ANA KAROLINA BARRETO BERSELLI MARINHO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/60 - Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina
LIM/60 - Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina
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- Liver disease accompanied by enteropathy in common variable immunodeficiency: Common pathophysiological mechanisms(2022) LIMA, Fabiana Mascarenhas Souza; TOLEDO-BARROS, Myrthes; ALVES, Venancio Avancini Ferreira; DUARTE, Maria Irma Seixas; TAKAKURA, Cleusa; BERNARDES-SILVA, Carlos Felipe; MARINHO, Ana Karolina Barreto Berselli; GRECCO, Octavio; KALIL, Jorge; KOKRON, Cristina MariaCommon variable immunodeficiency (CVID) is one of the inborn errors of immunity that have the greatest clinical impact. Rates of morbidity and mortality are higher in patients with CVID who develop liver disease than in those who do not. The main liver disorder in CVID is nodular regenerative hyperplasia (NRH), the cause of which remains unclear and for which there is as yet no treatment. The etiology of liver disease in CVID is determined by analyzing the liver injury and the associated conditions. The objective of this study was to compare CVID patients with and without liver-spleen axis abnormalities in terms of clinical characteristics, as well as to analyze liver and duodenal biopsies from those with portal hypertension (PH), to elucidate the pathophysiology of liver injury. Patients were divided into three groups: Those with liver disease/PH, those with isolated splenomegaly, and those without liver-spleen axis abnormalities. Clinical and biochemical data were collected. Among 141 CVID patients, 46 (32.6%) had liver disease/PH; 27 (19.1%) had isolated splenomegaly; and 68 (48.2%) had no liver-spleen axis abnormalities. Among the liver disease/PH group, patients, even those with mild or no biochemical changes, had clinical manifestations of PH, mainly splenomegaly, thrombocytopenia, and esophageal varices. Duodenal celiac pattern was found to correlate with PH (p < 0.001). We identified NRH in the livers of all patients with PH (n = 11). Lymphocytic infiltration into the duodenal mucosa also correlated with PH. Electron microscopy of liver biopsy specimens showed varying degrees of lymphocytic infiltration and hepatocyte degeneration, which is a probable mechanism of lymphocyte-mediated cytotoxicity against hepatocytes and enterocytes. In comparison with the CVID patients without PH, those with PH were more likely to have lymphadenopathy (p < 0.001), elevated beta(2)-microglobulin (p < 0.001), low B-lymphocyte counts (p < 0.05), and low natural killer-lymphocyte counts (p < 0.05). In CVID patients, liver disease/PH is common and regular imaging follow-up is necessary. These patients have a distinct immunological phenotype that may predispose to liver and duodenal injury from lymphocyte-mediated cytotoxicity. Further studies could elucidate the cause of this immune-mediated mechanism and its treatment options.
- Primary Immunodeficiency Diseases in Different Age Groups: A Report on 1,008 Cases from a Single Brazilian Reference Center(2013) CARNEIRO-SAMPAIO, Magda; MORAES-VASCONCELOS, Dewton; KOKRON, Cristina M.; JACOB, Cristina M. A.; TOLEDO-BARROS, Myrthes; DORNA, Mayra B.; WATANABE, Leticia A.; MARINHO, Ana Karolina B. B.; CASTRO, Ana Paula Moschione; PASTORINO, Antonio C.; SILVA, Clovis Artur A.; FERREIRA, Mauricio D.; RIZZO, Luiz V.; KALIL, Jorge E.; DUARTE, Alberto J. S.Primary immunodeficiencies (PIDs) represent a large group of diseases that affect all age groups. Although PIDs have been recognized as rare diseases, there is epidemiological evidence suggesting that their real prevalence has been underestimated. We performed an evaluation of a series of 1,008 infants, children, adolescents and adults with well-defined PIDs from a single Brazilian center, regarding age at diagnosis, gender and PID category according to the International Union of Immunological Societies classification. Antibody deficiencies were the most common category in the whole series (61 %) for all age groups, with the exception of <2-year-old patients (only 15 %). In the >30-year-old group, antibody deficiencies comprised 84 % of the diagnoses, mostly consisting of common variable immunodeficiency, IgA deficiency and IgM deficiency. Combined immunodeficiencies represented the most frequent category in <2-years-old patients. Most congenital defects of phagocytes were identified in patients <5 -years of age, as were the diseases of immune dysregulation, with the exception of APECED. DiGeorge syndrome and ataxia-telangiectasia were the most frequent entities in the category of well-defined syndromes, which were mostly identified in patients <10-years of age. Males represented three-quarters and two-thirds of <2 -years-old and 2-5-years -old patients, respectively, whereas females predominated among the >30-year-old patients. Our data indicated that some PIDs were only detected at early ages, likely because affected patients do not survive long. In addition, our data pointed out that different strategies should be used to search for PIDs in infants and young children as compared to older patients.
- Inversion of the V delta 1 to V delta 2 gamma delta T cell ratio in CVID is not restored by IVIg and is associated with immune activation and exhaustion(2016) PAQUIN-PROULX, Dominic; BARSOTTI, Nathalia Silveira; SANTOS, Bianca A. N.; MARINHO, Ana Karolina B. B.; KOKRON, Cristina M.; CARVALHO, Karina I.; BARROS, Myrthes T.; KALIL, Jorge; NIXON, Douglas F.; KALLAS, Esper G.Common variable immunodeficiency (CVID) is defined by low levels of IgG and IgA, but perturbations in T cells are also commonly found. However, there is limited information on gamma delta T cells in CVID patients. Newly diagnosed CVID patients (n=15) were enrolled before and after intravenous IgG (IVIg) replacement therapy. Cryopreserved peripheral blood mononuclear cells were then used to study gamma delta T cells and CVID patients were compared to healthy controls (n=22). The frequency and absolute count of V delta 1 gamma delta T cells was found to be increased in CVID (median 0.60% vs 2.64%, P<0.01 and 7.5 vs 39, P<0.01 respectively), while they were decreased for V delta 2 gamma delta T cells (median, 2.36% vs 0.74%, P<0.01 and 37.8 vs 13.9, P<0.01 respectively) resulting in an inversion of the V delta 1 to V delta 2 ratio (0.24 vs 1.4, P<0.001). Markers of immune activation were elevated on all subsets of gamma delta T cells, and HLA-DR expression was associated with an expansion of V delta 1 gamma delta T cells (r=0.73, P=0.003). Elevated PD-1 expression was found only on V delta 2 gamma delta T cells (median 1.15% vs 3.08%, P<0.001) and was associated with the decrease of V delta 2 gamma delta T cells (r=-0.67, P=0.007). IVIg had no effect on the frequency of V delta 1 and V delta 2 gamma delta T cells or HLA-DR expression, but alleviated CD38 expression on V delta 1 gamma delta T cells (median MFI 965 vs 736, P<0.05). These findings suggest that immunological perturbations of gamma delta T cells are a general feature associated with CVID and are only partially reversed by IVIg therapy.