmila Rodrigues Pinto Ferreira
- National Institute of Science and Technology for Vaccines (INCTV), Belo Horizonte, Brazil
- Centro de Tecnologia de Vacinas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- *Correspondence: Ludmila Rodrigues Pinto Ferreira,
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de Freitas FA, Levy D, Reichert CO, Cunha-Neto E, Kalil J, Bydlowski SP. Effects of Oxysterols on Immune Cells and Related Diseases. Cells 2022; 11:cells11081251. [PMID: 35455931 PMCID: PMC9031443 DOI: 10.3390/cells11081251] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 03/13/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022] Open
Abstract
Oxysterols are the products of cholesterol oxidation. They have a wide range of effects on several cells, organs, and systems in the body. Oxysterols also have an influence on the physiology of the immune system, from immune cell maturation and migration to innate and humoral immune responses. In this regard, oxysterols have been involved in several diseases that have an immune component, from autoimmune and neurodegenerative diseases to inflammatory diseases, atherosclerosis, and cancer. Here, we review data on the participation of oxysterols, mainly 25-hydroxycholesterol and 7α,25-dihydroxycholesterol, in the immune system and related diseases. The effects of these oxysterols and main oxysterol receptors, LXR and EBI2, in cells of the immune system (B cells, T cells, macrophages, dendritic cells, oligodendrocytes, and astrocytes), and in immune-related diseases, such as neurodegenerative diseases, intestinal diseases, cancer, respiratory diseases, and atherosclerosis, are discussed.
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Affiliation(s)
- Fábio Alessandro de Freitas
- Lipids, Oxidation and Cell Biology Team, Laboratory of Immunology (LIM19), Heart Institute (InCor), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, SP, Brazil; (F.A.d.F.); (D.L.); (C.O.R.)
| | - Débora Levy
- Lipids, Oxidation and Cell Biology Team, Laboratory of Immunology (LIM19), Heart Institute (InCor), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, SP, Brazil; (F.A.d.F.); (D.L.); (C.O.R.)
| | - Cadiele Oliana Reichert
- Lipids, Oxidation and Cell Biology Team, Laboratory of Immunology (LIM19), Heart Institute (InCor), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, SP, Brazil; (F.A.d.F.); (D.L.); (C.O.R.)
| | - Edecio Cunha-Neto
- Laboratory of Clinical Immunology and Allergy (LIM60), Heart Institute (InCor), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, SP, Brazil;
- National Institute of Science and Technology for Investigation in Immunology-III/INCT, Sao Paulo 05403-000, SP, Brazil;
| | - Jorge Kalil
- National Institute of Science and Technology for Investigation in Immunology-III/INCT, Sao Paulo 05403-000, SP, Brazil;
- Laboratory of Immunology (LIM19), Heart Institute (InCor), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, SP, Brazil
| | - Sérgio Paulo Bydlowski
- Lipids, Oxidation and Cell Biology Team, Laboratory of Immunology (LIM19), Heart Institute (InCor), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, SP, Brazil; (F.A.d.F.); (D.L.); (C.O.R.)
- National Institute of Science and Technology in Regenerative Medicine (INCT-Regenera), CNPq, Rio de Janeiro 21941-902, RJ, Brazil
- Correspondence:
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41
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Medeiros GX, Sasahara GL, Magawa JY, Nunes JPS, Bruno FR, Kuramoto AC, Almeida RR, Ferreira MA, Scagion GP, Candido ÉD, Leal FB, Oliveira DBL, Durigon EL, Silva RCV, Rosa DS, Boscardin SB, Coelho V, Kalil J, Santos KS, Cunha-Neto E. Reduced T Cell and Antibody Responses to Inactivated Coronavirus Vaccine Among Individuals Above 55 Years Old. Front Immunol 2022; 13:812126. [PMID: 35300337 PMCID: PMC8921991 DOI: 10.3389/fimmu.2022.812126] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/09/2021] [Accepted: 02/04/2022] [Indexed: 12/26/2022] Open
Abstract
CoronaVac is an inactivated SARS-CoV-2 vaccine that has been rolled out in several low and middle-income countries including Brazil, where it was the mainstay of the first wave of immunization of healthcare workers and the elderly population. We aimed to assess the T cell and antibody responses of vaccinated individuals as compared to convalescent patients. We detected IgG against SARS-CoV-2 antigens, neutralizing antibodies against the reference Wuhan SARS-CoV-2 strain and used SARS-CoV-2 peptides to detect IFN-g and IL-2 specific T cell responses in a group of CoronaVac vaccinated individuals (N = 101) and convalescent (N = 72) individuals. The frequency among vaccinated individuals, of whom 96% displayed T cell and/or antibody responses to SARS-CoV-2, is comparable to 98.5% responses of convalescent individuals. We observed that among vaccinated individuals, men and individuals 55 years or older developed significantly lower anti-RBD, anti-NP and neutralization titers against the Wuhan strain and antigen-induced IL-2 production by T cells. Neutralizing antibody responses for Gamma variant were even lower than for the Wuhan strain. Even though some studies indicated CoronaVac helped reduce mortality among elderly people, considering the appearance of novel variants of concern, CoronaVac vaccinated individuals above 55 years old are likely to benefit from a heterologous third dose/booster vaccine to increase immune response and likely protection.
