DEBORA RAQUEL BENEDITA TERRABUIO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- Anti-mitochondrial Antibody-Negative Primary Biliary Cholangitis Is Part of the Same Spectrum of Classical Primary Biliary Cholangitis(2022) CANCADO, Guilherme Grossi Lopes; BRAGA, Michelle Harriz; FERRAZ, Maria Lucia Gomes; VILLELA-NOGUEIRA, Cristiane Alves; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; GOMES, Nathalia Mota de Faria; OLIVEIRA, Elze Maria Gomes; ROTMAN, Vivian; OLIVEIRA, Maria Beatriz; CUNHA, Simone Muniz Carvalho Fernandes da; CUNHA-SILVA, Marlone; MENDES, Liliana Sampaio Costa; IVANTES, Claudia Alexandra Pontes; CODES, Liana; BORGES, Valeria Ferreira; PACE, Fabio Heleno de Lima; PESSOA, Mario Guimaraes; SIGNORELLI, Izabelle Venturini; CORAL, Gabriela Perdomo; BITTENCOURT, Paulo Lisboa; LEVY, Cynthia; COUTO, Claudia AlvesBackground Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease in which anti-mitochondrial antibodies (AMA) are the diagnostic hallmark. Whether AMA-negative PBC patients represent a different phenotype of disease is highly debated. Aims The purpose of our study was to compare AMA-positive and AMA-negative PBC patients in a large non-white admixed Brazilian cohort. Methods The Brazilian Cholestasis Study Group multicentre database was reviewed to assess demographics, clinical features and treatment outcomes of Brazilian PBC patients, stratifying data according to AMA status. Results A total of 464 subjects (95.4% females, mean age 56 +/- 5 years) with PBC were included. Three hundred and eighty-four (83%) subjects were AMA-positive, whereas 80 (17%) had AMA-negative PBC. Subjects with AMA-negative PBC were significantly younger (52.2 +/- 14 vs. 59.6 +/- 11 years, p = 0.001) and had their first symptom at an earlier age (43.2 +/- 13 vs. 49.5 +/- 12 years, p = 0.005). Frequency of type 2 diabetes was significantly increased in subjects with AMA-negative PBC (22.5% vs. 12.2%, p = 0.03). Lower IgM (272.2 +/- 183 vs. 383.2 +/- 378 mg/dL, p = 0.01) and triglycerides (107.6 +/- 59.8 vs.129.3 +/- 75.7 mg/dL, p = 0.025) and higher bilirubin (3.8 +/- 13.5 vs. 1.8 +/- 3.4 mg/dL, p = 0.02) levels were also observed in this subgroup. Response to ursodeoxycholic acid varied from 40.5 to 63.3% in AMA-positive and 34 to 62.3% in AMA-negative individuals, according to different response criteria. Outcomes such as development of liver-related complications, death and requirement for liver transplantation were similar in both groups. Conclusions AMA-negative PBC patients are similar to their AMA-positive counterparts with subtle differences observed in clinical and laboratory features.
