Navegando por Palavras-chave "Arterite De Takayasu"

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    Avaliação do infiltrado de macrófagos na parede arterial de pacientes com arterite de takayasu.
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-24) Santos, Joao Paulo Dos [UNIFESP]; Souza, Alexandre Wagner Silva De [UNIFESP]; http://lattes.cnpq.br/7033230017001241; http://lattes.cnpq.br/2564736745724709; Universidade Federal de São Paulo (UNIFESP)
    Introduction – Takayasu's arteritis (TA) is a systemic vasculitis of unknown etiology that affects large arteries, such as the aorta and its main branches. The inflammatory infiltrate of the arterial wall consists of macrophages, multinucleated giant cells, natural killer (NK) cells, neutrophils and CD4+ T cells, CD8+ T cells and γδ T cells. No studies have evaluated macrophages phenotypes present in the inflammatory infiltrate of the arterial walls in patients with TA. Objective – The primary aim of this study was to evaluate which macrophage phenotype is predominant in the inflammatory infiltration in the aorta of patients with TA. Secondary study aims were to compare the frequency of macrophages, T cells, B cells and NK cells in the aorta from TA patients, patients with atherosclerotic disease (AD) and healthy controls (HC); to describe the predominant localization of macrophages in the aorta from TA patients; to analyze associations between infiltration of macrophages and T cells, B cells and NK cells in the arterial wall and clinical disease activity, histological disease activity, concomitant atherosclerotic lesions and prednisone use. Materials and Methods – We performed a cross-sectional study using immunohistochemistry to evaluate the expression of macrophages (CD68), T cells (CD3), B cells (CD20), NK cells (CD56), as well as M1 (CD86) and M2 (CD206) macrophages in inflammatory infiltration in the aorta from TA patients (n = 22), patients with AD of the aorta (n = 9) and HC (n = 8). Results – The thoracic aorta was assessed in 86.4% of TA patients, in 77.8% of patients with atherosclerotic disease and in 100% of controls. The abdominal aorta was evaluated in remainder. The surgical procedure was performed at the time of diagnosis in 54.5% of patients with TA. Clinical activity of the disease was observed in 54.5% of cases, histological activity in 40.9% and atherosclerotic lesions in 27.3% of patients with TA. Only 36.3% of the patients with TA were on glucocorticoid, immunosuppressive and/or biologic agents. The frequency of macrophages, M1 macrophages, T cells, B cells and NK cells was higher in the aorta from TA and AD patients compared with HC, but no differences were found among all groups for M2 macrophages. In TA, macrophages and T cells were the most abundant cells in the aorta while M2 macrophages were more frequently found than M1 macrophages. No differences were found concerning macrophages, T cells, Bcells or NK cells between TA patients presenting active disease and those in remission nor between TA patients with and without concomitant atherosclerotic lesions in the aorta. T cells were more frequent in the aorta of TA patients with active disease based on histological evaluation compared with those presenting chronic fibrotic lesions, but no differences were found in the expression of macrophage markers. The use of prednisone was associated with a significantly lower T cell count in the aorta of TA patients whereas no differences were observed for other cell markers. Conclusions – M2 macrophages are more frequently found in the aorta of TA patients than M1 macrophages. Macrophages and T cells are the most frequent cells in the inflammatory infiltrate in the aorta of TA patients. T cells were associated with histological disease activity and with prednisone use in TAK but not macrophages.
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    Estudo longitudinal para avaliar a evolucao clinica e arteriografica de pacientes com Arterite de Takayasu submetidos ao PET-CT com 18F-FDG
    (Universidade Federal de São Paulo (UNIFESP), 2019-02-28) Janes, Anna Larissa Faria [UNIFESP]; Souza, Alexandre Wagner Silva De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction. The assessment of disease activity in Takayasu arteritis (TA) is a challenge, since silent progression occurs in patients considered to be in remission. PET-CT scan (Positron Emission Tomography - Computed Tomography) with 18-Fluorodeoxyglucose (18F-FDG) started to be used in the evaluation of disease activity in TA. The uptake of 18F-FDG in arterial walls may reflect the arterial inflammatory process and consequently the disease activity. Methods. In this study, we assessed longitudinally whether the higher uptake of 18F-FDG, measured by the SUV index (Standardized Uptake Value) and the maximum SUV (SUVmax) in arterial walls, is associated with the development of new arterial lesions in TA and reactivation of the disease. Patients who underwent PET-CT scan with 18F-FDG between 2009 and 2010 were reassessed annually by angioresonance and / or computed angiotomography. Results. Of the 36 patients with TA initially recruited, 32 were evaluated longitudinally by a median of 83.5 months. Twenty patients (62.5%) with TA showed disease activity according to PET-CT with 18F-FDG, considering SUVmax ≥ 1.3. The median SUVmax at baseline was 1.57 (1.16-2.23). At follow-up, 23 (71.9%) patients had at least one recurrence of TA and new arterial lesions were observed in 14 (43.8%) cases. There was no difference in the basal SUV value between arteries that developed and arteries that did not develop new lesions in patients with TA. There was a higher frequency of disease recurrences, a greater need to change the immunosuppressive agent and a lower frequency of death in patients with SUVmax ≥1.3. Conclusions. There is no association between arterial SUV and the development of a new arterial lesion in TA, but arterial SUVmax in patients with TA is associated with a higher frequency of disease recurrences and a greater need for changes in immunosuppressive therapy.