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Affiliation(s)
- Giuliana X Medeiros
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Greyce Luri Sasahara
- Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Jhosiene Y Magawa
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - João Paulo S Nunes
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Fernanda R Bruno
- Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Andreia C Kuramoto
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Rafael R Almeida
- Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Marcelo A Ferreira
- Laboratório de Biologia Celular, LIM59, Departamento de Patologia da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme P Scagion
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Érika D Candido
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Fabyano B Leal
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Danielle B L Oliveira
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil.,Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Edison L Durigon
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Virologia, Plataforma Científica Pasteur da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Carlos V Silva
- Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Daniela S Rosa
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, Brazil.,Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciências e Tecnologia (INCT), São Paulo, Brazil
| | - Silvia B Boscardin
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil.,Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciências e Tecnologia (INCT), São Paulo, Brazil
| | - Verônica Coelho
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.,Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciências e Tecnologia (INCT), São Paulo, Brazil
| | - Jorge Kalil
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.,Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciências e Tecnologia (INCT), São Paulo, Brazil
| | - Keity S Santos
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.,Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciências e Tecnologia (INCT), São Paulo, Brazil
| | - Edecio Cunha-Neto
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Disciplina de Alergia e Imunologia Clínica, São Paulo, Brazil.,Laboratório de Imunologia, Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.,Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciências e Tecnologia (INCT), São Paulo, Brazil
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42
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Baron MA, Ferreira LRP, Teixeira PC, Moretti AIS, Santos RHB, Frade AF, Kuramoto A, Debbas V, Benvenuti LA, Gaiotto FA, Bacal F, Pomerantzeff P, Chevillard C, Kalil J, Cunha-Neto E. Matrix Metalloproteinase 2 and 9 Enzymatic Activities are Selectively Increased in the Myocardium of Chronic Chagas Disease Cardiomyopathy Patients: Role of TIMPs. Front Cell Infect Microbiol 2022; 12:836242. [PMID: 35372112 PMCID: PMC8968914 DOI: 10.3389/fcimb.2022.836242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic Chagas disease (CCC) is an inflammatory dilated cardiomyopathy with a worse prognosis compared to other cardiomyopathies. We show the expression and activity of Matrix Metalloproteinases (MMP) and of their inhibitors TIMP (tissue inhibitor of metalloproteinases) in myocardial samples of end stage CCC, idiopathic dilated cardiomyopathy (DCM) patients, and from organ donors. Our results showed significantly increased mRNA expression of several MMPs, several TIMPs and EMMPRIN in CCC and DCM samples. MMP-2 and TIMP-2 protein levels were significantly elevated in both sample groups, while MMP-9 protein level was exclusively increased in CCC. MMPs 2 and 9 activities were also exclusively increased in CCC. Results suggest that the balance between proteins that inhibit the MMP-2 and 9 is shifted toward their activation. Inflammation-induced increases in MMP-2 and 9 activity and expression associated with imbalanced TIMP regulation could be related to a more extensive heart remodeling and poorer prognosis in CCC patients.
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Affiliation(s)
- Monique Andrade Baron
- Laboratory of Immunology, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology, Institutos Nacionais de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Ludmila Rodrigues Pinto Ferreira
- Laboratory of Immunology, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology, Institutos Nacionais de Ciência e Tecnologia (INCT), São Paulo, Brazil
- Department of Bioengineering, Universidade Santo Amaro, São Paulo, Brazil
| | - Priscila Camillo Teixeira
- Laboratory of Immunology, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology, Institutos Nacionais de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Ana Iochabel Soares Moretti
- Vascular Biology Laboratory, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | | | - Amanda Farage Frade
- Laboratory of Immunology, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology, Institutos Nacionais de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Andréia Kuramoto
- Laboratory of Immunology, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology, Institutos Nacionais de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Victor Debbas
- Department of Bioengineering, Universidade Santo Amaro, São Paulo, Brazil
| | - Luiz Alberto Benvenuti
- Division of Transplantation, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Fabio Antônio Gaiotto
- Vascular Biology Laboratory, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Fernando Bacal
- Vascular Biology Laboratory, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Pablo Pomerantzeff
- Vascular Biology Laboratory, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Christophe Chevillard
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
- *Correspondence: Edecio Cunha-Neto, ; Christophe Chevillard,
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology, Institutos Nacionais de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Division of Clinical Immunology and Allergy, University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Investigation in Immunology, Institutos Nacionais de Ciência e Tecnologia (INCT), São Paulo, Brazil
