JORGE ELIAS KALIL FILHO

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Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/19 - Laboratório de Histocompatibilidade e Imunidade Celular, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 9 Citação(ões) na Scopus
    The impact of pretransplant donor-specific antibodies on graft outcome in renal transplantation: a six-year follow-up study
    (2012) DAVID-NETO, Elias; SOUZA, Patricia Soares; PANAJOTOPOULOS, Nicolas; RODRIGUES, Helcio; VENTURA, Carlucci Gualberto; DAVID, Daisa Silva Ribeiro; LEMOS, Francine Brambate Carvalhinho; AGENA, Fabiana; NAHAS, William Carlos; KALIL, Jorge Elias; CASTRO, Maria Cristina Ribeiro
    OBJECTIVE: The significance of pretransplant, donor-specific antibodies on long-term patient outcomes is a subject of debate. This study evaluated the impact and the presence or absence of donor-specific antibodies after kidney transplantation on short-and long-term graft outcomes. METHODS: We analyzed the frequency and dynamics of pretransplant donor-specific antibodies following renal transplantation from a randomized trial that was conducted from 2002 to 2004 and correlated these findings with patient outcomes through 2009. Transplants were performed against a complement-dependent T-and B-negative crossmatch. Pre- and posttransplant sera were available from 94 of the 118 patients (80%). Antibodies were detected using a solid-phase (Luminex (R)), single-bead assay, and all tests were performed simultaneously. RESULTS: Sixteen patients exhibited pretransplant donor-specific antibodies, but only 3 of these patients (19%) developed antibody-mediated rejection and 2 of them experienced early graft losses. Excluding these 2 losses, 6 of 14 patients exhibited donor-specific antibodies at the final follow-up exam, whereas 8 of these patients (57%) exhibited complete clearance of the donor-specific antibodies. Five other patients developed ""de novo'' posttransplant donor-specific antibodies. Death-censored graft survival was similar in patients with pretransplant donor-specific and non-donor-specific antibodies after a mean follow-up period of 70 months. CONCLUSION: Pretransplant donor-specific antibodies with a negative complement-dependent cytotoxicity crossmatch are associated with a risk for the development of antibody-mediated rejection, although survival rates are similar when patients transpose the first months after receiving the graft. Our data also suggest that early posttransplant donor-specific antibody monitoring should increase knowledge of antibody dynamics and their impact on long-term graft outcome.
  • article 77 Citação(ões) na Scopus
    Preserving the B-Cell Compartment Favors Operational Tolerance in Human Renal Transplantation
    (2012) SILVA, Hernandez M.; TAKENAKA, Maisa C. S.; MORAES-VIEIRA, Pedro M. M.; MONTEIRO, Sandra M.; HERNANDEZ, Maristela O.; CHAARA, Wahiba; SIX, Adrien; AGENA, Fabiana; SESTERHEIM, Patricia; BARBE-TUANA, Florencia Maria; SAITOVITCH, David; LEMOS, Francine; KALIL, Jorge; COELHO, Veronica
    Transplanted individuals in operational tolerance (OT) maintain long-term stable graft function after completely stopping immunosuppression. Understanding the mechanisms involved in OT can provide valuable information about pathways to human transplantation tolerance. Here we report that operationally tolerant individuals display quantitative and functional preservation of the B-c ell compartment in renal transplantation. OT exhibited normal numbers of circulating total B cells, naive, memory and regulatory B cells (Bregs) as well as preserved B-cell receptor repertoire, similar to healthy individuals. In addition, OT also displayed conserved capacity to activate the cluster of differentiation 40 (CD40)/signal transducer and activator of transcription 3 (STAT3) signaling pathway in Bregs, in contrast, with chronic rejection. Rather than expansion or higher activation, we show that the preservation of the B-cell compartment favors OT. Online address: http://www.molmed.org doi: 10.2119/molmed.2011.00281
  • article 2 Citação(ões) na Scopus
    Pre- and Posttransplant Monitoring of Alloantibodies by Complement-Dependent Cytotoxicity and Luminex Methodologies in Liver Transplantation
    (2012) MONTEIRO, F.; RODRIGUES, H.; KALIL, J.; CASTRO, M. C.; PANAJOTOPOULOS, N.; PAREDES, M.; MASSAROLO, P.; MIES, S.
    Background. This study evaluated the influence of circulating anti-HLA antibodies on outcomes of 97 liver allografts from deceased donors. Methods. Human leukocyte antigen (HLA) antibody screening was performed by both complement-dependent cytotoxicity (CDC) and multiparameter Luminex microsphere-based assays (Luminex assay). Results. The agreements between T- and B- cell CDC and Luminex assays were 67% and 77% for pre- and posttransplant specimens, respectively. Graft dysfunction was not associated with either positive pretransplant CDC or Luminex panel-reactive antibody (PRA) values. Likewise, positive posttransplant T- or B- cell CDC PRA values were not associated with graft dysfunction. In contrast, posttransplant Luminex PRA values were significantly higher among patients with graft dysfunction compared with subjects with good outcomes (P = .017). Conclusion. Posttransplant monitoring of HLA antibodies with Luminex methodology allowed identification of patients at high-risk for poor graft outcomes.
