FABIANA AGENA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
conferenceObject Desensitization Using Only IVIG: Is That an Option for Highly-Sensitized Patients Waiting for Kidneys from Cadaveric Donors?(2019) PAIXAO, J. O.; ULISSES, L. R.; SOUZA, P. S.; BEZERRA, G.; AGENA, F.; RODRGUES, H. P.; PANAJOTOPOULOS, N.; PAULA, F. J.; DAVID-NETO, E.; CASTRO, M. R.- Aging and End Stage Renal Disease Cause A Decrease in Absolute Circulating Lymphocyte Counts with A Shift to A Memory Profile and Diverge in Treg Population(2019) FREITAS, Geraldo Rubens Ramos; FERNANDES, Maria da Luz; AGENA, Fabiana; JALUUL, Omar; SILVA, Sergio Colenci; LEMOS, Francine Brambate Carvalhinho; COELHO, Veronica; DAVID-NETO, Elias; GALANTE, Nelson ZocolerThere is a growing number of elderly kidney transplant (Ktx) recipients. Elderly recipients present lower acute rejection rates but higher incidence of infection and malignancies. Aging per se seems to result in a shift to memory profile and chronic kidney disease (CKD) in premature immunological aging. Understanding aging and CKD effects on the immune system can improve elderly Ktx immunosuppression. We analyzed the effects of aging and CKD in the immune system, comparing healthy adults (HAd) (n=14, 26 +/- 2y), healthy elderly (HEld) (n=15, 79 +/- 7y), end stage renal disease (ESRD) adults (EnAd) (n=18, 36 +/- 7y) and ESRD elderly (EnEld) (n=31, 65 +/- 3y) prior to Ktx regarding their naive, memory and regulatory T and B peripheral lymphocytes. Aging and ESRD presented additive effect decreasing absolute numbers of B and T-lymphocytes, affecting memory, naive and regulatory subsets without synergic effect. Both resulted in higher percentages of T memory subsets and opposing effects on regulatory T (TREG) subsets, higher percentage in aging and lower in ESRD. Combined effect of aging and ESRD also resulted in higher regulatory B cell percentages. In addition to global lymphopenia and TCD4(+) memory shift in both aging and ESRD, aging shifts to an immunoregulatory profile, inducing a increase in TREG percentages, contrasting with ESRD that decreases TREGs. Differential immunosuppression regimens for elderly Ktx may be required.
- BK virus salivary shedding and viremia in renal transplant recipients(2019) SARMENTO, Dmitry Jose de Santana; PALMIERI, Michelle; GALVAO, Gustavo Souza; TOZETTO-MENDOZA, Tania Regina; CANTO, Cynthia Motta do; PIERROTTI, Ligia Camera; DAVID-NETO, Elias; AGENA, Fabiana; GALLOTTINI, Marina; PANNUTI, Claudio Sergio; FINK, Maria Cristina Domingues; BRAZ-SILVA, Paulo HenriqueObjectives: This study aimed to verify the presence of polyomavirus BK (BKPyV) in the saliva of kidney transplant recipients and to correlate it with blood viremia. Material and Methods: We have conducted a cross-sectional study with a sample involving 126 renal transplant recipients. 126 samples of saliva and 52 samples of blood were collected from these patients. Detection and quantification of BKPyV were performed using a real-time PCR. To compare the presence of BKPyV in blood and saliva, the binomial proportion test was used. To verify associations between salivary shedding BKPyV and post-transplant periods (in months), the Mann-Whitney test was used. Spearman's correlation was used to correlate the viral load in the saliva with blood of kidney transplant recipients. Results: The mean age of the study group was 51.11 +/- 12.45 years old, and 69 participants (54.8%) were female, with a mean post-transplantation time of 4.80 +/- 6.04 months. BKPyV was quantified in several samples of saliva and blood, with medians of 1,108 cp/mL and 1,255 cp/mL, respectively. Only 16/52 (30.8%) participants presented BKPyV in blood, and 59/126 (46.8%) excreted the virus in saliva (p=0.004). BKPyV shedding was found in patients at a shorter post-transplantation period (3.86 +/- 5.25, p=0.100). A weak correlation was observed between viral quantification in saliva and blood (Spearman's correlation coefficient=0.193). Conclusion: The results of this study suggested that, although saliva excretes more BKPyV than blood, there is no reliable correlation between salivary shedding and blood viremia, showing two independent compartments of viral replication.
