BRUNO GUALANO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina - Líder
30 resultados
Resultados de Busca
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- Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function(2021) GIL, Saulo; PECANHA, Tiago; DANTAS, Wagner S.; MURAI, Igor Hisashi; MEREGE-FILHO, Carlos Alberto Abujabra; SA-PINTO, Ana Lucia de; PEREIRA, Rosa Maria Rodrigues; CLEVA, Roberto de; SANTO, Marco Aurelio; REZENDE, Diego Augusto Nunes; KIRWAN, John P.; GUALANO, Bruno; ROSCHEL, HamiltonBackground Bariatric surgery improves cardiovascular health, which might be partly ascribed to beneficial alterations in the autonomic nervous system. However, it is currently unknown whether benefits from surgery on cardiac autonomic regulation in post-bariatric patients can be further improved by adjuvant therapies, namely exercise. We investigated the effects of a 6-month exercise training program on cardiac autonomic responses in women undergoing bariatric surgery. Methods Sixty-two women eligible for bariatric surgery were randomly allocated to either standard of care (control) or an exercise training intervention. At baseline (PRE) and 3 (POST3) and 9 (POST9) months after surgery, we assessed chronotropic response to exercise (CR%; i.e., percentage change in heart rate from rest to peak exercise) and heart rate recovery (HRR30s, HRR60s, and HRR120s; i.e., decay of heart rate at 30, 60, and 120 s post exercise) after a maximal exercise test. Results Between-group absolute changes revealed higher CR% (Delta = 8.56%, CI95% 0.22-19.90, P = 0.04), HRR30s (Delta = 12.98 beat/min, CI95% 4.29-21.67, P = 0.01), HRR60s (Delta = 22.95 beat/min, CI95% 11.72-34.18, P = 0.01), and HRR120s (Delta = 34.54 beat/min, CI95% 19.91-49.17, P < 0.01) in the exercised vs. non-exercised group. Conclusions Our findings demonstrate that exercise training enhanced the benefits of bariatric surgery on cardiac autonomic regulation. These results highlight the relevance of exercise training as a treatment for post-bariatric patients, ensuring optimal cardiovascular outcomes.
- Daily Leucine Intake Is Positively Associated with Lower Limb Skeletal Muscle Mass and Strength in the Elderly(2021) LIXANDRAO, Manoel E.; LONGOBARDI, Igor; LEITAO, Alice E.; MORAIS, Joao V. M.; SWINTON, Paul A.; AIHARA, Andre Y.; GOES, Paola C. K.; UGRINOWITSCH, Carlos; CANDOW, Darren G.; GUALANO, Bruno; ROSCHEL, HamiltonHigher daily protein intake, with an emphasis on leucine content, is thought to mitigate age-related anabolic resistance, potentially counteracting age-related morphological and functional declines. The present study investigated potential associations between total daily leucine intake and dependent variables, including quadriceps muscle cross-sectional area (CSA) and maximum dynamic muscle strength (1-RM) in a cohort of healthy free-living older individuals of both sexes (n = 67; 34/33 men/women). Participants performed three 24 h dietary recalls and underwent a magnetic resonance imaging exam followed by 1-RM tests. Our results demonstrate moderate associations between total daily leucine and both quadriceps CSA (r = 0.42; p = 0.004) and 1-RM (r = 0.45; p = 0.001). Furthermore, our exploratory biphasic linear regression analyses, adjusted for sex, age, and protein intake relative to body weight, revealed a plateau for daily leucine intake and muscle mass and muscle strength (~7.6-8.0 g & BULL;day(-1)) in older adults. In conclusion, we demonstrated that total daily leucine intake is associated with muscle mass and strength in healthy older individuals and this association remains after controlling for multiple factors, including overall protein intake. Furthermore, our breakpoint analysis revealed non-linearities and a potential threshold for habitual leucine intake, which may help guide future research on the effects of chronic leucine intake in age-related muscle loss.
