Caracterização de modelo murino de granuloma não infeccioso em comparação à técnica de Shepard de infecção por M. leprae / Characterization of a murine model of non-infecious granuloma compared to the Shepard technique of M. leprae infection

Na hanseníase, o modelo de Shepard de inoculação por Mycobacterium leprae (M. leprae) em patas de camundongos vem sendo utilizado em diversos estudos sobre a resposta imune, avaliação de novas drogas e esquemas terapêuticos, além da dinâmica da infecção precoce e crônica. Para estudar o papel do microambiente granulomatoso na hanseníase, além de modelos animais convencionais ou imunocomprometidos, o desenvolvimento de modelos murinos de granuloma não infeccioso pode adicionar parâmetros patogênicos a serem comparados no desenvolvimento da doença. Preparações de nitrocelulose estão entre as formas de desenvolvimento de granulomas não imunogênicos em experimentação animal. O presente estudo investigou a formação de granulomas não infecciosos induzidos por partículas de nitrocelulose, em comparação a lesões induzidas por M. leprae. Grupos de camundongos nude e BALB/c, foram constituídos e inoculados, conforme a técnica de Shepard, com suspensão de M. leprae (ML), suspensão de nitrocelulose (NT), associação de M. leprae com nitrocelulose (ML/NT) e veículo controle (CTRL). Após 07, 14, 21 e 28 dias, amostras foram coletadas e analisadas histopatologicamente pelas colorações, HematoxilinaEosina e Fite-Faraco. Os grupos experimentais demonstraram a formação de granulomas em ambas os fenótipos murinos. Principalmente nos grupos NT e ML/NT, as lesões foram caracterizadas por infiltrado inflamatório mononuclear, predominantemente macrofágico, com presença de células epitelioides, eventuais macrófagos vacuolizados e ausência de células gigantes multinucleadas. As lesões induzidas exclusivamente por M. leprae pareceram menos exuberantes que àquelas observadas nos demais grupos, indicando que a nitrocelulose intensificou a resposta macrofágica nos espécimes avaliados e sugerindo que esse composto pode ser utilizado não só para o desenvolvimento de granulomas não imunogênicos, mas também na exacerbação da resposta imune em granulomas induzidos por agentes infecciosos, como M. leprae.

In leprosy, the Shepard model of inoculation by Mycobacterium leprae (M. leprae) in mouse footpad has been used in several studies on the immune response, evaluation of new drugs and therapeutic schemes, in addition to the dynamics of early and chronic infection. To study the role of the granulomatous microenvironment in leprosy, in addition to conventional or immunocompromised animal models, the development of murine models of non-infectious granuloma can add pathogenic parameters to be compared in the development of the disease. Nitrocellulose preparations are among the ways of developing non-immunogenic granulomas in animal experimentation. The present study investigated the formation of non-infectious granulomas induced by nitrocellulose particles, in comparison to lesions induced by M. leprae. Groups of athymic nude and BALB/c mice were set up and inoculated, according to Shepard technique, with M. leprae suspension (ML), nitrocellulose suspension (NT), M. leprae association with nitrocellulose (ML/NT) and control vehicle (CTRL). After 07, 14, 21 and 28 days, samples were collected and histopathologically analyzed by Hematoxylin-Eosin and FiteFaraco staining. The experimental groups demonstrated the formation of granulomas in both murine strains. Mainly in the NT and ML/NT groups, the lesions were characterized by mononuclear inflammatory infiltrate, predominantly macrophagic, with the presence of epithelioid cells, eventual vacuolated macrophages and absence of multinucleated giant cells. The lesions induced exclusively by M. leprae seemed less exuberant than those observed in the other groups, indicating that nitrocellulose intensified the macrophage response in the specimens evaluated, and suggesting that this compound can be used not only in the development of non-immunogenic granulomas, but also in exacerbation of the immune response in granulomas induced by infectious agents, such as M. leprae.

Nootkatone Inhibits Acute and Chronic Inflammatory Responses in Mice.

