Research Progress on the Role of Tumor-Associated Macrophages in Multiple Myeloma --Review / 中国实验血液学杂志

Bone marrow microenvironment is a highly complex environment surrounding tumor, which plays an important role in the survival, proliferation, drug resistance and migration of multiple myeloma (MM) cells. As an important cellular component in tumor microenvironment, tumor-associated macrophages(TAM) has attracted attention due to its key role in tumor progression and drug resistance. Targeting TAM has shown potential therapeutic value in cancer treatment. In order to clarify the role of macrophages in MM progression, it is necessary to understand the differentiation of TAM and its characteristics of promoting MM. This paper reviews the research progress on how TAM is programmed in MM and the mechanism of TAM promoting tumor development and drug resistance.

Inmunopatología de la brucelosis osteoarticular / Immunopathology of osteoarticular brucelosis

La brucelosis es una de las enfermedades zoonóticas más importantes a nivel mundial capaz de producir enfermedad crónica en los seres humanos. La localización osteoarticular es la presentación más común de la enfermedad activa en el hombre. Sin embargo, algunos de los mecanismos moleculares implicados en la enfermedad osteoarticular han comenzado a dilucidarse recientemente. Brucella abortus induce daño óseo a través de diversos mecanismos en los cuales están implicados TNF-α y RANKL. En estos procesos participan células inflamatorias que incluyen monocitos/macrófagos, neutrófilos, linfocitos T del tipo Th17 y linfocitos B. Además, B. abortus puede afectar directamente las células osteoarticulares. La bacteria inhibe la deposición de la matriz ósea por los osteoblastos y modifica el fenotipo de estas células para producir metaloproteinasas de matriz (MMPs) y la secreción de citoquinas que contribuyen a la degradación del hueso. Por otro lado, la infección por B. abortus induce un aumento en la osteoclastogénesis, lo que aumenta la resorción de la matriz ósea orgánica y mineral y contribuye al daño óseo. Dado que la patología inducida por Brucella afecta el tejido articular, se estudió el efecto de la infección sobre los sinoviocitos. Estos estudios revelaron que, además de inducir la activación de estas células para secretar quemoquinas, citoquinas proinflamatorias y MMPs, la infección inhibe la muerte por apoptosis de los sinoviocitos. Brucella es una bacteria intracelular que se replica en el retículo endoplásmico de los macrófagos. El análisis de los sinoviocitos infectados con B. abortus indicó que las bacterias también se multiplican en el retículo endoplasmático, lo que sugiere que la bacteria podría usar este tipo celular para la multiplicación intracelular durante la localización osteoarticular de la enfermedad. Los hallazgos presentados en esta revisión intentan responder a preguntas sobre los mediadores inflamatorios implicados en el daño osteoarticular causado por Brucella. (AU)

Brucellosis is one of the most important zoonotic diseases that can produce chronic disease in humans worldwide. Osteoarticular involvement is the most common presentation of human active disease. The molecular mechanisms implicated in bone damage have started to be elucidated. B. abortus induces bone damage through diverse mechanisms in which TNF-α and RANKL are implicated. These processes are driven by inflammatory cells, including monocytes/macrophages, neutrophils, Th17 lymphocytes and B cells. Also, Brucella abortus (B. abortus) can directly affect osteoarticular cells. The bacterium inhibits bone matrix deposition by osteoblast and modifies the phenotype of these cells to produce matrix methalloproteinases (MMPs) and cytokine secretion that contribute to bone matrix degradation. B. abortus also affects osteoclast increasing mineral and organic bone matrix resorption and contributing to bone damage. Since the pathology induced by Brucella species involves joint tissue, experiments conducted in sinoviocytes revealed that besides inducing the activation of these cells to secrete chemokines, proinflammatory cytokines and MMPS, the infection also inhibits sinoviocyte apoptosis. Brucella is an intracellular bacterium that replicate in the endoplasmic reticulum of macrophages. The analysis of B. abortus infected sinoviocytes indicated that bacteria also replicate in their reticulum suggesting that the bacterium could use this cell type for intracellular replication during the osteoarticular localization of the disease. The findings presented in this review try to answer key questions about the inflammatory mediators involved in osteoarticular damage caused by Brucella. (AU)

[Artigo Parcialmente Retratado] Prevalência da infecção por Helicobacter pylori em pacientes dispépticos e associação com fatores de riscos clínicos para o desenvolvimento de adenocarcinoma gástrico / [article partial retraction] prevalence of helicobacter pylori infection in dyspeptic patients and its association with clinical risk factors for developing gastric adenocarcinoma

ABSTRACT BACKGROUND: In Brazil, particularly in the underdeveloped localities, the prevalence of Helicobacter pylori (H. pylori) infections can range up to 90%. These rates are higher in older individuals and vary by country region. H. pylori infections are linked to the development of gastric pathologies, namely mild to moderate gastritis, gastroenteritis, peptic ulcer, intestinal metaplasia, and gastric cancer. In 1994, this organism was classified by the International Agency for Research on Cancer (IARC) as pertaining to the Group 1 carcinogen for gastric adenocarcinoma etiology. Gastric cancer represents a significant public health problem, being the fourth most common malignant tumor and the second largest cause of cancer-related deaths. OBJECTIVE: To investigate the prevalence of H. pylori infection in dyspeptic patients and determine the link between clinical risk factors and gastric adenocarcinoma diagnosis. METHODS: Polymerase chain reaction (PCR) analysis was employed for molecular diagnosis of gastric tissue biopsies collected from 113 dyspeptic patients at the University Hospital of Federal University of Goiás. Molecular analyses allowed the identification of H. pylori infections. Furthermore, histopathological examinations were performed to determine the clinical risks of developing gastric malignancies. RESULTS: The test results identified 69 individuals older than 44 years, from 75 (66.4%) positive H. pylori infection samples. The prevalence of gastric adenocarcinoma in this study was 1.3%. Among the infected patients, six (8.2%) had high risk, and 67 (91.8%) had a low risk of developing gastric cancer (P<0.05). CONCLUSION: This study shows a high prevalence of H. pylori infection and identifies its contribution to gastric inflammations, which in the long term are manifested in high-risk clinical factors for the development of gastric adenocarcinoma.

