DAGOBERTO CALLEGARO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
134 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 134
- Cerebrospinal Fluid Aquaporin-4 Antibody Levels in Neuromyelitis Optica Attacks(2014) SATO, Douglas Kazutoshi; CALLEGARO, Dagoberto; JORGE, Frederico M. de Haidar; NAKASHIMA, Ichiro; NISHIYAMA, Shuhei; TAKAHASHI, Toshiyuki; SIMM, Renata Faria; APOSTOLOS-PEREIRA, Samira Luisa; MISU, Tatsuro; STEINMAN, Lawrence; AOKI, Masashi; FUJIHARA, KazuoTo elucidate immunopathogenetic roles of aquaporin-4 antibodies in the cerebrospinal fluid (CSF) of neuromyelitis optica spectrum disorders (NMOSD), we analyzed aquaporin-4 antibody titers, cellular and inflammatory markers in the CSF collected from 11 aquaporin-4 antibody seropositive patients. The CSF aquaporin-4 antibody levels during attacks (but not in sera) closely correlated with pleocytosis, inflammatory cytokines including interleukin-6 that can regulate antibody-producing plasmablasts, and glial fibrillary acidic protein levels in the CSF. The amount of aquaporin-4 antibodies present in the central nervous system may have therapeutic implications, as it is associated with astrocyte injury and inflammatory responses during NMOSD attacks.
- The myths that drive therapeutic inertia in multiple sclerosis: a cost-effectiveness analysis of high-efficacy drugs in Brazil(2024) PIPEK, Leonardo Zumerkorn; MAHLER, Joao Vitor; NASCIMENTO, Rafaela Farias Vidigal; BECKER, Jefferson; APOSTOLOS-PEREIRA, Samira Luisa; ADONI, Tarso; SILVA, Guilherme Diogo; CALLEGARO, Dagoberto
conferenceObject Non-organ-specific auto-immunity disease in NMO-spectrum disorders - Brazilian experience(2012) APOSTOLOS-PEREIRA, S.; JORGE, F.; ZAGO, P.; SIMM, R.; FAZZITO, M.; GALVAO, C.; HOBI, C.; LANA-PEIXOTO, M.; MARCHIORI, P.; DELLAVANCE, A.; CALLEGARO, D.conferenceObject C-11-pib pet showed a distinct cerebrospinal fluid pattern in patients with progressive multiple sclerosis(2020) PITOMBEIRA, M.; DURAN, F.; CAMPANHOLO, K.; SOUZA, A.; APOSTOLOS-PEREIRA, S.; RIMKUS, C. Medeiros; MENDES, M. F.; BUSATTO FILHO, G.; CALLEGARO, D.; BUCHPIGUEL, C.; FARIA, D. De Paula- Clinical and MRI measures to identify non-acute MOG-antibody disease in adults(2023) CORTESE, Rosa; BATTAGLINI, Marco; PRADOS, Ferran; BIANCHI, Alessia; HAIDER, Lukas; JACOB, Anu; PALACE, Jacqueline; MESSINA, Silvia; PAUL, Friedemann; WUERFEL, Jens; MARIGNIER, Romain; DURAND-DUBIEF, Francoise; RIMKUS, Carolina de Medeiros; CALLEGARO, Dagoberto; SATO, Douglas Kazutoshi; FILIPPI, Massimo; ROCCA, Maria Assunta; CACCIAGUERRA, Laura; ROVIRA, Alex; SASTRE-GARRIGA, Jaume; ARRAMBIDE, Georgina; LIU, Yaou; DUAN, Yunyun; GASPERINI, Claudio; TORTORELLA, Carla; RUGGIERI, Serena; AMATO, Maria Pia; ULIVELLI, Monica; GROPPA, Sergiu; GROTHE, Matthias; LLUFRIU, Sara; SEPULVEDA, Maria; LUKAS, Carsten; BELLENBERG, Barbara; SCHNEIDER, Ruth; SOWA, Piotr; CELIUS, Elisabeth G.; PROEBSTEL, Anne-Katrin; YALDIZLI, Ozgur; MUELLER, Jannis; STANKOFF, Bruno; BODINI, Benedetta; CARMISCIANO, Luca; SORMANI, Maria Pia; BARKHOF, Frederik; STEFANO, Nicola De; CICCARELLI, OlgaMRI and clinical features of myelin oligodendrocyte glycoprotein (MOG)-antibody disease may overlap with those of other inflammatory demyelinating conditions