Nootkatone (NTK) is a sesquiterpenoid found in essential oils of many species of Citrus (Rutaceae). Considering previous reports demonstrating that NTK inhibited inflammatory signaling pathways, this study aimed to investigate the effects of this compound in mice models of acute and chronic inflammation. Murine models of paw edema induced by carrageenan, dextran, histamine, and arachidonic acid, as well as carrageenan-induced peritonitis and pleurisy, were used to evaluate the effects of NTK on acute inflammation. A murine model of granuloma induced by cotton pellets was used to access the impact of NTK treatment on chronic inflammation. In the acute inflammation models, NTK demonstrated antiedematogenic effects and inhibited leukocyte recruitment, which was associated with decreased vascular permeability, inhibition of myeloperoxidase (MPO), interleukin (IL)1-ß, and tumor necrosis factor (TNF)-α production. In silico analysis suggest that NTZ anti-inflammatory effects may also occur due to inhibition of cyclooxygenase (COX)-2 activity and antagonism of the histamine receptor type 1 (H1). These mechanisms might have contributed to the reduction of granuloma weight and protein concentration in the homogenates, observed in the chronic inflammation model. In conclusion, NTK exerted anti-inflammatory effects that are associated with inhibition of IL1-ß and TNF-α production, possibly due to inhibition of COX-2 activity and antagonism of the H1 receptor. However, further studies are required to characterize the effects of this compound on chronic inflammation.

Late-onset granulomatous prostatitis following intravesical bacille Calmette-Guerin therapy: case report. / Prostatitis granulomatosa de aparición tardía secundaria a terapia de bacilo de Calmette-Guerin intravesical: reporte de caso.

Bacille Calmette-Guerin intravesical treatment is the most effective treatment for reducing the recurrence of non-muscle-invasive urothelial carcinomas. This treatment can sometimes have side effects and serious complications. Granulomatous prostatitis is a common histological finding but it rarely has a clinical presentation. We report a case of a 75-year-old, type 2 diabetic, male patient who was diagnosed with urothelial in situ carcinoma, for which he began treatment with Bacille Calmette-Guerin instillations. Five years later the patient presented nocturia, pollakiuria, severe urgency, and intense and recurrent perineal pain associated with marked elevation of prostatic specific antigen. A prostatic biopsy was performed that showed a moderate to severe granulomatous prostatitis related to bacille Calmette-Guerin. The patient received full antituberculosis combination drugs with a favorable clinical response.

El bacilo de Calmette-Guerin es el tratamiento intravesical más efectivo para disminuir la recurrencia de los carcinomas uroteliales no-músculo-invasivos. La aplicación de este tratamiento en ocasiones puede presentar efectos secundarios y, excepcionalmente, complicaciones graves. La prostatitis granulomatosa es un hallazgo histológico frecuente pero una entidad rara desde el punto de vista clínico. Se presenta el caso de un paciente de 75 años, diabético tipo 2, que fue diagnosticado de carcinoma in situ vesical, para lo cual inició tratamiento con bacilo de Calmette-Guerin intravesical. El paciente consultó cinco años después por presentar cuadro de nicturia, frecuencia miccional aumentada, urgencia miccional grave y dolor perineal intenso y recurrente asociado a una curva de antígeno prostático específico con marcada elevación. Se le realizó biopsia prostática que mostró una prostatitis crónica granulomatosa de grado moderado a grave relacionada a bacilo de Calmette-Guerin. El paciente recibió esquema antituberculoso completo con buena respuesta clínica.

El bacilo de Calmette-Guerin es el tratamiento intravesical más efectivo para disminuir la recurrencia de los carcinomas uroteliales no-músculo-invasivos. La aplicación de este tratamiento en ocasiones puede presentar efectos secundarios y, excepcionalmente, complicaciones graves. La prostatitis granulomatosa es un hallazgo histológico frecuente pero una entidad rara desde el punto de vista clínico. Se presenta el caso de un paciente de 75 años, diabético tipo 2, que fue diagnosticado de carcinoma in situ vesical, para lo cual inició tratamiento con bacilo de Calmette-Guerin intravesical. El paciente consultó cinco años después por presentar cuadro de nicturia, frecuencia miccional aumentada, urgencia miccional grave y dolor perineal intenso y recurrente asociado a una curva de antígeno prostático específico con marcada elevación. Se le realizó biopsia prostática que mostró una prostatitis crónica granulomatosa de grado moderado a grave relacionada a bacilo de Calmette-Guerin. El paciente recibió esquema antituberculoso completo con buena respuesta clínica.

Granulomatous reaction to red tattoo pigment treated with allopurinol.