RESUMO CONTEXTO: No Brasil, particularmente nas áreas mais pobres, a prevalência da infecção por Helicobacter pylori pode variar até 90%. Esses índices aumentam com o envelhecimento da população e são distintos entre as diferentes regiões do país. Podendo manifestar diferentes sintomatologias, essa infecção está diretamente relacionada com o desenvolvimento de patologias gástricas como gastrite leve a moderada, gastroenterites, úlcera péptica, metaplasia intestinal e principalmente, o câncer gástrico. Em 1994 a bactéria foi categorizada pela International Agency for Research on Cancer (IARC) como carcinógeno do Grupo 1 para adenocarcinoma gástrico, tipo de câncer que representa um importante problema de saúde pública, sendo o quarto tumor maligno mais comum e a segunda maior causa de mortes por câncer no mundo. OBJETIVO: Analisar a prevalência da bactéria em pacientes dispépticos e avaliar a associação de fatores de risco clínicos para desenvolvimento de adenocarcinoma gástrico. MÉTODOS: Biópsias de tecido gástrico coletadas de 113 pacientes dispépticos, atendidos no Hospital das Clínicas da Universidade Federal de Goiás, foram submetidas a diagnóstico molecular por meio de Reação em Cadeia da Polimerase, para identificação da infecção por Helicobacter pylori, e exame histopatológico, para avaliar o risco clínico de desenvolvimento de adenocarcinoma gástrico. RESULTADOS: Foram diagnosticadas 75 (66,4%) amostras positivas para infecção por Helicobacter pylori, sendo 69 indivíduos maiores de 44 anos de idade. A prevalência do adenocarcinoma gástrico nesse estudo foi de 1,3% e dentre os pacientes positivos para a infecção bacteriana seis (8,2%) possuem alto risco e 67 (91,8%) baixo risco de desenvolver esse tipo de câncer (P<0,05). CONCLUSÃO: Esse estudo mostra uma alta prevalência da infecção por H. pylori na população estudada e identifica sua intrínseca contribuição para inflamações gástricas, que a longo prazo se manifestam em fatores clínicos de alto risco para o desenvolvimento de adenocarcinoma gástrico.

Macrophages subpopulations in chronic periapical lesions according to clinical and morphological aspects

Abstract: The aim of this study was to evaluate macrophage M1 and M2 subpopulations in radicular cysts (RCs) and periapical granulomas (PGs) and relate them to clinical and morphological aspects. M1 macrophages were evaluated by the percentage of CD68 immunostaining associated with the inflammatory cytokine TNF-α, and M2 macrophages, by its specific CD163 antibody. The CD68+/CD163+ ratio was adopted to distinguish between the two macrophage subpopulations. Clinical, radiographic, symptomatology, treatment, and morphological parameters of lesions were collected and a significance level of p = 0.05 was adopted for statistical analysis. The results showed that the CD68+/CD163+ ratio was higher in the RCs (median = 1.22, p = 0.002), and the highest TNF-α immunostaining scores were found in RCs (p = 0.018); in PGs, the CD68+/CD163+ ratio was lower and associated with a greater CD163+ immunostaining (median = 1.02, p <0.001). The TNF-α in cyst epithelium had a score of 3 in 10 cases and predominance of M1 macrophages by CD68+/CD163+ (median = 2.23). In addition, CD68+ cells had higher percentage of immunostaining in smaller RCs (p = 0.034). Our findings suggest that increased CD68 immunostaining associated with TNF-α cytokine in RCs results in a greater differentiation of the M1 phenotype. The higher CD163 immunostaining in PGs results in greater differentiation of the M2 phenotype. Therefore, the inflammatory state promoted by M1 macrophages is related to growth and progression of RCs; on the other hand, the immunomodulatory state of M2 macrophages is related to maintenance of PGs.

Avaliação lectino-histoquímica de fígado e linfonodo mesentérico de búfalos mantidos em pastagens de Brachiaria spp / Lectin histochemistry evaluation of liver and mesenteric lymph node of buffaloes kept on Brachiaria spp. pastures

Animais que se alimentam em pastos de Brachiaria spp. comumente apresentam macrófagos espumosos isolados ou agrupados no fígado, além de cristais no interior de ductos biliares. A patogênese da formação e a natureza do material armazenado nestas células, contudo, ainda não são completamente conhecidas. Através da avaliação lectino-histoquímica, saponinas esteroidais (metabólitos glicosilados secundários) têm sido identificadas nos cristais e no citoplasma das células espumosas, e provavelmente são responsáveis por danificar o fígado e levar ao acúmulo de filoeritrina. Por meio deste trabalho, objetivou-se padronizar e caracterizar a utilização da lectino-histoquímica na detecção de metabólitos glicosilados nos tecidos de búfalos mantidos em diferentes pastos de Brachiaria spp. no Brasil. Fragmentos de fígado e linfonodo mesentérico de 40 animais foram analisados: 10 búfalos mantidos em pastagem predominante de B. decumbens por aproximadamente 12 meses; 10 búfalos mantidos em pastagem predominante de B. brizantha por aproximadamente 18 meses; 10 búfalos mantidos em pastagem de B. brizantha por aproximadamente quatro anos; e, como controle negativo, 10 búfalos mantidos em pastagem livre de Brachiaria spp. desde o nascimento. Quatorze lectinas foram testadas (Con-A, SBA, WGA, DBA, UEA, RCA, PNA, GSL-I, PSA, LCA, PHA-E, PHA-L, SJA e SWGA), em um total de 1120 fragmentos avaliados. Estudos anteriores demonstraram que a lectina PNA possui marcada reatividade para macrófagos espumosos de bovinos e ovinos. No presente estudo, a lectina SWGA apresentou acentuada reatividade e alta especificidade para macrófagos espumosos; WGA, GSL, PHA-E e PHA-L mostraram moderada a acentuada reatividade, mas baixa especificidade aos macrófagos espumosos; as outras lectinas não apresentaram reatividade ou especificidade relevantes. Além disso, não houve diferença relevante de marcação entre os fragmentos coletados de animais que se alimentaram de B. decumbens por 12 meses e B. brizantha por 18 meses. Porém, a diminuição da presença e marcação lectino-histoquímica dos macrófagos espumosos nos tecidos dos búfalos que ingeriram Brachiaria brizantha durante mais tempo indica que os animais podem passar por um processo de adaptação de acordo com o tempo de ingestão da planta. A avaliação lectino-histoquímica pode ser utilizada para caracterizar o material armazenado em macrófagos espumosos presentes no fígado e linfonodo mesentérico de búfalos que se alimentam em pastagens de Brachiaria spp. e ajuda na compreensão da patogênese de formação destas células.(AU)

