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Velho S, Morão B, Gouveia C, Agostinho L, Torres J, Maio R, Baracos V, Cravo M. Body Composition And Crohn’s Disease Behavior: Is Adiposity The Main Game Changer? Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.099] [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: 03/28/2023]
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2
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Cravo M, Oliveira DG, Guimas A, Vita P, Rego AL, Alves R, Valadares D, Carvalheiras G, Ricardo M, Pinto A, Pessegueiro H, Nery F. The Role of a Medical Intermediate Care Unit in the Management of Budd-Chiari Syndrome: Case Series. J Med Cases 2021; 12:190-194. [PMID: 34434456 PMCID: PMC8383533 DOI: 10.14740/jmc3659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022] Open
Abstract
Budd-Chiari syndrome (BCS) has a wide spectrum of presentations, from an asymptomatic status to acute liver failure (ALF). The therapeutic approach depends on disease severity and related etiology with patients with severe forms of presentation classically managed in intensive care units (ICUs). Here, we report a series of five BCS patients managed in a medical intermediate care unit (IntCU), with three of them presenting with acute liver injury. Progression to ALF was seen in three patients, two of whom died, with one being successfully submitted to liver transplantation. IntCUs allow a 24-h patient surveillance and a prompt management of BCS, with less economic impact when compared to ICUs. Mortality was related to the presence of associated comorbidities that limited therapeutic approach.
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Affiliation(s)
- Marcia Cravo
- Servico de Medicina Interna, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Daniel G Oliveira
- Servico de Medicina Interna, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Arlindo Guimas
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Pedro Vita
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Ana Luisa Rego
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Rute Alves
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Diana Valadares
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Graziela Carvalheiras
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Miguel Ricardo
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Alexandre Pinto
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal.,Instituto de Ciencias Biomedicas Abel Salazar-Universidade do Porto, Porto, Portugal
| | - Helena Pessegueiro
- Unidade de Transplante Hepato-Pancreatica, Centro Hospitalar Universitario do Porto, Porto, Portugal
| | - Filipe Nery
- Unidade Intermedia Medica, Servico de Cuidados Intensivos, Centro Hospitalar Universitario do Porto, Porto, Portugal.,Instituto de Ciencias Biomedicas Abel Salazar-Universidade do Porto, Porto, Portugal.,EpiUnit, Instituto de Saude Publica da Universidade do Porto, Porto, Portugal
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3
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Velho S, Rodrigues S, Moço S, Costa L, Abreu C, Borges A, Clemente S, Godinho J, Faria A, Teixeira J, Maio R, Baracos V, Cravo M. Adherence to a combined exercise and dietary intervention in patients with gastrointestinal cancer undergoing neo-adjuvant therapy. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Magro F, Lopes S, Silva M, Coelho R, Portela F, Branquinho D, Correia L, Fernandes S, Cravo M, Caldeira P, Sousa HT, Patita M, Lago P, Ramos J, Afonso J, Redondo I, Machado P, Cornillie F, Lopes J, Carneiro F. Low Golimumab Trough Levels at Week 6 Are Associated With Poor Clinical, Endoscopic and Histological Outcomes in Ulcerative Colitis Patients: Pharmacokinetic and Pharmacodynamic Sub-analysis of the Evolution Study. J Crohns Colitis 2019; 13:1387-1393. [PMID: 30989180 DOI: 10.1093/ecco-jcc/jjz071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Golimumab has an established exposure-response relationship in patients with ulcerative colitis [UC]. However, the association of serum golimumab trough levels [TL] with objective markers of disease activity, such as endoscopic and histological activity scores and concentrations of biomarkers, remains less understood. This report describes the relationship of serum golimumab TL at the end of the induction period [Week 6] with clinical, endoscopic, histological, and biomarker parameters. METHODS This was an open-label, uncontrolled, prospective and interventional study. Moderate to severely active UC patients naïve to biologic therapy were treated with golimumab. Serum golimumab TL and faecal calprotectin levels were measured at baseline [Week 0 of induction] and Week 6. RESULTS A total of 34 patients completed the induction phase [Week 6] and were included in this analysis. Overall, 47.1% and 14.7% of patients achieved clinical response and remission with significantly higher serum golimumab TL in patients with early response or remission [3.7 μg/mL vs 1.3 μg/mL, p = 0.0013; and 3.1 μg/mL vs 1.7 μg/mL, p = 0.0164, respectively]. In addition, golimumab TL were significantly higher in patients achieving histological remission [4.2 μg/mL vs 1.7 μg/mL, p = 0.0049]. Week 6 golimumab TL were inversely correlated with the total Mayo score [rs = -0.546; p = 0.0008], the Mayo endoscopic subscore [rs = -0.381; p = 0.0262], the Geboes histological activity score [rs = -0.464; p = 0.0057], and faecal calprotectin levels [rs = -0.497; p = 0.0044]. CONCLUSIONS A higher early exposure to golimumab is associated with a better objective response in active UC patients and appears to drive the outcome at Week 6.
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Affiliation(s)
- F Magro
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - S Lopes
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - M Silva
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - R Coelho
- Centro Hospitalar São João, Departamento de Gastrenterologia, Porto, Portugal
| | - F Portela
- Centro Hospitalar Universitário de Coimbra, Departamento de Gastrenterologia, Coimbra, Portugal
| | - D Branquinho
- Centro Hospitalar Universitário de Coimbra, Departamento de Gastrenterologia, Coimbra, Portugal
| | - L Correia
- Centro Hospitalar Lisboa Norte, Departamento de Gastrenterologia, Lisboa, Portugal
| | - S Fernandes
- Centro Hospitalar Lisboa Norte, Departamento de Gastrenterologia, Lisboa, Portugal
| | - M Cravo
- Hospital Beatriz Ângelo, Departamento de Gastrenterologia, Loures, Portugal
| | - P Caldeira
- Centro Hospitalar Universitário do Algarve, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Algarve Biomedical Centre, Universidade do Algarve, Faro, Portugal
| | - H T Sousa
- Centro Hospitalar Universitário do Algarve, Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Algarve Biomedical Centre, Universidade do Algarve, Faro, Portugal
| | - M Patita
- Hospital Garcia de Orta, Departamento de Gastrenterologia, Almada, Portugal
| | - P Lago
- Centro Hospitalar do Porto, Departamento de Gastrenterologia, Porto, Portugal
| | - J Ramos
- Centro Hospitalar Lisboa Central, Departamento de Gastrenterologia, Lisboa, Portugal
| | - J Afonso
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - I Redondo
- MSD Portugal, Medical Affairs, Paço de Arcos, Portugal
| | - P Machado
- MSD Portugal, Medical Affairs, Paço de Arcos, Portugal
| | | | - J Lopes
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - F Carneiro
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Instituto de Patologia e Imunologia Molecular da Universidade do Porto [Ipatimup], i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Velho S, Santos M, Cunha C, Agostinho L, Cruz R, Costa F, Garcia M, Oliveira P, Maio R, Baracos V, Cravo M. MON-PO603: Body Composition Influences Major Post-Operative Complications, 90-Day and Overall Survival in Pancreatic Surgery Patients. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32436-7] [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: 10/26/2022]
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Costa Santos M, Cunha C, Velho S, Ferreira AO, Costa F, Ferreira R, Loureiro R, Santos AA, Maio R, Cravo M. Preoperative biliary drainage in patients performing pancreaticoduodenectomy : guidelines and real-life practice. Acta Gastroenterol Belg 2019; 82:389-395. [PMID: 31566326] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND AIM Preoperative biliary drainage (PBD) in patients with pancreatic cancer remains debatable. The aim of this study was to analyse the indications for PBD in patients performing pancreaticoduodenectomy (PD) and to evaluate the impact of this procedure on postoperative outcome. METHODS Observational retrospective cohort study of patients undergoing PD for pancreatic cancer. Clinical data and postoperative outcome, namely complications and 90-day mortality, were prospectively collected and compared between patients performing PBD or direct surgery (DS). RESULTS Eighty-two patients were included: 40 underwent PBD and 42 performed DS. Major complications (27.5% vs 33.3%, P=0.156) and 90-day mortality (10% vs 16.7%, P=0.376) were similar between the two groups. There was a trend for higher mean total bilirubin in patients with PBD (P=0.073). The indication for PBD was suspicion of cholangitis/choledocholithiasis or need to perform neoadjuvant chemotherapy in 24 (60%) patients. In the remaining, elevated bilirubin was probably the only reason to perform PBD. Length of hospital stay was longer in PBD group (P=0.003). On multiple logistic regression, 90-day mortality was not related with preoperative bilirubin levels, biliary drainage or its indication, but solely with age (OR 1.15, 95%CI 1.05-1.31, P=0.008). CONCLUSIONS PBD is often performed in patients undergoing PD without a formal indication, mainly due to high bilirubin levels. No increased morbidity/mortality was observed but length of hospital stay was prolonged in patients performing PBD.
