MARIANA PINHEIRO XERFAN

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina

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  • article 0 Citação(ões) na Scopus
    Hepatocellular carcinoma (HCC) in patients with Non-Alcoholic Fatty Liver Disease (NAFLD): screening, treatment and survival analysis in a Brazilian series
    (2022) ALENCAR, Regiane Saraiva de Souza Melo; OLIVEIRA, Claudia P.; CHAGAS, Aline Lopes; FONSECA, Leonardo Gomes da; MACCALI, Claudia; SAUD, Lisa Rodrigues da Cunha; XERFAN, Mariana Pinheiro; STEFANO, Jose Tadeu; HERMAN, Paulo; D'ALBUQUERQUE, Luiz Augusto Carneiro; ALVES, Venancio Avancini Ferreira; CARRILHO, Flair Jose
    Objective: The aim of the present study was to evaluate the clinical features, Hepatocellular Carcinoma (HCC) screening, treatment modalities, and Overall Survival (OS) in a series of Non-Alcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma (NAFLD-HCC) Brazilian patients. Methods: This was a cross-sectional study at the Instituto do Cancer do Estado de Sao Paulo, at the Faculdade de Medicina da Universidade de Sao Paulo with the approval of the local research ethics committee. NAFLD patients with HCC diagnosed, from May 2010 to May 2019, were included. Results: A total of 131 patients were included. Risk factors for NAFLD were present in 94.7% of the patients. Only 29% of patients were in the HCC screening program before diagnosis. HCC treatment was performed in 84.7% of patients. Cumulative survival at the end of the first year was 72%, second-year 52%, and fifth-year 32%. HCC screening before diagnosis was not significantly associated with higher cumulative survival. The independent factors associated with shorter general survival were BCLC C-D, p < 0.001, and the size of the largest nodule > 42 mm, p = 0.039. Conclusions: Although the efficacy of screening in our population regarding overall survival was hampered due to the sample size (29% had screening), BCLC stages C-D and the size of the largest nodule larger than 42 mm were identified as independent factors of worse prognosis.
  • article 0 Citação(ões) na Scopus
    Association between Metabolic Disorders and Cholangiocarcinoma: Impact of a Postulated Risk Factor with Rising Incidence
    (2022) FONSECA, Leonardo G. Da; HASHIZUME, Pedro H.; OLIVEIRA, Irai Santana de; IZQUIERDO-SANCHEZ, Laura; SAUD, Lisa Rodrigues da Cunha; XERFAN, Mariana Pinheiro; ALVES, Venancio Avancini Ferreira; MELLO, Evandro Sobroza de; HERMAN, Paulo; BANALES, Jesus M.; OLIVEIRA, Claudia P.; CARRILHO, Flair J.
    Simple Summary A potential relationship between cholangiocarcinoma and metabolic disorders has been suggested, but there is a lack of published data. This study aimed to describe the prevalence of metabolic disorders in a cohort of 122 patients with cholangiocarcinoma and report clinical outcomes. We found a prevalence of 42.6% of metabolic disorders. There was no significant difference in overall survival between patients with or without metabolic disorders, although there was a better survival in the subgroup of patients undergoing surgical resection. This indicates a need to better explore the association between cholangiocarcinoma in a metabolic background. Introduction and objectives: The incidence of cholangiocarcinoma (CCA) has been increasing globally. Although a concomitant increase in the incidence of metabolic disorders might suggest a causal relationship, the data are scarce. We aimed to describe the prevalence of metabolic disorders in patients with CCA and report the clinical features and outcomes. Patients and Methods: Retrospective study including patients with CCA. Patients were divided into: (1) past history of diabetes or/and overweight/obesity (""metabolic disorder group"") and (2) without any of these features (""non-metabolic-disorder group""). A Cox regression model was used to determine the prognostic factors. Results: 122 patients were included. In total, 36 (29.5%) had overweight/obesity, 24 (19.7%) had diabetes, and 8 (6.6%) had both. A total of 29 (23.8%) patients had resectable disease and received upfront surgery. A total of 104 (85.2%) received chemotherapy for advanced/recurrent disease. The overall survival of the cohort was 14.3 months (95% CI: 10.1-17.3). ECOG-PS 0 (p < 0.0001), resectable disease (p = 0.018) and absence of vascular invasion (p = 0.048) were independently associated with better prognosis. The ""metabolic disorder group"" (n = 52) had a median survival of 15.5 months (95% CI 10.9-33.9) vs. 11.5 months (95% CI 8.4-16.5) in the ""non-metabolic-disorder group"" (n = 70) (HR: 1.10; 95% CI 0.62-1.94). Patients with resectable disease in the ""metabolic group"" had longer survival than patients in the ""non-metabolic group"" (43.4 months (95% CI 33.9-NR) vs. 21.8 months (95% CI 8.6-26.9); HR = 0.12, 95% CI 0.03-0.59). Conclusion: Metabolic disorders are frequent among CCA patients. Underlying metabolic comorbidities may be associated with prognosis in resectable CCA. There is a need to explore the mechanism that drives CCA carcinogenesis in a metabolic background.