Animals grazing Brachiaria spp. commonly present foamy macrophages isolated or grouped in the liver, and crystals within biliary ducts. The pathogenesis of formation and the nature of the material stored in these cells however are not completely known. Through lectin histochemistry evaluation, steroidal saponins (secondary glycosylated metabolites) have been identified in the crystals and within the cytoplasm of the foam cells, which are probably liable for damaging the liver, leading to accumulation of phylloerythrin. This study aims to standardize and characterize the use of lectin histochemistry to detect glycosylated metabolites in tissues of buffaloes kept on different Brachiaria spp. pastures in Brazil. Fragments of liver and mesenteric lymph node from 40 buffaloes were analyzed: 10 buffaloes that were kept in predominant pasture of B. decumbens for 12 months; 10 buffaloes that were kept in pasture with a predominance of B. brizantha for 18 months; 10 buffaloes that were kept on pasture of B. brizantha for about four years; and as a negative control, 10 buffaloes that were maintained on native pasture without Brachiaria spp. since birth. Fourteen lectins were tested (Con-A, SBA, WGA, DBA, UEA, RCA, PNA, GSL-I, PSA, LCA, PHA-E, PHA-L, SJA and SWGA), in a total of 1120 evaluated samples. Previous studies demonstrated that PNA showed great binding reactivity for foamy macrophages in cattle and sheep. In the present study, SWGA showed high specificity and marked binding reactivity for foamy macrophages; WGA, GSL, PHA-E and PHA-L showed moderate to marked reactivity, but low specificity for foamy macrophages. The other lectins had not relevant reactivity or specificity. Moreover there was no relevant reactivity difference between the collected samplesd from buffaloes that grazed B. decumbens for 12 months and Brachiaria brizantha for 18 months. However the decreased presence of foamy macrophages and its lectin histochemical binding in animals that fed on B. brizantha for a longer time, indicates that the buffaloes can pass through an adaptation process according to the plant intake time. Lectin histochemistry analysis can be used to characterize the material stored in foamy macrophages present in liver and mesenteric lymph node of buffaloes that graze on Brachiaria spp. pastures and helps to clarify the pathogenesis of these cells.(AU)

Tumor-associated macrophages (TAMs): clinical-pathological parameters in squamous cell carcinomas of the lower lip

Abstract The objective of this study was to analyze the presence of tumor-associated macrophage (TAM) subpopulations M1 and M2 in squamous cell carcinoma of the lower lip (SCCLL) by immunohistochemitry, and to evaluate the possible role of these subtypes in the development of regional lymph node metastasis and their association with clinical and pathological parameters. Forty-two cases of SCCLL were divided into two groups (21 with and 21 without regional lymph node metastasis). The histopathological grade of malignancy was determined and the material was submitted to double staining with anti-CD68/anti-CD163 and anti-CD68/anti-HLA-DR monoclonal antibodies. The results were analyzed statistically using the Wilcoxon signed-rank and Spearman correlation tests. The M1 and M2 subpopulations were observed in all cases studied. No significant difference was observed between the quantities of M1 and M2 TAMs regarding tumor size (p > 0.05). A significantly larger number of M2 compared to M1 TAMs was observed in tumors without regional lymph node metastasis, tumors in early stages, and low-grade tumors (p < 0.05). No significant difference between the numbers of M1 and M2 TAMs was observed in tumors with regional lymph node metastasis, tumors in advanced stages, and high-grade tumors (p > 0.05). There was a positive weak correlation between M1 and M2 TAMs (r = 0.361; p = 0.019). The results suggest a more important role of M2 TAMs in early stages than advanced stages of lip carcinogenesis. The progression of SCCLL does not seem to be related to an imbalance of macrophage polarization in the microenvironment of these tumors.

Factors associated with knowledge of the nursing staff at a teaching hospital on blood transfusion / Fatores associados ao conhecimento da equipe de enfermagem de um hospital de ensino sobre hemotransfusão / Factores asociados al conocimiento del equipo de enfermería sobre transfusión sanguínea en un hospital de enseñanza

AbstractObjective: to determine whether there is an association between knowledge of the nursing professionals about blood transfusion and the variables related to the professional aspects.Method: this is an observational, cross-sectional and quantitative study, carried out at a large general teaching hospital. The sample consisted of 209 nursing professionals, obtained by simple random sampling. For data collection, a checklist was used. In the univariate analysis, descriptive statistics and central trend and dispersion measures were used. In the bivariate analysis, Student's t-Test, analysis of variance and Pearson's correlation were used. To determine the predictors, multiple linear regression was applied. The Institutional Review Board (Opinion number 2434) approved the study.Results: the overall average knowledge score was 52.66%; in the Pre-transfusion Step, it corresponded to 53.38%; in the Transfusion Step 51.25% and, in the Post-transfusion Step, 62.68%. The factors related to knowledge were professional category and received training and/or guidance to accomplish the transfusion process (p<0.01).Conclusion: this study showed the influence of training and guidance on the knowledge and provided a diagnosis to identify the professionals' difficulties regarding the transfusion process.