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Affiliation(s)
- M Costa Santos
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - C Cunha
- Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - S Velho
- Nutrition Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - A O Ferreira
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - F Costa
- Oncology Service, Hospital da Luz, Lisboa, Portugal
| | - R Ferreira
- Gastroenterology Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - R Loureiro
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - A A Santos
- Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
| | - R Maio
- Head of Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - M Cravo
- Head of Gastroenterology Service, Hospital Beatriz Ângelo, Loures, Portugal
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Guerreiro M, Guerreiro C, Cravo M, Santos Z, Chagas C, Augusto F. Effectiveness of two dietary approaches in improving symptoms and quality of life of individuals with irritable bowel syndrome: Low fodmap diet versus standard diet. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Ferreira A, Costa M, Palmela C, Velho S, Torres J, Ouro S, Luisa G, Cravo M. SUN-P264: The Impact of Preoperative Exclusive Enteral Nutrition in Malnourished Patients With Crohn’s Disease. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Torres J, Palmela C, Brito H, Bao X, Ruiqi H, Moura-Santos P, Pereira da Silva J, Oliveira A, Vieira C, Perez K, Itzkowitz SH, Colombel JF, Humbert L, Rainteau D, Cravo M, Rodrigues CM, Hu J. The gut microbiota, bile acids and their correlation in primary sclerosing cholangitis associated with inflammatory bowel disease. United European Gastroenterol J 2017; 6:112-122. [PMID: 29435321 DOI: 10.1177/2050640617708953] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/12/2017] [Indexed: 12/16/2022] Open
Abstract
Background Patients with primary sclerosing cholangitis associated with inflammatory bowel disease (PSC-IBD) have a very high risk of developing colorectal neoplasia. Alterations in the gut microbiota and/or gut bile acids could account for the increase in this risk. However, no studies have yet investigated the net result of cholestasis and a potentially altered bile acid pool interacting with a dysbiotic gut flora in the inflamed colon of PSC-IBD. Aim The aim of this study was to compare the gut microbiota and stool bile acid profiles, as well as and their correlation in patients with PSC-IBD and inflammatory bowel disease alone. Methods Thirty patients with extensive colitis (15 with concomitant primary sclerosing cholangitis) were prospectively recruited and fresh stool samples were collected. The microbiota composition in stool was profiled using bacterial 16S rRNA sequencing. Stool bile acids were assessed by high-performance liquid chromatography tandem mass spectrometry. Results The total stool bile acid pool was significantly reduced in PSC-IBD. Although no major differences were observed in the individual bile acid species in stool, their overall combination allowed a good separation between PSC-IBD and inflammatory bowel disease. Compared with inflammatory bowel disease alone, PSC-IBD patients demonstrated a different gut microbiota composition with enrichment in Ruminococcus and Fusobacterium genus compared with inflammatory bowel disease. At the operational taxonomic unit level major shifts were observed within the Firmicutes (73%) and Bacteroidetes phyla (17%). Specific microbiota-bile acid correlations were observed in PSC-IBD, where 12% of the operational taxonomic units strongly correlated with stool bile acids, compared with only 0.4% in non-PSC-IBD. Conclusions Patients with PSC-IBD had distinct microbiota and microbiota-stool bile acid correlations as compared with inflammatory bowel disease. Whether these changes are associated with, or may predispose to, an increased risk of colorectal neoplasia needs to be further clarified.
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Affiliation(s)
- J Torres
- Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal.,Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - C Palmela
- Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - H Brito
- Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - X Bao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - H Ruiqi
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - P Moura-Santos
- Gastroenterology and Hepatology Division, Hospital de Santa Maria, Lisboa, Portugal
| | - J Pereira da Silva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa, Portugal
| | - A Oliveira
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - C Vieira
- Department of Gastroenterology, Centro Hospitalar Barreiro Montijo, Portugal
| | - K Perez
- INSERM ERL1157, Sorbonne Université - UPMC Univ Paris 06, Paris, France
| | - S H Itzkowitz
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J F Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Humbert
- INSERM ERL1157, Sorbonne Université - UPMC Univ Paris 06, Paris, France
| | - D Rainteau
- INSERM ERL1157, Sorbonne Université - UPMC Univ Paris 06, Paris, France
| | - M Cravo
- Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - C M Rodrigues
- Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - J Hu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
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Cravo M, Velho S, Santos M, Palmela C, Cruz R, Strecht J, Torres J, Baracos V. MON-P047: Lower Skeletal Muscle Radiation Attenuation is Associated with Stricturing or Penetrating Phenotype in Patients with Crohn's Disease (CD): An Exploratory Study. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santos T, Cravo M. MON-P107: Nutritional Assessment of Elderly People with Pressure Ulcer in Hospital Environment. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30741-5] [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: 10/21/2022]
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12
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Velho S, Ferreira A, Luz G, Lopes F, Cruz R, Agostinho L, Strecht J, Gargaté L, Coelho JP, Maio R, Baracos V, Cravo M. MON-P243: Skeletal Mass Index and Visceral Mass Index as Predictors of Length of Hospital Stay of Surgical Gastrointestinal Cancer Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30877-9] [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: 10/21/2022]
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Barata A, Santos C, Cravo M, Vinhas M, Morais C, Carolino E, Roldão Vieira J, Fonseca J. MON-LB013: Handgrip Dynamometry and Patient-Generated Subjective Global Assessment in Patients With Non-Resectable Lung Cancer. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30777-9] [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: 10/23/2022]
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Moço S, Velho S, Agostinho L, Cruz R, Lopes F, Luz G, Rodrigues T, Teixeira J, Strecht J, Coelho J, Baracos V, Maio R, Cravo M. MON-LB011: Predictors of Sarcopenia in Patients With Gastrointestinal Cancer. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30775-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amaral O, Sousa Guerreiro C, Almeida A, Cravo M. SUN-LB028: Effect of Bread Containing High Level of Resistant Starch on Glucose and Insulin Responses. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30749-4] [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: 10/23/2022]
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Ferreira A, Cravo M, Maio R, Garrido R, Luz G. MON-PP142: Nutritional Assessment in Surgical Underwent Gastrectomy Patients. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kluk J, Moonim M, Duran A, Costa Rosa J, Cabeçadas J, Alvarez R, Cravo M, Whittaker S, Robson A. Cutaneous Richter syndrome: a better place to transform? Br J Dermatol 2014; 172:513-21. [PMID: 24935194 DOI: 10.1111/bjd.13193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Abstract
The development of high-grade lymphoma in patients with chronic lymphocytic leukaemia is known as Richter syndrome (RS) and is associated with a grave prognosis, with a mean survival of 8 months despite treatment. Cutaneous RS has been described in a handful of cases and may be associated with a better outcome than the more common extracutaneous variants. We review the literature with particular emphasis on pathogenesis, treatment and survival of RS. We postulate that the absence of B symptoms and a normal lactate dehydrogenase level, presumably reflecting localized or limited disease, and a lower tumour burden, may explain the apparently better survival in some patients with cutaneous RS than with extracutaneous variants.
