Browsing by Author "Burgos, Paula, I"

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    Cellular and molecular regulation of the programmed death-1/programmed death ligand system and its role in multiple sclerosis and other autoimmune diseases
    (2021) Ibanez-Vega, Jorge; Vilchez, Constanza; Jimenez, Karin; Guevara, Carlos; Burgos, Paula, I; Naves, Rodrigo
    Programmed Cell Death 1 (PD-1) receptor and its ligands (PD-Ls) are essential to maintain peripheral immune tolerance and to avoid tissue damage. Consequently, altered gene or protein expression of this system of coinhibitory molecules has been involved in the development of cancer and autoimmunity. Substantial progress has been achieved in the study of the PD-1/PD-Ls system in terms of regulatory mechanisms and therapy. However, the role of the PD-1/PD-Ls pathway in neuroinflammation has been less explored despite being a potential target of treatment for neurodegenerative diseases. Multiple Sclerosis (MS) is the most prevalent, chronic, inflammatory, and autoimmune disease of the central nervous system that leads to demyelination and axonal damage in young adults. Recent studies have highlighted the key role of the PD-1/PD-Ls pathway in inducing a neuroprotective response and restraining T cell activation and neurodegeneration in MS. In this review, we outline the molecular and cellular mechanisms regulating gene expression, protein synthesis and traffic of PD-1/PD-Ls as well as relevant processes that control PD-1/PD-Ls engagement in the immunological synapse between antigen-presenting cells and T cells. Also, we highlight the most recent findings regarding the role of the PD-1/PD-Ls pathway in MS and its murine model, experimental autoimmune encephalomyelitis (EAE), including the contribution of PD-1 expressing follicular helper T (TFH) cells in the pathogenesis of these diseases. In addition, we compare and contrast results found in MS and EAE with evidence reported in other autoimmune diseases and their experimental models, and review PD-1/PD-Ls-targeting therapeutic approaches.
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    Clinical and Serological Features in Latin American IgG4-Related Disease Patients Differ According to Sex, Ethnicity, and Clinical Phenotype
    (2022) Martin-Nares, Eduardo; Federico Baenas, Diego; Cuellar Gutierrez, Maria Carolina; Hernandez-Molina, Gabriela; Christian Ortiz, Alberto; Neira, Oscar; Gutierrez, Miguel A.; Calvo, Romina; Jose Saad, Emanuel; Elgueta Pinochet, Sergio; Gallo, Jesica; Herrera Moya, Alejandra; Mansilla Aravena, Bellanides Agustina; Crespo Espindola, Maria Elena; Cairoli, Ernesto; Maria Bertoli, Ana; Cordoba, Mercedes; Wurmann Kiblisky, Pamela; Basualdo Arancibia, Washington Javier; Badilla Pineiro, Maria Natalia; Andrea Gobbi, Carla; Ariel Berbotto, Guillermo; Pisoni, Cecilia N.; Juarez, Vicente; Ana Cosatti, Micaela; Aste, Nora Maria; Airoldi, Carla; Llanos, Carolina; Vergara Melian, Cristian Fabian; Erlij Opazo, Daniel; Goecke, Annelise; Pastenes Montano, Paula Andrea; Tate, Patricio; Pablo Pirola, Juan; Stange Nunez, Lilith; Burgos, Paula, I; Mezzano Robinson, Maria Veronica; Michalland, Susana H.; Silva Labra, Francisco; Labarca Solar, Cristian Humberto; Veronica Lencina, Maria; Izquierdo Loaiza, Jorge Hernan; Del Castillo Gil, David Julian; Caeiro, Francisco; Paira, Sergio
