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Dias MM, Mesquita Camelo R, de Magalhães LP, Lemos Jardim L, Gonçalves de Oliveira A, Ribeiro RDA, Karla Brognoli Franco V, Callado FMRDA, Lorenzato CS, Rezende SM. Changing recombinant factor VIII to plasma-derived factor VIII during immune tolerance induction. Pediatr Hematol Oncol 2023; 41:74-80. [PMID: 36825651 DOI: 10.1080/08880018.2023.2182853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Maíse Moreira Dias
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Mesquita Camelo
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Letícia Lemos Jardim
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Rosângela de Albuquerque Ribeiro
- Centro de Hematologia e Hemoterapia do Ceará (HEMOCE), Fortaleza, Brazil
- Hospital Universitário Walter Cantídeo, Universidade Federal do Ceará, Fortaleza, Brazil
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Camelo RM, Dias MM, Caram-Deelder C, Gouw S, de Magalhães LP, Zuccherato LW, Jardim LL, de Oliveira AG, de Albuquerque Ribeiro R, Franco VKB, do Rosário Ferraz Roberti M, de Araújo Callado FMR, Etto LY, de Cerqueira MAF, Cerqueira MH, Lorenzato CS, de Souza IS, Serafim ÉSS, Garcia AA, Anegawa TH, Neves DCF, Tan DM, van der Bom J, Rezende SM. Time between inhibitor detection and start of immune tolerance induction: Association with outcome in the BrazIT study. J Thromb Haemost 2022; 20:2526-2537. [PMID: 36102352 DOI: 10.1111/jth.15878] [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: 05/13/2022] [Revised: 08/26/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Immune tolerance induction (ITI) is the treatment of choice for eradication of anti-factor VIII (FVIII) neutralizing alloantibodies (inhibitors) in people with inherited hemophilia A and high-responding inhibitor (PwHA-HRi). The association between ITI outcome and time elapsed between inhibitor detection and start of ITI (∆tinhi-ITI ) is debatable. OBJECTIVE The aim of this study was to evaluate this association among a large cohort of severe PwHA-HRi. METHODS Severe (factor VIII activity level <1%) PwHA-HRi on ITI (n = 142) were enrolled in 15 hemophilia treatment centers. PwHA-HRi were treated according to the Brazilian ITI Protocol. ITI outcomes were defined as success (i.e., recovered responsiveness to exogenous FVIII) and failure (i.e., no responsiveness to exogenous FVIII and requirement of bypassing agents to control bleeding). RESULTS Median ages at inhibitor detection and at ITI start were 3.2 years (interquartile range [IQR], 1.6-8.1) and 6.9 years [IQR, 2.6-20.1), respectively. PwHA-HRi were stratified according to ∆tinhi-ITI quartiles: first (0.0-0.6 year), second (>0.6-1.7 year), third (>1.7-9.2 years), and fourth quartile (>9.2-24.5 years). The overall success rate was 65.5% (93/142), with no difference among first, second, third, and fourth quartiles (62.9%, 69.4%, 58.3%, and 71.4%, respectively) even after adjusting the analyses for potential confounders. CONCLUSION In conclusion, delayed ITI start is not associated with failure of ITI in PwHA-HRi. Therefore, ITI should be offered for these patients, regardless of the time elapsed between the detection of inhibitor and the ITI start.