  • article 5 Citação(ões) na Scopus
    Spirometric values in elderly asthmatic patients are not influenced by obesity
    (2012) AGONDI, R. C.; BISACCIONI, C.; AUN, M. V.; RIBEIRO, M. R.; KALIL, J.; GIAVINA-BIANCHI, P.
    Background Studies have suggested that asthma in obese individuals differs from the classic asthma phenotype, presenting as a disease that is more difficult to control. Objective The objective of the present study was to determine whether obesity, age or a combination of the two are associated with worse spirometry parameters in patients with asthma. Methods This was an observational cross-sectional study involving patients over 18 years of age who had been diagnosed with asthma (allergic or nonallergic). We evaluated the results of their spirometric tests. The patients were classified in accordance with two criteria: body mass index (BMI) and age. Based on their BMIs, the patients were divided into three groups: normal weight, overweight and obese. Patients were also separated into two categories by age: 18-59 years of age; and >= 60 years of age. Results We evaluated 451 patients with asthma and their spirometry tests. In the present study, the pulmonary function parameters were negatively correlated with BMI and age (P < 0.05). We found that there was a statistically significant correlation between spirometric values and BMI among patients 18-59 years of age (P < 0.001), however, among patients over 60, we did not observe this negative association. Conclusions and Clinical Relevance The spirometric values decreased significantly in proportion to the increase of BMI and age in patients with asthma, especially among young adults. There was no negative correlation between BMI and FEV1 in the group >= 60 years of age, suggesting that perhaps the time of disease is a major factor in the loss of lung function than weight gain in the elderly.
  • conferenceObject
    KIDNEY TISSUE PROTECTIVE RESPONSE OF LIVING RENAL TRANSPLANTATION: COMPARISON TO OPEN AND LAPAROSCOPIC DONOR NEPHRECTOMY.
    (2012) MACHADO, Christiano; MALHEIROS, Denise Maria Avancini C.; ANTONOPOULUS, Ioannis; SAITO, Fernando; URBAN, Cero de Andrade; KALIL, Jorge; LEMOS, Francine Brambate Carvalhinho; NAHAS, William Carlos
  • article 25 Citação(ões) na Scopus
    Broad and Cross-Clade CD4(+) T-Cell Responses Elicited by a DNA Vaccine Encoding Highly Conserved and Promiscuous HIV-1 M-Group Consensus Peptides
    (2012) ALMEIDA, Rafael Ribeiro; ROSA, Daniela Santoro; RIBEIRO, Susan Pereira; SANTANA, Vinicius Canato; KALLAS, Esper Georges; SIDNEY, John; SETTE, Alessandro; KALIL, Jorge; CUNHA-NETO, Edecio
    T-cell based vaccine approaches have emerged to counteract HIV-1/AIDS. Broad, polyfunctional and cytotoxic CD4(+) T-cell responses have been associated with control of HIV-1 replication, which supports the inclusion of CD4(+) T-cell epitopes in vaccines. A successful HIV-1 vaccine should also be designed to overcome viral genetic diversity and be able to confer immunity in a high proportion of immunized individuals from a diverse HLA-bearing population. In this study, we rationally designed a multiepitopic DNA vaccine in order to elicit broad and cross-clade CD4(+) T-cell responses against highly conserved and promiscuous peptides from the HIV-1 M-group consensus sequence. We identified 27 conserved, multiple HLA-DR-binding peptides in the HIV-1 M-group consensus sequences of Gag, Pol, Nef, Vif, Vpr, Rev and Vpu using the TEPITOPE algorithm. The peptides bound in vitro to an average of 12 out of the 17 tested HLA-DR molecules and also to several molecules such as HLA-DP, -DQ and murine IA(b) and IA(d). Sixteen out of the 27 peptides were recognized by PBMC from patients infected with different HIV-1 variants and 72% of such patients recognized at least 1 peptide. Immunization with a DNA vaccine (HIVBr27) encoding the identified peptides elicited IFN-gamma secretion against 11 out of the 27 peptides in BALB/c mice; CD4(+) and CD8(+) T-cell proliferation was observed against 8 and 6 peptides, respectively. HIVBr27 immunization elicited cross-clade T-cell responses against several HIV-1 peptide variants. Polyfunctional CD4(+) and CD8(+) T cells, able to simultaneously proliferate and produce IFN-gamma and TNF-alpha, were also observed. This vaccine concept may cope with HIV-1 genetic diversity as well as provide increased population coverage, which are desirable features for an efficacious strategy against HIV-1/AIDS.