- Skeletal muscle histidine-containing dipeptide contents are increased in freshwater turtles (C. picta bellii) with cold-acclimation(2021) DOLAN, Eimear; WARREN, Daniel E.; HARRIS, Roger C.; SALE, Craig; GUALANO, Bruno; SAUNDERS, BryanFreshwater turtles found in higher latitudes can experience extreme challenges to acid-base homeostasis while overwintering, due to a combination of cold temperatures along with the potential for environmental hypoxia. Histidine-containing dipeptides (HCDs; carnosine, anserine and balenine) may facilitate pH regulation in response to these challenges, through their role as pH buffers. We measured the HCD content of three tissues (liver, cardiac and skeletal muscle) from the anoxia-tolerant painted turtle (C. picta bellii) acclimated to either 3 or 20 degrees C. HCDs were detected in all tissues, with the highest content shown in the skeletal muscle. Turtles acclimated to 3 degrees C had more HCD in their skeletal muscle than those acclimated to 20 degrees C (carnosine = 20.8 +/- 4.5 vs 12.5 +/- 5.9 mmol. kg DM-1; ES = 1.59 (95%CI: 0.16-3.00), P = 0.013). The higher HCD content shown in the skeletal muscle of the cold-acclimated turtles suggests a role in acid-base regulation in response to physiological challenges associated with living in the cold, with the increase possibly related to the temperature sensitivity of carnosine's dissociation constant.
- Acute cardiometabolic effects of brief active breaks in sitting for patients with rheumatoid arthritis(2021) PINTO, Ana J.; MEIRELES, Kamila; PECANHA, Tiago; MAZZOLANI, Bruna C.; I, Fabiana Smaira; REZENDE, Diego; BENATTI, Fabiana B.; RIBEIRO, Ana C. M.; PINTO, Ana L. S.; LIMA, Fernanda R.; SHINJO, Samuel K.; DANTAS, Wagner S.; MELLETT, Natalie A.; MEIKLE, Peter J.; OWEN, Neville; DUNSTAN, David W.; ROSCHEL, Hamilton; GUALANO, BrunoExercise is a treatment in rheumatoid arthritis, but participation in moderate-to-vigorous exercise is challenging for some patients. Light-intensity breaks in sitting could be a promising alternative. We compared the acute effects of active breaks in sitting with those of moderate-to-vigorous exercise on cardiometabolic risk markers in patients with rheumatoid arthritis. In a crossover fashion, 15 women with rheumatoid arthritis underwent three 8-h experimental conditions: prolonged sitting (SIT), 30-min bout of moderate-to-vigorous exercise followed by prolonged sitting (EX), and 3-min bouts of light-intensity walking every 30 min of sitting (BR). Postprandial glucose, insulin, c-peptide, triglycerides, cytokines, lipid classes/subclasses (lipidomics), and blood pressure responses were assessed. Muscle biopsies were collected following each session to assess targeted proteins/genes. Glucose [-28% in area under the curve (AUC), P = 0.036], insulin (-28% in AUC, P = 0.016), and c-peptide (-27% in AUC, P = 0.006) postprandial responses were attenuated in BR versus SIT, whereas only c-peptide was lower in EX versus SIT (-20% in AUC, P = 0.002). IL-1 beta decreased during BR, but increased during EX and SIT (P = 0.027 and P = 0.085, respectively). IL-1ra was increased during EX versus BR (P = 0.002). TNF-alpha concentrations decreased during BR versus EX (P = 0.022). EX, but not BR, reduced systolic blood pressure (P = 0.013). Lipidomic analysis showed that 7 of 36 lipid classes/subclasses were significantly different between conditions, with greater changes being observed in EX. No differences were observed for protein/gene expression. Brief active breaks in sitting can offset markers of cardiometabolic disturbance, which may be particularly useful for patients who may find it difficult to adhere to exercise. NEW & NOTEWORTHY Exercise is a treatment in rheumatoid arthritis but is challenging for some patients. Light-intensity breaks in sitting could be a promising alternative. Our findings show beneficial, but differential, cardiometabolic effects of active breaks in sitting and exercise in patients with rheumatoid arthritis. Breaks in sitting mainly improved glycemic and inflammatory markers, whereas exercise improved lipidomic and hypotensive responses. Breaks in sitting show promise in offsetting aspects of cardiometabolic disturbance associated with prolonged sitting in rheumatoid arthritis.
