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
19 resultados
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- Th17/Treg-Related Intracellular Signaling in Patients with Chronic Obstructive Pulmonary Disease: Comparison between Local and Systemic Responses(2021) LOURENCO, Juliana D.; TEODORO, Walcy R.; BARBEIRO, Denise F.; VELOSA, Ana Paula P.; SILVA, Larissa E. F.; KOHLER, Julia B.; MOREIRA, Alyne R.; V, Marcelo Aun; SILVA, Isadora C. da; FERNANDES, Frederico L. A.; NEGRI, Elnara M.; GROSS, Jefferson L.; TIBERIO, Iolanda F. L. C.; ITO, Juliana T.; LOPES, Fernanda D. T. Q. S.Th17/Treg imbalance plays a pivotal role in COPD development and progression. We aimed to assess Th17/Treg-related intracellular signaling at different COPD stages in local and systemic responses. Lung tissue and/or peripheral blood samples were collected and divided into non-obstructed (NOS), COPD stages I and II, and COPD stages III and IV groups. Gene expression of STAT3 and -5, ROR gamma t, Foxp3, interleukin (IL)-6, -17, -10, and TGF-beta was assessed by RT-qPCR. IL-6, -17, -10, and TGF-beta levels were determined by ELISA. We observed increased STAT3, ROR gamma t, Foxp3, IL-6, and TGF-beta gene expression and IL-6 levels in the lungs of COPD I and II patients compared to those of NOS patients. Regarding the systemic response, we observed increased STAT3, ROR gamma t, IL-6, and TGF-beta gene expression in the COPD III and IV group and increased IL-6 levels in the COPD I and II group. STAT5 was increased in COPD III and IV patients, although there was a decrease in Foxp3 expression and IL-10 levels in the COPD I and II and COPD III and IV groups, respectively. We demonstrated that an increase in Th17 intracellular signaling in the lungs precedes this increase in the systemic response, whereas Treg intracellular signaling varies between the compartments analyzed in different COPD stages.
- Editorial: The Role of Mast Cells in Immediate Hypersensitivity Reactions(2021) AUN, Marcelo Vivolo; BLANCA-LOPEZ, Natalia; CASTELLS, Mariana C.; GIAVINA-BIANCHI, Pedro
- Vocal cord dysfunction diagnosis may be improved by a screening check list(2016) PINTO, Lucia Helena Eduardo; AUN, Marcelo Vivolo; CUKIER-BLAJ, Sabrina; STELMACH, Rafael; CUKIER, Alberto; KALIL, Jorge; AGONDI, Rosana Camara; GIAVINA-BIANCHI, PedroBackground: Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD. Methods: A prospective observational study involving 80 patients aged >= 8 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer ""yes"" counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list. Results: The proportion of affirmative answers to the question ""Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?"" was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable ""4 or more affirmative answers"" was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022). Conclusions: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.
- Diagnosis and treatment of systemic mastocytosis in Brazil: Recommendations of a multidisciplinary expert panel(2022) VELLOSO, Elvira D. Rodrigues Pereira; PADULLA, Georgia A.; CERQUEIRA, Ana Maria Mosca de; SOUSA, Adriana Martins de; SANDES, Alex Freire; TRAINA, Fabiola; SEGURO, Fernanda Salles; NOGUEIRA, Frederico Lisboa; PEREIRA, Grazielly de Fathima; BOECHAT, jose Laerte; PAGNANO, Katia Borgia Barbosa; MARCHI, Luan Lima; ENSINA, Luis Felipe; GIAVINA-BIANCHI, Mara; AUN, Marcelo Vivolo; AGONDI, Rosana Camara; SANTOS, Fabio Pires de Souza; GIAVINA-BIANCHI, PedroIntroduction: Systemic Mastocytosis comprises a group of neoplastic diseases character-ized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. Objective: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazil-ian specialists.Method and results: An online expert panel with 18 multidisciplinary specialists was con-vened to propose recommendations on the diagnosis and treatment of Systemic Mastocy-tosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Lev-els of Evidence Chart. Conclusion: Twenty-two recommendations or suggestions were proposed based on a litera-ture review and graded according to the findings.(c) 2022 Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular.
- Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions(2018) GARRO, Laila S.; V, Marcelo Aun; SOARES, Iracy Silvia C.; RIBEIRO, Marisa R.; MOTTA, Antonio A.; KALIL, Jorge; CASTELLS, Mariana C.; CARMONA, Maria Jose C.; GIAVINA-BIANCHI, PedroOBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of Sao Paulo School of Medicine, Hospital das Clinicas, Sao Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.
- Algorithm to guide re-exposure to penicillin in allergic pregnant women with syphilis: Efficacy and safety(2021) GARCIA, Juliana Foes Bianchini; AUN, Marcelo Vivolo; MOTTA, Antonio Abilio; CASTELLS, Mariana; KALIL, Jorge; GIAVINA-BIANCHI, PedroResults: Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%). Conclusion: We developed and showed the efficacy and safety of an algorithm to guide reexposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies Background: Gestational syphilis is underdiagnosed and undertreated, leading to stillbirth, prematurity, low birthweight, neonatal death, and congenital syphilis. Most patients who label as allergic to penicillin are misdiagnosed. Objective: To assess the efficacy and safety of an algorithm to guide re-exposure to penicillin in pregnant women with syphilis and reporting allergy to the antibiotic. Methods: We performed a prospective study assessing pregnant women with syphilis and labeled as allergic to penicillin. Based on clinical history, patients were divided in two groups: high risk and low-risk to penicillin allergy. Low-risk patients with negative skin testing and negative serum specific IgE to penicillin underwent drug provocation test. The remaining patients underwent desensitization. Results: Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%). Conclusion: We developed and showed the efficacy and safety of an algorithm to guide re exposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies may confirm the greater safety of the intravenous protocol compared to the oral protocol.