ResumoObjetivo:verificar se há associação entre o conhecimento dos profissionais da equipe de enfermagem sobre hemotransfusão e as variáveis relacionadas aos aspectos profissionais.Método:trata-se de um estudo observacional, transversal, quantitativo, realizado em um hospital geral, de ensino e de grande porte. A amostra foi constituída por 209 profissionais da equipe de enfermagem, obtida por sorteio aleatório simples. A coleta de dados utilizou um instrumento do tipo checklist. Na análise univariada, utilizaram-se estatística descritiva e medidas de centralidade e de dispersão. Na análise bivariada, utilizaram-se o Teste t de Student, a análise de variância e a correlação de Pearson. Para determinar os preditores, utilizou-se a regressão linear múltipla. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (Parecer n° 2434).Resultados:a média de escore geral de conhecimento foi de 52,66%, na Etapa Pré-transfusional foi de 53,38%; na Etapa Transfusional, 51,25%; e na Etapa Pós-transfusional, 62,68%. Os fatores relacionados ao conhecimento foram categoria profissional e receber treinamento e/ou orientação para a realização do processo transfusional (p<0,01).Conclusão:este estudo evidenciou a influência do treinamento e orientação sobre o conhecimento e forneceu um diagnóstico para a identificação das dificuldades dos profissionais relacionadas ao processo transfusional.

ResumenObjetivo:verificar si existe asociación entre el conocimiento de los profesionales del equipo de enfermería sobre transfusión sanguínea con las variables relacionadas a aspectos profesionales.Método:se trata de un estudio observacional, transversal, cuantitativo, realizado en un hospital general, de enseñanza y de gran porte. La muestra fue constituida por 209 profesionales del equipo de enfermería, obtenida por sorteo aleatorio simple. La recolección de datos utilizó un instrumento del tipo lista de verificación. En el análisis univariado, se utilizó la estadística descriptiva y las medidas de centralidad y de dispersión. En el análisis bivariado, se utilizaron el test t de Student, el análisis de variancia y la correlación de Pearson. Para determinar los factores de predicción, se utilizó la regresión linear múltiple. El estudio fue aprobado por el Comité de Ética en Investigación con dictamen n° 2434.Resultados:el promedio del puntaje general de conocimiento fue de 52,66%; en la Etapa de Pre-transfusión fue de 53,38%; en la Etapa de Transfusión, 51,25%; y, en la Etapa Post-transfusión, 62,68%. Los factores relacionados al conocimiento fueron: categoría profesional y recibir entrenamiento y/u orientación para la realización del proceso de transfusión (p<0,01).Conclusión:este estudio evidenció la influencia del entrenamiento y la orientación sobre el conocimiento y suministró un diagnóstico para la identificación de las dificultades de los profesionales relacionadas al proceso de transfusión.

Distrofia muscular facioescapulohumeral en Chile: presentación de serie en hospital de referencia terciario / Facioscapulohumeral muscular dystrophy: Report of seven patients

Background: Facioscapulohumeral muscular dystrophy is the third most common muscular dystrophy with an estimated prevalence of 1 per 20.000 and a normal life expectancy in the majority of patients. However, approximately 15% of patients become wheelchair bound in the course of their life. It is a hereditary autosomal dominant disease with high (95%) penetrance by the age of 20, but with variable degree of phenotypic expression even in the same family group. Symptoms frequently start in the second decade of life, with facial and scapular weakness. Aim: To report the clinical features of seven patients with the disease, seen at a public hospital. Material and Methods: Analysis of seven patients with genetic study seen in a public Hospital in Santiago. Results: The age of patients fluctuated from 18 to 61 years and four were females. The mean age at onset of symptoms was 29 years and four had a family history of the disease. The usual presenting complaint was arm or shoulder asymmetric weakness. Four patients had bone pain. Facial involvement was present in four. A genetic study was done in five patients, the other two patients were relatives, confirming the contraction or lower number of repetitions in D4Z4 region. After 12 years of follow up only 2 patients older than 60 years cannot work and one female patients is in a semi dependent state at the age of 30. Conclusions: The clinical workup in the diagnosis and the timely indication of genetic studies are highlighted, to avoid unnecessary and invasive procedures. The variability in the phenotypic expression in a similar genetic defect is discussed and the genetic or epigenetic mechanisms of this muscular dystrophy are described.

Análisis molecular del cáncer de colon esporádico / Molecular analysis of sporadic colon cancer

Background: In Chile, colorectal cancer (CRC) is often diagnosed in late stages. Thus, surgical treatment must be complemented with chemotherapy. KRAS mutations and microsatellite instability have been detected in these tumors. However, the response to treatment in patients without KRAS mutations varies and requires a better understanding. Aim: To determine the frequency and distribution of somatic point mutations in KRAS, BRAF and PIK3CA genes and microsatellite instability status (MSI) in patients with colon cancer (CC). Material and Methods: A prospective observational study of patients undergoing surgery for colon cancer. Tumor-derived DNA was analyzed by polymerase chain reaction (PCR) for the most frequent mutations of KRAS, BRAF and PIK3CA. PCR was also used to analyze MSI. Results: Fifty-eight patients with sporadic CC were analyzed, 16 showed KRAS mutations (G12R, G12D, G12V, G13D) and out of the 42 patients that did not show any mutation, 10 had mutations in BRAF (V600E) and PIK3CA (E542K, E545D, E545K, Q546E, H1047R). BRAF mutations alone or in combination with PIK3CA mutations were observed in 27% of high MSI tumors and in 2% of tumors without instability (p < 0.049). A higher percentage of high MSI tumors were located in the right colon (p < 0.001), and showed BRAF mutation (p < 0.020). Conclusions: The highest percentage of high MSI and BRAF mutations was observed in the right colon. Therefore, this study suggests the presence of different molecular features between right and left colon tumors that should be considered when defining the therapeutic management.

