KARINA PIERANTOZZI VERGANI
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- Bronchial eosinophils, neutrophils, and CD8+T cells influence asthma control and lung function in schoolchildren and adolescents with severe treatment-resistant asthma(2022) ELLER, Miriam Cardoso Neves; VERGANI, Karina Pierantozzi; SARAIVA-ROMANHOLO, Beatriz Mangueira; COSTA, Natalia de Souza Xavier; BRITO, Jose Mara de; ANTONANGELO, Leila; FARIA, Caroline Silverio; RODRIGUES, Joaquim Carlos; MAUAD, ThaisBackgroundStudies in adult severe treatment-resistant asthma (STRA) have demonstrated heterogeneous pathophysiology. Studies in the pediatric age group are still scarce, and few include bronchial tissue analysis. ObjectiveWe investigated 6-18-year-old patients diagnosed with STRA in Sao Paulo, Brazil, by characterizing the different lung compartments and their correlations with asthma control and lung function. MethodsInflammatory profiles of 13 patients with a confirmed diagnosis of STRA were analyzed using blood, induced sputum, bronchoalveolar lavage, viral and bacterial screens and endobronchial biopsy. Inflammatory cells, cytokines, and basement membrane thickening were tested for correlations with the asthma control test (ACT) and spirometry and plethysmography parameters. ResultsEndobronchial biopsy specimens from 11 patients were viable for analysis. All biopsies showed eosinophilic infiltration. Submucosal (SM) eosinophils and neutrophils were correlated with worse lung function (pre-BD FEV1), and SM neutrophils were correlated with fixed obstruction (post-BD FEV1). Intraepithelial (IE) neutrophils were positively correlated with lung function (pre-BD sGaw). CD8 + T cells had the highest density in the IE and SM layers and were positively correlated with ACT and negatively correlated with the cytokines IL1 beta, IL2, IL5, IL7, IL10, IL12, IL17, GCSF, MCP-1, INF-delta, and TNF alpha in sputum supernatant. The ASM chymase + mast cell density correlated positively with quality-of-life score (pAQLQ) and ACT. ConclusionEosinophils and SM neutrophils correlated with worse lung function, while IE neutrophils correlated with better lung function. Most importantly, CD8 + T cells were abundant in bronchial biopsies of STRA patients and showed protective associations, as did chymase + mast cells.
- Analysis of the inflammatory profile of children with controlled and uncontrolled severe asthma(2016) ELLER, Miriam; VERGANI, Karina; SARAIVA-ROMANHOLO, Beatriz; ANTONANGELO, Leila; MAUAD, Thais; RODRIGUES, Joaquim
bookPart Asma grave em pediatria(2019) VERGANI, Karina Pierantozzi; ELLER, Miriam Cardoso Neves; PITREZ, Paulo Marcio Condessa; RODRIGUES, Joaquim CarlosbookPart Lavado broncoalveolar em crianças e adolescentes(2023) VERGANI, Karina Pierantozzi; ELLER, Miriam Cardoso Neves; RODRIGUES, Joaquim Carlos- Can inflammatory markers in induced sputum be used to detect phenotypes and endotypes of pediatric severe therapy-resistant asthma?(2018) ELLER, Miriam C. N.; VERGANI, Karina P.; SARAIVA-ROMANHOLO, Beatriz M.; ANTONANGELO, Leila; LEONE, Claudio; RODRIGUES, Joaquim C.BackgroundThe phenotypes and endotypes of severe therapy-resistant asthma (STRA) have not been fully elucidated in children. The aim of the present study was to investigate inflammatory markers in the induced sputum of children with STRA and to compare them with those present in a group of children who achieved control. MethodsA prospective cohort of children (6-18 years of age) diagnosed with severe asthma (GINA criteria) who had undergone treatment for at least 6 months was comprehensively followed for 3 months. Inhalation technique, adherence to treatment, ACT score, and main comorbidities were assessed. Induced sputum samples were collected for cytology analysis and quantitative assessment of cytokines; the participants also underwent spirometry, plethysmography, and fractional exhaled nitric oxide (FeNO) measurement. ResultsForty patients were included (average age 12.8 years; 62.5% male); of these, 13 (32.5%) were classified as STRA at the end of follow-up. There were no significant differences between the STRA and control groups in demographic data, functional test results, or FeNO levels. The eosinophilic inflammatory pattern predominated in both groups; however, the STRA group showed a proportionally higher percentage of sputum neutrophils (P<0.05). The median sputum levels of the cytokines IL-10, GM-CSF, IFN-, and TNF- were significantly higher in the STRA group (P<0.05). GM-CSF and TNF- levels showed inverse correlations with ACT scores. ConclusionThe presence of neutrophils, the cytokines IL-10, and IFN- and, more particularly, TNF-, and GM-CSF in the sputum may play an important role in the pathophysiological mechanism of STRA in children and adolescents. Specific antagonists for these cytokines may represent a future therapeutic strategy.
bookPart Sibilância recorrente(2022) VERGANI, Karina Pierantozzi; ELLER, Miriam Cardoso NevesbookPart Tuberculose(2019) MARQUES, Heloisa Helena de Sousa; SANT´ANNA, Clemax Couto; OGATA, Irmi Sgarbi; VERGANI, Karina Pierantozzi- Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents(2020) FELICIO-JUNIOR, Egberto Luiz; BARNABE, Viviani; ALMEIDA, Francine Maria de; AVONA, Monise Dematte; GENARO, Isabella Santos de; KURDEJAK, Adriana; ELLER, Miriam Cardoso Neves; VERGANID, Karina Pierantozzi; RODRIGUES, Joaquim Carlos; TIBERIO, Iolanda de Fatima Lopes Calvo; MARTINS, Milton de Arruda; SARAIVA-ROMANHOLO, Beatriz MangueiraOBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.
- Mast cell subtypes in adults and children with severe asthma(2017) ARAUJO-PAULINO, Bianca Bergamo de; ELLER, Miriam Cardoso Neves; VERGANI, Karina Pierantozzi; CARVALHO-PINTO, Regina Maria; STELMACH, Rafael; YOSHIZAKI, Kelly; GROTH, Espen Elias; RODRIGUES, Joaquim; DOLHNIKOFF, Marisa; MAUAD, Thais