Granulomatous reactions to tattoo ink are most commonly associated with mercury sulfide, a component of red pigments. Treatment options show limited results. Allopurinol, an inhibitor of xanthine oxidase, has been reported as a successful alternative treatment to granulomatous disorders, such as sarcoidosis and granulomatous reactions to fillers and tattoos. We report a case of granulomatous reaction to red tattoo pigment treated with allopurinol for 6 months. Good clinical improvement could be noticed during this time. Two months after we stopped the treatment, the lesion recurred. Allopurinol emerges as an important drug for the management of granulomatous reactions caused by tattoo pigments. Based on the significant clinical improvement noticed during its use, we recommend new studies to elucidate all the potential benefits of the use of allopurinol for the treatment of granulomatous reactions to tattoo ink.

Management of complications of injectable silicone.

Soft tissue augmentation is a common procedure, and a wide variety of injectable fillers are used. Liquid injectable silicone (LIS) was the first highly popularized injectable filler. LIS is a permanent filler and can be used in the correction of facial furrows and wrinkles. Some complications are inherent to the procedure and can resolve spontaneously, such as redness, swelling, and immediate hypersensitivity reactions. Unintended reactions, such as granulomas, infections, vascular occlusion, can also follow the treatment with LIS and may appear several years after the injections. These can be difficult to manage, show little or no tendency to spontaneous resolutions, and rarely resolve completely. Injecting physicians must be aware of these potential complications caused by LIS because early medical care and treatment, including psychological support for these patients, can minimize the consequences for patients and physicians, and may also help obtaining better outcomes when treating complications.

Multiple FDG-avid injection site granulomas due to lovenox injection.

An initial staging FDG PET/CT scan in a 15-year-old female patient with lymphoma revealed FDG-avid tumor in the mediastinum and the neck. After chemotherapy, a restaging PET/CT scan was performed. Although mediastinal and cervical lesions were not visualized, multiple new foci of activity were noted in the bilateral anterior thighs, which corresponded to soft tissue nodules in the subcutaneous tissue on the low-dose CT. On the third PET/CT study, multiple new foci appeared in the subcutaneous tissue in the anterior abdomen. Additional clinical history was obtained, indicating multiple recent subcutaneous injections of anticoagulants.

Early undernutrition is associated with attenuated inflammatory response and alteration in pharmacological efficacy of indomethacin in rats.

AIM: The intent of this study is to examine whether intrauterine malnutrition provokes alterations in the progression of the acute and subchronic inflammatory response, and its influence on the pharmacological effect of indomethacin. METHODS DESIGN: Rat offspring of dams which were fed from the first day of their gestation to term receiving a balanced diet (Labina) or a basic regional diet (BRD) from northeastern Brazil. According to their dams, the offspring were divided in two groups: Control-N (nourished) and BRD-g (undernourished during gestation). At 2 months of age, the animals were divided into groups (n=06): (1) Animals that were subjected to carrageenan or (2) zymosan-induce paw edema (acute inflammation models) and (3) Animals that were subjected to cotton pellet-induced granuloma (subchronic inflammation model). All animals received (saline 0.9%; p.o.). Another set of adult offspring was submitted to the same procedure as above, but instead of saline they received (via gavage) a single oral dose of indomethacin (10mg/kg) for the animals subjected to acute inflammation models or 2mg/kg for seven consecutive days for the animals subjected to subchronic inflammation model. The animals were further divided in two groups: Control-NI (Control-N treated with indomethacin), and BRDI-g (BRD-g treated with indomethacin). The volume of hind paw swelling (mL) was measured at time zero (before), 30, 60, 120, 180 and 240 min after carrageenan or zymosan injection. In the subchronic model of inflammation, the pellets were removed and dried to a constant weight. Hind paw swelling, weight of granuloma, blood albumin and C-reactive protein (CRP) levels, leukocyte count and cytokine levels were evaluated as indicators of inflammation. RESULTS: Undernutrition during pregnancy caused fetal growth retardation which was shown in terms of low birth weight (5.38±0.28), when compared to the Control-N (7.26±0.64) group. The volume of paw edema, the serum levels of CRP and albumin and cytokine levels were lower than those in the BRD-g group when compared to those in the Control-N groups, in both models of acute inflammation studied. However, no difference was found in the total leukocyte count. When compared to the respective groups treated with saline (Control-N and BRD-g), the antiinflammatory effect of indomethacin in the animals of BRDI-g groups was lower than in the Control-NI groups, in the model of acute inflammation. In the model of subchronic inflammation, the pharmacological effect of indomethacin was effective only in nourished animals. CONCLUSION: Malnutrition in the early stages of development attenuated the severity of the acute inflammatory response, but there was no statistically significant change in subchronic inflammation induced by granulomatous lesion. Our findings provide impetus for larger trials to assess the influence of undernutrition on the pharmacokinetics/pharmacodynamics of indomethacin.

