VILMA DOS SANTOS TRINDADE VIANA
Projetos de Pesquisa
Unidades Organizacionais
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Dyslipidemia in Juvenile Dermatomyositis: The Role of Disease Activity(2012) KOZU, Katia T.; SILVA, Clovis Artur; BONFA, Eloisa; SALLUM, Adriana M.; PEREIRA, Rosa M. R.; VIANA, Vilma S.; BORBA, Eduardo F.; CAMPOS, Lucia M. A.- Anti-DNase I Antibody A New Serological Reactivity in Primary Sjogren Syndrome(2020) GRIFFO, Priscilla; VIANA, Vilma V. S. T.; PASOTO, Sandra G.; LEON, Elaine P.; BONFA, EloisaBackground and Objective: Primary Sjogren syndrome (pSS) is a systemic autoimmune rheumatic disease that particularly affects exocrine glands. Dry eye is one of the most important features of this syndrome, and a recent study reported reduced deoxyribonuclease I (DNase I) activity in the tear of patients with dry eye. We therefore postulated that patients with pSS might have antibodies targeting DNAse I. Methods: We have evaluated in a cross-sectional study 85 patients with pSS (2002 American-European Consensus Group Criteria), 50 rheumatoid arthritis (RA) patients (1987 American College of Rheumatology Criteria) without sicca symptoms, and 88 healthy volunteers. IgG anti-DNase I was detected by enzyme-linked immunosorbent assay using as antigen bovine pancreas enzyme and confirmed by immunoblotting. Results: Age and sex were alike in the 3 groups (p > 0.05). Anti-DNase I was detected in 43.5% of the pSS patients. In contrast, this reactivity was absent in all RA patients (p = 0.0001). Additional comparison of pSS patients with (n = 37) or without (n = 48) anti-DNase I showed that the former group had higher IgG serum levels (2293.2 +/- 666.2 vs 1483.9 +/- 384.6 mg/dL, p = 0.0001) and greater rate of non-drug-induced leukopenia (43% vs 19%, p = 0.02). A multivariate logistic regression analysis identified that only IgG levels were independently associated with anti-DNase I. Conclusions: We describe a high frequency of anti-DNase I antibodies in pSS patients associated with higher serum IgG levels. The lack of this reactivity in RA patients without sicca symptoms suggests that this antibody may be helpful in the differential diagnosis of these diseases.
conferenceObject Pandemic Influenza Immunization in Primary Antiphospholipid Syndrome (PAPS): A Trigger to Autoantibody Production?(2012) MEDEIROS, Danielle M.; BUENO, Cleonice; RIBEIRO, Ana Cristina M.; CALICH, Ana L. G.; BONFIGLIOLI, Karina Rossi; VIANA, Vilma S.; CARVALHO, Jozelio F.; SILVA, Clovis Artur; BONFA, EloisaBackground/Purpose: There are scarce data suggesting that pan-demic influenza vaccination may induce antiphospholipid (APL) autoan- tibodies in inflammatory rheumatic diseases, particularly in systemic lupus erythematosus patients. However, there is no study evaluating the APL autoantibodies induction in primary antiphospholipid syndrome (PAPS) patients. The objective was to perform short and long-term evaluations of a large panel of APL autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in PAPS patients and healthy controls. Lupus specific antibodies were also investigated in these patients. Methods: Forty-five PAPS patients (Sapporo criteria) and 33 healthy controls were vaccinated with monovalent, inactivated H1N1 vaccine (Butantan Institute/Sanofi Pasteur, São Paulo, Brazil). They were prospec-tively assessed at pre-vaccination, 3 weeks and 6 