PAULO CESAR SERAFINI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
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
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- Ovarian reserve in adult patients with childhood-onset lupus: a possible deleterious effect of methotrexate?(2014) ARAUJO, D. B. de; YAMAKAMI, L. Y. S.; AIKAWA, N. E.; BONFA, E.; VIANA, V. S. T.; PASOTO, S. G.; PEREIRA, R. M. R.; SERAFIN, P. C.; BORBA, E. F.; SILVA, C. A.Objectives: To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in adult patients with childhood-onset systemic lupus erythematosus (c-SLE). Method: Fifty-seven adult c-SLE female patients and 21 healthy controls were evaluated for anti-CoL. Ovarian reserve was assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, anti-Mullerian hormone (AMH), and antral follicle count (AFC). Demographic data, menstrual abnormalities, disease activity, damage, and treatment were also analysed. Results: The median current age was similar in adult c-SLE patients and controls (27.7 vs. 27.7 years, p = 0.414). The medians of AMH (1.1 vs. 1.5 ng/mL, p = 0.037) and AFC (6 vs. 16, p < 0.001) were significantly reduced in SLE patients compared to controls without significant menstrual abnormalities. Anti-CoL were solely observed in c-SLE patients (16% vs. 0%, p = 0.103) and were not associated with demographic data, ovarian reserve parameters, disease activity/damage, and treatment. Further evaluation of c-SLE patients treated with cyclophosphamide revealed a higher median of FSH levels compared to c-SLE patients not treated with cyclophosphamide and controls (8.8 vs. 5.7 vs. 5.6 IU/L, p = 0.032) and lower median AMH (0.4 vs. 1.5 vs. 1.5 ng/mL, p = 0.004) and AFC (4.0 vs. 6.5 vs. 16 IU/L, p = 0.001) levels. Nineteen patients treated exclusively with methotrexate demonstrated a negative correlation between the cumulative dose and AMH levels (p = 0.027, r = -0.507). Conclusions: The present study demonstrated for the first time that a high cumulative methotrexate dose is a possible cause of subclinical ovarian dysfunction in adult c-SLE patients. Further studies are required to confirm this deleterious effect in other rheumatic diseases, particularly juvenile idiopathic arthritis and idiopathic inflammatory myopathy.
- Clark CA, Laskin CA. Ovarian reserve in antiphospholipid syndrome: the jury is still out. Lupus 2015; 24: 773(2015) YAMAKAMI, L. Y. S.; SERAFINI, P. C.; ARAUJO, D. B. de; BONFA, E.; LEON, E. P.; BARACAT, E. C.; SILVA, C. A.
bookPart Tratamentos de baixa complexidade em reprodução humana(2015) BIANCHI, Paulo Homem de Mello; YAMAKAMI, Lucas Yugo Shiguehara; SERAFINI, Paulo CesarconferenceObject DO WOMEN WITH PRIMARY ANTIPHOSPHOLIPID SYNDROME HAVE LOW OVARIAN RESERVE?(2013) YAMAKAMI, L. Y. S.; SERAFINI, P. C.; ARAUJO, D. B.; BONFA, E.; BARACAT, E. C.; SILVA, C. A.conferenceObject Ovarian Reserve In Women With Primary Antiphospholipid Syndrome(2013) YAMAKAMI, Lucas; SERAFINI, Paulo; ARAUJO, Daniel B.; BONFA, Eloisa; LEON, Elaine P.; BARACAT, Edmund C.; SILVA, Clovis A.- Ovarian reserve in women with primary antiphospholipid syndrome(2014) YAMAKAMI, L. Y. S.; SERAFINI, P. C.; ARAUJO, D. B. de; BONFA, E.; LEON, E. P.; BARACAT, E. C.; SILVA, C. A.Objective: The objective of this paper is to evaluate ovarian reserve in primary antiphospholipid syndrome (PAPS) women and the association between ovarian reserve tests and clinical and laboratorial parameters, and anti-corpus luteum antibody (anti-CoL). Methods: We screened 85 female patients between 18 to 40 years old with APS. Of these, 67 patients were excluded because of association with other autoimmune diseases (n = 42), contraindication or unwillingness to stop hormonal contraceptive (n = 21), current pregnancy or breastfeeding (n = 3) and previous ovarian surgery (n = 1). Therefore, a cross-sectional study was conducted in 18 PAPS patients and 24 healthy women. They were evaluated at early follicular phase with measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Mullerian hormone (AMH) and sonographic antral follicle count (AFC). Serum measurement of anti-CoL was determined by immunoblot analysis. All analyses were performed after at least six months from the last intake of hormonal contraceptive and resumption of menstruation. Results: The mean age was comparable in PAPS and controls (33.0 +/- 5.0 vs. 30.4 +/- 7.0 years; p = 0.19). Regarding ovarian reserve tests, the frequencies of low AFC (<= 10) (56% vs. 22%, p = 0.04) and very low AFC (<= 5) (37% vs. 9%, p = 0.04) were significantly higher in PAPS patients than controls. Trends of higher frequencies of reduced (< 1.0 ng/ml), low (< 0.5 ng/ml) and negligible (< 0.2 ng/ml) AMH levels were found in PAPS patients (p = 0.08, p = 0.07 and p = 0.07, respectively). FSH, LH and estradiol were similar in patients and controls. There was no association between low ovarian reserve and specific types of antiphospholipid antibodies. Anti-CoL was solely observed in PAPS patients (11% vs. 0%; p = 0.177) and was not related to ovarian reserve tests. Conclusion: Women suffering from PAPS possessed reduced ovarian reserve, with prevalence greater than 50%.
conferenceObject Ovarian Dysfunction In Adult Childhood-Onset Systemic Lupus Erythematosus Patients: A Possible Role Of Methotrexate?(2013) ARAUJO, Daniel B.; YAMAKAMI, Lucas; BONFA, Eloisa; VIANA, Vilma S. T.; PASOTO, Sandra G.; PEREIRA, Rosa M.; SERAFIN, Paulo C.; BORBA, Eduardo F.; SILVA, Clovis A.bookPart Infertilidade feminina(2013) SERAFINI, Paulo; RIBOLDI, Marcia; YAMAKAMI, Lucas; BARACAT, Edmund Chada