- Histidine dipeptides are key regulators of excitation-contraction coupling in cardiac muscle: Evidence from a novel CARNS1 knockout rat model(2021) GONCALVES, Livia de Souza; SALES, Lucas Peixoto; SAITO, Tiemi Raquel; CAMPOS, Juliane Cruz; FERNANDES, Alan Lins; NATALI, Jose; JENSEN, Leonardo; ARNOLD, Alexandre; RAMALHO, Lisley; BECHARA, Luiz Roberto Grassmann; ESTECA, Marcos Vinicius; CORREA, Isis; SANT'ANNA, Diogo; CERONI, Alexandre; MICHELINI, Lisete Compagno; GUALANO, Bruno; TEODORO, Walcy; CARVALHO, Victor Henrique; VARGAS, Bianca Scigliano; MEDEIROS, Marisa Helena Gennari; BAPTISTA, Igor Luchini; IRIGOYEN, Maria Claudia; SALE, Craig; FERREIRA, Julio Cesar Batista; ARTIOLI, Guilherme GianniniHistidine-containing dipeptides (HCDs) are abundantly expressed in striated muscles. Although important properties have been ascribed to HCDs, including H+ buffering, regulation of Ca2+ transients and protection against oxidative stress, it remains unknown whether they play relevant functions in vivo. To investigate the in vivo roles of HCDs, we developed the first carnosine synthase knockout (CARNS1-/-) rat strain to investigate the impact of an absence of HCDs on skeletal and cardiac muscle function. Male wild-type (WT) and knockout rats (4 months-old) were used. Skeletal muscle function was assessed by an exercise tolerance test, contractile function in situ and muscle buffering capacity in vitro. Cardiac function was assessed in vivo by echocardiography and cardiac electrical activity by electrocardiography. Cardiomyocyte contractile function was assessed in isolated cardiomyocytes by measuring sarcomere contractility, along with the determination of Ca2+ transient. Markers of oxidative stress, mitochondrial function and expression of proteins were also evaluated in cardiac muscle. Animals were supplemented with carnosine (1.8% in drinking water for 12 weeks) in an attempt to rescue tissue HCDs levels and function. CARNS1-/- resulted in the complete absence of carnosine and anserine, but it did not affect exercise capacity, skeletal muscle force production, fatigability or buffering capacity in vitro, indicating that these are not essential for pH regulation and function in skeletal muscle. In cardiac muscle, however, CARNS1-/- resulted in a significant impairment of contractile function, which was confirmed both in vivo and ex vivo in isolated sarcomeres. Impaired systolic and diastolic dysfunction were accompanied by reduced intracellular Ca2+ peaks and slowed Ca2+ removal, but not by increased markers of oxidative stress or impaired mitochondrial respiration. No relevant increases in muscle carnosine content were observed after carnosine supplementation. Results show that a primary function of HCDs in cardiac muscle is the regulation of Ca2+ handling and excitation-contraction coupling.
