MARCELO VIVOLO AUN
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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conferenceObject Intradermal test is a relevant biomarker of the outcome of rapid desensitization in penicillin allergy(2017) GARCIA, J. F.; V, M. Aun; MOTTA, A. A.; KALIL, J.; GIAVINA-BIANCHI, P.conferenceObject Gender influence on hereditary angioedema with C1-inhibitor deficiency(2017) GARCIA, J. F.; TAKEJIMA, P. M.; V, M. Aun; MOTTA, A. A.; KALIL, J.; GIAVINA-BIANCHI, P.- Animal models of asthma: utility and limitations(2017) AUN, Marcelo Vivolo; BONAMICHI-SANTOS, Rafael; ARANTES-COSTA, Fernanda Magalhaes; KALIL, Jorge; GIAVINA-BIANCHI, PedroClinical studies in asthma are not able to clear up all aspects of disease pathophysiology. Animal models have been developed to better understand these mechanisms and to evaluate both safety and efficacy of therapies before starting clinical trials. Several species of animals have been used in experimental models of asthma, such as Drosophila, rats, guinea pigs, cats, dogs, pigs, primates and equines. However, the most common species studied in the last two decades is mice, particularly BALB/c. Animal models of asthma try to mimic the pathophysiology of human disease. They classically include two phases: sensitization and challenge. Sensitization is traditionally performed by intraperitoneal and subcutaneous routes, but intranasal instillation of allergens has been increasingly used because human asthma is induced by inhalation of allergens. Challenges with allergens are performed through aerosol, intranasal or intratracheal instillation. However, few studies have compared different routes of sensitization and challenge. The causative allergen is another important issue in developing a good animal model. Despite being more traditional and leading to intense inflammation, ovalbumin has been replaced by aeroallergens, such as house dust mites, to use the allergens that cause human disease. Finally, researchers should define outcomes to be evaluated, such as serum-specific antibodies, airway hyperresponsiveness, inflammation and remodeling. The present review analyzes the animal models of asthma, assessing differences between species, allergens and routes of allergen administration.
- Allergic and Nonallergic Asthma Have Distinct Phenotypic and Genotypic Features(2017) TAKEJIMA, Priscila; AGONDI, Rosana Camara; RODRIGUES, Helcio; AUN, Marcelo Vivolo; KALIL, Jorge; GIAVINA-BIANCHI, PedroBackground: Identification of asthma phenotypes enables a better understanding and management of this heterogeneous disease. Studies have reported associations between human leukocyte antigens (HLA) and asthma in different populations, but the results have been inconclusive and they have rarely considered the distinct disease phenotypes. Our objective was to characterize allergic and nonallergic asthma phenotypes and evaluate possible associations with the HLA system. Methods: A total of 109 patients with asthma were prospectively followed during 2 years. They were divided into 2 groups, i.e., allergic and nonallergic asthma, according to their clinical history and skin prick test and serum-specific immunoglobulin E (IgE) results. The control group comprised 297 deceased donors of solid organs. Patients' features and HLA class I and II genotypes were assessed and compared. Results: This study showed different features between asthma phenotypes. Nonallergic patients were older at the onset of asthma symptoms and had a higher rate of intolerance to nonsteroidal anti-inflammatory drugs. Allergic patients had higher total serum IgE levels, reported atopic dermatitis and rhinoconjunctivitis more frequently, and, unexpectedly, had a greater disease severity. New associations between the HLA genotypes and allergic and nonallergic asthma were identified. The HLA-B*42, HLA-C*17, HLA-DPA1*03, and HLA-DPB1*105 genotypes were associated with allergic asthma and the HLA-B*48 genotype with the nonallergic phenotype. The presence of the haplotype HLA-DPA1*03 DQA*05 was associated with allergic asthma, and the presence of HLA-DPA1*03 and the absence of HLA-DQA*05 with nonallergic asthma. Conclusions: Allergic and nonallergic asthma have distinct phenotypic and genotypic features. New associations between asthma phenotypes and HLA class I and II were identified. (C) 2017 S. Karger AG, Basel
- Regulatory T-Cell Distribution within Lung Compartments in COPD(2017) SALES, Davi S.; ITO, Juliana T.; ZANCHETTA, Ivy A.; ANNONI, Raquel; AUN, Marcelo V.; FERRAZ, Luiz Fernando S.; CERVILHA, Daniela A. B.; NEGRI, Elnara; MAUAD, Thais; MARTINS, Milton A.; LOPES, Fernanda D. T. Q. S.The importance of the adaptive immune response, specifically the role of regulatory T (Treg) cells in controlling the obstruction progression in smokers, has been highlighted. To quantify the adaptive immune cells in different lung compartments, we used lung tissues from 21 never-smokers without lung disease, 22 current and/or ex-smokers without lung disease (NOS) and 13 current and/or ex-smokers with chronic obstructive pulmonary disease (COPD) for histological analysis. We observed increased T, B, IL-17 and BAFF(+) cells in small and large airways of COPD individuals; however, in the NOS, we only observed increase in T and IL-17(+) cells only in small airways. A decrease in the density of Treg(+), TGF-beta(+) and IL-10(+) in small and large airways was observed only in COPD individuals. In the lymphoid tissues, Treg, T,B-cells and BAFF(+) cells were also increased in COPD; however, changes in Treg inhibitory associated cytokineswere not observed in this compartment. Therefore, our results suggest that difference in Treg(+) cell distributions in lung compartments and the decrease in TGF-beta(+) and IL-10(+) cells in the airways may lead to the obstruction in smokers.