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Affiliation(s)
- Ricardo Mesquita Camelo
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maíse Moreira Dias
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Center of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Samantha Gouw
- Amsterdam UMC, University of Amsterdam, Department of Pediatric Hematology, Amsterdam, the Netherlands
| | | | | | - Letícia Lemos Jardim
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Rosângela de Albuquerque Ribeiro
- Centro de Hematologia e Hemoterapia do Ceará (HEMOCE), Fortaleza, Brazil
- Hospital Universitário Walter Cantídeo, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | | | - Leina Yukari Etto
- Hemocentro da Paraíba (HEMOÍBA), João Pessoa, Brazil
- Department of Internal Medicine, Center of Medical Sciences, Universidade Federal da Paraíba, João Pessoa, Brazil
| | | | | | | | - Ieda Solange de Souza
- Department of Clinical Haematology, Centro de Hematologia e Hemoterapia do Pará (HEMOPA), Belém, Brazil
- Universitary Hospital João de Barros Barreto, Universidade Federal do Pará, Belém, Brazil
| | | | - Andrea Aparecida Garcia
- Centro de Sangue de São José do Rio Preto, São José do Rio Preto, Brazil
- Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil
| | - Tânia Hissa Anegawa
- Centro de Hematologia Regional de Londrina (HEMEPAR Londrina), Londrina, Brazil
- Faculty of Medicine, Universidade Estadual de Londrina, Londrina, Brazil
| | - Daniele Campos Fontes Neves
- Fundação Hemocentro de Rondônia (FHEMERON), Porto Velho, Brazil
- Department of Medicine, Universidade de Rondônia, Porto Velho, Brazil
| | - Doralice Marvulle Tan
- Department of Paediatric Onco-haematology, Faculdade de Medicina de Marília, Marília, Brazil
| | - Johanna van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Pagliosa CM, Vieira FGK, Dias BV, Brognoli Franco VK, Ramos HP, da Silva EL. Ilex paraguariensis (A. St.-Hil.) leaf infusion decreases iron absorption in patients with hereditary hemochromatosis: a randomized controlled crossover study. Food Funct 2021; 12:7321-7328. [PMID: 34173816 DOI: 10.1039/d1fo00482d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study proposed to investigate the effect of Ilex paraguariensis infusion on the absorption of non-heme iron in hereditary hemochromatosis (HH) patients with the HFE genotype. A two-way randomized, controlled, crossover trial was conducted on patients, aged 29-69 years, undergoing maintenance therapy. Fourteen HFE-HH patients ingested a meal containing 11.4 mg iron and 200 mL either of water (control) or of Ilex paraguariensis leaf infusion. The beverages were offered in random order, at intervals separated by a washout period of 7 days. Active surveillance showed no adverse effects. Blood samples were drawn shortly before and 1, 2, 3, and 4 h after the meal for serum iron measurement. A significant reduction in the postprandial serum iron was observed for HH patients after intake of the Ilex paraguariensis infusion (area under the curve (AUC) expressed as mean ± SEM: 173.3 ± 44.7 μmol h-1 L-1) compared to water (1449.4 ± 241.5 μmol h-1 L-1) (p < 0.001). In summary, intake of Ilex paraguariensis leaf infusion significantly inhibited the absorption of iron in patients with HH and, therefore, should be considered as a potential adjuvant for iron overload control.
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Affiliation(s)
- Cristiane Manfé Pagliosa
- Post-graduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil.
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de Oliveira LMM, Jardim LL, Santana MAP, Cerqueira MH, Lorenzato CS, Franco VKB, Zuccherato LW, Rezende SM, Chaves DG. Effect of the First Factor VIII Infusions on Immunological Biomarkers in Previously Untreated Patients with Hemophilia A from the HEMFIL Study. Thromb Haemost 2021; 121:891-899. [PMID: 33423244 DOI: 10.1055/s-0040-1722353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hemophilia A (HA) is an inherited bleeding disorder which requires continuous replacement with factor (F) VIII concentrate. The main complication of HA is the development of neutralizing alloantibodies which inhibit FVIII activity (inhibitors). The objective of this study was to investigate the effect of the first FVIII infusions on immunological biomarkers in previously untreated patients with HA. Plasma samples were collected at enrollment before any FVIII infusion (T0) and at inhibitor development (INB +/T1) or up to 35 exposure days without inhibitors (INB -/T1). Anti-FVIII antibodies (immunoglobulin M, immunoglobulin G [IgG] 1, IgG3, and IgG4), chemokines (CCL2, CCL5, CXCL8, CXCL9, and CXCL10), and cytokines (interleukin [IL]-2, IL-4, IL-6, IL-10, interferon-γ, tumor necrosis factor, and IL-17) were assessed. A total of 71 children with severe HA were included, of whom 28 (39.4%) developed inhibitors. Plasma levels of anti-FVIII IgG4, IL-6, and CXCL8 were higher at INB +/T1 when compared with INB -/T1. This group presented a mixed cytokine profile and higher plasma levels of CXCL9 and CXL10 when compared with INB +/T1. We conclude that exposure to FVIII triggers a proinflammatory response mediated by IL-6 and CXCL8 in patients with HA who developed inhibitors. Regardless of inhibitor status, the immune system of all HA patients is stimulated after infusions of FVIII.
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Affiliation(s)
| | - Letícia Lemos Jardim
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | | | | | - Luciana Werneck Zuccherato
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Instituto Mário Penna, Belo Horizonte, Minas Gerais, Brazil
| | - Suely Meireles Rezende
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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