- The role of chronic muscle (in)activity on carnosine homeostasis: a study with spinal cord-injured athletes(2021) NEMEZIO, Kleiner; YAMAGUCHI, Guilherme de Carvalho; RAMKRAPES, Ana Paula Boito; SCHULZ, Mariane Leichsenring; BAPTISTA, Igor Luchini; RIANI, Luiz Augusto; GONCALVES, Livia de Souza; SALE, Craig; MEDEIROS, Marisa Helena Gennari de; GUALANO, Bruno; ARTIOLI, Guilherme GianniniTo examine the role of chronic (in)activity on muscle carnosine (MCarn) and how chronic (in)activity affects MCarn responses to 13-alanine supplementation in spinal cord-injured athletes, 16 male athletes with paraplegia were randomized (2:1 ratio) to receive 13-alanine (n = 11) or placebo (PL, n = 5). They consumed 6.4 g/day of 13-alanine or PL for 28 days. Muscle biopsies of the active deltoid and the inactive vastus lateralis (VL) were taken before and after supplementation. MCarn in the VL was also compared with the VL of a group of individuals without paraplegia (n = 15). MCarn was quantified in whole muscle and in pools of individual fibers by high-performance liquid chromatography. MCarn was higher in chronically inactive VL vs. well-trained deltoid (32.0 +/- 12.0 vs. 20.5 +/- 6.1 mmol/kg DM; P = 0.018). MCarn was higher in inactive vs. active VL (32.0 +/- 12.0 vs. 21.2 +/- 7.5 mmol/kg DM; P = 0.011). In type-I fibers, MCarn was significantly higher in the inactive VL than in the active deltoid (38.3 +/- 4.7 vs. 27.3 +/- 11.8 mmol/kg DM, P = 0.014). MCarn increased similarly between inactive VL and active deltoid in the 13-alanine group (VL: 68.9 +/- 55.1%, P = 0.0002; deltoid: 90.5 +/- 51.4%, P < 0.0001), with no changes in the PL group. MCarn content was higher in the inactive VL than in the active deltoid and the active VL, but this is probably a consequence of fiber type shift (type I to type II) that occurs with chronic inactivity. Chronically inactive muscle showed an increase in MCarn after BA supplementation equally to the active muscle, suggesting that carnosine accretion following 13-alanine supplementation is not influenced by muscle inactivity.
- Changes in Eating Habits and Sedentary Behavior During the COVID-19 Pandemic in Adolescents With Chronic Conditions(2021) MAZZOLANI, Bruna Caruso; SMAIRA, Fabiana Infante; ASTLEY, Camilla; IRAHA, Amanda Yuri; PINTO, Ana Jessica; MARQUES, Isabela Gouveia; AMARANTE, Milla Cordeiro; REZENDE, Nathalia Saffioti; SIECZKOWSKA, Sofia Mendes; FRANCO, Tathiane Christine; MIRANDA, Luana Cristina do Amaral; LINDOSO, Livia; HELITO, Alberto Carame; OBA, Jane; QUEIROZ, Ligia Bruni; PEREIRA, Rosa Maria R.; ROSCHEL, Hamilton; SILVA, Clovis Artur; GUALANO, BrunoIntroduction: Among healthy adolescents, school closures and home confinement were shown to increase unhealthier eating habits and sedentary behavior. It remains unknown to which extent the pandemic has impacted the lifestyle of adolescents with chronic conditions. Thus, the aim of this study is to report on the impact of the COVID-19 outbreak on eating habits and sedentary behavior among adolescents with multiple chronic conditions (n = 347) from a tertiary, referral hospital vs. healthy peers.Methods: This observational study was conducted in Sao Paulo (Brazil) between July and October 2020, period in which a set of social distancing measures to contain the pandemic.Results: The main findings of this study were that adolescents with chronic conditions and health peers showed important changes in eating habits (e.g., more often cooking and eating in front of television than before quarantine). Also, 86.8% of adolescents with chronic conditions and 91.6% of healthy adolescents reported increasing screen time during pandemic. No major differences were observed between patients and controls.Conclusions: Adolescents with chronic conditions and healthy peers exposed to pandemic showed substantial changes in lifestyle, stressing the need for specific care to mitigate poor eating habits and excessive sedentary behavior for patients and healthy adolescents.