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    Tomografia por Emissão de Pósitrons/ Ressonância Magnética (PET/RM) é um bom método para avaliar atividade vascular em pacientes com arterite de Takayasu (AT) juvenil sob tratamento? Estudo multicêntrico
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-12) Russo, Gleice Clemente Souza [UNIFESP]; Terreri, Maria Teresa De Sande E Lemos Ramos Ascensao [UNIFESP]; Silva de Souza, Alexandre Wagner; http://lattes.cnpq.br/7033230017001241; http://lattes.cnpq.br/2661280959330284; http://lattes.cnpq.br/6137604710211807; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The improving therapeutic approach towards childhood-onset Takayasu’s arteritis (c-TA) has decreasead the mortality rate over the years and increased concerns on how to improve disease monitoring on an ongoing basis. Our aim was to assess whether 18F-FDG-PET/MRI can contribute in detecting vessel wall inflammation by increased 18F-FDG uptake in patients under immunosuppressive therapy and in apparent remission of the disease. Methods: It was a three-center cross-sectional study where we analysed a combined imaging of 18F-FDG-PET and MRA in an integrated system. 18F-FDGPET/ MRI scan was performed in c-TA patients, alongside clinical evaluation through clinical activity score (Indian Takayasu Arteritis Clinical Activity Score - ITAS2010 and Pediatric Vasculitis Activity Score – PVAS), and damage score (Takayasu Arteritis Damage Score - TADS and Pediatric Vasculitis Damage Index - PVDI) and laboratorial analysis providing measures of ESR, CRP, HMGB1 (High Mobility Group Box 1), IFN-γ, IL-10, IL-12p70, IL -1ra, IL-1β, IL-6, TNF-α, VEGF and PDGF. There were control groups for the serum and plasma cytokine levels (healthy controls) and for 18F-FDG-PET/MRI (oncologic patients) findings. Results: Seventeen c-TA patients (65% females) between the ages of 6 and 21 years, with median disease duration of 9.4 years were recruited. Only one patient presented clinical disease activity according to the ITAS2010 and six of them (35.6%) had increased ESR and/or CRP. The most frequent MRA finding was stenosis, followed by thickness, visualized in 82.4% and 75%, respectively. 18F-FDG-PET revealed that 88.2% patients had FDG uptake higher than liver (visual score=3) in at least one arterial segment. The qualitative assessment of vascular FDG uptake across the arterial segments – PETVAS - was 21.8 ± 3.3. Median SUVmax was 3.22 (2.76-3.69) and mean metabolic inflammatory volume (MIV) was 1990cm3 ± 1077. Patients presented significantly higher SUVmax than controls (p<0.001). Plasma IFN- γ levels showed a tendency to be higher in patients compared to controls (p=0.052). There was a positive moderate correlation between aortic wall thickness extent and CRP levels (Rho=0.542), and also with SUVmax value (Rho=0.501). Additionally, there was a negative moderate correlation between aortic wall thickness extent and IL-1ra (Rho= -0.662) and also with IL1 β (Rho=-0.562). Finally, there was a positive moderate correlation between SUVmax and CRP levels (Rho=0.528) and also with MIV value (Rho=0.615) and a negative moderate correlation between MIV and VEGF (Rho=-0.520). Conclusion: This study used a state-of-the-art imaging modality that revealed a strong vascular FDG uptake even in clinically and laboratory inactive patients. We suppose that this finding may mean a silent activity in the vessel wall. However, only a prospective international multicentre initiative could clarify whether these changes really represent vascular inflammation and whether they will lead to further arterial lesion progression, what would help to guide the therapy for c-TA more adequately.