IARA MORENO LINHARES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
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- Influence of recurrent vulvovaginal candidiasis on quality of life issues(2019) I, Eiko Fukazawa; WITKIN, Steven S.; ROBIAL, Renata; VINAGRE, Joao G.; BARACAT, Edmund C.; LINHARES, Iara M.Purpose More than 370 million women will experience recurrent vulvovaginal candidiasis (RVVC) during their lifetime. However, RVVC is often trivialized as clinically insignificant and not worthy of research funding. We evaluated the influence of RVVC on the quality of life in affected women. Methods The validated World Health Organization Quality of Life Abbreviated Assessment (WHOQOL-Bref) questionnaire was administered to 100 women with RVVC and to 101 epidemiologically matched women with no history of vulvovaginal candidiasis. RVVC was defined as at least four episodes of clinical and culture-positive vaginal candidiasis within a 1 year period. Data were analyzed by Chi square, Student t test and analysis of variance. Internal consistency of responses to questions was evaluated by Cronbach alpha. Results The Cronbach alpha coefficient was > 0.80 for responses to generalized questions and > 0.65 for answers to more specific questions, indicating substantial internal consistency. Perception of quality of life and satisfaction with their health was greatly reduced in the RVVC group (p < 0.001). Diminished responses to physical and psychological well-being were also reported by women with RVVC (p < 0.001). Various aspects of social relations including sexual activity were similarly reduced (p < 0.001) as were satisfaction with issues such as home environment, financial resources and employment (p < 0.001). Conclusion RVVC affects multiple aspects of a woman's well-being. Women with this condition deserve serious attention from clinicians and research into susceptibility, prevention and treatment of this infection deserves much greater emphasis.
- Vaginal Biomarkers That Predict Cervical Length and Dominant Bacteria in the Vaginal Microbiomes of Pregnant Women(2019) WITKIN, Steven S.; MORON, Antonio F.; RIDENHOUR, Benjamin J.; MINIS, Evelyn; HATANAKA, Alan; SARMENTO, Stephanno G. P.; FRANCA, Marcelo S.; CARVALHO, Francisco H. C.; HAMAMOTO, Tatiana K.; MATTAR, Rosiane; SABINO, Ester; LINHARES, Iara M.; RUDGE, Marilza V. C.; FORNEY, Larry J.In many impoverished regions of the world, it may not be possible to assess two major risk factors for preterm birth: a short cervical length and the depletion of vaginal lactobacilli. We determined whether measuring specific compounds in vaginal fluid might be a simple, noninvasive, and cost-effective way to predict the bacteria that dominate the vaginal microbiome and indicate the presence of a shortened cervix (<25 mm). Vaginal fluid samples were prospectively collected from mid-trimester pregnant women, and the concentrations of D- and L-lactic acid, tissue inhibitor of matrix metalloproteinases TIMP-1 and TIMP-2, matrix metalloproteinases MMP-2 and MMP-8, the 70-kDa heat shock protein, a2 isoform of vacuolar ATPase, and sequestrome-1 were quantified by an enzyme-linked immunosorbent assay (ELISA). The compositions of vaginal microbiomes were assessed by analysis of the V1-V3 regions of 16S rRNA genes, while cervical length was determined by transvaginal ultrasonography. The vaginal microbiomes could be clustered into five community state types (CSTs), four of which were dominated by a single Lactobacillus species. The dominance of Lactobacillus crispatus or Lactobacillus jensenii in the vaginal microbiome predicted the level of D-lactic acid present. Several of the biomarkers, especially TIMP-1, in combination with the subject's age and race, were significantly associated with cervical length. Using piecewise structural equation modeling, we established a causal network that links CST to cervical length via biomarkers. We concluded that measuring levels of TIMP-1 and D-lactic acid in vaginal secretions might be a straightforward way to assess the risk for preterm birth due to a short cervix and microbiome composition. IMPORTANCE Premature birth and its complications are the largest contributors to infant death in the United States and globally. A short cervical length and the depletion of Lactobacillus species are known risk factors for preterm birth. However, in many resource-poor areas of the world, the technology to test for their occurrence is unavailable, and pregnant women with these risk factors are neither identified nor treated. In this study, we used path analysis to gain an unprecedented understanding of interactions between vaginal microbiome composition, the concentrations of various compounds in vaginal secretions, and cervical length. We identified low-cost point-of-care measures that might be used to identify pregnant women at risk for preterm birth. The use of these measures coupled with appropriate preventative or treatment strategies could reduce the incidence of preterm births in poor areas of the world that lack access to more sophisticated diagnostic methods.