posing diagnostic challenges, especially in non-acute phases and when serologic testing for MOG antibodies is unavailable or shows uncertain results. We aimed to identify MRI and clinical markers that differentiate non-acute MOG-antibody disease from aquaporin 4 (AQP4)-antibody neuromyelitis optica spectrum disorder and relapsing remitting multiple sclerosis, guiding in the identification of patients with MOG-antibody disease in clinical practice. In this cross-sectional retrospective study, data from 16 MAGNIMS centres were included. Data collection and analyses were conducted from 2019 to 2021. Inclusion criteria were: diagnosis of MOG-antibody disease; AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis; brain and cord MRI at least 6 months from relapse; and Expanded Disability Status Scale (EDSS) score on the day of MRI. Brain white matter T-2 lesions, T-1-hypointense lesions, cortical and cord lesions were identified. Random forest models were constructed to classify patients as MOG-antibody disease/AQP4-neuromyelitis optica spectrum disorder/multiple sclerosis; a leave one out cross-validation procedure assessed the performance of the models. Based on the best discriminators between diseases, we proposed a guide to target investigations for MOG-antibody disease. One hundred and sixty-two patients with MOG-antibody disease [99 females, mean age: 41 (+/- 14) years, median EDSS: 2 (0-7.5)], 162 with AQP4-neuromyelitis optica spectrum disorder [132 females, mean age: 51 (+/- 14) years, median EDSS: 3.5 (0-8)], 189 with multiple sclerosis (132 females, mean age: 40 (+/- 10) years, median EDSS: 2 (0-8)] and 152 healthy controls (91 females) were studied. In young patients (<34 years), with low disability (EDSS < 3), the absence of Dawson's fingers, temporal lobe lesions and longitudinally extensive lesions in the cervical cord pointed towards a diagnosis of MOG-antibody disease instead of the other two diseases (accuracy: 76%, sensitivity: 81%, specificity: 84%, P < 0.001). In these non-acute patients, the number of brain lesions < 6 predicted MOG-antibody disease versus multiple sclerosis (accuracy: 83%, sensitivity: 82%, specificity: 83%, P < 0.001). An EDSS < 3 and the absence of longitudinally extensive lesions in the cervical cord predicted MOG-antibody disease versus AQP4-neuromyelitis optica spectrum disorder (accuracy: 76%, sensitivity: 89%, specificity: 62%, P < 0.001). A workflow with sequential tests and supporting features is proposed to guide better identification of patients with MOG-antibody disease. Adult patients with non-acute MOG-antibody disease showed distinctive clinical and MRI features when compared to AQP4-neuromyelitis optica spectrum disorder and multiple sclerosis. A careful inspection of the morphology of brain and cord lesions together with clinical information can guide further analyses towards the diagnosis of MOG-antibody disease in clinical practice. In a multicentre MAGNIMS study, Cortese et al. show that brain and cord lesion characteristics on conventional MRI, together with clinical features, can help differentiate non-acute MOG-antibody disease from AQP4-NMOSD and multiple sclerosis, aiding identification of non-acute patients for MOG antibody testing.
