Immunological Hallmarks of Inflammatory Status in Vaso-Occlusive Crisis of Sickle Cell Anemia Patients.

Sickle Cell Anemia (SCA) is the most common genetic disorder around the world. The mutation in the ß-globin gene is responsible for a higher hemolysis rate, with further involvement of immunological molecules, especially cytokines, chemokines, growth factors, and anaphylatoxins. These molecules are responsible for inducing and attracting immune cells into circulation, thus contributing to increases in leukocytes and other pro-inflammatory mediators, and can culminate in a vaso-occlusive crisis (VOC). This study aimed to characterize the levels of these molecules in SCA patients in different clinical conditions in order to identify potential hallmarks of inflammation in these patients. An analytical prospective study was conducted using the serum of SCA patients in steady-state (StSt; n = 27) and VOC (n = 22), along with 53 healthy donors (HD). Samples from the VOC group were obtained on admission and on discharge, in the convalescent phase (CV). Levels of chemokines (CXCL8, CXCL10, CL2, CLL3, CCL4, CL5, and CCL11), cytokines (IL-1ß, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-10, IL-12p70, IL-13, IL-17A, TNF-α, and IFN-γ) and growth factors (VEGF, FGFb, PDGF-BB, GM-CSF, and G-CSF) were measured using a Luminex assay, and anaphylatoxins (C3a, C4a, and C5a) were measured using Cytometric Bead Array. SCA patients in StSt showed a pro-inflammatory profile, and were indicated as being higher producers of CCL2, IL-1ß, IL-12p70, IFN-γ, IL-17A, and GM-CSF, while VOC is highlighted by molecules IL-4 and IL-5, but also IL-2, IL-7, PDGF-BB, and G-CSF. PDGF-BB and IL-1ra seemed to be two important hallmarks for the acute-to-chronic stage, due to their significant decrease after crisis inflammation and statistical difference in VOC and CV groups. These molecules show higher levels and a strong correlation with other molecules in VOC. Furthermore, they remain at higher levels even after crisis recovery, which suggest their importance in the role of inflammation during crisis and participation in immune cell adhesion and activation. These results support a relevant role of cytokines, neutrophil and monocytes, since these may act as markers of VOC inflammation in SCA patients.

Association between skin thickness and bone density in adult women.

BACKGROUND: Osteoporosis mainly affects menopausal women and the elderly, predisposing these individuals to fractures that result in morbidity, mortality and costs to the healthcare system. Since dermal collagen reduces in parallel with a decrease in bone mass with aging, skin thickness may be indicative of a risk of osteoporosis. OBJECTIVES: To evaluate the correlation between bone density and skin thickness on the backs of the hands of adult women. METHODS: A cross sectional study involving adult women attending a university hospital outpatient clinic who were interviewed individually and submitted to bone densitometry and measurement of skin thickness on the backs of their hands using skinfold calipers. Other risk factors for osteoporosis were also investigated. RESULTS: A total of 140 patients were evaluated. Mean age (± standard deviation) was 57 ± 11 years. Mean skin thickness on the backs of the hands was 1.4 ± 0.4 mm. There was a correlation between the right and left hands (R = 0.9; p<0.01). A direct correlation was found between skin thickness on the backs of the hands and bone density at the lumbar spine and femur (p<0.01). These results remained consistent even following adjustment for the covariables of age, skin phototype, body mass index, smoking, use of oral corticoids, anti-inflammatory use and time since menopause. Osteoporosis was inversely associated with the thickness of the skin on the back of the hands (odds ratio = 0.10; p<0.03) CONCLUSION: An independent correlation was found between skin thickness and bone density, suggesting that these events occur simultaneously. Skin signs may represent a non-invasive method of stratifying risk in these patients, helping identify cases requiring early treatment.

Associação entre espessura da pele e densidade óssea em mulheres adultas / Association between skin thickness and bone density in adult women

FUNDAMENTOS: Osteoporose acomete principalmente mulheres em menopausa e idosos, predispondo a fraturas que geram morbidade, mortalidade e custos ao sistema de saúde. Como o colágeno dérmico diminui paralelamente à redução da massa óssea com o envelhecimento, a medida da espessura da pele pode ser indício do risco de osteoporose. OBJETIVOS: Avaliar a correlação entre densidade óssea e espessura da pele do dorso das mãos de mulheres adultas. MÉTODOS: Estudo transversal envolvendo mulheres adultas atendidas em ambulatório de hospital universitário submetidas à densitometria óssea, que foram avaliadas individualmente e mensurada, por paquímetro, a espessura da pele no dorso das mãos, além de investigados demais fatores de risco para osteoporose. RESULTADOS: Avaliaram-se 140 pacientes. A média (±dp) de idade foi de 57 (±11) anos; a média da espessura da pele do dorso das mãos foi de 1,4 (±0,4) mm. Houve correlação entre as medidas das mãos direita e esquerda (R=0,9; p<0,01). Observou-se correlação direta entre as espessuras de pele do dorso das mãos e as densidades ósseas lombares e femorais (p<0,01). Tais resultados permaneceram consistentes mesmo quando ajustados pelas covariáveis: idade, fototipo, índice de massa corpórea, tabagismo, uso de corticoide oral, uso de anti-inflamatório oral e tempo de menopausa. Osteoporose se associou inversamente com a espessura da pele das mãos (Odds Ratio=0,10; p<0,03). CONCLUSÃO: Espessura da pele correlacionou-se, independentemente, com a densidade óssea, sugerindo simultaneidade dos eventos. Sinais cutâneos podem contribuir para a estratificação de risco não invasiva desses pacientes, e colaborar na identificação e tratamentos precoces.

BACKGROUND: Osteoporosis mainly affects menopausal women and the elderly, predisposing these individuals to fractures that result in morbidity, mortality and costs to the healthcare system. Since dermal collagen reduces in parallel with a decrease in bone mass with aging, skin thickness may be indicative of a risk of osteoporosis. OBJECTIVES: To evaluate the correlation between bone density and skin thickness on the backs of the hands of adult women. METHODS: A cross sectional study involving adult women attending a university hospital outpatient clinic who were interviewed individually and submitted to bone densitometry and measurement of skin thickness on the backs of their hands using skinfold calipers. Other risk factors for osteoporosis were also investigated. RESULTS: A total of 140 patients were evaluated. Mean age (± standard deviation) was 57 ± 11 years. Mean skin thickness on the backs of the hands was 1.4 ± 0.4 mm. There was a correlation between the right and left hands (R = 0.9; p<0.01). A direct correlation was found between skin thickness on the backs of the hands and bone density at the lumbar spine and femur (p<0.01). These results remained consistent even following adjustment for the covariables of age, skin phototype, body mass index, smoking, use of oral corticoids, anti-inflammatory use and time since menopause. Osteoporosis was inversely associated with the thickness of the skin on the back of the hands (odds ratio = 0.10; p<0.03) CONCLUSION: An independent correlation was found between skin thickness and bone density, suggesting that these events occur simultaneously. Skin signs may represent a non-invasive method of stratifying risk in these patients, helping identify cases requiring early treatment.