conferenceObject Thymoglobulin Induction with Tacrolimus and Everolimus Maintenance Therapy in Elderly Kidney Transplantation Results in Prolonged Lymphocyte Depletion and Do Not Favor Regulatory Profile.(2019) DAVID-NETO, E.; FREITAS, G. Ramos de; FERNANDES, M.; AGENA, F.; LEMOS, F. Brambate Carvalhinho; PAULA, F. Jota de; COELHO, V.; GALANTE, N. Zocoler- Discovery and cross-validation of peripheral blood and renal biopsy gene expression signatures from ethnically diverse kidney transplant populations(2019) VENTURA, Carlucci G.; WHISENANT, Thomas; GELBART, Terri; DAVID, Daisa S. R.; AGENA, Fabiana; SALOMON, Daniel R.; DAVID-NETO, Elias; KURIAN, Sunil M.We determined peripheral blood (PB) and biopsy (Bx) RNA expression signatures in a Brazilian and US cohort of kidney transplant patients. Phenotypes assigned by precise histology were: acute rejection (AR), interstitial fibrosis/tubular atrophy/chronic rejection (CR), excellent functioning transplants (TX), and glomerulonephritis recurrence (GN). Samples were analyzed on microarrays and profiles from each cohort were cross-validated on the other cohort with similar phenotypes. We discovered signatures for each tissue: (1) AR vs TX, (2) CR vs TX, and (3) GN vs TX using the Random Forests algorithm. We validated biopsies signatures of AR vs TX (area under the curve [AUC] 0.97) and CR vs TX (AUC 0.87). We also validated both PB and Bx signatures of AR vs TX and CR vs TX with varying degrees of accuracy. Several biological pathways were shared between AR and CR, suggesting similar rejection mechanisms in these 2 clinical phenotypes. Thus, we identified gene expression signatures for AR and CR in transplant patients and validated them in independent cohorts of significantly different racial/ethnic backgrounds. These results reveal that there are strong unifying immune mechanisms driving transplant diseases and identified in the signatures discovered in each cohort, suggesting that molecular diagnostics across populations are feasible despite ethnic and environmental differences.
- Longitudinal Pharmacokinetics of Mycophenolic Acid in Elderly Renal Transplant Recipients Compared to a Younger Control Group: Data from the nEverOld Trial(2019) ROMANO, Paschoalina; AGENA, Fabiana; EBNER, Persio de Almeida Rezende; SUMITA, Nairo Massakazu; TRIBONI, Ana Heloisa Kamada; RAMOS, Fernanda; GARCIA, Marcio dos Santos; DUARTE, Nilo Jose Coelho; LEMOS, Francine Brambate Carvalhinho; GALANTE, Nelson Zocoler; DAVID-NETO, EliasBackground and ObjectivesElderly patients are increasingly likely to be recipients of transplants. However, the pharmacokinetics of mycophenolic acid (MPA) in this population are yet to be studied in detail. The objective of this study was to assess whether there were differences in MPA pharmacokinetic parameter values between elderly recipients and younger-adult recipients during the 6months immediately following renal transplantation.MethodsIn this analysis, the longitudinal 12-h pharmacokinetics of MPA, administered as enteric-coated mycophenolate sodium (EC-MPS), were evaluated in 44 elderly renal transplant recipients and compared with the corresponding pharmacokinetics of MPA in 31 younger adult recipients. Measurements were performed at 7, 30, 60, 90, and 180days post-transplantation. All patients received tacrolimus and prednisone.ResultsThe elderly patients were 30years older than the younger controls, with a predominance of males and Caucasians. Elderly patients had lower serum albumin than the younger controls during the first 6months after transplantation. The mean estimated total body MPA clearance of the elderly recipients was not significantly different from that of the controls at any analyzed time point (the mean clearance across all time points was 0.310.17 vs 0.300.25L/h/kg). MPA exposure, as evaluated from the area under the 12-h time versus measured MPA concentration (adjusted for dose/body weight) curve, did not differ between the groups at any time point (mean exposure across all time points was 4.68 +/- 3.61 vs 5.95 +/- 4.29 mu gh/mL per mg/kg for the elderly recipients and the controls).ConclusionsThese data show that the pharmacokinetics of MPA in elderly renal transplant recipients were no different to those of younger-adult recipients in this study population.Clinicaltrials.govp id=""Par5000"">NCT 01631058.