    Background/Objective Data on IgG4-related disease (IgG4-RD) come almost exclusively from cohorts from Asia, Europe, and North America. We conducted this study to describe the clinical presentation, phenotype distribution, and association with sex, ethnicity, and serological markers in a large cohort of Latin American patients with IgG4-RD. Methods We performed a multicenter medical records review study including 184 Latin American IgG4-RD patients. We assigned patients to clinical phenotypes: group 1 (pancreato-hepato-biliary), group 2 (retroperitoneal/aortic), group 3 (head and neck-limited), group 4 (Mikulicz/systemic), and group 5 (undefined). We focused the analysis on how sex, ethnicity, and clinical phenotype may influence the clinical and serological presentation. Results The mean age was 50.8 +/- 15 years. Men and women were equally affected (52.2% vs 48.8%). Fifty-four patients (29.3%) were assigned to group 1, 21 (11.4%) to group 2, 57 (30.9%) to group 3, 32 (17.4%) to group 4, and 20 (10.8%) to group 5. Male sex was associated with biliary tract (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.36-8.26), kidney (OR, 3.4; 95% CI, 1.28-9.25), and retroperitoneal involvement (OR, 5.3; 95% CI, 1.45-20). Amerindian patients presented more frequently with atopy history and gallbladder involvement. Group 3 had a female predominance. Conclusions Latin American patients with IgG4-RD were younger, and men and women were equally affected compared with White and Asian cohorts. They belonged more commonly to group 1 and group 3. Retroperitoneal and aortic involvement was infrequent. Clinical and serological features differed according to sex, ethnicity, and clinical phenotype.
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    Current status of the rheumatologists' workforce in Latin America: a PANLAR collaborative study
    (2021) Gerardo Fernandez-Avila, Daniel; Patino-Hernandez, Daniela; Kowalskii, Sergio; Vargas-Caselles, Alfredo; Sapag, Ana Maria; Cachafeiro-Vilar, Antonio; Melendez-Munoz, Lucia; Santiago-Pastelin, Carlos; Graf, Cesar; Rossetto, Chayanne; Palleiro, Daniel; Trincado, Daniela; Fernandez-Avila, Diana; Arrieta, Dina; Reyes, Gil; Baez, Jossiel Then; Ugarte-Gil, Manuel F.; Cardiel, Mario; Colman, Nelly; Chavez, Nilmo; Burgos, Paula, I; Montufar, Ruben; Sandino, Sayonara; Fuentes-Silva, Yurilis; Soriano, Enrique R.
    Introduction Studies conducted by various scientific societies have shown that the demand for specialized rheumatology care is greater than the projected growth of the workforce. Our research aims to assess the current status of the rheumatology workforce in Latin America.
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    Impact of COVID-19 pandemic on patients with rheumatic diseases in Latin America
    (2022) Fernandez-Avila, Daniel G.; Barahona-Correa, Julian; Romero-Alvernia, Diana; Kowalski, Sergio; Sapag, Ana; Cachafeiro-Vilar, Antonio; Melendez, Belia; Pastelin, Carlos; Palleiro, Daniel; Arrieta, Dina; Reyes, Gil; Pons-Estel, Guillermo J.; Then-Baez, Jossiell; Ugarte-Gil, Manuel F.; Cardiel, Mario H.; Colman, Nelly; Chavez, Nilmo; Burgos, Paula, I; Montufar, Ruben; Sandino, Sayonara; Fuentes-Silva, Yurilis J.; Soriano, Enrique R.