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Affiliation(s)
- J Kluk
- Skin Tumour Unit, 2nd Floor, Block C, South Wing, St. John's Institute of Dermatology, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K
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Velho S, Santos M, Castro A, Cravo M, Passos Coelho J. LB012-MON: Nutrition Support in Head and Neck Cancer Patients. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50670-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Guerreiro C, Coelho V, Cravo M, Alexandre D, Dias-Pereira A, Mendes L. PP149-SUN: Compliance with Mediterranean Diet by Crohn’s Patients. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cabral M, Batalha S, Nunes J, Jotta R, Cravo M, Oom P. PReS-FINAL-2080: Overlap syndrome between primary sclerosing cholangitis and autoimmune hepatitis associated with ulcerative colitis - a case of unusual presentation in a patient with systemic juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044478 DOI: 10.1186/1546-0096-11-s2-p92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cravo M, Sousa P, Tavora I, Zozimo N, Velosa J. Endoscopic appearance of sclerosing mesenteritis in the colon. Endoscopy 2012; 44 Suppl 2 UCTN:E60. [PMID: 22396281 DOI: 10.1055/s-0031-1291563] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Cravo
- Department of Gastroenterology, Hospital de Santa Maria, Lisbon, Portugal.
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Azevedo LF, Magro F, Portela F, Lago P, Deus J, Cotter J, Cremers I, Vieira A, Peixe P, Caldeira P, Lopes H, Gonçalves R, Reis J, Cravo M, Barros L, Ministro P, Lurdes M, Duarte A, Campos M, Carvalho L, Costa-Pereira A. Estimating the prevalence of inflammatory bowel disease in Portugal using a pharmaco-epidemiological approach. Pharmacoepidemiol Drug Saf 2010; 19:499-510. [DOI: 10.1002/pds.1930] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Cardoso JC, Cravo M, Cardoso R, Brites MM, Reis JP, Tellechea O, Eloy C, Figueiredo A. Langerhans cell histiocytosis in an adult: good response of cutaneous lesions to acitretin. Clin Exp Dermatol 2010; 35:627-30. [DOI: 10.1111/j.1365-2230.2010.03784.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Magro F, Portela F, Lago P, Deus J, Cotter J, Cremers I, Vieira A, Peixe P, Caldeira P, Lopes H, Gonçalves R, Reis J, Cravo M, Barros L, Ministro P, Lurdes Tavares M, Duarte A, Campos M, Carvalho L. Inflammatory bowel disease: a patient's and caregiver's perspective. Dig Dis Sci 2009; 54:2671-9. [PMID: 19130226 DOI: 10.1007/s10620-008-0658-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Accepted: 11/28/2008] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to conduct a survey examining the impact of inflammatory bowel disease (IBD) on patients' and their caregivers' daily activities. Questionnaires were distributed to patients registered in the APDI (Portuguese Association for IBD) database and their respective caregivers in 2007. Of 422 patient respondents, 251 had Crohn's disease (CD) and 171 had ulcerative colitis (UC), with the majority of patients being women (58.1%) and aged over 40 years (37.4%). The number of disease flares experienced by IBD patients was slightly higher for patients with CD than for patients with UC (2.64 vs. 2.34), and surgery was more often required in CD patients as compared to UC patients (42.4 vs. 7%). Sixty percent (60%) of patients reported having no problems with mobility, daily activities, or personal hygiene; however, over half of all patients experienced some pain and anxiety. Adult patients and children and adolescents respectively experienced time off work or school due to their disease but caregivers were not affected in this regard. The caregivers life (N=324) was affected by anxiety, with the major concern reported as the risk of the patient developing cancer. Both IBD patients and caregivers thought that the provision of information on new drugs and contact time with a doctor would have the biggest impact on improving care. The symptoms and complications of IBD have a considerable impact on the lives of patients and their caregivers, and several actions could be taken to improve their care.
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Affiliation(s)
- F Magro
- GEDII--Portuguese Group of Studies of IBD, Porto, Portugal.
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Filipe B, Baltazar C, Albuquerque C, Fragoso S, Lage P, Vitoriano I, Mão de Ferro S, Claro I, Rodrigues P, Fidalgo P, Chaves P, Cravo M, Nobre Leitão C. APCorMUTYHmutations account for the majority of clinically well-characterized families with FAP and AFAP phenotype and patients with more than 30 adenomas. Clin Genet 2009; 76:242-55. [DOI: 10.1111/j.1399-0004.2009.01241.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Magro F, Portela F, Lago P, Deus J, Vieira A, Peixe P, Cotter J, Cremers I, Cravo M, Tavares L, Reis J, Gonçalves R, Caldeira P, Lopes H, Ministro P. P099 A PHARMACO-EPIDEMIOLOGICAL APPROACH TO ESTIMATE IBD PREVALENCE AND INCIDENCE IN PORTUGAL. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1873-9954(08)70110-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salazar M, Barata A, André S, Venâncio J, Francisco I, Cravo M, Nobre-Leitão C. First report of a complete pathological response of a pelvic GIST treated with imatinib as neoadjuvant therapy. Gut 2006; 55:585-6. [PMID: 16531543 PMCID: PMC1856177 DOI: 10.1136/gut.2005.086744] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Lage P, Cravo M, Sousa R, Chaves P, Salazar M, Fonseca R, Claro I, Suspiro A, Rodrigues P, Raposo H, Fidalgo P, Nobre-Leitão C. Management of Portuguese patients with hyperplastic polyposis and screening of at-risk first-degree relatives: a contribution for future guidelines based on a clinical study. Am J Gastroenterol 2004; 99:1779-84. [PMID: 15330918 DOI: 10.1111/j.1572-0241.2004.30178.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hyperplastic polyposis (HP) is a rare condition characterized by the presence of multiple hyperplastic polyps in the colon, which has been associated to an increased risk of colorectal cancer (CRC). Guidelines for management of this disease remain, so far, undefined. AIMS To evaluate, in symptomatic patients with HP, phenotypic characteristics as well as results of a screening program in their at-risk first-degree relatives. PATIENTS Pedigree information and clinical and endoscopic data of 14 patients with HP was studied. SEVENTEEN AND METHODS: at-risk first-degree relatives from six families were also invited to perform screening colonoscopy. RESULTS Twelve of fourteen (86%) patients had fewer than 100 colorectal polyps. Polyps' sizes ranged from 2 to 25 mm and were uniformly distributed through the whole colon in 43% of the patients. Hyperplastic polyps predominated, but 11/14 (79%) patients also harbored serrated as well as classic adenomatous polyps. CRC was present in 6/14 (43%) of the patients at the time of diagnosis. Familial history of CRC/polyps was positive in 6/12 (50%) of cases. Colonoscopy in at-risk relatives disclosed polyps in 10/17 (59%) of cases with at least one additional patient having criteria for HP. CONCLUSIONS Although small, this series demonstrates that a high level of suspicion is needed to diagnose the HP syndrome, in which serrated adenomas seem to be the hallmark. Although an elevated percentage of CRC was observed in this series of symptomatic patients with HP, prospective studies in asymptomatic individuals are needed to clearly quantify the risk of CRC in patients with HP. Because familial aggregation of HP was present in 3/12 (25%) of kindreds, screening colonoscopy should be offered to first-degree relatives.