Avaliação da resposta inflamatória tecidual de pacientes com leishmaniose cutânea recente / Evaluation of tissue inflammatory response in patients with recent cutaneous leishmaniasis

Introdução: A leishmaniose cutânea (LC) é a forma clínica mais frequente da leishmaniose humana, considerada um importante problema de saúde no Brasil. A infecção por Leishmania braziliensis induz um amplo espectro de lesões que pode se manifestar como uma única lesão cutânea localizada, geralmente em partes descobertas do corpo. Tem início com uma pápula, caracterizando a leishmaniose cutânea recente (LCR) e, na maioria dos casos, tende a desenvolver uma úlcera, representando a leishmaniose cutânea clássica (LCC). Pacientes com LCR apresentam um elevado número de parasitas na lesão e, frequentemente, não respondem positivamente à terapia padrão, desenvolvendo a lesão mesmo após o tratamento. Objetivo: Descrever de modo comparativo os aspectos histopatológicos na Leishmaniose Cutânea Recente e Leishmaniose Cutânea Clássica. Métodos: Secções histológicas obtidas de biópsias de pele de 15 pacientes com LCR e 28 com LCC, foram coradas em HE e mensuradas as áreas de inflamação e necrose nas diferentes fases da doença. Realizamos imunohistoquímica para marcação de células CD3+, CD4+, CD8+, CD20+, CD68+ e CD138+...

Introduction: Cutaneous leishmaniasis (CL) is the most common clinical form of human leishmaniasis induced by L. braziliensis. It is considered a major health problem in Brazil. Leishmania braziliensis infection induces a large spectrum of lesions that can manifest as one localized skin lesion, usually undressed body parts. It starts with a papule in early cutaneous leishmaniasis (ECL) clinical manifestation and, in most cases, tends to develop an ulcer, in the late cutaneous leishmaniasis (LCL). ECL patients have a high number of parasites in the lesion, and often do not respond to standard therapy, developing the lesion even after treatment. Aim: To describe comparative the histopathological aspects of early cutaneous leishmaniasis compared to late ulcerated cutaneous leishmaniasis. Methods: Histological sections of skin biopsies from 15 ECL patients and 28 LCL, were stained with HE and measured areas of inflammation and necrosis in the different stages of the disease. We performed immunohistochemical for CD3+, CD4+, CD8+, CD20+, CD68+ and CD138+...

Avaliação do papel do ferro e de proteínas envolvidas em seu metabolismo na infecção in vitro de macrófagos por Leishmania amazonenses ou Leishmania major / Iron paper and evaluation of proteins involved in the metabolism of macrophages in vitro infection by Leishmania amazonenses or Leishmania major

A leishmaniose é uma antropozoonose causada por protozoários do gênero Leishmania e é considerada uma das principais doenças negligenciadas. Modelos experimentais são amplamente utilizados para uma melhor compreensão da doença e dos mecanismos relacionados à resistência e susceptibilidade à infecção. Macrófagos de camundongos CBA controlam a infecção por Leishmania major ao passo que são permissivos a Leishmania amazonensis. Além disso, estudos baseados em abordagem proteômica demonstraram padrões distintos de expressão proteica em macrófagos derivados de medula óssea (BMMΦ) infectados por essas espécies de Leishmania. Dentre as proteínas diferentemente expressas, foram identificadas proteínas envolvidas no metabolismo de ferro moduladas positivamente em macrófagos infectados por L. amazonensis. Adicionalmente, embora ainda existam controvérsias, diversos estudos têm abordado a participação do elemento ferro na interação parasito-hospedeiro e no estabelecimento das infecções por tripanossomatídeos, incluindo Leishmania. Assim, para melhor compreender os mecanismos envolvidos nessa doença, o presente estudo buscou explorar o modelo comparativo de resistência e suscetibilidade do camundongo CBA para determinar o papel do ferro na infecção por Leishmania. Nossa hipótese é que a expressão de proteínas envolvidas no metabolismo de ferro é modulada diferentemente em macrófagos de camundongos CBA infectados por L. amazonensis, em comparação à L. major, favorecendo a sobrevivência intracelular do parasito. Nosso objetivo foi avaliar a expressão de proteínas que participam do metabolismo de ferro, como receptor de transferrina (Tf), CD71, e heme oxigenasse-1, HO-1, e determinar o efeito da modulação da disponibilidade de ferro na infecção por Leishmania. Observamos maior expressão de HO-1 em BMMΦ infectados por L. amazonensis (18,34 ± SD ng/mL), quando comparados a BMMΦ infectados por L. major (7,07 ± SD ng/mL), utilizando ELISA. Maior expressão de CD71 também foi observada na infecção por L. amazonensis (MFI 2.103) em comparação à infecção por L. major (MFI 472), utilizando FACS, além de uma maior ligação e captação de HoloTf (Tf carregada com ferro). Embora tenha sido observado que essas proteínas encontram-se diferentemente expressas em BMMΦ infectados por essas duas espécies de Leishmania, não foram observadas diferenças significativas na concentração intracelular do ferro. Em seguida, ensaios funcionais a partir da modulação da disponibilidade intracelular de ferro foram realizados com o objetivo de avaliar seu papel no desfecho da infecção por Leishmania. Os resultados mostraram que a depleção de ferro reduz em 90% o percentual de BMMΦ infectados por L. amazonensis e 70% dos infectados por L. major...