- Nutritional Inadequacies Among Post-bariatric Patients During COVID-19 Quarantine in Sao Paulo, Brazil(2021) NICOLETTI, Carolina Ferreira; ESTEVES, Gabriel Perri; GENARIO, Rafael; SANTO, Marco Aurelio; CLEVA, Roberto de; GUALANO, Bruno; ROSCHEL, HamiltonPost bariatric control of food intake is influenced by psychological and behavioral factors. We investigated dietary habits and food intake during COVID-19 quarantine among recently operated patients. Patients were assessed for total and per meal energy and macronutrient intake as well as frequency of food consumption per processing level. Patients were also classified according to adherence to nutritional recommendations from our outpatient clinic. Main results are indicative of inappropriate nutritional intake during COVID-19 quarantine in postoperative bariatric patients. We observed that many patients failed to meet the recommended protein intake (89.2%) along a relatively high intake of ultra-processed foods (similar to 1/4 of the diet). Our data suggest the need for the implementation of strategies to extend nutritional care to at-risk patients during social distancing.
- Influence of Adherence to Social Distancing Due to the COVID-19 Pandemic on Physical Activity Level in Post-bariatric Patients(2021) REZENDE, Diego A. N.; PINTO, Ana J.; GOESSLER, Karla F.; NICOLETTI, Carolina F.; SIECZKOWSKA, Sofia M.; MEIRELES, Kamila; ESTEVES, Gabriel P.; GENARIO, Rafael; OLIVEIRA JUNIOR, Gersiel N.; SANTO, Marco A.; CLEVA, Roberto de; ROSCHEL, Hamilton; GUALANO, BrunoWe assessed physical activity using accelerometers and a questionnaire in 33 post-bariatric patients who reported to be adherent (n = 15) or not (n = 18) to social distancing due to the COVID-19 pandemic. Patients adherent to social distancing spent more time in sedentary behavior (1.1 h/day, 0.1, 2.2;p = 0.045) and less time in moderate-to-vigorous physical activity (- 12.2 min/day, - 23.8, - 0.6;p = 0.040) vs. non-adherent ones. Bland-Altman analysis comparing objective and subjective physical activity estimates showed a bias for time spent in sedentary behavior and moderate-to-vigorous activity of 2.8 h/day and 8.5 min/day. In conclusion, post-bariatric patients who were adherent to social distancing measures were more inactive and sedentary than non-adherent ones. Strategies to increase physical activity in post-bariatric patients exposed to social distancing are necessary during the COVID-19 pandemic.
- Effect of a Single High-Dose Vitamin D-3 on the Length of Hospital Stay of Severely 25-Hydroxyvitamin D-Deficient Patients with COVID-19(2021) MURAI, Igor H.; FERNANDES, Alan L.; ANTONANGELO, Leila; GUALANO, Bruno; PEREIRA, Rosa Maria RodriguesOBJECTIVES: In this ancillary analysis of a multicenter, double-blinded, randomized, placebo-controlled trial, we investigated the effect of a single high dose of vitamin D-3 on the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19. METHODS: The primary outcome was length of hospital stay, defined as the total number of days that patients remained hospitalized from the date of randomization until the date of hospital discharge. Secondary outcomes included serum levels of 25-hydroxyvitamin D, mortality during hospitalization, number of patients admitted to the intensive care unit, and number of patients who required mechanical ventilation. RESULTS: Thirty-two patients were included in the study. The mean (SD) age was 58.5 (15.6) years, body mass index was 30.8 (8.6) kg/m(2), and 25-hydroxyvitamin D level was 7.8 (1.6) ng/mL. No significant difference was observed in the median interquartile range of length of hospital stay between the vitamin D-3 group (6.0 [4.0- 18.0] days) versus placebo (9.5 [6.3-15.5] days) (log-rank p=0.74; hazard ratio, 1.13 [95% confidence interval (CI), 0.53-2.40]; p=0.76). Vitamin D-3 significantly increased serum 25-hydroxyvitamin D levels in the vitamin D-3 group compared with that in the placebo group (between-group difference, 23.9 ng/mL [95% CI, 17.7-30.1]; p<0.001). CONCLUSIONS: A dose of 200.000 IU of vitamin D-3 did not significantly reduce the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19.
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