Oleoma: rare complication of mesotherapy for cellulite.

BACKGROUND: Mesotherapy or intradermotherapy is used as a cosmetic procedure for many purposes, among them for cellulite. METHODS: We report a case of oleoma on the thighs and buttocks that appeared two years after the injection of an unknown substance for improvement of cellulite. RESULTS: Lesions and associated pruritus resolved with colchicine, leaving depressed scars. CONCLUSIONS: Serious and peer-reviewed investigations must be performed to certify the efficacy and safety of this procedure.

Modulation of inflammatory processes by leaves extract from Clusia nemorosa both in vitro and in vivo animal models.

The present study was carried out to investigate the anti-inflammatory effect of the hexane extract of the leaves from Clusia nemorosa G. Mey, called HECn, using carrageenan-induced mice pleurisy and cotton pellet-induced mice granuloma. Additionally, the ability of HECn to affect both neutrophil migration as viability was investigated by use of the Boyden chamber assay and flow cytometry, respectively. The HECn significantly inhibited exudation, total leukocytes and neutrophils influx, as well as TNFα levels in carrageenan-induced pleurisy. However, the extract not suppressed the granulomatous tissue formation in the cotton pellet-induced granuloma test. Experiments performed in vitro revealed that HECn on human neutrophils inhibited a dose-dependent manner the CXCL1-induced neutrophil chemotaxis. Furthermore, HECn also inhibited the chemoattraction of human neutrophils induced by formyl-methionyl-leucyl-phenylalanine (fMLP), leukotriene B4 (LTB4) and platelet activating factor (PAF) in a Boyden chamber. However, this same treatment not was able to induce apoptosis. The results obtained in this study showed that the extract from leaves of C. nemorosa possess a potent inhibitory activity in acute model of inflammation, being the effects mediated, in part, by inhibition of neutrophil responsiveness. These results indicate that C. nemorosa could be a good source for anti-inflammatory compounds.

The immunomodulatory effects of Ipomoea carnea in rats vary depending on life stage.

Ipomoea carnea Jacq. ssp. fistulosa (Mart. Ex Choisy; Convolvulaceae; I. carnea) possesses a toxic component: an indolizidine alkaloid swainsonine (SW) that has immunomodulatory effects due to its inhibition of glycoprotein metabolism. It is also known that SW is excreted into both the amniotic fluid and milk of female rats exposed to I. carnea. Thus, the aim of this study was to determine whether SW exposure, either in utero or from the milk of dams treated with I. carnea, modulates offspring immune function into adulthood. In addition, adult (70 days old) and juvenile rats (21 days old) were exposed to I. carnea in order to evaluate several other immune parameters: lymphoid organs relative weight and cellularity, humoral and cellular immune responses. Offspring exposed to I. carnea during lactation developed rheumatoid arthritis (RA) in adulthood after an immunogenic challenge. In addition, both adult and juvenile rats exposed to I. carnea showed discrepancies in several immune parameters, but did not exhibit any decrease in humoral immune response, which was enhanced at both ages. These findings indicate that SW modulates immune function in adult rats exposed to SW during lactation and in juvenile and adult rats exposed to SW as juveniles and adults, respectively.

Granulomas of the penis: a rare complication of intravesical therapy with Bacillus Calmette-Guerin.

Immunotherapy with Bacillus Calmette-Guérin is widely used for treatment and prophylaxis of superficial urothelial cancer. Complications associated with Bacillus Calmette-Guérin treatment are common. The authors describe a case of granulomatous inflammation of the penis associated with intravesical Bacillus Calmette-Guérin therapy, presenting with multiple erythematous and painless nodules located on the glans. A review of the literature is also performed. Granulomatous balanoposthitis is a rare complication of Bacillus Calmette-Guérin immunotherapy, with heterogeneous clinical presentation, which can make the diagnosis difficult. Its clinical recognition is essential for early start of therapy with antitubercular agents and interruption of Bacillus Calmette-Guérin.

Granulomas do pênis: uma complicação rara da terapia intravesical com Bacilo Calmette-Guérin / Granulomas of the penis: a rare complication of intravesical therapy with Bacillus Calmette-Guerin

A imunoterapia com o Bacilo Calmette-Guérin é amplamente usada no tratamento e profilaxia da neoplasia urotelial superficial. As complicações associadas ao tratamento são comuns. Os autores relatam um caso de inflamação granulomatosa do pênis, associada à terapia intravesical com Bacilo Calmette-Guérin, com múltiplos nódulos eritematosos indolores localizados na glande. É também efetuada uma revisão da literatura. A balanopostite granulomatosa é uma complicação rara associada à imunoterapia com Bacilo Calmette-Guérin, com uma apresentação clinicamente heterogênea que pode dificultar o diagnóstico. O seu reconhecimento clínico é essencial para o início precoce de tuberculostáticos e interrupção de Bacilo Calmette-Guérin.