Leishmaniasis is an anthropozoonosis caused by the protozoan parasite Leishmania and is considered one of the main neglected diseases. Animal models are widely used to better understand the disease and the mechanisms involved in resistance and susceptibility to infection. CBA mouse macrophages control the infection by L. major, while are permissive to L. amazonensis. Proteomic studies showed different protein profiles in bone marrow macrophages (BMMΦ) infected these species of Leishmania. We also observed that proteins involved in iron metabolism were positively modulated in L. amazonensis-infected macrophages. In addition, although literature review showed controverse data, several studies have addressed the role iron plays in host-parasite interaction and the establishment of trypanosomatids infections, including Leishmania. To better understand the mechanisms of the disease, this study sought to evaluate in a comparative model of resistance and susceptibility, using CBA macrophages, the role iron plays in Leishmania infection. Our hypothesis is that the expression of proteins involved in iron metabolism is differently modulated in CBA mice macrophages infected with L. amazonensis in comparison to L. major, favoring the intracellular survival of the parasite. Our goal was to evaluate the expression of proteins involved in iron metabolism of CBA mice macrophages, such as transferrin receptor (Tf), CD71, and heme oxygenase 1 (HO-1) and determine the effect of the modulation of intracellular iron in Leishmania infection. Using ELISA, we confirmed a higher expression of HO-1 in L. amazonensis- (18.34 ng/mL) compared to L. major-infected CBA macrophages (7.07 ng/mL). Using FACS analysis, CD71 showed to be higher expressed in L. amazonensis- (MFI 2.103) than in L. major-infected macrophages (MFI 472), in addition to higher binding and take up of HoloTf in these cells. Although it has been observed that proteins involved in iron metabolism were differently expressed in BMMΦ infected with these Leishmania species, no significant differences were observed in intracellular iron concentration. To further evaluate the role iron plays in the outcome of Leishmania infection, we modulated iron availability to Leishmania-infected cells using iron chelates or iron supplements. The results show that iron depletion reduces in 90% L. amazonensis infection and in 70% L. major infection. In addition, iron supplementation increased the percentage of L. amazonensis-infected cells from 69.64 to 82.79% and parasite load from 2,996 to 4,001 Leishmania/cell, as well as in the intracellular viability of both Leishmania species. In sum, these data indicate that although there is a positive modulation...

FOCAL ENHANCED GASTRITIS AND MACROPHAGE MICROAGGREGATES IN THE GASTRIC MUCOSA: potential role in the differential diagnosis between Crohn’s disease and ulcerative colitis / Gastrite focal e microagregados de macrófagos na mucosa gástrica: uso potencial no diagnóstico diferencial entre doença de Crohn e colite ulcerativa

Context and Objectives Focally enhanced gastritis and macrophage microaggregates are found in the upper gastrointestinal involvement of Crohn’s disease, and may reflect an underlying defective innate immunity. These features, however, are also described in patients with Helicobacter pylori infection. The role of these gastric abnormalities in the diagnosis of Crohn’s disease was assessed in a population with high prevalence of H. pylori infection. Methods Thirty-seven Crohn’s disease, 26 ulcerative colitis, and 30 control patients were included. The H. pylori status was evaluated by the rapid urease test and histology. The presence of focally enhanced gastritis and macrophage microaggregates was recorded. Results Focally enhanced gastritis was present in 24% of Crohn’s disease patients, 4% of ulcerative colitis patients and 11.5% of controls, presenting an overall sensitivity and specificity for Crohn’s disease of 24% and 88%, respectively. Macrophage microaggregates were found in all groups, but were only detected in ulcerative colitis and controls in association with H. pylori infection, with an overall sensitivity and specificity for Crohn’s disease of 61% and 69%, respectively. In the absence of H. pylori infection, focally enhanced gastritis and macrophage microaggregates were significantly associated with Crohn’s disease (P<0.02 and P = 0.001 respectively). Conclusions Focally gastritis and macrophage microaggregates are suggestive of Crohn’s disease only in H. pylori-negative specimens. HEADINGS - Crohn’s disease. Ulcerative colitis. Gastritis. Macrophages. Helicobacter pylori. .

Contexto e objetivos Gastrite focal e microagregados de macrófagos são encontradas no acometimento gástrico da doença de Crohn, e podem refletir um defeito subjacente na imunidade inata. Estas características, no entanto, são também descritas em pacientes com infecção por Helicobacter pylori. O papel destas anormalidades gástricas no diagnóstico da doença de Crohn foi avaliada em uma população com alta prevalência de infecção por H. pylori. Métodos Trinta e sete pacientes com doença de Crohn, 26 pacientes com colite ulcerativa e 30 pacientes-controle foram incluídos. O status de infecção por H. pylori foi avaliado pelo teste da urease e histologia. A presença de gastrite focal e microagregados de macrófagos foi avaliada. Resultados Gastrite focal estava presente em 24% dos pacientes com doença de Crohn, 4% dos indivíduos com colite ulcerativa e 11,5% dos controles, apresentando uma sensibilidade e especificidade para doença de Crohn de 24% e 88%, respectivamente. Microagregados de macrófagos foram encontrados em todos os grupos, mas foram apenas detectados em colite ulcerativa e controles em associação com infecção por H. pylori, com sensibilidade e especificidade para doença de Crohn de 61% e 69%, respectivamente. Na ausência da infecção por H. pylori comprovada, gastrite focal e microagregados de macrófagos foram significativamente associados com doença de Crohn (P<0,02 e P = 0,001, respectivamente). Conclusões Gastrite focal e microagregados de macrófagos são sugestivos de doença de Crohn apenas em pacientes com avaliação dignóstica negativa para H. pylori. .

Avaliação do papel do receptor marco na infecção de macrófagos murinos por Leishmania major / Evaluation of the role of the receptor in March infection of murine macrophages with Leishmania major

Camundongos CBA são resistentes à infecção por Leishmania major e permissivos à infecção por L. amazonensis. Adicionalmente, macrófagos de camundongos CBA controlam à infecção por L. major, mas não por L. mazonensis in vitro. Em estudo comparativo realizado por nosso grupo foi demonstrado que o receptor scavenger MARCO teve expressão aumentada em resposta à infecção por L. major, mas não na infecção por L. amazonensis. Ainda, o bloqueio do receptor com o anticorpo específico reduziu a infecção por L. major em 30%, indicando que esta proteína tem participação no reconhecimento de promastigotas de L. major em macrófagos de CBA. Assim, nossa hipótese é que o receptor MARCO participa do reconhecimento e fagocitose de L. major por macrófagos, direcionando o curso da infecção. O objetivo do presente estudo consistiu em evidenciar o papel do receptor MARCO na infecção de macrófagos por L. major. Inicialmente, células J774 foram transfectadas com os vetores pcDNA3.1-MARCO (J774-MARCO) ou pcDNA3.1 (J774-MOCK)...

