Autoinflammatory diseases in pediatrics.

Monogenic autoinflammatory syndromes are caused by mutations in protein-coding genes that have a pivotal role in the regulation of the inflammatory response. Due to their genetic nature, most of these syndromes usually begin during childhood. They are clinically characterized by recurrent episodes of systemic inflammation (fever with different clinical manifestations, such as skin rash, serositis or arthritis) associated with elevation of acute phase reactants. During symptom-free intervals, patients achieve clinical well-being and normalize infammatory parameters. Amyloidosis is a serious long-term complication. In this update we will discuss the clinical presentation and therapeutic strategies for these diseases in pediatrics.

Autoinflammatory diseases in pediatrics. / Autoinflammatory diseases in pediatrics.

Monogenic autoinflammatory syndromes are caused by mutations in protein-coding genes that have a pivotal role in the regulation of the inflammatory response. Due to their genetic nature, most of these syndromes usually begin during childhood. They are clinically characterized by recurrent episodes of systemic inflammation (fever with different clinical manifestations, such as skin rash, serositis or arthritis) associated with elevation of acute phase reactants. During symptom-free intervals, patients achieve clinical well-being and normalize infammatory parameters. Amyloidosis is a serious long-term complication. In this update we will discuss the clinical presentation and therapeutic strategies for these diseases in pediatrics.

Epidermólise bolhosa em animais

Esta tese inclui três artigos sobre epidermólise bolhosa (EB) em animais, uma doença hereditária, cuja principal característica é a formação de bolhas e erosões na pele e mucosas em resposta ao mínimo trauma. O primeiro capítulo é um artigo de revisão que abrange o diagnóstico, a classificação, a epidemiologia, o modo de herança, a clínica, a patologia e as alterações ultraestruturais e moleculares da EB em animais. Baseado no nível ultraestrutural de separação do tecido, a EB é dividida em três tipos: simples, juncional e distrófica. Em humanos estima-se que a EB afeta 1 em 17.000 nascidos vivos, mas em animais a frequência de EB não é estimada. Os achados clínicos e patológicos são semelhantes em todos os tipos de EB, variando apenas na intensidade. A EB é causada por mutações nos genes que expressam as proteínas do citoesqueleto dos queratinócitos ou da zona da membrana basal (ZMB). No segundo capítulo foram descritos em caprinos os achados clínicos, histopatológicos e ultraestruturais da EB distrófica transmitida por um gene autossômico recessivo. Os caprinos apresentaram exungulação, erosões, crostas e cicatrizes na pele e úlceras na cavidade oral. Histologicamente, a pele apresentava uma separação subepidérmica preenchida com fluido eosinofílico claro, restos celulares ou neutrófilos. Ultraestruturalmente, o local de separação foi abaixo da lâmina densa na ZMB. Na pele com formação de bolhas e na pele não envolvida clinicamente, a lâmina basal foi preservada, mas as fibrilas de ancoragem eram escassas e rudimentares. Sugere-se que a doença é similar a EB distrófica recessiva generalizada e severa observada em humanos. No terceiro capítulo é descrito um caso de EB em um bezerro. [...] Os hemidesmossomos apresentavam-se pequenos, pobremente definidos e sem demarcação clara. Os achados clínicos, histológicos e ultraestruturais encontrados no bezerro são característicos da EB juncional.

This thesis includes three papers on epidermolysis bullosa (EB) in animals, which is an hereditary disease, characterized by the formation of blisters and erosions on the skin and mucous in response to minor mechanical trauma. The first paper reviews the diagnosis, classification, epidemiology, mode of inheritance, clinical, pathology, and ultrastructural and molecular changes of EB reported in animals. Based on the ultrastructural level of tissue separations EB is divided into three types: simplex, junctional, and dystrophic. In humans it is estimated that EB affect 1 in 17000 live births, but in animal the frequency of EB is not estimated. The clinical and pathological findings are similar in all types of EB, varying only in intensity. EB is due to mutations in genes that express the protein constituent the cytoskeleton of the basal keratinocytes or of the basement membrane zone (BMZ). In the second paper, clinical, histopathological, and ultrastructural findings of dystrophic EB in goats transmitted by an autosomal recessive gene are reported. The goats presented with exungulation, erosions, crusts and scars on the skin and ulcers in the oral cavity. Histologically, the skin showed subepidermal separation, with clefts filled with clear eosinophilic fluid, cellular debris or neutrophils. Ultrastructurally, the site of blister formation was the sub-lamina densa in the BMZ. In skin with blister formation and in clinically uninvolved skin, the basal lamina was preserved, but the anchoring fibrils were scarce and rudimentary. It is suggested that the disease is similar to human severe generalized recessive dystrophic EB. In the third paper, a case of EB in a calf is reported. It was presented exungulation of all hooves, widespread erosions and crusts on the skin, and ulcers in the oral cavity. [...] The hemidesmosomes were poorly defined and small. The clinical, histological and ultrastructural findings are characteristic of junctional EB.