RESUMO
Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease characterized by chronic inflammation of the biliary tree resulting in liver fibrosis. PSC is more common in male less than 40 years of age. The diagnosis of PSC is based on clinical, laboratory, image, and histological findings. A biochemical profile of mild to severe chronic cholestasis can be observed. Endoscopic retrograde cholangiography is the golden standard method for diagnosis, but magnetic resonance cholangiography is currently also considered a first-line method of investigation. Differences in clinical and laboratory findings were observed in young patients, including higher incidence of overlap syndromes, mostly with autoimmune hepatitis, higher serum levels of aminotransferases and gamma-glutamyl transferase, and lower incidence of serious complications as cholangiocarcinoma. In spite of the detection of several HLA variants as associated factors in large multicenter cohorts of adult patients, the exact role and pathways of these susceptibility genes remain to be determined in pediatric population. In addition, the literature supports a role for an altered immune response to pathogens in the pathogenesis of PSC. This phenomenon contributes to abnormal immune system activation and perpetuation of the inflammatory process. In this article, we review the role of immune and genetic factors in the pathogenesis of PSC in pediatric patients.
RESUMO
Epididymal lithiasis is a dysfunction of unknown origin characterized by the formation of calcium stones into the lumen of efferent ductules of roosters. Affected animals present an imbalance in the hormonal responsive systems that regulate the expression of proteins involved in the transepithelial calcium transport, as TRPV6, CaBP-D28K, NCX1, and PMCA. Because the efferent ductules are the major site of fluid and calcium reabsorption in excurrent ducts, it was hypothesized that impairment in local calcium homeostasis would lead to lithiasis. To test this hypothesis, we addressed the expression of these proteins in the epididymal region of affected animals. The present study focused on the investigation of the occurrence, tissue distribution, and physiological impact of the transepithelial calcium transport in roosters under normal and pathological conditions. The results showed that affected roosters presented a significant increase in TRPV6 and CaBP-D28k levels, whereas NCX1 and PMCA were not changed. Such alterations were more conspicuous in the proximal efferent ductules, in which was also observed accumulation of calcium within the epithelial cells. These findings provided the first evidences for the involvement of alteration in the expression of proteins essential for calcium reabsorption as a plausible mechanism for the formation of calcium stones within efferent ductules.