CBA mice are resistant to Leishmania major yet permissive to L. amazonensis infection. In addition, CBA macrophages control L. major, but not L. amazonensis infection in vitro. In a comparative study performed by our group increase in expression of the scavenger receptor MARCO has been detected in response to L. major, but not to L. amazonensis infection. Moreover, ED31 monoclonal antibody against MARCO reduced by 30% L. major infection in CBA macrophages. These findings indicate that MARCO plays a role in L. major recognition by CBA macrophages. We hypothesized that MARCO receptor participates in the recognition and phagocytosis of L. major by macrophages, directing the outcome of infection. In the present study, we aimed to further disclose the role MARCO plays in L. major infection of murine macrophages. First J774 cells were transfected with pcDNA3.1-MARCO vector (MARCO-J774) or pcDNA3.1 vector (MOCK-J774)...

Tumor-Infiltrating Macrophage and Microvessel Density in Oral Squamous Cell Carcinoma

Tumor-associated macrophages (TAM) are the main cellular component in stroma of many tumors and participate in tumor angiogenesis. The aim of present study was to compare the microvascular density (MVD) and infiltrating macrophage density (IMD) in oral squamous cell carcinomas (OSCCs) with different histological grades. A histomorphometric analysis was performed after immunohistochemistry using antibodies such as von-Willebrand factor and CD68. A significant difference in MVD was found between well and moderately differentiated OSCCs (p<0.05). TAM were largely present in all studied tumors and the IMD was not different among OSCCs with different histological grades (p=0.381). Significant correlation between MVD and IMD was not observed (p=0.870). In conclusion, these results suggest that TAM and angiogenesis have an influence at different histological grades of OSCC. However, the lack of correlation between MVD and IMD could suggest that angiogenesis does not depend on the number of macrophages present in OSCC, but their predominant phenotype. Further studies involving distinct phenotypes of macrophages should be done to better understand the influence of TAM on the tumor angiogenesis.

Macrófagos associados a tumores (MAT) representam o componente principal do estroma de muitos tumores, além de participar da angiogênese tumoral. Este estudo comparou a microdensidade vascular (MDV) e densidade de macrófagos infiltrando o tumor (DMIT) em carcinoma escamocelular da boca (CEC) com diferentes graus histológicos de malignidade. Análise histomorfométrica foi empregada após técnica imuno-histoquímica para os anticorpos fator von-Willebrand e CD68. Uma diferença significante entre MDV e carcinomas bem e moderadamente diferenciados foi observada (p<0,05). MAT estavam fortemente presentes em todos os tumores estudados e a DMIT não foi diferente entre os diferentes graus histológicos de malignidade do CEC (p=0,381). Correlação significante entre MDV e DMIT não foi observada (p=0,870). Em conclusão, os resultados desse estudo sugerem a influência de MAT e angiogênese nos diferentes graus histológicos de malignidade do CEC. Entretanto, a ausência de correlação entre MDV e DMIT sugere que a angiogênese não depende do número de macrófagos presentes neste tipo de câncer, mas do fenótipo predominante. Outros estudos devem ser realizados a fim de contribuir para melhor compreensão da participação de MAT na angiogênese tumoral.

Inflammation in disseminated lesions: an analysis of CD4+, CD20+, CD68+, CD31+ and vW+ cells in non-ulcerated lesions of disseminated leishmaniasis

Disseminated leishmaniasis (DL) differs from other clinical forms of the disease due to the presence of many non-ulcerated lesions (papules and nodules) in non-contiguous areas of the body. We describe the histopathology of DL non-ulcerated lesions and the presence of CD4-, CD20-, CD68-, CD31- and von Willebrand factor (vW)-positive cells in the inflamed area. We analysed eighteen biopsies from non-ulcerated lesions and quantified the inflamed areas and the expression of CD4, CD20, CD68, CD31 and vW using Image-Pro software (Media Cybernetics). Diffuse lymphoplasmacytic perivascular infiltrates were found in dermal skin. Inflammation was observed in 3-73% of the total biopsy area and showed a significant linear correlation with the number of vW+ vessels. The most common cells were CD68+ macrophages, CD20+ B-cells and CD4+ T-cells. A significant linear correlation between CD4+ and CD20+ cells and the size of the inflamed area was also found. Our findings show chronic inflammation in all DL non-ulcerated lesions predominantly formed by macrophages, plasmacytes and T and B-cells. As the inflamed area expanded, the number of granulomas and extent of the vascular framework increased. Thus, we demonstrate that vessels may have an important role in the clinical evolution of DL lesions.

O papel da flagelina e do sistema de secreção de Escherichia coli enteroinvasora na resposta imune inata dos macrófagos / The role of flagellin and secretion system of enteroinvasive Escherichia coli in the immune response innate macrophages