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Affiliation(s)
- P Lage
- Instituto Português de Oncologia Francisco Gentil, CRL, SA, Rua Prof. Lima Basto, 1099-023 Lisbon, Portugal.
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Albuquerque C, Cravo M, Cruz C, Lage P, Chaves P, Fidalgo P, Suspiro A, Nobre Leitão C. Genetic characterisation of patients with multiple colonic polyps. J Med Genet 2002; 39:297-302. [PMID: 11950865 PMCID: PMC1735100 DOI: 10.1136/jmg.39.4.297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cravo M, Afonso AJ, Lage P, Albuquerque C, Maia L, Lacerda C, Fidalgo P, Chaves P, Cruz C, Nobre-Leitão C. Pathogenicity of missense and splice site mutations in hMSH2 and hMLH1 mismatch repair genes: implications for genetic testing. Gut 2002; 50:405-12. [PMID: 11839723 PMCID: PMC1773142 DOI: 10.1136/gut.50.3.405] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In hereditary non-polyposis colorectal cancer, over 90% of the identified mutations are in two genes, hMSH2 and hMLH1. A large proportion of the mutations detected in these genes are of the missense type which may be either deleterious mutations or harmless polymorphisms. AIM To investigate whether nine missense and one splice site mutation of hMLH1 and hMSH2, in 10 kindreds with a familial history of colorectal cancer or young age of onset, could be interpreted as pathogenic. METHODS Clinical and genetic characteristics were collected: (i) evolutionary conservation of the codon involved; (ii) type of amino acid change; (iii) occurrence of mutation in healthy controls; (iv) cosegregation of mutation with disease phenotype; (v) functional consequences of gene variant; and (vi) microssatellite instability and immunoexpression of hMSH2 and hMLH1 analysis. RESULTS Seven different missense and one splice site mutation were identified. Only 1/8 was found in the control group, 2/7 occurred in conserved residues, and 5/7 resulted in non-conservative changes. Functional studies were available for only 2/8 mutations. Segregation of the missense variant with disease phenotype was observed in three kindreds. CONCLUSION In the majority of families included, there was no definitive evidence that the missense or splice site alterations were causally associated with an increased risk of developing colorectal cancer. Until further evidence is available, these mutational events should be regarded and interpreted carefully and genetic diagnosis should not be offered to these kindreds.
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Affiliation(s)
- M Cravo
- Serviço de Gastrenterologia and Centro de Investigação de Patobiologia Molecular, Instituto Português de Oncologia Francisco Gentil, 1093 Lisboa Codex, Portugal.
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Chaves P, Cruz C, Lage P, Claro I, Cravo M, Leitão CN, Soares J. Immunohistochemical detection of mismatch repair gene proteins as a useful tool for the identification of colorectal carcinoma with the mutator phenotype. J Pathol 2000. [PMID: 10918209 DOI: 10.1002/1096-9896(2000)9999:9999<::aid-path644>3.0.co;2-t] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There are two well-defined pathways for colorectal carcinogenesis, the suppressor and the mutator pathways. The latter is characteristic of hereditary non-polyposis colorectal cancer (HNPCC), but can also be found in a subset of sporadic colorectal cancer (SCC) possessing distinctive clinical and pathological features, namely early age of onset, location in the right colon, poor differentiation, and a predominant mucinous component. This mutator pathway results from inactivation of mismatch repair (MMR) genes, namely MSH2 and MLH1. The aim of this study was to ascertain if abnormal MMR protein gene expression is a good indicator for identifying tumours from the mutator pathway. Seventy-six cases of SCC were studied by immunohistochemistry using two monoclonal mouse antibodies that react against MSH2 and MLH1 protein gene products. Immunoexpression was assessed both in tumour and in non-neoplastic, adjacent and distant mucosa. Microsatellite instability (MSI) was detected by evaluating the length of poly(CA) repeated sequences at seven loci, or by the detection of small unstable alleles in a poly(A) repeat - BAT-26. Except for BAT-26, in which only tumour DNA was used, MSI analysis was performed in both tumour and normal mucosal DNA. MSI was classified as high (MSI-H), low (MSI-L) or stable (MSS). Abnormal protein expression was found in 9/76 (12%) tumours. Immunohistochemistry for hmlh1 and hmsh2 detected 75% of MSI-H. There was also a highly significant correlation between the observed immunoexpression and several clinical and pathological characteristics described as the phenotypic profile of the mutator pathway, such as right-sided location (p=0.003), mucin production (p=0.008), and a peritumoural lymphoid infiltrate (p=0.009). Non-neoplastic adjacent mucosa showed normal hMSH2 expression in all cases, but in ten cases there was no hMLH1 expression in this transitional mucosa, which is known to display an alterated mucin pattern and a high proliferative rate. These results demonstrated a good correlation between hMLH1 and hMSH2 gene immunoexpression and the clinico-pathological features characteristic of the mutator phenotype and support the use of this method as a rapid and efficient way to detect tumours arising from this pathway.