- *Correspondence: Edecio Cunha-Neto, ; Christophe Chevillard,
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43
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Vieira RDS, Nascimento MS, Noronha IH, Vasconcelos JRC, Benvenuti LA, Barber GN, Câmara NOS, Kalil J, Cunha-Neto E, Almeida RR. STING Signaling Drives Production of Innate Cytokines, Generation of CD8 + T Cells and Enhanced Protection Against Trypanosoma cruzi Infection. Front Immunol 2022; 12:775346. [PMID: 35095849 PMCID: PMC8795786 DOI: 10.3389/fimmu.2021.775346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/13/2021] [Accepted: 12/16/2021] [Indexed: 12/22/2022] Open
Abstract
A variety of signaling pathways are involved in the induction of innate cytokines and CD8+ T cells, which are major players in protection against acute Trypanosoma cruzi infection. Previous data have demonstrated that a TBK-1/IRF3-dependent signaling pathway promotes IFN-β production in response to Trypanosoma cruzi, but the role for STING, a main interactor of these proteins, remained to be addressed. Here, we demonstrated that STING signaling is required for production of IFN-β, IL-6, and IL-12 in response to Trypanosoma cruzi infection and that STING absence negatively impacts activation of IRF-dependent pathways in response to the parasite. We reported no significant activation of IRF-dependent pathways and cytokine expression in RAW264.7 macrophages in response to heat-killed trypomastigotes. In addition, we showed that STING is essential for T. cruzi DNA-mediated induction of IFN-β, IL-6, and IL-12 gene expression in RAW264.7 macrophages. We demonstrated that STING-knockout mice have significantly higher parasitemia from days 5 to 8 of infection and higher heart parasitism at day 13 after infection. Although we observed similar heart inflammatory infiltrates at day 13 after infection, IFN-β, IL-12, CXCL9, IFN-γ, and perforin gene expression were lower in the absence of STING. We also showed an inverse correlation between parasite DNA and the expression of CXCL9, IFN-γ, and perforin genes in the hearts of infected animals at day 13 after infection. Finally, we reported that STING signaling is required for splenic IFN-β and IL-6 expression early after infection and that STING deficiency results in lower numbers of splenic parasite-specific IFN-γ and IFN-γ/perforin-producing CD8+ T cells, indicating a pivotal role for STING signaling in immunity to Trypanosoma cruzi.
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Affiliation(s)
- Raquel de Souza Vieira
- Laboratório de Imunologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marilda Savoia Nascimento
- Laboratório de Imunologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isaú Henrique Noronha
- Laboratório de Vacinas Recombinantes, Departamento de Biociências, Universidade Federal de São Paulo, Santos, Brazil
| | | | - Luiz Alberto Benvenuti
- Divisão de Patologia, Instituto do Coração (INCOR), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Glen N Barber
- Department of Cell Biology, University of Miami, Miami, FL, United States
| | - Niels Olsen Saraiva Câmara
- Laboratório de Imunologia Experimental e Clínica, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Laboratório de Imunologia de Transplantes, Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Laboratório de Imunologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto de Investigação em Imunologia (III), Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Edecio Cunha-Neto
- Laboratório de Imunologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Disciplina de Imunologia Clínica e Alergia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto de Investigação em Imunologia (III), Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Rafael Ribeiro Almeida
- Laboratório de Imunologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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44
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de Castro MV, Santos KS, Apostolico JS, Fernandes ER, Almeida RR, Levin G, Magawa JY, Nunes JPS, Bruni M, Yamamoto MM, Lima AC, Silva MVR, Matos LRB, Coria VR, Castelli EC, Scliar MO, Kuramoto A, Bruno FR, Jacintho LC, Nunes K, Wang JYT, Coelho VP, Neto MM, Maciel RMB, Naslavsky MS, Passos-Bueno MR, Boscardin SB, Rosa DS, Kalil J, Zatz M, Cunha-Neto E. Recurrence of COVID-19 associated with reduced T-cell responses in a monozygotic twin pair. Open Biol 2022; 12:210240. [PMID: 35104433 PMCID: PMC8807054 DOI: 10.1098/rsob.210240] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Recurrence of COVID-19 in recovered patients has been increasingly reported. However, the immune mechanisms behind the recurrence have not been thoroughly investigated. The presence of neutralizing antibodies (nAbs) in recurrence/reinfection cases suggests that other types of immune response are involved in protection against recurrence. Here, we investigated the innate type I/III interferon (IFN) response, binding and nAb assays and T-cell responses to severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) with IFN gamma (IFNγ) enzyme-linked spot assay (ELISPOT) in three pairs of young adult monozygotic (MZ) twins with previous confirmed COVID-19, one of them presenting a severe recurrence four months after the initial infection. Twin studies have been of paramount importance to comprehend the immunogenetics of infectious diseases. Each MZ twin pair was previously exposed to SARS-CoV-2, as seen by clinical reports. The six individuals presented similar overall recovered immune responses except for the recurrence case, who presented a drastically reduced number of recognized SARS-CoV-2 T-cell epitopes on ELISPOT as compared to her twin sister and the other twin pairs. Our results suggest that the lack of a broad T-cell response to initial infection may have led to recurrence, emphasizing that an effective SARS-CoV-2-specific T-cell immune response is key for complete viral control and avoidance of clinical recurrence of COVID-19.