months after vaccination. APL autoantibodies were determined by an enzyme-linked immunosor-bent assay (ELISA) and included: anti-cardiolipin (aCL) IgG/IgM and anti-β2GPI IgG/IgM antibodies (Inova Diagnostics, USA); anti-annexin V IgG/IgM, anti-phosphatidyl serine IgG/IgM and anti-prothrombin IgG/IgM (Orgentec Diagnostica, Germany). Anti-Sm was determined by ELISA (Inova Diagnostics, USA) and anti-dsDNA by indirect immun-fluorescence. Arterial and venous thromboses were also clinically assessed. The statistical analyses were carried out with qui square test, McNemar s test and one-way repeated measures analysis of variance (ANOVA). Results: Pre-vaccination frequency of at least one APL antibody was significantly higher in PAPS patients compared to controls (58% vs. 21%, p=0.003). The overall frequencies of APL antibody at pre-vaccination, 3 weeks and 6 months after immunization remained unchanged in patients (p=0.89) and controls (p=0.83). Further analysis of each evaluated antibody in PAPS revealed that their percentages at pre-vaccination and after 3 weeks and 6 months were also comparable (p>0.05): aCL IgG (42%, 38% and 42%), aCL IgM (22%, 20% and 24%), anti-β2GPI IgG (22%, 22% and 20%), anti-β2GPI IgM (15%, 15% and 18%), anti- annexin V IgG (4.5%, 4.5% and 2.5%), anti-annexin V IgM (uniformly negative), anti-phosphatidyl serine IgG (38%, 35% and 38%), anti- phosphatidyl serine IgM (15%, 13% and 13%), anti-prothrombin IgG (20%, 15% and 18%) and anti-prothrombin IgM (2.5%, 2.5% and 2.5%). The same pattern was observed for the control group (p>0.05). At 3 weeks, 2 PAPS patients developed a new but transient APL anti-body (moderate titer aCL IgG and IgM) whereas at 6 months, new APL antibodies were observed in 6 PAPS patients: 3 moderate titer aCL IgM, 1 moderate anti-β2GPI IgM, 1 low anti-phosphatidyl serine IgG and 1 low anti-prothrombin IgG. Fluctuations of antibody levels were not detected for any evaluated antibody (p>0.05). Of note, anti-Sm and anti-dsDNA autoantibodies were consistently negative during all evaluations. No new arterial or venous thrombosis events occurred during the study period. Conclusion: This was the first study to demonstrate that pandemic non-adjuvant influenza A/H1N1 in PAPS patients does not trigger a change in APL antibody profile or induce lupus specific autoantibodies.- Immunogenicity and safety of the 2009 non-adjuvanted influenza A/H1N1 vaccine in a large cohort of autoimmune rheumatic diseases(2011) SAAD, Carla G. S.; BORBA, Eduardo F.; AIKAWA, Nadia E.; SILVA, Clovis A.; PEREIRA, Rosa M. R.; CALICH, Ana Luisa; MORAES, Julio C. B.; RIBEIRO, Ana C. M.; VIANA, Vilma S. T.; PASOTO, Sandra G.; CARVALHO, Jozelio F.; FRANCA, Ivan L. A.; GUEDES, Lissiane K. N.; SHINJO, Samuel K.; SAMPAIO-BARROS, Percival D.; CALEIRO, Maria T.; GONCALVES, Celio R.; FULLER, Ricardo; LEVY-NETO, Mauricio; TIMENETSKY, Maria do Carmo S.; PRECIOSO, Alexander R.; BONFA, EloisaBackground Despite the WHO recommendation that the 2010-2011 trivalent seasonal flu vaccine must contain A/California/7/2009/H1N1-like virus there is no consistent data regarding its immunogenicity and safety in a large autoimmune rheumatic disease (ARD) population. Methods 1668 ARD patients (systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic sclerosis, psoriatic arthritis (PsA), Behcet's disease (BD), mixed connective tissue disease, primary antiphospholipid