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Affiliation(s)
- P Chaves
- Department of Pathology, Instituto Português de Oncologia de Francisco Gentil, Lisboa, Portugal
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Chaves P, Cruz C, Lage P, Claro I, Cravo M, Leitão CN, Soares J. Immunohistochemical detection of mismatch repair gene proteins as a useful tool for the identification of colorectal carcinoma with the mutator phenotype. J Pathol 2000; 191:355-60. [PMID: 10918209 DOI: 10.1002/1096-9896(2000)9999:9999<::aid-path644>3.0.co;2-t] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There are two well-defined pathways for colorectal carcinogenesis, the suppressor and the mutator pathways. The latter is characteristic of hereditary non-polyposis colorectal cancer (HNPCC), but can also be found in a subset of sporadic colorectal cancer (SCC) possessing distinctive clinical and pathological features, namely early age of onset, location in the right colon, poor differentiation, and a predominant mucinous component. This mutator pathway results from inactivation of mismatch repair (MMR) genes, namely MSH2 and MLH1. The aim of this study was to ascertain if abnormal MMR protein gene expression is a good indicator for identifying tumours from the mutator pathway. Seventy-six cases of SCC were studied by immunohistochemistry using two monoclonal mouse antibodies that react against MSH2 and MLH1 protein gene products. Immunoexpression was assessed both in tumour and in non-neoplastic, adjacent and distant mucosa. Microsatellite instability (MSI) was detected by evaluating the length of poly(CA) repeated sequences at seven loci, or by the detection of small unstable alleles in a poly(A) repeat - BAT-26. Except for BAT-26, in which only tumour DNA was used, MSI analysis was performed in both tumour and normal mucosal DNA. MSI was classified as high (MSI-H), low (MSI-L) or stable (MSS). Abnormal protein expression was found in 9/76 (12%) tumours. Immunohistochemistry for hmlh1 and hmsh2 detected 75% of MSI-H. There was also a highly significant correlation between the observed immunoexpression and several clinical and pathological characteristics described as the phenotypic profile of the mutator pathway, such as right-sided location (p=0.003), mucin production (p=0.008), and a peritumoural lymphoid infiltrate (p=0.009). Non-neoplastic adjacent mucosa showed normal hMSH2 expression in all cases, but in ten cases there was no hMLH1 expression in this transitional mucosa, which is known to display an alterated mucin pattern and a high proliferative rate. These results demonstrated a good correlation between hMLH1 and hMSH2 gene immunoexpression and the clinico-pathological features characteristic of the mutator phenotype and support the use of this method as a rapid and efficient way to detect tumours arising from this pathway.
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Affiliation(s)
- P Chaves
- Department of Pathology, Instituto Português de Oncologia de Francisco Gentil, Lisboa, Portugal
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Cravo M, Lage P, Albuquerque C, Chaves P, Claro I, Gomes T, Gaspar C, Fidalgo P, Soares J, Nobre-Leitão C. BAT-26 identifies sporadic colorectal cancers with mutator phenotype: a correlative study with clinico-pathological features and mutations in mismatch repair genes. J Pathol 2000. [PMID: 10419591 DOI: 10.1002/(sici)1096-9896(199907)188:3<252::aid-path354>3.0.co;2-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Microsatellite instability (MSI) is present in most colorectal cancers (CRC) associated with hereditary nonpolyposis colorectal cancer (HNPCC). MSI testing in so-called sporadic forms of CRC may become a useful tool in identifying new HNPCC kindred. The aim of this study was to analyse the utility of BAT-26 as a marker to identify CRCs with MSI and to investigate whether sporadic CRCs with MSI have a phenotypic expression similar to HNPCC cases. MSI was detected using two methods, an association of 7 poly(CA) repeats and a poly(A) repeat alone, BAT-26, in a series of 62 patients with apparently sporadic forms of CRC. Germ-line and somatic mutations in the hMSH2, hMLH1, and hMSH6 genes were analysed in patients with MSI+ tumours. Patients with MSI+ at poly(CA) loci and at BAT-26 were younger (p=0.024 and p=0.002), had tumours more frequently right sided (p=0.017 and p=0.0001) and more often mucinous (p=0.037 and p=0.005, respectively) than patients with MSI negative tumours. Mutation analysis allowed the identification of two patients carrying germ-line mutations in the hMLH1 gene (both were BAT-26+) and two other patients who had somatic mutation in the hMSH2 and in hMLH1 genes. In conclusion, the detection of MSI using poly(CA) repeats or BAT-26 alone allowed the identification of a subset of patients with clinico-pathological characteristics similar to those associated to HNPCC. BAT-26 has the advantage of being a simple and less expensive method that might be used as a screening procedure before mutation analysis.
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Affiliation(s)
- M Cravo
- Serviço de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil, 1093 Lisboa Codex, Portugal.
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Fidalgo P, Almeida MR, West S, Gaspar C, Maia L, Wijnen J, Albuquerque C, Curtis A, Cravo M, Fodde R, Leitao CN, Burn J. Detection of mutations in mismatch repair genes in Portuguese families with hereditary non-polyposis colorectal cancer (HNPCC) by a multi-method approach. Eur J Hum Genet 2000; 8:49-53. [PMID: 10713887 DOI: 10.1038/sj.ejhg.5200393] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mutation searching was performed in the hMSH2 and hMLH1 genes in 20 Portuguese families representing 124 registered affected individuals. Of the 20, 16 fulfilled the classic 'Amsterdam' criteria for HNPCC, whereas the remaining four families satisfied a modified set of criteria. These criteria required a CRC diagnosed before age 50 years and cancers diagnosed in two other relatives within the HNPCC spectrum. A multi-method approach was performed using the protein truncation test (PTT), single strand conformation polymorphism (SSCP) with two different sets of conditions, heteroduplex analysis (HA) and denaturing gradient gel electrophoresis (DGGE). Putative phenotype-genotype correlations were also explored. Ten different germline mutations were identified. Six of these were found in hMLH1 in seven families and four in hMSH2 in four families. SSCP and DGGE had the highest diagnostic yields with the percentage of variants detected above 67% and together HA and PTT had the lowest. No single technique detected all variants. Trends for the absence of extracolonic manifestations were observed in families carrying hMLH1 germline mutations (four of seven in hMLH1 vs one of four in hMSH2). Most of the families with rectal cancer were associated with hMLH1 (six of seven in hMLH1 vs two of four in hMSH2). A multi-technique approach is necessary to identify a high percentage of germline mutations. Seven novel mutations were found in this Portuguese population.
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Affiliation(s)
- P Fidalgo
- Gastroenterology Department, Instituto Portugues de Oncologia, Lisbon, Portugal
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Cravo M, Lage P, Albuquerque C, Chaves P, Claro I, Gomes T, Gaspar C, Fidalgo P, Soares J, Nobre-Leitão C. BAT-26 identifies sporadic colorectal cancers with mutator phenotype: a correlative study with clinico-pathological features and mutations in mismatch repair genes. J Pathol 1999; 188:252-7. [PMID: 10419591 DOI: 10.1002/(sici)1096-9896(199907)188:3<252::aid-path354>3.0.co;2-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Microsatellite instability (MSI) is present in most colorectal cancers (CRC) associated with hereditary nonpolyposis colorectal cancer (HNPCC). MSI testing in so-called sporadic forms of CRC may become a useful tool in identifying new HNPCC kindred. The aim of this study was to analyse the utility of BAT-26 as a marker to identify CRCs with MSI and to investigate whether sporadic CRCs with MSI have a phenotypic expression similar to HNPCC cases. MSI was detected using two methods, an association of 7 poly(CA) repeats and a poly(A) repeat alone, BAT-26, in a series of 62 patients with apparently sporadic forms of CRC. Germ-line and somatic mutations in the hMSH2, hMLH1, and hMSH6 genes were analysed in patients with MSI+ tumours. Patients with MSI+ at poly(CA) loci and at BAT-26 were younger (p=0.024 and p=0.002), had tumours more frequently right sided (p=0.017 and p=0.0001) and more often mucinous (p=0.037 and p=0.005, respectively) than patients with MSI negative tumours. Mutation analysis allowed the identification of two patients carrying germ-line mutations in the hMLH1 gene (both were BAT-26+) and two other patients who had somatic mutation in the hMSH2 and in hMLH1 genes. In conclusion, the detection of MSI using poly(CA) repeats or BAT-26 alone allowed the identification of a subset of patients with clinico-pathological characteristics similar to those associated to HNPCC. BAT-26 has the advantage of being a simple and less expensive method that might be used as a screening procedure before mutation analysis.