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Affiliation(s)
- Mateus V. de Castro
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Keity S. Santos
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Juliana S. Apostolico
- Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Edgar R. Fernandes
- Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Rafael R. Almeida
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil
| | - Gabriel Levin
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil
| | - Jhosiene Y. Magawa
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - João Paulo S. Nunes
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Mirian Bruni
- Department of Parasitology, Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcio M. Yamamoto
- Department of Parasitology, Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ariane C. Lima
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Monize V. R. Silva
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Larissa R. B. Matos
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vivian R. Coria
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Erick C. Castelli
- School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Marilia O. Scliar
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andreia Kuramoto
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Fernanda R. Bruno
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Lucas C. Jacintho
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | - Kelly Nunes
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jaqueline Y. T. Wang
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Veronica P. Coelho
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil
| | | | | | - Michel S. Naslavsky
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Rita Passos-Bueno
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia B. Boscardin
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Division of Clinical Immunology and Allergy, Department of Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo SP, Brazil,Department of Parasitology, Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniela S. Rosa
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Jorge Kalil
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil,Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil,Institute for Investigation in Immunology—Instituto Nacional de Ciência e Tecnologia—iii-INCT, São Paulo, SP, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center (HUG-CELL), Biosciences Institute, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, (HCFMUSP), São Paulo, SP, Brazil
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45
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Giavina-Bianchi P, Aun MV, Garcia JFB, Gomes LS, Ribeiro AJ, Takejima P, Agondi RC, Kalil J, Motta AA. Clinical features of hereditary angioedema and warning signs (H4AE) for its identification. Clinics (Sao Paulo) 2022; 77:100023. [PMID: 35318167 PMCID: PMC8943246 DOI: 10.1016/j.clinsp.2022.100023] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The study describes a case series of hereditary angioedema with C1 Inhibitor Deficiency (C1INH-HAE) in order to corroborate six clinical warning signs "HAAAAE (H4AE)" to enable early identification of this disease. METHODS The authors analyzed the C1INH-HAE cohort to analyze the clinical aspects of the present study's patients and corroborate the six clinical warning signs of the Hereditary Angioedema Brazilian Guidelines. Data regarding demographics, the onset of disease, time to diagnosis, frequency of attacks per year, organs involved, triggers, crisis duration and their outcomes, and disease treatment were collected. Then the authors developed an acronym, H4AE, to help healthcare professionals remember the warning signs. RESULTS The authors included 98 patients in the study, with a mean age of 38.1 years, 67.3% being female, and 75.3% with a family history of HAE. HAE diagnosis was delayed, on average, 13.7 years after its initial manifestation. Exploratory laparotomy was reported by 26.9%, and orotracheal intubation by 21.3% of the present study's patients; 61.3% and 30.3% of them were admitted at least once in the hospital and in the intensive care unit, respectively. The authors constructed an acronym "H4AE" with the six warning signs of HAE: Hereditary, recurrent Angioedema, Abdominal pain, Absence of urticaria, Absence of response to antihistamines, Estrogen association. CONCLUSION C1INH-HAE is still underdiagnosed and associated with high morbidity. The study showed clinical features of this disease, corroborating the warning signs, which may be useful in raising awareness and improving the diagnosis of C1INH-HAE. The authors suggest the acronym "H4AE" to remind the warning signs.