syndrome (PAPS), dermatomyositis (DM), primary Sjogren's syndrome, Takayasu's arteritis, polymyositis and Granulomatosis with polyangiitis (Wegener's) (GPA)) and 234 healthy controls were vaccinated with a non-adjuvanted influenza A/California/7/2009(H1N1) virus-like strain flu. Subjects were evaluated before vaccination and 21 days post-vaccination. The percentage of seroprotection, seroconversion and the factor increase in geometric mean titre (GMT) were calculated. Results After immunisation, seroprotection rates (68.5% vs 82.9% p < 0.0001), seroconversion rates (63.4% vs 76.9%, p < 0.001) and the factor increase in GMT (8.9 vs 13.2 p < 0.0001) were significantly lower in ARD than controls. Analysis of specific diseases revealed that seroprotection significantly reduced in SLE (p < 0.0001), RA (p < 0.0001), PsA (p=0.0006), AS (p=0.04), BD (p=0.04) and DM (p=0.04) patients than controls. The seroconversion rates in SLE (p < 0.0001), RA (p < 0.0001) and PsA (p=0.0006) patients and the increase in GMTs in SLE (p < 0.0001), RA (p < 0.0001) and PsA (p < 0.0001) patients were also reduced compared with controls. Moderate and severe side effects were not reported. Conclusions The novel recognition of a diverse vaccine immunogenicity profile in distinct ARDs supports the notion that a booster dose may be recommended for diseases with suboptimal immune responses. This large study also settles the issue of vaccine safety. (ClinicalTrials.gov #NCT01151644)
- Reduced ovarian reserve in patients with adult polymyositis(2015) SOUZA, Fernando Henrique Carlos de; SILVA, Clovis Artur da; YAMAKAMI, Lucas Yugo Shiguehara; VIANA, Vilma dos Santos Trindade; BONFA, Eloisa; SHINJO, Samuel KatsuyukiPolymyositis (PM) affects female gender during reproductive age; however, there is no study assessing ovarian reserve in these patients to evaluate ovarian reserve markers in PM. Eight female patients with PM (Bohan and Peter criteria, 1975) with aged 18-40 years, followed at our tertiary centre from March 2011 to May 2014, were invited to participate. They were age-matched with 16 healthy individuals (control group). All were evaluated at early follicular phase of menstrual cycle. Follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Mullerian hormone (AMH) serum levels (ELISA) and sonographic antral follicle count (AFC) were determined. PM patients and controls had comparable mean age (31.4 +/- 6.5 vs. 30.7 +/- 6.2 years, P = 0.946), ethnicity and socioeconomic class (P > 0.05). PM mean age of onset was 27.3 +/- 6.5 years and disease duration of 6.5 +/- 4.1 years. Menstrual cycles were alike in both groups with a similar frequency of age at menarche, gynaecological age, duration and length of menstrual cycle (P > 0.05). The median serum level of AMH was significantly lower in PM compared to controls [0.7(0.3-3.4) vs. 3.1(1.4-4.0), P = 0.021]. AMH levels a parts per thousand currency sign1 ng/mL (50 vs. 6.3 %, P = 0.024) and very low AFC (37.5 vs. 6.3 %, P = 0.037) were significantly in PM patients versus controls. The other hormones (FSH, inhibin B and estradiol levels) were similar between both groups (P > 0.05). The present study was the first to identify subclinical ovarian dysfunction in PM patients during reproductive ages. Further study is necessary to assess the possible role of PM-related factors that may influence the ovarian function of these patients.