  • conferenceObject
    SITOSTEROLEMIA AND PREMATURE CORONARY ATHEROSCLEROSIS IN A YOUNG WOMAN: A CASE REPORT.
    (2023) CORSO, Mariana P. Xerfan; MARTINHAGO, Gustavo; BORGES, Kartagena; BECERE, Matheus AndraDe lazzari; CHACRA, Ana Paula Marte; MIZUTA, Marjorie Hayashida; MINAME, Marcio Hiroshi; SANTOS, Raul; ROCHA, Viviane Zorzanelli
  • conferenceObject
    Sorafenib improves liver mitochondrial dysfunction attenuating liver fibrosis in non-alcoholic steatohepatitis (NASH) model
    (2012) STEFANO, Jose Tadeu; PEREIRA, Isabel V.; COELHO, Ana Maria M.; XERFAN, Mariana P.; BARBEIRO, Denise F.; TORRES, Mariana Maciel; BIDA, Patricia Martins; MAZO, Daniel F.; COGLIATI, Bruno; SOUZA, Heraldo Possolo; D'ALBUQUERQUE, Luiz C.; CARRILHO, Flair J.; OLIVEIRA, Claudia P.
    Background/Aim: Mitochondria dysfunction in liver may play an important role in the induction of NASH and fibrosis. Recent evidences have shown that kinase inhibitors are able to inhibit angiogenesis, a key mechanism in fibrosis development. We investigated the role of sorafenib as an antifibrotic agent in a rodent model of NASH. Methods: Adult Sprague-Dawley rats, weighing 250-300g, were fed a choline-deficient high fat diet (CDHFD)(35% total fat, 54% trans fatty acid enriched) and simultaneously exposed to diethylnitrosamine (DEN)(100 mg/Kg) in drinking water during 6 weeks to induce NASH and fibrosis. Sorafenib group (n=10) received sorafenib 2.5 mg/kg/day; NASH group (n=10) received CDHFD plus DEN by daily gavage. Control group (n=4) was fed a standard diet. After this period the animals were sacrificed and liver tissues were collected for histologic examination, mRNA isolation and analysis of mitochondrial function. Genes related to fibrosis [matrix metalloproteinases-9 (MMP-9), tissue inhibitor of matrix metalloproteinases 1 and 2 (TIMP-1 and 2)], oxidative stress [Heat Shock Protein 60 and 90 (HSP-60 and 90)] and mitochondrial biogenesis [peroxisome proliferator-activated receptorgamma co-activator 1 α (PGC-1 α )] were evaluated by RT-qPCR method. Liver mitochondrial oxidation and phosphorylation activities were measured by polarographic method. Results: Sorafenib treatment restored the liver mitochondrial function almost similar with control group, and increased RCR and state 3 respiration in comparison to NASH group (Table 1). Besides, sorafenib upregulated PGC-1 α (p<0,001), a gene related to mitochondrial biogenesis. In the other side, TIMP-2 gene expression also was upregulated (p=0,026). There was no difference in expression of HSP-60 (p=0,447), HSP-90 (p=0,141), TIMP-1 (p=0,623) and MMP-9 (p=0,623) between both groups. All of the animals treated with sorafenib showed a significant lost weight and a decreased of fibrosis score in comparison to control (p<0.05). Conclusions: 1) Treatment with sorafenib reduced fibrosis in a rodent model of NASH; 2)Sorafenib increased mRNA expression of PGC-1α and TIMP-2. 3) Sorafenib treatment improves liver mitochondrial dysfunction. Considering that PGC1 α coordinates gene expression that stimulates mitochondrial biogenesis and the TIMP-2 abrogates endothelial cell proliferation and blocks angiogenesis, sorafenib could be used in the treatment of liver fibrosis and prevent fibrosis in this model.