- Risk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation(2022) MONTANO-LOZA, Aldo J.; RONCA, Vincenzo; EBADI, Maryam; HANSEN, Bettina E.; HIRSCHFIELD, Gideon; ELWIR, Saleh; ALSAED, Mohamad; MILKIEWICZ, Piotr; JANIK, Maciej K.; MARSCHALL, Hanns-Ulrich; BURZA, Maria Antonella; EFE, Cumali; CALISKAN, Ali Riza; HARPUTLUOGLU, Murat; KABACAM, Gokhan; TERRABUIO, Debora; ONOFRIO, Fernanda de Quadros; SELZNER, Nazia; BONDER, Alan; PARES, Albert; LLOVET, Laura; AKYILDIZ, Murat; ARIKAN, Cigdem; MANNS, Michael P.; TAUBERT, Richard; WEBER, Anna-Lena; SCHIANO, Thomas D.; HAYDEL, Brandy; CZUBKOWSKI, Piotr; SOCHA, Piotr; OLDAK, Natalia; AKAMATSU, Nobuhisa; TANAKA, Atsushi; LEVY, Cynthia; MARTIN, Eric F.; GOEL, Aparna; SEDKI, Mai; JANKOWSKA, Irena; IKEGAMI, Toru; RODRIGUEZ, Maria; STERNECK, Martina; WEILER-NORMANN, Christina; SCHRAMM, Christoph; DONATO, Maria Francesca; LOHSE, Ansgar; ANDRADE, Raul J.; PATWARDHAN, Vilas R.; HOEK, Bart van; BIEWENGA, Maaike; KREMER, Andreas E.; UEDA, Yoshihide; DENEAU, Mark; PEDERSEN, Mark; MAYO, Marlyn J.; FLOREANI, Annarosa; BURRA, Patrizia; SECCHI, Maria Francesca; BERETTA-PICCOLI, Benedetta Terziroli; SCIVERES, Marco; MAGGIORE, Giuseppe; JAFRI, Syed-Mohammed; DEBRAY, Dominique; GIRARD, Muriel; LACAILLE, Florence; LYTVYAK, Ellina; MASON, Andrew L.; HENEGHAN, Michael; OO, Ye HtunBackground & Aims: Autoimmune hepatitis can recur after liver transplantation (LT), though the impact of recurrence on patient and graft survival has not been well characterized. We evaluated a large, international, multicenter cohort to identify the probability and risk factors associated with recurrent AIH and the association between recurrent disease and patient and graft survival. Methods: We included 736 patients (77% female, mean age 42 +/- 1 years) with AIH who underwent LT from January 1987 through June 2020, among 33 centers in North America, South America, Europe and Asia. Clinical data before and after LT, biochemical data within the first 12 months after LT, and immunosuppression after LT were analyzed to identify patients at higher risk of AIH recurrence based on histological diagnosis. Results: AIH recurred in 20% of patients after 5 years and 31% after 10 years. Age at LT <= 42 years (hazard ratio [HR] 3.15; 95% CI 1.22-8.16; p = 0.02), use of mycophenolate mofetil post-LT (HR 3.06; 95% CI 1.39-6.73; p = 0.005), donor and recipient sex mismatch (HR 2.57; 95% CI 1.39-4.76; p = 0.003) and high IgG pre-LT (HR 1.04; 95% CI 1.01-1.06; p = 0.004) were associated with higher risk of AIH recurrence after adjusting for other confounders. In multivariate Cox regression, recurrent AIH (as a time-dependent covariate) was significantly associated with graft loss (HR 10.79, 95% CI 5.37-21.66, p <0.001) and death (HR 2.53, 95% CI 1.48-4.33, p = 0.001). Conclusion: Recurrence of AIH following transplant is frequent and is associated with younger age at LT, use of mycophenolate mofetil post-LT, sex mismatch and high IgG pre-LT. We demonstrate an association between disease recurrence and impaired graft and overall survival in patients with AIH, highlighting the importance of ongoing efforts to better characterize, prevent and treat recurrent AIH. Lay summary: Recurrent autoimmune hepatitis following liver transplant is frequent and is associated with some recipient features and the type of immunosuppressive medications use. Recurrent autoimmune hepatitis negatively affects outcomes after liver transplantation. Thus, improved measures are required to prevent and treat this condition.
- Evolution of Biomarkers of Atherogenic Risk in Liver Transplantation Recipients(2018) LINHARES, L. M. C.; OLIVEIRA, C. P.; ALVARES-DA-SILVA, M. R.; STEFANO, J. T.; BARBEIRO, H. V.; BARBEIRO, D. F.; TERRABUIO, D. R. B.; ABDALA, E.; SORIANO, F. G.; CARRILHO, F. J.; FARIAS, A. Q.; SIDDIQUI, M. S.; D'ALBUQUERQUE, L. A. C.Background. Cardiovascular disease is a major contributing factor to long-term mortality after liver transplantation (LT). Methods. This study evaluated the evolution of atherogenic risk in liver transplant recipients (LTRs). Thirty-six subjects were prospectively enrolled at 12 months and followed for 48 months after liver transplantation. Serum biomarkers of endothelial dysfunction (sICAM-1 and sVCAM-1), chronic inflammation (serum amyloid A), and oxidative stress (myeloperoxidase) were measured at 12 and 48 months after LT. Additionally, at 12 months all patients underwent a cardiac computed tomography (CT) scan and a coronary artery calcium score (CACS). Results. The prevalence of risk factors of metabolic syndrome (MS) increased over the course of the study. The patients' sVCAM-1 and sICAM-1 increased from 1.82 +/- 0.44 ng/mL to 9.10 +/- 5.82 ng/mL (P < .001) and 0.23 +/- 0.09 ng/mL to 2.7 +/- 3.3 ng/mL, respectively from month 12 to 48. Serum myeloperoxidase increased from 0.09 +/- 0.07 ng/mL to 3.46 +/- 3.92 ng/mL (P < .001) over the course of the study. Serum amyloid A also increased from 21.4 +/- 40.7 ng/mL at entry to 91.5 +/- 143.6 ng/mL at end of study (P < .001). Conclusion. No association between these biomarkers and MS was noted. The cardiac CT revealed mild and moderate disease in 19% and 25% of the cohort, respectively. No association between serum biomarkers and CACS was noted. Serum biomarkers of atherogenic risk increase rapidly in LTRs and precede coronary plaques.