conferenceObject Reduction of Ovarian Reserve in Adult Patients with Dermatomyositis.(2014) SOUZA, Fernando Henrique Carlos de; SHINJO, Samuel Katsuyuki; YAMAKAMI, Lucas Yugo Shiguehara; VIANA, Vilma dos Santos Trindade; BARACAT, Edmund Chada; BONFA, Eloisa; SILVA, Clovis Artur AlmeidaconferenceObject Is Uric Acid Level a Predictor of Long-Term Renal Outcome in Lupus Nephritis?(2017) LOPES, Michelle; GAVINIER, Samara; LEON, Elaine; VIANA, Vilma; BORBA, Eduardo Ferreira; BONFA, Eloisaarticle 9 Citação(ões) na Scopus Anti-Lipoprotein Lipase Antibodies in Patients with Hypertriglyceridemia without Associated Autoimmune Disease(2011) CARVALHO, Jozelio Freire de; VIANA, Vilma Santos Trindade; BORBA NETO, Eduardo Ferreira; SANTOS, Raul Dias; BONFA, EloisaBackground: Anti-lipoprotein lipase antibodies have been described in rare cases of patients with hypertriglyceridemia. However, no systematic study evaluating these antibodies in patients with this lipid abnormality has been undertaken. Objectives: To analyze the correlation of anti-lipoprotein lipase (anti-LPL) antibodies with other laboratory findings in patients with hypertriglyceridemia but no autoimmune disease. Methods: We evaluated 44 hypertriglyceridemic patients without autoimmune disease. Clinical and laboratory evaluations included analyses of comorbidities, fasting lipid profile and anti-LPL antibodies. Results: Mean patient age was 55 +/- 10 years; 46% of the patients were female and 64% were Caucasian. The mean disease duration was 94.4 months and mean body mass index 28.7 +/- 3.6 kg/m(2); 34.0% were diabetic, 25.0% were obese, 72.7% had systemic arterial hypertension, 75% were sedentary, 15.9% were smokers, 56.8% had a family history of dyslipidemia, 45.5% had a family history of coronary insufficiency, 20.5% had acute myocardial infarction, 9.0% had undergone revascularization and 11.0% angioplasty, 79.5% were being treated with statins and 43.2% were taking fibrates. Median triglyceride levels were 254 mg/dl (range 100-3781 mg/dl), and total cholesterol level was 233 +/- 111 mg/dl. High-density lipoprotein was 42.6 +/- 15.4 mg/dl, low-density lipoprotein 110.7 +/- 42.4 mg/dl and very low-density lipoprotein 48 +/- 15 mg/dl. Anti-LPL antibodies were identified in 2 patients (4.5%), both of whom had a family history of dyslipidemia, coronary insufficiency and acute myocardial infarction; one had undergone myocardial revascularization and percutaneous transluminal coronary angioplasty, and both were using fibrates and had normal triglyceride levels. Conclusions: Our findings demonstrate a correlation between the immune response and dyslipoproteinemia in hypertriglyceridemic patients, suggesting that autoimmune disease contributes to the dyslipidemia process.- EBV reactivation serological profile in primary Sjogren's syndrome: an underlying trigger of active articular involvement?(2013) PASOTO, Sandra Gofinet; NATALINO, Renato Romera; CHAKKOUR, Henrique Pires; VIANA, Vilma dos Santos Trindade; BUENO, Cleonice; LEON, Elaine Pires; VENDRAMINI, Margarete Borges Gualhardo; LEVY NETO, Mauricio; BONFA, EloisaAntibody to Epstein-Barr virus (EBV) early antigen diffuse (anti-EA-D) is associated with viral replication. However, their possible associations with clinical/therapeutic features in primary Sjogren's syndrome (pSS) were not established. We evaluated 100 pSS patients (American-European Criteria) and 89 age/gender/ethnicity-matched healthy controls. Disease activity was measured by EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI). Antibodies to EBV (anti-VCA IgG/IgM, anti-EBNA-1 IgG, anti-EA-D IgG) were determined by ELISA. Patients and controls had comparable frequencies and mean levels of anti-VCA