MARIANA COLOMBINI ZANIBONI
Projetos de Pesquisa
Unidades Organizacionais
LIM/56 - Laboratório de Investigação em Dermatologia e Imunodeficiências, Hospital das Clínicas, Faculdade de Medicina
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- Skin barrier in atopic dermatitis: beyond filaggrin(2016) ZANIBONI, Mariana Colombini; SAMORANO, Luciana Paula; ORFALI, Raquel Leao; AOKI, ValeriaAtopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis, where changes in skin barrier and imbalance of the immune system are relevant factors. The skin forms a mechanic and immune barrier, regulating water loss from the internal to the external environment, and protecting the individual from external aggressions, such as microorganisms, ultraviolet radiation and physical trauma. Main components of the skin barrier are located in the outer layers of the epidermis (such as filaggrin), the proteins that form the tight junction (TJ) and components of the innate immune system. Recent data involving skin barrier reveal new information regarding its structure and its role in the mechanic-immunological defense; atopic dermatitis (AD) is an example of a disease related to dysfunctions associated with this complex.
- Consensus on the therapeutic management of atopic dermatitis Brazilian Society of Dermatology(2019) AOKI, Valeria; LORENZINI, Daniel; ORFALI, Raquel Leao; ZANIBONI, Mariana Colombini; OLIVEIRA, Zilda Najjar Prado de; RIVITTI-MACHADO, Maria Cecilia; TAKAOKA, Roberto; WEBER, Magda Blessmann; CESTARI, Tania; GONTIJOS, Bernardo; RAMOSS, Andrea Machado Coelho; SILVA, Claudia Marcia de Resende; CESTARI, Silmara da Costa Pereira; SOUTO-MAYOR, Silvia; CARNEIRO, Francisca Regina; CERQUEIRA, Ana Maria Mosca de; LACZYNSKI, Cristina; PIRES, Mario CezarBACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.
- Atopic dermatitis in adults: clinical and epidemiological considerations(2013) ORFALI, Raquel Leao; SHIMIZUA, Marta M.; TAKAOKA, Roberto; ZANIBONI, Mariana C.; ISHIZAKI, Aline S.; COSTA, Anderson A.; TIBA, Ana Paula L.; SATO, Maria Notomi; AOKI, ValeriaObjective: Atopic dermatitis (AD) is a chronic inflammatory disease causing intense pruritus, and with typical clinical features. There are few epidemiological studies concerning AD in adults, aswell as little information about its prognostic. The aim of this study was to evaluate the clinical and epidemiological course of adults with AD. Methods: 80 patients aged above 18 years (mean age = 29 years) were selected (30 males and 50 females) and interviewed about hospitalization, systemic corticoid usage, age of ADonset, and personal and/or familial history of atopy. Disease severity was evaluated through the Scoring Atopic Dermatitis (SCORAD) tool. Laboratory examination included IgE serum levels and eosinophil blood count. Results: 71 out of 80 patients referred association with respiratory symptoms (18 had asthma, 17 had rhinitis, and 36 had both conditions); nine out of 80 patients denied any respiratory disease. AD patients were divided in mild (n = 25), moderate (n = 30), and severe (n = 25); 56% had one or more hospitalizations due to AD. A positive association was found between IgE serum levels, eosinophil blood count, and disease severity. Conclusion: Adult AD represents a clinical challenge that needs to be better characterized, since it can be misdiagnosed and interferes with the patient's social and personal life. The association of skin and respiratory atopic disease is frequent, and laboratory parameters such as circulating IgE levels and eosinophil blood count may be helpful to assess disease severity.
- Staphylococcus aureus enterotoxins modulate IL-22-secreting cells in adults with atopic dermatitis(2018) ORFALI, Raquel Leao; OLIVEIRA, Luanda Mara da Silva; LIMA, Josenilson Feitosa de; CARVALHO, Gabriel Costa de; RAMOS, Yasmim Alefe Leuzzi; PEREIRA, Natalli Zanete; PEREIRA, Naiura Vieira; ZANIBONI, Mariana Colombini; SOTTO, Mirian Nacagami; DUARTE, Alberto Jose da Silva; SATO, Maria Notomi; AOKI, ValeriaAtopic dermatitis (AD) is a chronic inflammatory immune-mediated skin disease characterized by skin colonization by Staphylococcus aureus. Interleukin (IL)-22, in cooperation with IL-17, triggers antimicrobial peptide elaboration and enhances certain immunological responses. In AD, IL-22 is related to epidermal hyperplasia, keratinocyte apoptosis, and inhibition of antimicrobial peptide (AMP) production. We aimed to evaluate the impact of staphylococcal enterotoxins on the Tc22/Th22 induction in the peripheral blood of AD patients and on CD4(+/)CD8(+)T cells expressing IL-22 in AD skin. Our study showed inhibition of the staphylococcal enterotoxins A and B (SEA and SEB) response by Th22 (CD4(+)IL22(+)IL-17A(-)IFN-gamma(-)) cells in AD patients. In contrast, Tc22 (CD8(+)IL-22(+)IL-17A(-)IFN-gamma(-)) cells were less susceptible to the inhibitory effects of staphylococcal enterotoxins and exhibited an enhanced response to the bacterial stimuli. In AD skin, we detected increased IL-22 transcript expression and T lymphocytes expressing IL-22. Together, our results provide two major findings in response to staphylococcal enterotoxins in adults with AD: dysfunctional CD4(+)IL-22 secreting T cells and increased Tc22 cells. Our hypothesis reinforces the relevance of CD8 T cells modulated by staphylococcal enterotoxins as a potential source of IL-22 in adults with AD, which is relevant for the maintenance of immunological imbalance.
- Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique(2023) ORFALI, Raquel Leao; LORENZINI, Daniel; BRESSAN, Aline; TANAKA, Anber Ancel; CERQUEIRA, Ana Maria Mosca de; HIRAYAMA, Andre da Silva; RAMOS, Andrea Machado Coelho; PROENCA, Carolina Contin; SILVA, Claudia Marcia de Resende; LACZYNSKI, Cristina Marta Maria; CARNEIRO, Francisca Regina; DUARTE, Gleison; HANS FILHO, Gunter; GONCALVES, Heitor de Sa; MELO, Ligia Pessoa de; AZULAY-ABULAFIA, Luna; WEBER, Magda Blessmann; RIVITTI-MACHADO, Maria Cecilia; ZANIBONI, Mariana Colombini; OGAWA, Marilia; PIRES, Mario Cezar; IANHEZ, Mayra; FELIX, Paulo Antonio Oldani; BONAMIGO, Renan; TAKAOKA, Roberto; LAZZARINI, Rosana; CESTARI, Silmara; MAYOR, Silvia Assumpcao Soutto; CESTARI, Tania; OLIVEIRA, Zilda Najjar Prado de; SPULS, Phyllis I.; GERBENS, Louise A. A.; AOKI, ValeriaThis publication is an update of the ""Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology"" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript. (c) 2023 Sociedade Brasileira de Dermatologia.