conferenceObject FACTORS ASSOCIATED WITH RECURRENCE OF AUTOIMMUNE HEPATITIS AFTER LIVER TRANSPLANTATION AND EFFECTS ON GRAFT AND PATIENT SURVIVAL(2019) MONTANO-LOZA, Aldo J.; EBADI, Maryam; HANSEN, Bettina E.; HIRSCHFIELD, Gideon; MASON, Andrew L.; MILKIEWICZ, Piotr; JANIK, Maciej; MARSCHALL, Hanns-Ulrich; BURZA, Maria Antonella; PARES, Albert; LLOVET, Laura Patricia; TERRABUIO, Debora; AKYILDIZ, Murat; ARIKAN, Cigdem; LIBERAL, Rodrigo; KERKAR, Nanda; BOER, Ynte S.; LOHSE, Ansgar W.; DRENTH, Joost P. H.; FLOREANI, Annarosa; CZUBKOWSKI, Piotr; SOCHA, Piotr; OLDAK, Natalia; BELLIDO, Raul Jesus Andrade; BURRA, Patrizia; SECCHI, Maria Francesca; LYTVYAK, Ellina; JANKOWSKA, Irena; RODRIGUEZ, Maria; STERNECK, Martina; WEILER-NORMANN, Christina; SCHRAMM, Christoph; TERZIROLI, Benedetta; SCHIANO, Thomas D.; HAYDEL, Brandy; DEBRAY, Dominique; GIRAND, Muriel; LACAILLE, Florence; DONATO, Maria Francesca; AKAMATSU, Nobuhisa; TANAKA, Atsushi; IKEGAMI, Toru; UEDA, Yoshihide; VERGANI, Diego; HENEGHAN, Michael A.- Viral Hepatitis Recommendations for Solid-Organ Transplant Recipients and Donors(2018) FARIA, Luciana Costa; TERRABUIO, Debora Raquel Benedita; LEBLEBICIOGLU, Hakan; HUPRIKAR, ShirishLIM/07
conferenceObject ANTI-MITOCONDRIAL-NEGATIVE PRIMARY BILIARY CHOLANGITIS: SPECTRUM OF THE SAME DISEASE?(2021) CANCADO, Guilherme Grossi Lopes; BRAGA, Michelle Harriz; FERRAZ, Maria Gomes; VILLELA-NOGUEIRA, Cristiane Alves; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; GOMES, Nathalia Mota De Faria; OLIVEIRA, Elze Maria G.; ROTMAN, Vivian; OLIVEIRA, Maria Beatriz; CUNHA, Simone Muniz Carvalho Fernandes Da; CUNHA-SILVA, Marlone; MENDES, Liliana; IVANTES, Claudia Alexandra Pontes; CODES, Liana; BORGES, Valeria Ferreira De Almeida E; PACE, Fabio Heleno De Lima; PESSOA, Mario Guimaraes; SIGNORELLI, Izabelle Venturini; CORAL, Gabriela Perdomo; BITTENCOURT, Paulo L.; LEVY, Cynthia; COUTO, Claudia Alves- Chloroquine Is Effective for Maintenance of Remission in Autoimmune Hepatitis: Controlled, Double-Blind, Randomized Trial(2019) TERRABUIO, Debora Raquel Benedita; DINIZ, Marcio Augusto; FALCAO, Lydia Teofilo de Moraes; GUEDES, Ana Luiza Vilar; NAKANO, Larissa Akeme; EVANGELISTA, Andreia Silva; LIMA, Fabiana Roberto; ABRANTES-LEMOS, Clarice Pires; CARRILHO, Flair Jose; CANCADO, Eduardo Luiz RachidBetween 50% and 86% of patients with autoimmune hepatitis (AIH) relapse after immunosuppression withdrawal; long-term immunosuppression is associated with increased risk of neoplasias and infections. Chloroquine diphosphate (CQ) is an immunomodulatory drug that reduces the risk of flares in rheumatologic diseases. Our aims were to investigate the efficacy and safety of CQ for maintenance of biochemical remission of AIH in a double-blind randomized trial and to define a subgroup that obtained a greater benefit from its use. A total of 61 patients with AIH in histologic remission (90.1% AIH type 1 [AIH-1]) were randomized to receive CQ 250 mg/day or placebo for 36 months. Of the 61 patients, 31 received CQ and 30 placebo. At baseline, clinical, laboratory, histologic findings, and human leukocyte antigen (HLA) profile were similar between the two groups. Relapse-free