IgG (90 vs. 86.5 %, p = 0.501; 2.6 +/- A 1.1 vs. 2.5 +/- A 1.1 AU/mL, p = 0.737) and anti-EBNA-1 IgG (92 vs. 94.4 %, p = 0.576; 141.3 +/- A 69.8 vs. 135.6 +/- A 67.5 RU/mL, p = 0.464). Anti-VCA IgM was negative in all cases. Noteworthy, higher frequency and increased mean levels of anti-EA-D were observed in patients than controls (36 vs. 4.5 %, p < 0.0001; 38.6 +/- A 57.4 vs. 7.9 +/- A 26.3 RU/mL, p < 0.0001). Further analysis of patients with (n = 36) and without (n = 64) anti-EA-D revealed comparable age/gender/ethnicity (p a parts per thousand yen 0.551), current prednisone dose (4.8 +/- A 6.9 vs. 5.1 +/- A 10.4 mg/day, p = 0.319), and current uses of prednisone (52.8 vs. 37.5 %, p = 0.148) and immunosuppressants (44.4 vs. 31.3 %, p = 0.201). ESSDAI values were comparable (p = 0.102), but joint activity was more frequent (25 vs. 9.4 %, p = 0.045) in anti-EA-D positive patients. Anti-EA-D antibodies were not associated with anti-Ro/SSA (p = 1.000), anti-La/SSB (p = 0.652), rheumatoid factor (p = 1.000), anti-alpha-fodrin (p = 0.390) or antiphospholipid antibodies (p = 0.573), not suggesting cross-reactivity. The higher anti-EA-D frequency associated with joint activity raises the possibility that a subclinical EBV reactivation may trigger or perpetuate the articular involvement in pSS.
- IL-23/Th17 axis is not influenced by TNF-blocking agents in ankylosing spondylitis patients(2016) MILANEZ, Fernanda Manente; SAAD, Carla G. S.; VIANA, Vilma T.; MORAES, Julio C. B.; PERICO, Gregory Vinicius; SAMPAIO-BARROS, Percival Degrava; GONCALVES, Celio R.; BONFA, EloisaBackground: Advances in pathophysiology and treatment of ankylosing spondylitis (AS) was recently demonstrated. However, the effect of anti-TNF in the newly described inflammatory pathways involved pathogenesis of this disease remains to be determined. The aim of our study was, therefore, to investigate long-term influence of anti-TNF drugs in IL-23/IL-17 axis of AS patients and their possible correlation with treatment, clinical, laboratory and radiographic parameters. Methods: Eighty-six AS anti-TNF naive patients, 47 referred for anti-TNF therapy (active-AS; BASDAI >= 4) and 39 with BASDAI < 4 (control-AS) were included. The active group was evaluated at baseline, 12-months and 24-months after TNF blockade and compared at baseline to control-AS group and to 47 healthy age-and gender-matched controls. Plasma levels of IL-17A, IL-22, IL-23 and PGE2 were measured. Non-steroidal anti-inflammatory drugs (NSAIDs) intake were recorded every 6 months. Radiographic severity and progression was assessed by mSASSS at baseline and 24 months after therapy. Results: At baseline, active-AS group presented higher IL-23 and PGE2 levels compared to control-AS group (p < 0.001 and p = 0.008) and to healthy controls (p < 0.001 and p = 0.02). After 24-months of TNF blockade, IL-23 and PGE2 remained elevated with higher levels compared with the healthy group (p < 0.001 and p = 0.03) in spite of significant improvements in all clinical/inflammatory parameters (p < 0.001). Further analysis of 27 anti-TNF-treated patients who achieved a good response (ASDAS-CRP < 2.1, with a drop >= 1.1) at 24-months revealed that IL-23 plasma levels remained higher than healthy controls (p < 0.001) and higher than control-AS group with similar disease activity (ASDAS-CRP < 2.1, p = 0.01). In active-AS group (n = 47), there was a strong correlation between IL-23 and IL-17A at baseline, 12-months and 24-months after anti-TNF therapy (p <= 0.001). Conclusion: This study provides novel data demonstrating that the IL-23/IL-17 axis is not influenced by TNF blockade in AS patients despite clinical and inflammation improvements and NSAID intake.