- The Complex Interaction Between Polycystic Ovary Syndrome and Hereditary Angioedema: Case Reports and Review of the Literature(2017) IAHN-AUN, Marina; AUN, Marcelo Vivolo; MOTTA, Antonio Abilio; KALIL, Jorge; GIAVINA-BIANCHI, Pedro; HAYASHIDA, Sylvia Asaka; BARACAT, Edmund Chada; MACIEL, Gustavo ArantesImportance Hereditary angioedema (HAE) is a rare but severe disease, with high risk of death, and attacks have been associated to high estrogen levels. Polycystic ovary syndrome (PCOS) is a common hyperandrogenic condition, which is frequently treated with combined oral contraceptives. Objective The aim of this study was to describe 2 clinical cases of young women diagnosed as having PCOS who developed HAE attacks after the introduction of combined estrogen-progestin pills to treat PCOS symptoms. Evidence Acquisition Literature review of sex hormones' role in genesis of HAE attacks and possible mechanisms involved. Results In the cases reported, after initiation of combined contraceptives, patients presented with facial swelling with airway involvement (laryngeal edema) and abdominal pain. They had a familial history of angioedema and normal C1 inhibitor (C1-INH) levels, leading to the diagnosis of HAE with normal C1-INH (HAEnC1-INH) or HAE type III. After suspension of exogenous estrogen, patients remained asymptomatic from HAE. Conclusions and Relevance HAEnC1-INH is an estrogen-dependent form of HAE. It is well established that exogenous estrogen triggers attacks of all types of HAE. However, this is the first description of the association between PCOS and HAE, in which PCOS could be masking HAE symptoms. We propose that PCOS might have a protective role regarding HAE attacks, because of its particular hormonal features, that is, hyperandrogenism and relative stable levels of estradiol. The use of combined estrogen-progestin compounds in women with PCOS and HAE must be avoided, and treatment must be individualized. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to evaluate for hereditary angioedema (HAE) in patients with recurrent angioedema attacks and abdominal pain, particularly when they are under exogenous estrogen treatment; ask patients about personal or familial history of angioedema attacks before prescribing exogenous estrogen; recall that isolated progestins can be used as long-term prophylaxis to HAE patients; and explain that hyperandrogenism of polycystic ovary syndrome could mask HAE symptoms.
conferenceObject HIV Infection in a Patient with Hypogammaglobulinemia, Evolving with Severe Opportunistic Infections: Report of Two Cases(2017) CASTRO, Raisa Borges de; BRUGNOLLI, Rebeca Mussi; PENIDO, Antonio Paulo Costa; ASSIS, Joao Paulo de; GRECCO, Octavio; KALIL, Jorge; AUN, Marcelo Vivolo; KOKRON, Cristina Maria; MARINHO, Ana Karolina Barreto Berselli; BARROS, Myrthes Toledo- Drug-Induced Anaphylaxis(2017) AUN, Marcelo Vivolo; KALIL, Jorge; GIAVINA-BIANCHI, PedroDrugs are among the main triggers of anaphylaxis, but identification of the culprit drug is frequently difficult. To confirm diagnosis of the causative agent, medical records and clinical history are fundamental. There are a few in vitro tests available in clinical practice, such as serum-specific IgE and basophil activation test. Skin tests are often useful for the diagnosis, although drug challenge is indicated in patients with inconclusive clinical history or to provide safe alternatives. Treatment of anaphylaxis is standard and intramuscular epinephrine is the main agent to prevent morbidity and mortality. Rapid desensitization may be indicated in selected cases.