- Characterization of pain syndromes in patients with neuromyelitis optica(2020) VALERIO, Fernanda; APOSTOLOS-PEREIRA, Samira L.; SATO, Douglas Kazutoshi; CALLEGARO, Dagoberto; LUCATO, Leandro Tavares; BARBOZA, Victor Rosseto; SILVA, Valquiria A.; GALHARDONI, Ricardo; RODRIGUES, Antonia L. de Lima; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi deBackground Pain is common and refractory in spinal cord injury (SCI). Currently, most studies evaluated pain in male-predominant traumatic-SCI. Also, concomitant secondary pain syndromes and its temporal evolution were seldom reported. Methods We aimed to prospectively describe the main and secondary pain and its associated factors in inflammatory-SCI evaluating neuromyelitis optica (NMO) patients. In-remission NMO patients underwent neurological, imaging and autoantibody evaluations. Questionnaires detailing main and secondary pains, functional state, mood, catastrophizing, quality of life (QoL) and ""non-motor symptoms"" were used at two time points. Results Pain was present in 53 (73.6%) of the 72 patients included. At-level neuropathic pain was the most common main pain syndrome, affecting 32 subjects (60.4% of those with pain). Over 70% (n = 38) of this cohort reported two pain syndromes. Those without pain were significantly younger (26.1 +/- 12.7 y.o. in those without pain and 40.1 +/- 12.5, 37.2 +/- 11.4 y.o. in those whose main pain was neuropathic and non-neuropathic, respectively,p = .001), and no differences in the inflammatory status were observed between groups. On follow-up, one-fifth (n = 11) had a different main pain syndrome from the first visit. Pain impacted QoL as much as disability and motor strength. Conclusion Pain is a prevalent and disabling non-motor symptom in NMO-SCI. Most patients experience more than one pain syndrome which can change in time even in the absence of clinical relapse. Age of the inflammatory-SCI was a major determinant of pain. Acknowledging temporal changes and multiplicity of pain syndromes in NMO-SCI may give insights into more precise designs of clinical trials and general management of pain in SCI. Significance In this longitudinal study with NMO-related SCI, pain affected almost three-quarters of patients with NMO. Over 70% have more than one pain syndrome and at-level neuropathic pain is the most common type of pain syndrome. Patients without pain were significantly younger but had the same burden of inflammatory lesions than those with pain. During follow-up, up to one fifth of patients presented with changes in the main pain syndromes, which can occur even in the absence of clinical activity of the inflammatory disease. In this cohort, Pain affected quality of life as much as disability or motor strength.
- Is there a role for off-label high-efficacy disease-modifying drugs in progressive multiple sclerosis? A network meta-analysis(2022) SILVA, Guilherme Diogo; CASTRILLO, Bruno Batitucci; APOSTOLOS-PEREIRA, Samira Luisa; CALLEGARO, DagobertoOcrelizumab and siponimod are the two on-label drugs used for progressive forms of multiple sclerosis (PMS). However, many patients with PMS do not have access to these high-efficacy disease-modifying drugs (DMDs). Off-label prescription of other high-efficacy DMDs (fingolimod, rituximab and natalizumab) may be a strategy to improve access to immunotherapy for these patients. We aim to compare on-label and off-label high-efficacy drugs for their effect on disability progression in PMS. In December 2021, we searched MEDLINE (PubMed), Embase, Cochrane Central and Scopus databases for randomized clinical trials involving patients with PMS. High-efficacy drugs were considered as intervention and placebos as comparison. The outcome contemplated was risk of Expanded Disability Severity Scale (EDSS) progression at 2 years. A network meta-analysis was performed to compare the relative risk of EDSS progression at 2 years compared with placebo in on-label and off-label drugs. We included five studies with 4526 patients. The median EDSS progression at 2 years in patients that received any immunotherapy was 30%, compared with 35% in placebo groups. Overall, the risk of bias of individual studies was low. Network analysis revealed overlapping confidence intervals in off-label drugs (CI95% 0.51-2.16) versus ocrelizumab (reference) and off-label drugs (CI 95% 0.53-1.96) versus siponimod (reference), suggesting similar efficacy. The same result was found even after excluding studies with the risk of publication bias. Off-label high efficacy immunotherapy in PMS has biological plausibility and presented similar effectiveness to on-label DMDs in this network meta-analysis. The use of fingolimod, rituximab or natalizumab may be a strategy that reduces costs and improves access to immunotherapy for patients with PMS.