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Affiliation(s)
- M Cravo
- Serviço de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil, 1093 Lisboa Codex, Portugal.
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Pinto A, Fidalgo P, Cravo M, Midões J, Chaves P, Rosa J, dos Anjos Brito M, Leitão CN. Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis: randomized, double-blind, controlled trial. Dis Colon Rectum 1999; 42:788-95; discussion 795-6. [PMID: 10378604 DOI: 10.1007/bf02236937] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Short chain fatty acids are the main energy source of colonocytes and their use may be impaired in chronic radiation proctitis. The aim of the present study was to evaluate the therapeutic effect of short chain fatty acid enemas in patients with chronic radiation proctitis. METHODS A prospective, randomized, double-blind trial comparing short chain fatty acid enemas with placebo was conducted in 19 patients with chronic radiation proctitis. Short chain fatty acid enemas contained 60 mM sodium acetate, 30 mM sodium propionate, and 40 mM sodium butyrate. The treatment period lasted five weeks and patients were followed up for six months. RESULTS On admission, both groups were similar regarding all parameters evaluated. After five weeks short chain fatty acid-treated patients showed a significant decrease in the number of days with rectal bleeding from the previous week (4.4+/-1.8 to 1.4+/-2.2; P = 0.001) and an improvement of endoscopic score (4.8+/-1.4 to 2.2+/-1.2; P = 0.001). Hemoglobin values were also significantly higher in short chain fatty acid-treated patients (13.1+/-0.9 g/dl vs. 10.7+/-2.1 g/dl; P = 0.02). Mucosal DNA and protein concentrations decreased in both groups but significantly so only in placebo-treated patients (P = 0.05). Changes in histologic parameters were not significant in either group. Although short chain fatty acid-treated patients did not get worse in the next six months, placebo-treated ones gradually improved, and at the end of six months, differences between the two groups were no longer observed. CONCLUSIONS Short chain fatty acid enemas can accelerate the process of healing in chronic radiation proctitis, but treatment has to be continuous if a complete and sustained clinical, endoscopic, and histologic response is to be obtained.
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Affiliation(s)
- A Pinto
- Serviço de Gastrenterologia, Lisboa, Portugal
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Abstract
BACKGROUND The global DNA methylation of 136 breast lesions (117 primary invasive carcinomas, 5 benign phyllodes tumors, 11 fibroadenomas, and 3 sclerosing adenosis) and their respective adjacent parenchyma was analyzed using an in vitro enzyme assay. METHODS In the group of patients with breast carcinoma, DNA hypomethylation was correlated with clinical and pathologic parameters known to affect disease prognosis. Histopathologic type, disease stage, and tumor grade were evaluated according to the World Health Organization classification, the TNM system, and the criteria of Elston and Ellis' criteria, respectively. DNA flow cytometry was performed in fresh/frozen samples stained with propidium iodide. Hormone receptor (estrogen and progesterone receptor) status was determined by immunocytochemistry. RESULTS The comparative study of DNA methylation showed that the DNA of breast carcinomas was statistically significantly less methylated than the DNA of the respective adjacent parenchyma (P=0.0001), the DNA of breast benign lesions (P=0.0002), and the DNA of normal parenchyma (P < 0.0001). A statistically significant correlation was found between the global DNA hypomethylation and the disease stage (P=0.0009), tumor size (P=0.0026), and histologic grade (P=0.0097) of malignant neoplasms. A trend for DNA from breast carcinomas with positive axillary lymph nodes (N1) to be more hypomethylated than those without nodal involvement (NO) (P=0.055) was verified. In contrast, no significant association was found between DNA methylation and histologic type of tumors, hormone receptors, DNA ploidy, and S-phase fraction. CONCLUSIONS The current shows that DNA hypomethylation is increased in breast carcinomas, playing a potentially important role in tumor development. These findings also suggest that DNA methylation status may be a biologic marker with prognostic significance in this group of neoplasms.
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Affiliation(s)
- J Soares
- Departamento de Patologia Morfológica, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
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Claro I, Cravo M, Glória L, Gaspar C, Albuquerque C, Lage P, Fidalgo P, Ramalho E, Chaves P, Cardoso P, Nobre Leitão C. Colonic cancer in a 34-yr-old woman: should it prompt microsatellite instability studies and mismatch repair gene testing? Am J Gastroenterol 1998; 93:1991-2. [PMID: 9772075 DOI: 10.1111/j.1572-0241.1998.00565.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It remains debatable whether young patients with colorectal tumors should undergo genetic testing with the aim of identifying new hereditary nonpolyposis colorectal cancer families. We describe a case of a young woman with colon cancer with no clinical criteria of hereditary nonpolyposis colorectal cancer, whose genetic analysis showed that the tumor displayed microsatellite instability, and in whom a truncated protein in hMSH2 gene was found, which was also present in two at-risk relatives.
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Affiliation(s)
- I Claro
- Centro de Investigação em Patobiologia Molecular, and Departamento de Patologia Morfológica, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
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Suspiro A, Fidalgo P, Cravo M, Albuquerque C, Ramalho E, Leitão CN, Costa Mira F. The Muir-Torre syndrome: a rare variant of hereditary nonpolyposis colorectal cancer associated with hMSH2 mutation. Am J Gastroenterol 1998; 93:1572-4. [PMID: 9732950 DOI: 10.1111/j.1572-0241.1998.00487.x] [Citation(s) in RCA: 27] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Muir-Torre syndrome is a rare autosomal dominant disorder characterized by the association of visceral malignancies with typical skin lesions. This syndrome is now considered a subtype of the more common hereditary nonpolyposis colorectal cancer syndrome (HNPCC). This last condition has been ascribed to mutations in four mismatch repair genes, and similar mutations, mostly located at hMSH2 gene, are now being described in some Muir-Torre patients. We describe the case of a 64-yr-old woman with no family history of colorectal cancer, who developed two visceral malignancies belonging to the usual spectrum of hereditary nonpolyposis colorectal cancer (colon and stomach), beginning at age 41. She additionally developed several skin tumors, including multiple keratoacanthomas, thus fulfilling Muir-Torre diagnostic criteria. Because of her cutaneous phenotype, she was screened for DNA mismatch repair gene mutations by in vitro synthetized protein assay (IVSP) and a truncating mutation was identified at hMSH2. We further discuss the clinical significance of the Muir-Torre phenotype, the association of this syndrome with hMSH2 mutations and the important implications of genetic diagnosis for the patient and her offspring.