- Brazilian Guidelines for Hereditary Angioedema Management-2017 Update Part 1: Definition, Classification and Diagnosis(2018) GIAVINA-BIANCHI, Pedro; ARRUDA, Luisa Karla; AUN, Marcelo V.; CAMPOS, Regis A.; CHONG-NETO, Herberto J.; CONSTANTINO-SILVA, Rosemeire N.; FERNANDES, Fatima R.; FERRARO, Maria F.; FERRIANI, Mariana P. L.; FRANCA, Alfeu T.; FUSARO, Gustavo; GARCIA, Juliana F. B.; KOMNINAKIS, Shirley; MAIA, Luana S. M.; MANSOUR, Eli; MORENO, Adriana S.; MOTTA, Antonio A.; PESQUERO, Joao B.; PORTILHO, Nathalia; ROSARIO, Nelson A.; SERPA, Faradiba S.; SOLE, Dirceu; TAKEJIMA, Priscila; TOLEDO, Eliana; VALLE, Solange O. R.; VERONEZ, Camila L.; GRUMACH, Anete S.Hereditary angioedema is an autosomal dominant disease characterized by recurrent angioedema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40% due to asphyxiation by laryngeal angioedema. Intestinal angioedema is another important and incapacitating presentation that may be the main or only manifestation during an attack. In this article, a group of experts from the ""Associacao Brasileira de Alergia e Imunologia (ASBAI)'' and the ""Grupo de Estudos Brasileiro em Angioedema Hereditario (GEBRAEH)'' has updated the Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.
article 3 Citação(ões) na Scopus Anafilaxia perioperatória: A experiência brasileira(2016) AUN, Marcelo Vivolo; GARRO, Laila Sabino; RIBEIRO, Marisa Rosimeire; MOTTA, Antônio Abílio; KALIL, Jorge; GIAVINA-BIANCHI, PedroPerioperative anaphylaxis is a rare hypersensitivity reaction, but it has a rapid onset and is potentially fatal. The true incidence is not well known and varies in accordance with the country from 1:1 250 to 1:13 000 surgeries. It may occur through an allergic (IgE-mediated or not) or non-allergic mechanism, but it is believed that the IgE-mediated reactions are the most common and severe. Any product or drug used in the procedure has the potential to be the cause of a reaction, but neuromuscular blocking agents are the most frequently reported, followed by latex and antibiotics. In this mini-review we discuss some key points of the management of these patients and w present Brazilian data, which suggest that an active search for cases by working together with anesthesiologists could lead to an increase in diagnosis and, therefore, better prevention of future reactions- Clinical, functional and inflammatory evaluation in asthmatic patients after a simple short-term educational program: a randomized trial(2021) FELIX, Soraia Nogueira; AGONDI, Rosana Camara; AUN, Marcelo Vivolo; OLIVO, Clarice Rosa; ALMEIDA, Francine Maria de; AMORIM, Thais Santos; CEZARIO, Julia Caroline; GIAVINA-BIANCHI, Pedro; TIBERIO, Iolanda de Fatima Lopes Calvo; MARTINS, Milton de Arruda de; ROMANHOLO, Beatriz Mangueira SaraivaThis study aimed to evaluate the clinical evolution, functional parameters and inflammatory activity of asthma in patients who submitted to an educational intervention. 58 adult patients over 18 years of age with partly controlled and uncontrolled asthma were randomized into an intervention group (IG) (N = 32) and a control group (CG) (N = 26) and evaluated for 12 weeks. The Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), Asthma Quality Life Questionnaire (AQLQ) and Beck Depression Inventory (BDI) questionnaires were applied. Spirometry, exhaled nitric oxide (NO), exhaled breath condensate (EBC) and induced sputum (IS), measurement of the peak flow and symptoms were performed. The IG patients received an educational activity for 30 min applied by a nurse. Statistical analysis: analysis of variance with repeated intragroup measures. IG presented a decreased number of eosinophils in IS and IL-17A in EBC, an increase in the percentage of FEV1 before and after bronchodilator and an improvement in quality of life compared to the CG. There was an improvement in depression levels and a decrease in IL-4 and IL-5 in the IS and in the EBC in both groups. Our results suggest that an educational intervention can bring benefits concerning the control of inflammation, lung function alterations, quality of life and levels of depression in asthmatic patients. Registration: ClinicalTrials.gov; NCT03655392.
- Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment(2020) SPINDOLA, Maria Anita Costa; SOLE, Dirceu; AUN, Marcelo Vivolo; AZI, Liana Maria Torres de Araujo; BERND, Luiz Antonio Guerra; GARCIA, Daniela Bianchi; CAPELO, Albertina Varandas; CUMINO, Debora de Oliveira; LACERDA, Alex Eustaquio; LIMA, Luciana Cavalcanti; MORATO, Edelton Flavio; NUNES, Rogean Rodrigues; RUBINI, Norma de Paula Motta; SILVA, Jane da; TARDELLI, Maria Angela; WATANABE, Alexandra Sayuri; CURI, Erick Freitas; SANO, FlavioExperts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests. (C) 2020 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.