survival was significantly higher in the CQ group compared to the placebo group (59.3% and 19.9%, respectively P = 0.039). For those patients completing 3-year treatment, relapse rates were 41.6% and 0% after CQ and placebo withdrawal, respectively. Factors associated with a higher risk of relapse in multiple Cox regression were placebo use (hazard ratio, 2.4; 95% confidence interval [CI], 1.055.5; P = 0.039) and anti-soluble liver antigen/liver-pancreas (anti-SLA/LP) seropositivity (hazard ratio, 5.4; 95% CI, 1.91-15.3; P = 0.002). Although it was not possible to define a subgroup that obtained a greater benefit from CQ according to anti-SLA/LP reactivity or HLA profile, 100% of patients who were anti-SLA/LP-positive (+) relapsed with placebo compared to 50% with CQ (P = 0.055). In the CQgroup, 54.8% had side effects and 19.3% interrupted the drug regimen. Conclusion: CQ safely reduced the risk of relapse of AIH, but it was not possible to define a subgroup that obtained a greater benefit with CQ use, probably because of sample size.
- Fibrates for the Treatment of Primary Biliary Cholangitis Unresponsive to Ursodeoxycholic Acid: An Exploratory Study(2022) CANCADO, Guilherme Grossi Lopes; COUTO, Claudia Alves; GUEDES, Laura Vilar; BRAGA, Michelle Harriz; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; FERRAZ, Maria Lucia Gomes; VILLELA-NOGUEIRA, Cristiane Alves; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; OLIVEIRA, Elze Maria Gomes de; ROTMAN, Vivian; MAZO, Daniel Ferraz de Campos; BORGES, Valeria Ferreira de Almeida e; MENDES, Liliana Sampaio Costa; CODES, Liana; PESSOA, Mario Guimaraes; SIGNORELLI, Izabelle Venturini; LEVY, Cynthia; BITTENCOURT, Paulo LisboaAim: Up to 40% of patients with primary biliary cholangitis (PBC) will have a suboptimal biochemical response to ursodeoxycholic acid (UDCA), which can be improved by the addition of fibrates. This exploratory study aims to evaluate the long-term real-life biochemical response of different fibrates, including ciprofibrate, in subjects with UDCA-unresponsive PBC.Methods: The Brazilian Cholestasis Study Group multicenter database was reviewed to assess the response rates to UDCA plus fibrates in patients with UDCA-unresponsive PBC 1 and 2 years after treatment initiation by different validated criteria.Results: In total, 27 patients (100% women, mean age 48.9 +/- 9.2 years) with PBC were included. Overall response rates to fibrates by each validated criterion varied from 39 to 60% and 39-76% at 12 and 24 months after treatment combination, respectively. Combination therapy resulted in a significant decrease in ALT and ALP only after 2 years, while GGT significantly improved in the first year of treatment. Treatment response rates at 1 and 2 years appear to be comparable between ciprofibrate and bezafibrate using all available criteria.Conclusion: Our findings endorse the efficacy of fibrate add-on treatment in PBC patients with suboptimal response to UDCA. Ciprofibrate appears to be at least as effective as bezafibrate and should be assessed in large clinical trials as a possibly new, cheaper, and promising option for treatment of UDCA-unresponsive PBC patients.