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Affiliation(s)
- A Suspiro
- Serviço de Gastroenterologia and Centro de Patobiologia Molecular, Instituto Português de Oncologia Francisco Gentil, Lisboa
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Nobre-Leitão C, Lage P, Cravo M, Cabeçadas J, Chaves P, Alberto-Santos A, Correia J, Soares J, Costa-Mira F. Treatment of gastric MALT lymphoma by Helicobacter pylori eradication: a study controlled by endoscopic ultrasonography. Am J Gastroenterol 1998; 93:732-6. [PMID: 9625118 DOI: 10.1111/j.1572-0241.1998.215_a.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous studies have demonstrated a link between Helicobacter pylori infection and low grade B-cell gastric MALT lymphoma. The aim of this study was to evaluate the effect of Helicobacter pylori eradication in 17 patients with low grade B-cell gastric MALT lymphoma stage EI. METHODS For disease staging EUS and CT scan were systematically performed. Eight patients were excluded from the present series because stage EII disease was diagnosed. To demonstrate B-cell monoclonality, immunohistochemistry and polymerase chain reaction were used. H. pylori eradication was performed with triple therapy. RESULTS H. pylori was eradicated in all patients after first (n = 15) or second line (n = 2) treatment. Histologic regression of lymphoma was observed in all patients after a median period of 2 mo. Disappearance of monoclonality according to polymerase chain reaction took significantly longer (7 mo). At the end of the study, four of 16 patients still exhibited persistent monoclonal bands. Relapse of lymphoma occurred in two patients associated with H. pylori reinfection/recrudescence. CONCLUSION Eradication of H. pylori seems to be an effective therapy in patients with stage EI gastric MALT lymphoma, although long-term results are still uncertain. Endoscopic ultrasonography is useful for a more accurate staging of the disease. The clinical significance of detecting monoclonality by polymerase chain reaction remains to be determined.
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MESH Headings
- Adult
- Aged
- Anti-Bacterial Agents
- Anti-Ulcer Agents/therapeutic use
- Drug Therapy, Combination/therapeutic use
- Endosonography
- Female
- Helicobacter Infections/complications
- Helicobacter Infections/drug therapy
- Helicobacter pylori
- Humans
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Omeprazole/therapeutic use
- Prospective Studies
- Recurrence
- Stomach Diseases/drug therapy
- Stomach Neoplasms/diagnostic imaging
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
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Affiliation(s)
- C Nobre-Leitão
- Serviço de Gastrenterologia, Centro de Investigação em Patobiologia Molecular, Departamento de Patologia Morfológica, Instituto Português de Oncologia Francisco Gentil, Lisboa
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43
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Albuquerque C, Fidalgo P, Chagas C, Suspiro A, Cravo M, Ramalho E, Leitão CN, Mira FC. [Genetic diagnosis of familial adenomatous polyposis: detection of APC gene mutations based on an in vitro synthetized protein]. ACTA MEDICA PORT 1998; 11:25-32. [PMID: 9580364] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Familial adenomatous polyposis of the colon (FAP) is a dominant autosomic disease in which virtually 100% of the affected individuals develop colorectal cancer before the age of forty. The gene responsible for this disease (APC gene) is mutated in the germ line of these patients. The genetic diagnosis of FAP was initially done using linkage analysis. Because 95% of the mutations in APC gene result in a stop codon which will originate a truncated protein, previous authors have proposed that the mutation analysis should be performed using an in vitro synthesized protein (IVSP) assay. In this study we searched for germinal mutations in exon 15 of the APC gene in subjects belonging to families with FAP, using the IVSP assay. Eighty individuals belonging to 23 families were included in this series. We started by studying exon 15 which encompasses 6500/8535 bp and which corresponds to 75% of the coding region. This exon was divided into four fragments, which were amplified by PCR and the product was used in a transcription/translation assay. Mutations resulting in a truncated protein were detected in 9/23 (39%) of the families. This corresponds to 20/42 (48%) of individuals analysed in these nine families. All the mutations were located in the 5' region of exon 15, with seven of them being in the first fragment and the remaining two in the same place of the second fragment. With the exception of two healthy individuals at risk, all the others with a detected mutation, already exhibited clinical manifestations. One of these two individuals was later confirmed to harbor colonic polyps, strengthening the diagnostic accuracy of this IVSP analysis. We also identified 10 other healthy subjects at risk with a negative genetic diagnosis, who were therefore removed from surveillance programs. In conclusion, our results show that IVSP analysis has a high sensitivity as a diagnostic tool and should be used as the first screening method to identify those individuals who have inherited the genetic defect, even before they have developed any symptoms. This will enable us to try new drugs which may potentially delay or prevent the development of colonic polyps.
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Affiliation(s)
- C Albuquerque
- Centro de Investigação de Patobiologia Molecular, Instituto Português de Oncologia, Lisboa
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44
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Glória L, Cravo M, Camilo ME, Resende M, Cardoso JN, Oliveira AG, Leitão CN, Mira FC. Nutritional deficiencies in chronic alcoholics: relation to dietary intake and alcohol consumption. Am J Gastroenterol 1997; 92:485-9. [PMID: 9068475] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Relationships of nutritional status with ethanol consumption and diet were studied in 33 chronic alcoholics with no clinical or laboratory evidence of liver disease. METHODS Nutritional assessment included subjective global assessment, weight-height index, body mass index, and serum albumin measurements. Dietary intake included estimates of daily intake of substrates, folic acid, vitamins B1, B5, B6, and B12. Circulating concentrations of folate, pyridoxal-phosphate and vitamin B12 were evaluated as well. RESULTS Only 18.1% of patients were considered malnourished, with body mass indices lower than those with an average or good nutritional status (p < 0.0001). Body weight was under 90% of the ideal in 8/33 (24%) patients. Serum albumin values were within normal range in all patients. In terms of calories provided by nonalcoholic substrates, protein, or vitamin intake, we observed no differences between well and poorly nourished individuals. However, malnourished alcoholics consumed significantly more ethanol (p = 0.01) and an inverse correlation was found between ethanol intake and weight-height index (r = -0.35; p = 0.03). Low circulating concentrations of pyridoxal-phosphate and red blood cell folate were found in 51.5% and 60.6% of alcoholics, respectively. These were not correlated with vitamin dietary intake or ethanol consumption, but there was a trend toward malnourished patients to present lower concentrations of red blood cell folate (p = 0.13). CONCLUSIONS Although over malnutrition is infrequent in this group of chronic alcoholics, specific vitamin deficiencies are present in a substantial proportion of patients and are more likely related to alcohol consumption.