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Affiliation(s)
- Pedro Giavina-Bianchi
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcelo Vivolo Aun
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Fóes Bianchini Garcia
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Laís Souza Gomes
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ana Júlia Ribeiro
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Priscila Takejima
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosana Câmara Agondi
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jorge Kalil
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antonio Abilio Motta
- Divisão de Imunologia Clinica e Alergia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, SP, Brazil
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46
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Ribeiro SP, De Moura Mattaraia VG, Almeida RR, Valentine EJG, Sales NS, Ferreira LCS, Sa-Rocha LC, Jacintho LC, Santana VC, Sidney J, Sette A, Rosa DS, Kalil J, Cunha-Neto E. A promiscuous T cell epitope-based HIV vaccine providing redundant population coverage of the HLA class II elicits broad, polyfunctional T cell responses in nonhuman primates. Vaccine 2021; 40:239-246. [PMID: 34961636 DOI: 10.1016/j.vaccine.2021.11.076] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/07/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022]
Abstract
Over the last few decades, several emerging or reemerging viral diseases with no readily available vaccines have ravaged the world. A platform to fastly generate vaccines inducing potent and durable neutralizing antibody and T cell responses is sorely needed. Bioinformatically identified epitope-based vaccines can focus on immunodominant T cell epitopes and induce more potent immune responses than a whole antigen vaccine and may be deployed more rapidly and less costly than whole-gene vaccines. Increasing evidence has shown the importance of the CD4+ T cell response in protection against HIV and other viral infections. The previously described DNA vaccine HIVBr18 encodes 18 conserved, promiscuous epitopes binding to multiple HLA-DR-binding HIV epitopes amply recognized by HIV-1-infected patients. HIVBr18 elicited broad, polyfunctional, and durable CD4+and CD8+ T cell responses in BALB/c and mice transgenic to HLA class II alleles, showing cross-species promiscuity. To fully delineate the promiscuity of the HLA class II vaccine epitopes, we assessed their binding to 34 human class II (HLA-DR, DQ, and -DP) molecules, and immunized nonhuman primates. Results ascertained redundant 100% coverage of the human population for multiple peptides. We then immunized Rhesus macaques with HIVBr18 under in vivo electroporation. The immunization induced strong, predominantly polyfunctional CD4+ T cell responses in all animals to 13 out of the 18 epitopes; T cells from each animal recognized 7-11 epitopes. Our results provide a preliminary proof of concept that immunization with a vaccine encoding epitopes with high and redundant coverage of the human population can elicit potent T cell responses to multiple epitopes, across species and MHC barriers. This approach may facilitate the rapid deployment of immunogens eliciting cellular immunity against emerging infectious diseases, such as COVID-19.
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Affiliation(s)
- Susan Pereira Ribeiro
- Emory University, Atlanta, USA; Laboratory of Clinical Immunology and Allergy-LIM60/University of Sao Paulo School of Medicine, São Paulo, Brazil; Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil; Laboratory of Immunology, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Rafael Ribeiro Almeida
- Laboratory of Clinical Immunology and Allergy-LIM60/University of Sao Paulo School of Medicine, São Paulo, Brazil; Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil; Laboratory of Immunology, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Natiely Silva Sales
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, São Paulo, Brazil
| | - Luís Carlos S Ferreira
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, São Paulo, Brazil
| | | | - Lucas Cauê Jacintho
- Laboratory of Clinical Immunology and Allergy-LIM60/University of Sao Paulo School of Medicine, São Paulo, Brazil; Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil
| | - Vinicius Canato Santana
- Laboratory of Clinical Immunology and Allergy-LIM60/University of Sao Paulo School of Medicine, São Paulo, Brazil; Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil; Laboratory of Immunology, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - John Sidney
- La Jolla Institute for Immunology (LJI), LA Jolla, CA, USA
| | | | - Daniela Santoro Rosa
- Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil; Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil
| | - Jorge Kalil
- Laboratory of Clinical Immunology and Allergy-LIM60/University of Sao Paulo School of Medicine, São Paulo, Brazil; Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil; Laboratory of Immunology, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Laboratory of Clinical Immunology and Allergy-LIM60/University of Sao Paulo School of Medicine, São Paulo, Brazil; Institute for Investigation in Immunology - iii-INCT, São Paulo, Brazil; Laboratory of Immunology, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil.
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47
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Krein P, Yogolare GG, Pereira MA, Grecco O, Barros MAMT, Dias AR, Marinho AKBB, Zilberstein B, Kokron CM, Ribeiro-Júnior U, Kalil J, Nahas SC, Ramos MFKP. Common variable immunodeficiency: an important but little-known risk factor for gastric cancer. Rev Col Bras Cir 2021; 48:e20213133. [PMID: 34932733 PMCID: PMC10683469 DOI: 10.1590/0100-6991e-20213133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/24/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION although it is a rare disease, common variable immunodeficiency (CVID) stands out as the most frequent primary symptomatic immunodeficiency. Carriers are prone to a variety of recurrent bacterial infections, in addition to the risk of developing autoimmune diseases and neoplasms including gastric cancer (GC). Despite the recognized risk, there are no specific standardized protocols for the management of GC in these patients, so the reported oncological results are varied. Thus, this study aims to describe the clinicopathological characteristics and prognosis of patients with CVID undergoing surgical treatment of GC. METHODS all patients with GC undergoing surgical treatment between 2009 and 2020 were retrospectively evaluated. Later, patients diagnosed with CVID were identified and this group was compared with the remaining patients without any immunodeficiency. RESULTS among the 1101 patients with GC evaluated in the period, 10 had some type of immunodeficiency, and 5 were diagnosed with CVID. Patients with CVID had younger age, lower BMI, and smaller lesions compared to those without CVID. Four patients underwent curative gastrectomy and one patient underwent jejunostomy. Two patients died (1 palliative and 1 curative) and one patient had disease recurrence. There was no statistically significant difference regarding the incidence of postoperative complications and survival between the evaluated groups. CONCLUSION the CVID incidence in patients with GC undergoing surgical treatment was 0.5%, occurring at a less advanced age, but with no difference regarding surgical and oncological results.
