MARIANA MEIRA CLAVE
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/31 - Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/31 - Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas, Faculdade de Medicina
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- Decreased circulating thrombomodulin is improved by tadalafil therapy in hypoxemic patients with advanced pulmonary arterial hypertension(2016) MAEDA, N. Y.; CLAVE, M. M.; BYDLOWSKI, S. P.; LOPES, A. A.Introduction: Advanced pulmonary arterial hypertension (PAH) in patients with congenital cardiac communications and right -to -left shunting (Eisenmenger syndrome - PAH-ES) is associated with hypoxemia and decreased circulating levels o{thrombomodulin (TM), probably reflecting decreased endothelial TM production. The combination of these two factors has been shown to induce fibrin deposition, with increased risk of thrombosis, a well known complication in this syndrome. Patients and methods: We tested the hypothesis that vasodilator therapy with the phosphocliesterase-5 inhibitor taclalafil, an approved drug for management of PAH could improve endothelial dysfunction markers, in particular plasma TM, in addition to improving the physical capacity (expected effect of pulmonary vasodilatation) in PAHES patients. This was a prospective observational study of treatment naive patients subjected to specific PAH therapy. Fifteen patients aged 12 to 51 years (median 30 years) were treated for 6 months with a single daily dose of 40 mg oral tadalafil. The physical capacity (distance walked during the 6 -min walk test - 6MWD), systemic oxygen saturation and laboratory parameters were measured at baseline, and 90 days and 180 days of treatment. Results: Plasma TM, which was decreased at baseline compared to controls (p < 0.001) increased at 90 and 180 days (p = 0.003), and this was directly related (r = 0.57, p = 0.026) to improvement of oxygen saturation (p = 0.008). Heightened baseline tissue -type plasminogen activator decreased during treatment (p = 0.010), while heightened von Willebrancl factor antigen remained unchanged. The 6MWD improved significantly (p < 0.001). Conclusion: Tadalafil therapy improved circulating TM and tissue -type plasminogen activator, in addition to improving the physical capacity and oxygen saturation in PAM ES patients. (C) 2016 Published by Elsevier Ltd.
bookPart Alterações endoteliais na hipertensão pulmonar(2016) CLAVé, Mariana Meira; LOPES, Antonio Augusto- Serum Cytokines in Young Pediatric Patients with Congenital Cardiac Shunts and Altered Pulmonary Hemodynamics(2016) ZORZANELLI, Leina; MAEDA, Nair Yukie; CLAVE, Mariana Meira; AIELLO, Vera Demarchi; RABINOVITCH, Marlene; LOPES, Antonio AugustoBackground and Objective. Inflammation is central in the pathogenesis of pulmonary hypertension. We investigated how serum cytokines correlate with clinical features, hemodynamics, and lung histology in young patients with pulmonary hypertension associated with congenital cardiac shunts. Design. Prospective, observational study. Methods and Results. Patients (n = 44) were aged 2.6 to 37.6 months. Group I patients (n = 31) were characterized by pulmonary congestion and higher pulmonary blood flow compared to group II (p = 0.022), with no need for preoperative cardiac catheterization. Group II patients (n = 13) had no congestive features. At catheterization, they had elevated pulmonary vascular resistance (5.7 [4.4-7.4] Wood units.m(2), geometric mean with 95% CI). Cytokines were measured by chemiluminescence. Macrophage migration inhibitory factor (MIF) was found to be inversely related to pulmonary blood flow(r = -0.33,p = 0.026) and was higher in group II (high pulmonary vascular resistance) compared to group I (high pulmonary blood flow) (p = 0.017). In contrast, RANTES chemokine (regulated on activation, normal T cell expressed and secreted) was characteristically elevated in Group I (p = 0.022). Interleukin 16 was also negatively related to pulmonary blood flow (r(s) = -0.33, p = 0.029) and was higher in patients with obstructive vasculopathy at intraoperative lung biopsy (p = 0.021). Conclusion. Cytokines seem to be important and differentially regulated in subpopulations of young patients with cardiac shunts.