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Affiliation(s)
- L Glória
- Serviço de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil de Lisboa, Portugal
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Cravo M, Glória L, Camilo M, Resende M, Cardoso JN, Leitão CN, Mira FC. DNA methylation and subclinical vitamin deficiency of folate, pyridoxal-phosphate and vitamin B12 in chronic alcoholics. Clin Nutr 1997. [DOI: 10.1016/s0261-5614(97)80256-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Glória L, Cravo M, Pinto A, de Sousa LS, Chaves P, Leitão CN, Quina M, Mira FC, Soares J. DNA hypomethylation and proliferative activity are increased in the rectal mucosa of patients with long-standing ulcerative colitis. Cancer 1996. [PMID: 8940998 DOI: 10.1002/(sici)1097-0142(19961201)78:11<2300::aid-cncr5>3.0.co;2-q] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND DNA methylation and DNA cytometric parameters were evaluated in the rectal mucosa from patients with extensive and long-standing ulcerative colitis. METHODS Twenty-six patients with extensive disease for more than 7 years and 11 healthy controls were included. Global DNA methylation was assessed as the capacity of the DNA test to incorporate [3H]methyl groups from [3H]-S-adenosyl-methionine in the presence of Sss1 methylase. A higher incorporation reflects a lower state of intrinsic methylation. DNA ploidy, S-phase fraction, and proliferative index (PI = S + G2M) of the cell cycle were analyzed by flow cytometry. RESULTS Incorporation of the [3H]methyl groups into DNA was 10-fold higher in patients compared with controls (P < 0.001) and was significantly higher in patients with histologically active disease (P = 0.02). With regard to flow cytometry, all samples showed a diploid pattern, but S-phase fraction and the proliferative index values were significantly increased in patients compared with controls (P = 0.0007 and P = 0.003, respectively). A positive correlation was found between S-phase fraction and proliferative index and the number of exacerbations of the disease (P < 0.005), and there was a trend among those patients who had disease for longer than 20 years to present with increased cellular proliferation compared with those with a shorter evolution of disease (P > 0.05). CONCLUSIONS DNA hypomethylation and proliferative activity are increased in this group of patients, supporting the concept that their colonic mucosa undergoes epigenetic and kinetic changes that might predispose these individuals to develop colorectal neoplasms. However, it cannot be ruled out that these markers solely reflect hyperproliferation associated with active inflammation.
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Affiliation(s)
- L Glória
- Servico de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil de Lisboa, Portugal
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Glória L, Cravo M, Pinto A, de Sousa LS, Chaves P, Leitão CN, Quina M, Mira FC, Soares J. DNA hypomethylation and proliferative activity are increased in the rectal mucosa of patients with long-standing ulcerative colitis. Cancer 1996; 78:2300-6. [PMID: 8940998 DOI: 10.1002/(sici)1097-0142(19961201)78:11<2300::aid-cncr5>3.0.co;2-q] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND DNA methylation and DNA cytometric parameters were evaluated in the rectal mucosa from patients with extensive and long-standing ulcerative colitis. METHODS Twenty-six patients with extensive disease for more than 7 years and 11 healthy controls were included. Global DNA methylation was assessed as the capacity of the DNA test to incorporate [3H]methyl groups from [3H]-S-adenosyl-methionine in the presence of Sss1 methylase. A higher incorporation reflects a lower state of intrinsic methylation. DNA ploidy, S-phase fraction, and proliferative index (PI = S + G2M) of the cell cycle were analyzed by flow cytometry. RESULTS Incorporation of the [3H]methyl groups into DNA was 10-fold higher in patients compared with controls (P < 0.001) and was significantly higher in patients with histologically active disease (P = 0.02). With regard to flow cytometry, all samples showed a diploid pattern, but S-phase fraction and the proliferative index values were significantly increased in patients compared with controls (P = 0.0007 and P = 0.003, respectively). A positive correlation was found between S-phase fraction and proliferative index and the number of exacerbations of the disease (P < 0.005), and there was a trend among those patients who had disease for longer than 20 years to present with increased cellular proliferation compared with those with a shorter evolution of disease (P > 0.05). CONCLUSIONS DNA hypomethylation and proliferative activity are increased in this group of patients, supporting the concept that their colonic mucosa undergoes epigenetic and kinetic changes that might predispose these individuals to develop colorectal neoplasms. However, it cannot be ruled out that these markers solely reflect hyperproliferation associated with active inflammation.
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Affiliation(s)
- L Glória
- Servico de Gastrenterologia, Instituto Português de Oncologia Francisco Gentil de Lisboa, Portugal
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Abstract
BACKGROUND Global DNA hypomethylation has been found in the premalignant stages of some neoplasms and has been implicated as an important factor for tumour progression. AIMS The aim of this study was to evaluate whether DNA hypomethylation occurs during the process of gastric carcinogenesis. METHODS Gastric specimens were obtained from 49 patients and histologically classified as: normal 10, superficial gastritis 14, chronic atrophic gastritis with intestinal metaplasia 15, and intestinal type of gastric carcinoma 10. Global DNA methylation was assessed by incubating DNA with (3H)-S-adenosylmethionine and Sss1 methylase. A higher incorporation of (3H) methyl groups reflects a lower degree of intrinsic methylation. RESULTS A graduated increase in (3H) methyl group incorporation into DNA was found over the range extending from normal gastric mucosa, to superficial gastritis and to chronic atrophic gastritis (136,556 (24,085) v 235,725 (38,636) v 400,998 (26,747 dpm/micrograms/DNA respectively; p = 0.0002). No further increase was found in specimens from patients with carcinoma. No differences were found between extent of DNA methylation in neoplastic or non-neoplastic mucosa from patients with gastric carcinoma. Hypomethylation of DNA increased substantially with severe atrophy (p = 0.01) or with type III intestinal metaplasia (p = 0.15). CONCLUSIONS Global DNA hypomethylation occurs in the early stages of gastric carcinogenesis, and it may be a novel biomarker of gastric neoplasia, useful in monitoring the response to chemopreventive agents.
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Affiliation(s)
- M Cravo
- Serviço de Gastrenterologia, Instituto Português de Oncologia, Francisco Gentil, Lisbon, Portugal
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Cravo M, Pinto A, Cruz A, Nobre-Leitão C, Costa-Mira F. O.28 Nutrient intake in patients with colonic adenomas and its correlation with DNA methylation in rectal mucosa: effect of foliate supplementation. Clin Nutr 1996. [DOI: 10.1016/s0261-5614(96)80075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nobre-Leitão C, Chaves P, Fidalgo P, Cravo M, Gouveia-Oliveira A, Ferra MA, Mira FC. Calcium regulation of colonic crypt cell kinetics: evidence for a direct effect in mice. Gastroenterology 1995; 109:498-504. [PMID: 7615199 DOI: 10.1016/0016-5085(95)90338-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND & AIMS Oral calcium supplementation is believed to decrease colonic hyperproliferation through neutralization of fatty acids and bile acids. In the present study, the effect of oral calcium, given with low-fat diets, in the early stages of colorectal carcinogenesis is evaluated. METHODS In experiment A, mice received normal or low-calcium diets and were killed at 25 weeks. In experiment B, mice were fed the same diets but were submitted to six weekly injections of dimethylhydrazine and were killed at 10, 16, and 21 weeks. Cell proliferation was evaluated using bromodeoxyuridine immunohistochemistry. RESULTS In experiment A, mice fed low-calcium diets showed a significant upward shift of the proliferative compartment (P = 0.04) (phase 2 defect) in the absence of hyperproliferation. In experiment B, besides a phase 2 defect, dimethylhydrazine-induced hyperproliferation was also significantly enhanced in animals fed low-calcium diets (phase 1 defect) as shown by an increased number of labeled cells per column and total labeling index (P = 0.01). CONCLUSIONS Low-calcium diets induce an upward shift of the main proliferative compartment, which reflects an increased risk for malignant transformation. This effect was observed with a low-fat diet, suggesting a direct mechanism, rather than the usual indirect one, documented with high-fat diets.
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Affiliation(s)
- C Nobre-Leitão
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Lisbon
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