- Influence of a mannose-binding lectin gene polymorphism and exposure to Chlamydia trachomatis on fallopian tube obstruction in Brazilian woman(2019) VINAGRE, Joao G.; WITKIN, Steven S.; RIBEIRO, Sergio C.; ROBIAL, Renata; I, Eiko Fukazawa; ORTOLANI, Carla C.; BARACAT, Edmund C.; LINHARES, Iara M.Purpose Factors influencing fallopian tube occlusion in women with a lower genital tract infection remain incompletely elucidated. We evaluated whether a polymorphism in the mannose-binding lectin (MBL) gene at codon 54 influences the occurrence of fallopian tube blockage in relation to exposure to Chlamydia trachomatis. Methods In a case-control study at The Hospital das Clinicas, University of Sao Paulo, Brazil, 75 women with hysterosalpingography-documented tubal occlusion and 75 women with patent fallopian tubes were analyzed for detection of single-nucleotide polymorphism in codon 54 of the MBL gene and for IgG anti-C. trachomatis antibodies in their sera. Both groups were matched for age, race, and sexual variables. Results Prior exposure to C. trachomatis, as evidenced by the presence of IgG antibodies, was comparable in both groups. Detection of the polymorphic MBL allele was more prevalent in women with blocked tubes (p < 0.01), regardless of whether or not there was evidence of prior chlamydial exposure. Conclusion The level of MBL-related innate immunity influences the consequences of infection by C. trachomatis or other microbes.
conferenceObject Mannose-Binding Lectin Gene Polymorphism and Chlamydia Trachomatis Antibodies in Brazilian Women with Tubal Occlusion.(2019) VINAGRE, Joao G.; WITKIN, Steven S.; FUKAZAWA, Eiko I.; ROBIAL, Renata; BARACAT, Edmund C.; LINHARES, Iara M.- The human vaginal microbiome(2019) LINHARES, I. M.; MINIS, E.; ROBIAL, R.; WITKIN, S. S.Women have developed a unique vaginal microbiome, distinct from all other mammals, to prevent infection and to protect both the mother and fetus during pregnancy. Lactobacilli, predominantly L. crispatus and L. iners, are numerically dominant in the vagina, and their presence increases further during pregnancy. Their predominance may prevent other microorganisms, from adhering to the vaginal epithelium and initiating an infection. They produce lactic acid that acidifies the vagina and inhibits the growth of other microorganisms. Lactic acid also specifically inactivates a number of sexually transmitted viral and bacterial pathogens, such as human immunodeficiency virus, herpesvirus, Chlamydia trachomatis, Neisseria gonorrhoeae, and the bacteria associated with bacterial vaginosis. Lactic acid also possesses immunological properties that prevent activation of proinflammatory immunity in the vagina, while concomitantly promoting the release of antibacterial products from vaginal epithelial cells. L. crispatus also uniquely promotes vaginal health, by inducing autophagy in epithelial cells. © 2019 Elsevier Inc. All rights reserved.
conferenceObject Influence of Recurrent Vulvovaginal Candidiasis on Quality of Life.(2019) FUKAZAWA, Eiko I.; WITKIN, Steven S. Steven Sol; ROBIAL, Renata; VINAGRE, Joao G.; BARACAT, Edmund C.; LINHARES, Iara M.- Contribution of Epithelial Cells to Defense Mechanisms in the Human Vagina(2019) LINHARES, Iara M.; SISTI, Giovanni; MINIS, Evelyn; FREITAS, Gabriela B. de; MORON, Antonio F.; WITKIN, Steven S.Purpose of ReviewThe vaginal milieu in women differs from that of other mammals, including non-human primates, in composition of secretions, the endogenous microbiota, and level of acidity. These changes apparently reflect evolutionary variations that maximized productive responses to a uniquely human vaginal environment. This review will highlight recent findings on properties of human vaginal epithelial cells that contribute to maintenance of a healthy vaginal environment.Recent FindingsVaginal epithelial cells are responsive to the composition of the vaginal microbiome even in women who are in apparently good health and do not exhibit any adverse physical symptoms. This is especially important during pregnancy when immune defenses are modified and an effective epithelial cell-derived anti-microbial activity is essential to prevent the migration to the uterus of bacteria potentially harmful to pregnancy progression. When Lactobacillus crispatus numerically predominates in the vagina, epithelial cell activity is low. Conversely, predominance of Lactobacillus iners, Gardnerella vaginalis, or other non-Lactobacilli evokes production and release of a large variety of compounds to minimize the potentially negative consequences of an altered microbiome. The extent of autophagy in vaginal epithelial cells, a basic process that functions to maintain intracellular homeostasis and engulf microbial invaders, is also sensitive to the external microbial environment Vaginal epithelial cells bind and release norepinephrine and upregulate their anti-microbial activity in response to external stress.SummaryVaginal epithelial cells in women are responsive to local conditions that are unique to humans and, thereby, contribute to maintenance of a healthy milieu.