Immunotherapy with Bacillus Calmette-Guérin is widely used for treatment and prophylaxis of superficial urothelial cancer. Complications associated with Bacillus Calmette-Guérin treatment are common. The authors describe a case of granulomatous inflammation of the penis associated with intravesical Bacillus Calmette-Guérin therapy, presenting with multiple erythematous and painless nodules located on the glans. A review of the literature is also performed. Granulomatous balanoposthitis is a rare complication of Bacillus Calmette-Guérin immunotherapy, with heterogeneous clinical presentation, which can make the diagnosis difficult. Its clinical recognition is essential for early start of therapy with antitubercular agents and interruption of Bacillus Calmette-Guérin.

Anti-inflammatory effect of Acacia visco extracts in animal models.

The aqueous and organic extracts of Acacia visco Lor. Ap Griseb (Fabaceae) were tested for anti-inflammatory activity in experimental models in rat. Besides, the free-radical scavenging capacity of extracts from A. visco was determined. The extracts revealed anti-inflammatory effect against carrageenan-induced oedema, phospholipase A(2)-induced oedema, cotton pellet-induced granuloma and they did not show acute toxic effect. Among the class of compounds characterized from A. visco leaves, the triterpenoid 20(29)-lupen-3ß-ol (lupeol), 12-ursen-3ß-ol (α-amyrin) and 12-oleanen-3ß-ol (ß-amyrin) may be mainly responsible for the pharmacological activities.

The effect of the aqueous extract of Helietta parvifolia A. Gray (Rutaceae) stem bark on carrageenan-induced paw oedema and granuloma tissue formation in mice.

AIMS OF STUDY: Despite the ethnopharmacological relevance of Helietta parvifolia A. Gray (Rutaceae) in Mexico, we found no significant pharmacological studies of this plant in the scientific literature. The aim of the present study was to establish the anti-inflammatory effect of an aqueous extract of the stem bark of Helietta parvifolia in mice. MATERIALS AND METHODS: The anti-inflammatory activity of the aqueous extract of the stem bark of Helietta parvifolia was evaluated using carrageenan-induced paw oedema in mice, and the cotton pellet granuloma method. RESULTS: An extract dose ranging from 20 to 80 mg/kg p.o. showed a non-significant effect over the initial phase of carrageenan-induced oedema. However, it showed a significant inhibition of oedema after 3h, which can be related to the inhibition of the release of kinin-like substances. An ID(50) value of 47.4 mg/kg was obtained for the plant extract. The extract also suppressed granulomatous tissue formation during chronic inflammation. The inhibitory values were 19.2, and 22.2, corresponding to 40 and 80 mg/kg doses of extract respectively. CONCLUSIONS: Aqueous extract showed a statistically significant anti-inflammatory effect in mice during the late phase of acute inflammation and during chronic inflammation. However, the exact mechanism(s) of anti-inflammatory effects of Helietta parvifolia observed in this study remains unclear.

Fluctuation of annexin-A1 positive mast cells in chronic granulomatous inflammation.

OBJECTIVE: We have applied here a model of chronic granulomatous inflammation to study the profile of mast cell activation and their expression of annexin-A1 in the nodular lesion. MATERIALS: Granulomatous inflammation was induced by injection of croton oil and Freund's complete adjuvant (CO/FCA) into the dorsal air-pouches of mice. Skin tissue samples were collected from control group (24 h time-point; i. e. before disease development) and 7, 14, 21, 28 and 42 days post-CO/FCA treatment. RESULTS: Histopathological analyses revealed an on-going inflammation characterized by an increased number of activated mast cells at sites of the chronic inflammatory reaction in all experimental groups. Immunohistochemical analysis showed skin mast cells highly immunoreactive for annexin-A1, both at an initial (day 7) and a delayed (day 28) phase of the inflammatory reaction. CONCLUSIONS: The observed time-dependent modulation of mast cell activation, during the granulomatous injury, indicates that multiple pathways centred on annexin-A1 might become activated at different stages of this chronic inflammatory response, including the delayed and pro-resolving phase.