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Affiliation(s)
- Paula Krein
- - Faculdade de Medicina, Universidade de São Paulo, Curso de Medicina - São Paulo - SP - Brasil
| | - Gustavo Gonçalves Yogolare
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Gastroenterologia - São Paulo - SP - Brasil
| | - Marina Alessandra Pereira
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Gastroenterologia - São Paulo - SP - Brasil
| | - Octavio Grecco
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Clínica Médica - Disciplina de Imunologia Clínica e Alergia - São Paulo - SP - Brasil
| | - Myrthes Anna Maragna Toledo Barros
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Clínica Médica - Disciplina de Imunologia Clínica e Alergia - São Paulo - SP - Brasil
| | - Andre Roncon Dias
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Gastroenterologia - São Paulo - SP - Brasil
| | - Ana Karolina Barreto Berselli Marinho
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Clínica Médica - Disciplina de Imunologia Clínica e Alergia - São Paulo - SP - Brasil
| | - Bruno Zilberstein
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Gastroenterologia - São Paulo - SP - Brasil
| | - Cristina Maria Kokron
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Clínica Médica - Disciplina de Imunologia Clínica e Alergia - São Paulo - SP - Brasil
| | - Ulysses Ribeiro-Júnior
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Gastroenterologia - São Paulo - SP - Brasil
| | - Jorge Kalil
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Clínica Médica - Disciplina de Imunologia Clínica e Alergia - São Paulo - SP - Brasil
| | - Sergio Carlos Nahas
- - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Gastroenterologia - São Paulo - SP - Brasil
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48
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Teixeira PC, Ducret A, Langen H, Nogoceke E, Santos RHB, Silva Nunes JP, Benvenuti L, Levy D, Bydlowski SP, Bocchi EA, Kuramoto Takara A, Fiorelli AI, Stolf NA, Pomeranzeff P, Chevillard C, Kalil J, Cunha-Neto E. Impairment of Multiple Mitochondrial Energy Metabolism Pathways in the Heart of Chagas Disease Cardiomyopathy Patients. Front Immunol 2021; 12:755782. [PMID: 34867990 PMCID: PMC8633876 DOI: 10.3389/fimmu.2021.755782] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 12/26/2022] Open
Abstract
Chagas disease cardiomyopathy (CCC) is an inflammatory dilated cardiomyopathy occurring in 30% of the 6 million infected with the protozoan Trypanosoma cruzi in Latin America. Survival is significantly lower in CCC than ischemic (IC) and idiopathic dilated cardiomyopathy (DCM). Previous studies disclosed a selective decrease in mitochondrial ATP synthase alpha expression and creatine kinase activity in CCC myocardium as compared to IDC and IC, as well as decreased in vivo myocardial ATP production. Aiming to identify additional constraints in energy metabolism specific to CCC, we performed a proteomic study in myocardial tissue samples from CCC, IC and DCM obtained at transplantation, in comparison with control myocardial tissue samples from organ donors. Left ventricle free wall myocardial samples were subject to two-dimensional electrophoresis with fluorescent labeling (2D-DIGE) and protein identification by mass spectrometry. We found altered expression of proteins related to mitochondrial energy metabolism, cardiac remodeling, and oxidative stress in the 3 patient groups. Pathways analysis of proteins differentially expressed in CCC disclosed mitochondrial dysfunction, fatty acid metabolism and transmembrane potential of mitochondria. CCC patients’ myocardium displayed reduced expression of 22 mitochondrial proteins belonging to energy metabolism pathways, as compared to 17 in DCM and 3 in IC. Significantly, 6 beta-oxidation enzymes were reduced in CCC, while only 2 of them were down-regulated in DCM and 1 in IC. We also observed that the cytokine IFN-gamma, previously described with increased levels in CCC, reduces mitochondrial membrane potential in cardiomyocytes. Results suggest a major reduction of mitochondrial energy metabolism and mitochondrial dysfunction in CCC myocardium which may be in part linked to IFN-gamma. This may partially explain the worse prognosis of CCC as compared to DCM or IC.