- Response to Ursodeoxycholic Acid May Be Assessed Earlier to Allow Second-Line Therapy in Patients with Unresponsive Primary Biliary Cholangitis(2023) CANCADO, Guilherme Grossi Lopes; COUTO, Claudia Alves; TERRABUIO, Debora Raquel Benedita; CANCADO, Eduardo Luiz Rachid; VILLELA-NOGUEIRA, Cristiane Alves; FERRAZ, Maria Lucia Gomes; BRAGA, Michelle Harriz; NARDELLI, Mateus Jorge; FARIA, Luciana Costa; GOMES, Nathalia Mota de Faria; OLIVEIRA, Elze Maria Gomes; ROTMAN, Vivian; OLIVEIRA, Maria Beatriz; CUNHA, Simone Muniz Carvalho Fernandes da; CUNHA-SILVA, Marlone; MENDES, Liliana Sampaio Costa; IVANTES, Claudia Alexandra Pontes; CODES, Liana; BORGES, Valeria Ferreira de Almeida E; PACE, Fabio Heleno de Lima; PESSOA, Mario Guimaraes; GUEDES, Laura Vilar; SIGNORELLI, Izabelle Venturini; CORAL, Gabriela Perdomo; LEVY, Cynthia; BITTENCOURT, Paulo LisboaBackground Response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) has been traditionally assessed 1 to 2 years after treatment initiation. With the development of new drugs, some patients may benefit from an earlier introduction of second-line therapies. Aims This study aims to identify whether well-validated response criteria could correctly identify individuals likely to benefit from add-on second-line therapy at 6 months. Methods Analysis of a multicenter retrospective cohort which included only patients with clear-cut PBC. Results 206 patients with PBC (96.6% women; mean age 54 +/- 12 years) were included. Kappa concordance was substantial for Toronto (0.67), Rotterdam (0.65), Paris 1 (0.63) and 2 (0.63) criteria at 6 and 12 months, whereas Barcelona (0.47) and POISE trial (0.59) criteria exhibited moderate agreement. Non-response rates to UDCA was not statistically different when assessed either at 6 or 12 months using Toronto, Rotterdam or Paris 2 criteria. Those differences were even smaller or absent in those subjects with advanced PBC. Mean baseline alkaline phosphatase was 2.73 +/- 1.95 times the upper limit of normal (x ULN) among responders versus 5.05 +/- 3.08 x ULN in non-responders (p < 0.001). Conclusions After 6 months of treatment with UDCA, the absence of response by different criteria could properly identify patients who could benefit from early addition of second-line therapies, especially in patients with advanced disease or high baseline liver enzymes levels.
conferenceObject A multicentric study to estimate mortality and graft loss risk after liver transplantation (LT) in patients with recurrent primary biliary cholangitis (PBC)(2022) MONTANO-LOZA, Aldo J.; BERNEY, Thierry; TOSO, Christian; MAGINI, Giulia; HIRSCHFIELD, Gideon; HANSEN, Bettina; MASON, Andrew L.; EBADI, Maryam; NEVENS, Frederik; ENDE, Natalie Van den; TERRABUIO, Debora Raquel; PARES, Albert; RUIZ, Pablo; BONDER, Alan; LYTVYAK, Ellina; MEER, Adriaan Van der; VEER, Rozanne de; FLOREANI, Annarosa; CAZZAGON, Nora; CASU, Stefania; RUSSO, Francesco Paolo; PEDERSEN, Mark; MAYO, Marlyn J.; MANNS, Michael P.; TAUBERT, Richard; KIRCHNER, Theresa; SCHIANO, Thomas; HAYDEL, Brandy; VERHELST, Xavier; ROBLES-DIAZ, Mercedes; JIMENEZ-PEREZ, Miguel; DUMORTIER, Jerome; LOHSE, Ansgar; SCHRAMM, Christoph; RUETHER, Darius; BERETTA-PICCOLI, Benedetta Terziroli; DONATO, Maria Francesca; CORPECHOT, Christophe