  • conferenceObject
    Perioperative Anaphylaxis: Clinical Features of 51 Patients
    (2012) GARRO, L. S.; RODRIGUES, A. T.; RIBEIRO, M. R.; AUN, M. V.; KALIL, J.; MOTTA, A. A.; GIAVINA-BIANCHI, P.
    Rationale: Perioperative anaphylaxis is an important and life-threatening adverse reaction in clinical practice. We aimed to evaluate the prevalence and the etiology of perioperative anaphylaxis referred to an outpatient clinic specialized in adverse drug reactions (ADRs). Methods: We evaluated 806 patients with history of ADRs through the questionnaire “European Network for Drug Allergy” (ENDA) from October 2006 to June 2011. Patients with a history of perioperative anaphylaxis were selected. The diagnostic criteria for anaphylaxis were based on the World Allergy Organization Guidelines. Etiological investigation was made with skin tests for latex, neuromuscular blockers (NMBs), antibiotics, hypnotics, opioids and local anesthetics. Drug provocation tests (DPTs) for antibiotics, NSAIDs, local anesthetics and latex were also performed. Serum specific IgE was tested for antibiotics (Penicillin, Ampicillin and Amoxicillin) and latex. Results: We identified 51 (6%) patients with a history of perioperative anaphylaxis. Among them, 16 patients (31%) had hypersensitivity reactions with positive cutaneous test, 14 patients (27%) abandoned the investigation and 8 patients (16%) completed the investigation with all tests being negative. Currently 12 patients (23%) are still under investigation. The main cause of perioperative anaphylaxis was latex allergy (22%), followed by NMBs hypersensitivity (6%). Three patients had positive tests for two different agents. Conclusions: Latex allergy was the main cause of perioperative anaphylaxis in this study. The importance of testing all the possible agents involved was demonstrated by the occurrence of three cases with positive test for two agents.
  • article 6 Citação(ões) na Scopus
    Oral manifestations in patients with hypogammaglobulinemia
    (2012) FERNANDES, Karin Sa; KOKRON, Cristina Maria; BARROS, Myrthes Toledo; KALIL, Jorge; GALLOTTINI, Marina
    Objective. The overall objective of this study was to assess the oral manifestations and their association with immunologic status and health history, of individuals with hypogammaglobulinemia. Study Design. A case-controlled study of 100 subjects with hypogammaglobulinemia and 93 control individuals was performed. All participants were examined for dental caries, periodontal disease, mucosal lesions/infections, and general oral health problems. Decayed, missing, filled teeth and community periodontal index were recorded. Complete blood count, serum immunoglobulins, and lymphocyte immunophenotyping were measured on the same day of the oral health assessment. Results. Individuals with hypogammaglobulinemia showed higher prevalence of enamel hypoplasia and complaints of dry mouth, and lower prevalence of dental caries and periodontal disease. Conclusions. The systemic conditions associated with hypogammaglobulinemia were not associated with enhanced susceptibility to caries, gingivitis, or periodontitis; however, individuals with hypogammaglobulinemia were more likely to report more episodes of recurrent aphthous ulcers compared with control individuals. (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:e19-e24)
  • conferenceObject
    Proteomic approach to search for differentially expressed proteins between human pancreatic islets and human insulinomas
    (2012) TERRA, L. F.; TEIXEIRA, P. C.; WAILEMANN, R. A. M.; ZELANIS, A.; PALMISANO, G.; CUNHA-NETO, E.; KALIL, J.; LABRIOLA, L.; SOGAYAR, M. C.
  • conferenceObject
    Evaluation of Clinical and Laboratory Response to Influenza and H1N1 Vaccines in a Group of Brazilian CVID Patients
    (2012) PEDRESCHI, Maira; OLIVEIRA, Ana Karolina Barreto; BARROS, Myrthes Toledo; COHON, Andrea; CELESTINO, A. T.; VILAS-BOAS, L. S.; FELIX, A. C.; PANNUTI, C. S.; KALIL, Jorge; KOKRON, Cristina M.
    CVID pts lack vaccine-specific ab production. We studied the clinical / laboratorial responses to influenza and H1N1 immunization in 22 CVID pts. Clinical evaluation was done through a score (infections, hospitalizations, antibiotic use). The score was applied during the previous and following year post immunization (PI). Blood was drawn before and 1/3/6/12 m PI. A significant reduction was observed in upper respiratory infections and sinusitis in the year PI (p<0.001), and 6 pts seroconverted. Statistical analysis showed no difference among ab levels before and PI. Among the 9 pts who presented H1N1 ab production, 4 reduced the clinical score. Of note, 50% of the 22 pts presented reduction of clinical scores. Then, although ab production to H1N1 wasn’t statistically significant, we observed a reduction in the number of infections in the year PI. This observation may be due to eventual presence of influenza’sabs but reinforces potential benefits of vaccination in CVID pts.