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Affiliation(s)
- Priscila Camillo Teixeira
- Laboratory of Immunology, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Axel Ducret
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Hanno Langen
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | - Everson Nogoceke
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Basel, Switzerland
| | | | - João Paulo Silva Nunes
- Laboratory of Immunology, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France.,Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Luiz Benvenuti
- Anatomical Pathology Division, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Debora Levy
- Laboratory of Immunology, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Paulo Bydlowski
- Laboratory of Immunology, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edimar Alcides Bocchi
- Heart Failure Team, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Andréia Kuramoto Takara
- Laboratory of Immunology, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alfredo Inácio Fiorelli
- Division of Surgery, Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Noedir Antonio Stolf
- Division of Surgery, Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pablo Pomeranzeff
- Division of Surgery, Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Christophe Chevillard
- INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Jorge Kalil
- Laboratory of Immunology, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Instituto Nacional de Ciência e Tecnologia, INCT, iii- Institute for Investigation in Immunology, São Paulo, Brazil
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49
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Nunes JPS, Andrieux P, Brochet P, Almeida RR, Kitano E, Honda AK, Iwai LK, Andrade-Silva D, Goudenège D, Alcântara Silva KD, Vieira RDS, Levy D, Bydlowski SP, Gallardo F, Torres M, Bocchi EA, Mano M, Santos RHB, Bacal F, Pomerantzeff P, Laurindo FRM, Teixeira PC, Nakaya HI, Kalil J, Procaccio V, Chevillard C, Cunha-Neto E. Co-Exposure of Cardiomyocytes to IFN-γ and TNF-α Induces Mitochondrial Dysfunction and Nitro-Oxidative Stress: Implications for the Pathogenesis of Chronic Chagas Disease Cardiomyopathy. Front Immunol 2021; 12:755862. [PMID: 34867992 PMCID: PMC8632642 DOI: 10.3389/fimmu.2021.755862] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
Infection by the protozoan Trypanosoma cruzi causes Chagas disease cardiomyopathy (CCC) and can lead to arrhythmia, heart failure and death. Chagas disease affects 8 million people worldwide, and chronic production of the cytokines IFN-γ and TNF-α by T cells together with mitochondrial dysfunction are important players for the poor prognosis of the disease. Mitochondria occupy 40% of the cardiomyocytes volume and produce 95% of cellular ATP that sustain the life-long cycles of heart contraction. As IFN-γ and TNF-α have been described to affect mitochondrial function, we hypothesized that IFN-γ and TNF-α are involved in the myocardial mitochondrial dysfunction observed in CCC patients. In this study, we quantified markers of mitochondrial dysfunction and nitro-oxidative stress in CCC heart tissue and in IFN-γ/TNF-α-stimulated AC-16 human cardiomyocytes. We found that CCC myocardium displayed increased levels of nitro-oxidative stress and reduced mitochondrial DNA as compared with myocardial tissue from patients with dilated cardiomyopathy (DCM). IFN-γ/TNF-α treatment of AC-16 cardiomyocytes induced increased nitro-oxidative stress and decreased the mitochondrial membrane potential (ΔΨm). We found that the STAT1/NF-κB/NOS2 axis is involved in the IFN-γ/TNF-α-induced decrease of ΔΨm in AC-16 cardiomyocytes. Furthermore, treatment with mitochondria-sparing agonists of AMPK, NRF2 and SIRT1 rescues ΔΨm in IFN-γ/TNF-α-stimulated cells. Proteomic and gene expression analyses revealed that IFN-γ/TNF-α-treated cells corroborate mitochondrial dysfunction, transmembrane potential of mitochondria, altered fatty acid metabolism and cardiac necrosis/cell death. Functional assays conducted on Seahorse respirometer showed that cytokine-stimulated cells display decreased glycolytic and mitochondrial ATP production, dependency of fatty acid oxidation as well as increased proton leak and non-mitochondrial oxygen consumption. Together, our results suggest that IFN-γ and TNF-α cause direct damage to cardiomyocytes’ mitochondria by promoting oxidative and nitrosative stress and impairing energy production pathways. We hypothesize that treatment with agonists of AMPK, NRF2 and SIRT1 might be an approach to ameliorate the progression of Chagas disease cardiomyopathy.
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Affiliation(s)
- João Paulo Silva Nunes
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,iii-Institute for Investigation in Immunology, Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil.,INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Pauline Andrieux
- INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Pauline Brochet
- INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Rafael Ribeiro Almeida
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,iii-Institute for Investigation in Immunology, Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Eduardo Kitano
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Kenji Honda
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leo Kei Iwai
- Laboratório Especial de Toxinologia Aplicada, Center of Toxins, Immune-Response and Cell Signaling (CeTICS), Instituto Butantan, São Paulo, Brazil
| | - Débora Andrade-Silva
- Laboratório Especial de Toxinologia Aplicada, Center of Toxins, Immune-Response and Cell Signaling (CeTICS), Instituto Butantan, São Paulo, Brazil
| | - David Goudenège
- Department of Biochemistry and Genetics, University Hospital of Angers, Angers, France
| | - Karla Deysiree Alcântara Silva
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Raquel de Souza Vieira
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Débora Levy
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Paulo Bydlowski
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Frédéric Gallardo
- INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Magali Torres
- INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Edimar Alcides Bocchi
- Heart Failure Team, Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Miguel Mano
- Functional Genomics and RNA-based Therapeutics Laboratory, Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
| | | | - Fernando Bacal