Escherichia coli enteroinvasora (EIEC) é um dos agentes etiológicos da disenteria bacilar. Seu processo fisiopatológico é desencadeado pela expressão de fatores de virulência, que proporcionam sua invasão e sobrevivência nas células do hospedeiro, ativando o sistema imune inato e adaptativo da mucosa intestinal. Trabalhos recentes têm salientado a importância do sistema de secreção e da flagelina bacteriana como agonista de receptores da imuninade inata dos macrófagos, em especial alguns dos receptores do tipo NLR. Uma vez que esta espécie de E. coli também é capaz de expressar flagelina e fazer a montagem completa do flagelo e do sistema de secreção do tipo III, a nossa proposta foi avaliar o papel da flagelina e do sistema de secreção de EIEC na resposta imune dos macrófagos murinos. Para isso, utilizamos três cepas de EIEC: a cepa selvagem; a cepa mutante no gene responsável pela síntese da flagelina; e a cepa sem o plasmídio de virulência plnv, deficiente no sistema de secreção, para a infecção de macrófagos peritoniais de camundongos C57BI/6, caspase-1-/-, IPAF-/- e ASC-/-. Neste estudo foi possível observar que o escape bacteriano e a morte dos macrófagos infectados por EIEC, assim como a ativação da caspase-1 e posterior secreção de IL-1ß é independente da flagelina bacteriana, mas dependente do sistema de secreção, além disso, a ativação da caspase-1 de macrófagos infectados por EIEC é dependente do receptor IPAF e parcialmente da proteína adaptadora ASC. Assim, no nosso modelo, a ativação da caspase-1 dos macrófagos infectados por EIEC parece estar envolvida com o processamento e secreção de IL-1ß e, possivelmente na secreção de IL-18, mas não na morte celular. No modelo de infecção in vivo, o sistema de secreção bacteriano foi importante para a sobrevivência bacteriana no hospedeiro, assim como para a indução de uma resposta inflamatória no local da infecção. Ainda, a caspase-1 parece ter um papel importante para o controle da infecção in vivo por EIEC, podendo assim contribuir para uma resposta imune protetora do hospedeiro

Enteroinvasive Escherichia coli (EIEC) is one of the etiologic agents responsible for bacillary dysentery. The pathophysiological process induced by this bacteria is triggered by the expression of virulence factors that provide the invasion and survival in host cells, resulting in activation of innate and adaptive immune system present on intestinal mucosa. Recent studies have emphasized the importance of the secretion system and bacterial flagellin as agonist of innate immune receptors present in macrophage, especially NLR (Nod like receptors). Then, our proposal was evaluate the role of flagellin (f1iC) and secretion system of EIEC in the induction of immune response of murine macrophages using the EIEC strains wild type (WT), mutant flagellin gene (f1iC), and a strain deficient in secretion system (DSS) for infection of peritoneal macrophages of C57Bl/6, caspase-1-/-, IPAF-/- and ASC-/-- mice. In this study we observed that the bacterial escape and death of infected macrophages with EIEC, the caspase-1 activation and subsequent IL-1ß secretion is independent of bacterial flagellin, but dependent of secretion system, moreover, the caspase-1 activation in infected macrophages is IPAF-dependent and partially dependent of the adapter protein ASC. Thus, in our model, the caspase-1 activation in EIEC infected macrophages seems to be involved with the processing and secretion of IL-1ß and possibly with the secretion of IL-18, but not involved with cell death. In the infection model in vivo, bacterial secretion system was important for bacterial survival in the host, as well as for the inflammatory response induction at the infection site. In addition, caspase-1 seems to have an important role to the control of in vivo infection by EIEC and can contribute to a protective immune response of the host

Renal macrophage infiltration is associated with a poor outcome in IgA nephropathy

OBJECTIVES: The objectives of our study were as follows: 1) to analyze the prognostic value of macrophage infiltration in primary IgA nephropathy (IgAN) and 2) to study the relationship between macrophages and other factors associated with the development of renal fibrosis, including mast cells, TGF-β1, α-SMA and NF-kB. METHODS: We analyzed 62 patients who had been diagnosed with IgAN between 1987 and 2003. Immunohistochemical staining was performed with monoclonal antibodies against CD68 and mast cell tryptase and polyclonal antibodies against TGF-β1, α-SMA and NF-kB p65. We also used Southwestern histochemistry for the in situ detection of activated NF-kB. RESULTS: The infiltration of macrophages into the tubulointerstitial compartment correlated with unfavorable clinical and histological parameters, and a worse clinical course of IgAN was significantly associated with the number of tubulointerstitial macrophages. Kaplan-Meier curves demonstrated that increased macrophage infiltration was associated with decreased renal survival. Moreover, the presence of macrophages was associated with mast cells, tubulointerstitial α-SMA expression and NF-kB activation (IH and Southwestern histochemistry). In the multivariate analysis, the two parameters that correlated with macrophage infiltration, proteinuria and tubulointerstitial injury, were independently associated with an unfavorable clinical course. CONCLUSION: An increased number of macrophages in the tubulointerstitial area may serve as a predictive factor for poor prognosis in patients with IgAN, and these cells were also associated with the expression of pro-fibrotic factors.

Immunomorphological assessment of regional lymph nodes for predicting metastases in oral squamous cell carcinoma.

Background: Oral squamous cell carcinoma is the most common neoplasm and comprises of approximately 80% of the cancers occurring in the oral cavity. The role of the host response to this neoplasm has been recognized, and for many years the regional lymph node in tumor-bearing hosts has been considered as an anatomic barrier to the systematic dissemination of tumor cells. Morphological evaluation of the regional nodes has aided in understanding the immune response. Aim: The current study was carried out to observe the morphological changes occurring in the regional lymph nodes and to evaluate whether these features could be helpful in assessing the immunological status of the patient, and thereby, the prognosis of the patient. Materials and Methods: The study was based on lymph nodes from 63 patients with oral squamous cell carcinoma, who underwent radical neck dissection or modified neck dissection. In the lymph node, four morphological patterns were observed that included lymphocyte predominance, germinal center predominance, mixed pattern (sinus Histiocytosis), and an unstimulated pattern. The cases were then divided into four groups according to the predominant immunoreactivity pattern based on the World Health Organization (WHO) standardized system for reporting human lymph node morphology. Results: Revealed that risk of metastases to cervical lymph nodes in patients with lymphocyte predominance was less (28.6%) when compared to the high risk of metastases with germinal center predominance (68%), and these results were statistically significant (P < 0.05). Patients with a mixed pattern showed less risk of metastases (45.4%), while those with an unstimulated pattern had increased risk of metastases (66.6%), but the results were not statistically significant. It was also found that in the positive nodes, germinal center hyperplasia (50.2%) was the predominant pattern. Conclusion: The present study revealed that patients with lymphocyte predominance had less risk of metastases and patients with germinal center predominance had a high risk of metastases to the lymph node.