- Normative values of the Brief Repeatable Battery of Neuropsychological Tests in a Brazilian population sample: discrete and regression-based norms(2018) DAMASCENO, Alfredo; AMARAL, Juliana Machado Santiago dos Santos; BARREIRA, Amilton Antunes; BECKER, Jefferson; CALLEGARO, Dagoberto; CAMPANHOLO, Kenia Repiso; DAMASCENO, Luciana Azevedo; DINIZ, Denise Sisterolli; FRAGOSO, Yara Dadalti; FRANCO, Paula S.; FINKELSZTEJN, Alessandro; JORGE, Frederico M. H.; LANA-PEIXOTO, Marco Aurelio; MATTA, Andre Palma da Cunha; MENDONCA, Andreia Costa Rabelo; NOAL, Janaina; PAES, Renata Alves; PAPAIS-ALVARENGA, Regina Maria; PEREIRA, Adriana Gutterres; SPEDO, Carina Tellaroli; DAMASCENO, Benito PereiraObjective: Cognitive dysfunction is common in multiple sclerosis. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) was developed to assess cognitive functions most-frequently impaired in multiple sclerosis. However, normative values are lacking in Brazil. Therefore, we aimed to provide continuous and discrete normative values for the BRB-N in a Brazilian population sample. Methods: We recruited 285 healthy individuals from the community at 10 Brazilian sites and applied the BRB-N version A in 237 participants and version B in 48 participants. Continuous norms were calculated with multiple-regression analysis. Results: Mean raw scores and the 5th percentile for each neuropsychological measure are provided, stratified by age and educational level. Healthy participants' raw scores were converted to scaled scores, which were regressed on age, sex and education, yielding equations that can be used to calculate predicted scores. Conclusion: Our normative data allow a more widespread use of the BRB-N in clinical practice and research.
conferenceObject Clinically suspected neuromyelitis optica associated to anti-MOG antibodies(2015) SALLES, L. M. O. de Paula; SATO, D. K.; APOATOLOS-PEREIRA, S. L.; SIMM, R. F.; JORGE, F. M. H.; FUJIHARA, K.; CALLEGARO, D.- MOG-IgG-Associated Optic Neuritis, Encephalitis, and Myelitis: Lessons Learned From Neuromyelitis Optica Spectrum Disorder(2018) PASSOS, Giordani Rodrigues dos; OLIVEIRA, Luana Michelli; COSTA, Bruna Klein da; APOSTOLOS-PEREIRA, Samira Luisa; CALLEGARO, Dagoberto; FUJIHARA, Kazuo; SATO, Douglas KazutoshiAntibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been found in some cases diagnosed as seronegative neuromyelitis optica spectrum disorder (NMOSD). MOG-IgG allowed the identification of a subgroup with a clinical course distinct from that of NMOSD patients who are seropositive for aquaporin-4-IgG antibodies. MOG-IgG is associated with a wider clinical phenotype, not limited to NMOSD, with the majority of cases presenting with optic neuritis (ON), encephalitis with brain demyelinating lesions, and/or myelitis. Therefore, we propose the term MOG-IgG-associated Optic Neuritis, Encephalitis, and Myelitis (MONEM). Depending on the clinical characteristics, these patients may currently be diagnosed with NMOSD, acute disseminated encephalomyelitis, pediatric multiple sclerosis, transverse myelitis, or ON. With specific cell-based assays, MOG-IgG is emerging as a potential biomarker of inflammatory disorders of the central nervous system. We review the growing body of evidence on MONEM, focusing on its clinical aspects.