- Division of Surgery, Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pablo Pomerantzeff
- Division of Surgery, Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Priscila Camillo Teixeira
- Translational Research Sciences, Pharma Research and Early Development F. Hoffmann-La Roche, Basel, Switzerland
| | | | - Jorge Kalil
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,iii-Institute for Investigation in Immunology, Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Vincent Procaccio
- MitoLab, UMR CNRS 6015-INSERM U1083, Université d'Angers, Angers, France
| | - Christophe Chevillard
- INSERM, UMR_1090, Aix Marseille Université, TAGC Theories and Approaches of Genomic Complexity, Institut MarMaRa, Marseille, France
| | - Edecio Cunha-Neto
- Laboratory of Immunology, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Division of Clinical Immunology and Allergy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,iii-Institute for Investigation in Immunology, Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
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50
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Steiner A, Reygaerts T, Pontillo A, Ceccherini I, Moecking J, Moghaddas F, Davidson S, Caroli F, Grossi A, Castro FFM, Kalil J, Gohr FN, Schmidt FI, Bartok E, Zillinger T, Hartmann G, Geyer M, Gattorno M, Mendonça LO, Masters SL. Recessive NLRC4-Autoinflammatory Disease Reveals an Ulcerative Colitis Locus. J Clin Immunol 2021; 42:325-335. [PMID: 34783940 PMCID: PMC8821057 DOI: 10.1007/s10875-021-01175-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/26/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE NLRC4-associated autoinflammatory disease (NLRC4-AID) is an autosomal dominant condition presenting with a range of clinical manifestations which can include macrophage activation syndrome (MAS) and severe enterocolitis. We now report the first homozygous mutation in NLRC4 (c.478G > A, p.A160T) causing autoinflammatory disease with immune dysregulation and find that heterozygous carriers in the general population are at increased risk of developing ulcerative colitis. METHODS Circulating immune cells and inflammatory markers were profiled and historical clinical data interrogated. DNA was extracted and sequenced using standard procedures. Inflammasome activation assays for ASC speck formation, pyroptosis, and IL-1β/IL-18 secretion confirmed pathogenicity of the mutation in vitro. Genome-wide association of NLRC4 (A160T) with ulcerative colitis was examined using data from the IBD exomes portal. RESULTS A 60-year-old Brazilian female patient was evaluated for recurrent episodes of systemic inflammation from six months of age. Episodes were characterized by recurrent low-grade fever, chills, oral ulceration, uveitis, arthralgia, and abdominal pain, followed by diarrhea with mucus and variable skin rash. High doses of corticosteroids were somewhat effective in controlling disease and anti-IL-1β therapy partially controlled symptoms. While on treatment, serum IL-1β and IL-18 levels remained elevated. Genetic investigations identified a homozygous mutation in NLRC4 (A160T), inherited in a recessive fashion. Increased ASC speck formation and IL-1β/IL-18 secretion confirmed pathogenicity when NLRC4 (A160T) was analyzed in human cell lines. This allele is significantly enriched in patients with ulcerative colitis: OR 2.546 (95% 1.778-3.644), P = 0.01305. CONCLUSION NLRC4 (A160T) can either cause recessively inherited autoinflammation and immune dysregulation, or function as a heterozygous risk factor for the development of ulcerative colitis.
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Affiliation(s)
- Annemarie Steiner
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3010, Australia.,Institute of Structural Biology, Medical Faculty, University of Bonn, 53127, Bonn, Germany
| | - Thomas Reygaerts
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Alessandra Pontillo
- Immunogenetic Laboratory, Department of Immunology, Biomedical Science Institute, Universidade of São Paulo, São Paulo, Brazil
| | - Isabella Ceccherini
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Jonas Moecking
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3010, Australia.,Institute of Structural Biology, Medical Faculty, University of Bonn, 53127, Bonn, Germany
| | - Fiona Moghaddas
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, VIC, 3052, Australia
| | - Sophia Davidson
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Francesco Caroli
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Alice Grossi
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Fabio Fernandes Morato Castro
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Universidade of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Universidade of São Paulo, São Paulo, Brazil
| | - Florian N Gohr
- Institute of Innate Immunity, Medical Faculty, University of Bonn, 53127, Bonn, Germany.,Department of Microbiology and Immunology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Florian I Schmidt
- Institute of Innate Immunity, Medical Faculty, University of Bonn, 53127, Bonn, Germany
| | - Eva Bartok
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, 53127, Bonn, Germany.,Unit of Experimental Immunology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thomas Zillinger
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, 53127, Bonn, Germany.,Institute of Immunology, Philipps-University Marburg, BMFZ, 35043, Marburg, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, 53127, Bonn, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Matthias Geyer
- Institute of Structural Biology, Medical Faculty, University of Bonn, 53127, Bonn, Germany
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Primary Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Leonardo Oliveira Mendonça
- Immunogenetic Laboratory, Department of Immunology, Biomedical Science Institute, Universidade of São Paulo, São Paulo, Brazil.,Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.,Division of Clinical Immunology and Allergy, Department of Internal Medicine, Universidade of São Paulo, São Paulo, Brazil.,Center for Autoinflammatory Diseases and Primary Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.,Center for Rare and Immunological Disorders, DASA-Hospital 9 de Julho, São Paulo, Brazil
| | - Seth L Masters
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia. .,Department of Medical Biology, The University of Melbourne, Parkville, VIC, 3010, Australia.
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