- T cell receptor excision circles as a tool for evaluating thymic function in young children(2019) LEVY, A.; RANGEL-SANTOS, A.; TORRES, L. C.; SILVEIRA-ABREU, G.; AGENA, F.; CARNEIRO-SAMPAIO, M.The thymus is a primary lymphoid organ responsible for the maturation of T cells as well as the immunological central tolerance. It is in the antenatal period and infancy that it plays its major role. In clinical practice, T cell receptor excision circles (TRECs) are considered a direct and reliable measure of the thymic function. TRECs are a by-product of DNA formation in gene rearrangement of T cell receptors. They are stable and they do not duplicate during mitosis, representing the recent emigrant T cells from the thymus. Despite their importance, TRECs have been neglected by physicians and there is a lack of data regarding thymic function during infancy of healthy children. In order to evaluate thymic function in the first years of life, we propose measuring TRECs as a valuable tool. One hundred and three blood samples from children and adolescents between 3 months and 20 years of age were analyzed. The mean TRECs count was 136.77 +/- 96.7 copies of TRECs/mu L of DNA. The individuals between 0 and 5 years of age had significantly higher TRECs values than those between 10 and 20 years of age. No significant difference was observed in TRECs values among age groups below 5 years of age. An inverse correlation between TRECs and age was found (r=0.3 P=0.003). These data highlight and validate the evidence of decreased thymus function with age, even during infancy. Awareness should be raised with this important albeit ignored organ.
conferenceObject The Benefit of Kidney Transplantation over the Waitlist Depends on the Patient's Comorbidities.(2019) IZQUIERDO, A. Andrade; REUSING JR., J. V.; ONUSIC, V.; AGENA, F.; LEMOS, F. C.; PAULA, F. de; GERAB, F.; DAVID-NETO, E.conferenceObject Everolimus/Low Tacrolimus Exposure versus Sodium Mycophenolate/ Standard Tacrolimus for the Elderly Kidney Transplant Recipient. A 4-y Follow -Up of the nEverOld Trial(2019) DAVID-NETO, E.; AGENA, F.; PAULA, F. J.; GALANTE, N. Z.; DAVID, D. S.; RAMOS, F.; TRIBONI, A. K.; ROMANO, P.; EBNER, P. A.; COELHO, V.; ALTONA, M.; FALCI, R.; PIOVESAN, A.; NAHAS, W. C.- Effect of polyoma viremia on 3-year allograft kidney function(2019) DAVID-NETO, Elias; AGENA, Fabiana; DAVID, Daisa Silva Ribeiro; PAULA, Flavio Jota de; PIERROTTI, Ligia Camera; FINK, Maria Cristina Domingues; AZEVEDO, Luiz Sergio Fonseca deBackground Polyoma viremia is associated with damage to renal tubular and urothelial cells. This may imply that a certain level of viremia, even cleared thereafter, could be associated with long-term renal dysfunction. Methods We, retrospectively, analyzed 390 first renal transplants adult recipients (>= 18 years) who were monitored for BK viremia in the first 12 months and evaluated estimated GFR (MDRD-4 equation) at 1 month and at the last follow-up (959 +/- 392 days). Results One hundred and ninety-nine patients (51%) developed at least one positive viremia: 105 (53%) low viremia (<10(4) copies/mL), 36 (18%) high viremia (4 x 10(4) > viremia >= 10(4) copies/mL) and 58 (15%) viremia (>= 4 x 10(4) copies/mL) consistent with polyoma virus associated nephropathy (PyVAN). Out of these 58 patients, 24 (6%) developed bx-proven (SV40+) PyVAN and 34(8.7%) presumptive PyVAN (SV40-). Baseline characteristics, immunosuppression, KDRI, rejection episodes, etc., did not differ among groups but there were more deceased donors and ATG induction therapy in the high viremia group. At last follow-up, all patients in the low, high viremia and presumptive PyVAN (except 2) had cleared BK viremia. Bx-proven PyVAN led to 14 graft losses, 10 due to PyVAN. In the presumptive PyVAN there was only one graft loss registered as due to PyVAN. eGFR, at 1 month after KTx, did not differ among groups (51 +/- 22 vs 48 +/- 24 vs 45 +/- 27 vs 43 +/- 18 vs 46 +/- 22 mL/min/1.73 m(2)), for no, low and high viremia as well for presumptive PyVAN and bx-proven PyVAN groups, respectively. At the last follow-up, eGFR did not differ between the no, low, and high viremia compared to baseline and to each other but was statistically lower in the presumptive and bx-proven PyVAN (38 +/- 15 and 17 +/- 7 mL/min/1.73 m(2)) either compared to baseline or to the other groups. Conclusions This study shows that low and high levels of BK viremia do not lead to GFR changes although very high viremia levels, compatible with presumptive or bx-proven PyVAN, even if cleared thereafter, lead to allograft damage and decreased GFR.