    The objective of our study was to describe knowledge, attitudes and practices of Latin-American rheumatology patients regarding management and follow-up of their disease during COVID-19 pandemic. A cross-sectional observational study was conducted using a digital anonymous survey. Rheumatic patients >= 18 years from non-English-speaking PANLAR countries were included. Our survey included 3502 rheumatic patients living in more than 19 Latin-American countries. Median age of patients was 45.8(36-55) years and the majority (88.9%) was female. Most frequently self-reported disease was rheumatoid arthritis (48.4%). At least one anti-rheumatic treatment was suspended by 23.4% of patients. Fear of contracting SARS-Cov2 (27.7%) and economic issues (25%) were the most common reasons for drug discontinuation. Self-rated disease activity increased from 30 (7-50) to 45 (10-70) points during the pandemic. Communication with their rheumatologist during the pandemic was required by 55.6% of patients, mainly by telephone calls (50.2%) and social network messages (47.8%). An adequate knowledge about COVID-19 was observed in 43% of patients. Patients with rheumatic diseases in Latin America were negatively affected by the COVID-19 pandemic. An increase in self-rated disease activity, a reduction in medication adherence, and hurdles for medical follow-up were reported. Teleconsultation was perceived as a valid alternative to in-person visits during the pandemic.
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    Impact of COVID-19 Pandemic on Rheumatology Practice in Latin America
    (2021) Fernandez-Avila, Daniel G.; Barahona-Correa, Julian; Romero-Alvernia, Diana; Kowalski, Sergio; Sapag, Ana; Cachafeiro-Vilar, Antonio; Melendez, Belia; Santiago-Pastelin, Carlos; Palleiro, Daniel; Arrieta, Dina; Reyes, Gil; Pons-Estel, Guillermo J.; Then-Baez, Jossiell; Ugarte-Gil, Manuel F.; Cardiel, Mario H.; Colman, Nelly; Chavez, Nilmo; Burgos, Paula, I; Montufar, Ruben; Sandino, Sayonara; Fuentes-Silva, Yurilis J.; Soriano, Enrique R.
    Objective. To describe the effect of the coronavirus disease 2019 (COVID-19) pandemic on Latin American rheumatologists from a professional, economic, and occupational point of view. Methods. We conducted an observational cross-sectional study using an online survey sent to rheuma-tologists of each non-English-speaking country member of the Pan American League of Rheumatology Associations (PANLAR). A specific questionnaire was developed. Results. Our survey included 1097 rheumatologists from 19 Latin American countries. Median (IQR) age of respondents was 48 (40-59) years and 618 (56.3%) were female. Duration of practice since graduation as a rheumatologist was 17 years, and 585 (53.3%) were aged < 50 years. Most rheumatologists worked in private practice (81.8%) and almost half worked in institutional outpatient centers (55%) and inpatient care (49.9%). The median number of weekly hours (IQR) of face-to-face practice before the pandemic was 27 (15-40) hours, but was reduced to 10 (5-20) hours during the pandemic. Telehealth was used by 866 (78.9%) respondents during the pandemic. Most common methods of communication were video calls (555; 50.6%), telephone calls (499; 45.5%), and WhatsApp voice calls (423; 38.6%). A reduction in monthly wages was reported by 946 (86.2%) respondents. Consultation fees also were reduced and 88 (8%) rheumatologists stated they had lost their jobs. A reduction in patient adherence to medication was reported by nearly 50% of respondents. Eighty-one (7.4%) rheumatologists received a COVID-19 diagnosis and 7 (8.6%) of them were hospitalized. Conclusion. The COVID-19 pandemic has reshaped rheumatology practice in Latin America and has had a profound effect on rheumatologists' behaviors and clinical practice.
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    Rheumatology Training in Latin America A Collaborative Study by the Pan American League of Associations for Rheumatology
    (2022) Fernandez-Avila, Daniel G.; Patino-Hernandez, Daniela; Kowalskii, Sergio; Vargas-Caselles, Alfredo; Sapag, Ana Maria; Cachafeiro-Vilar, Antonio; Melendez, Belia; Santiago-Pastelin, Carlos; Graf, Cesar; Rossetto, Chayanne; Palleiro, Daniel; Trincado, Daniela; Fernandez-Avila, Diana Carolina; Arrieta, Dina; Reyes, Gil; Baez, Jossiel Then; Ugarte-Gil, Manuel F.; Cardiel, Mario; Colman, Nelly; Chavez, Nilmo; Burgos, Paula, I; Montufar, Ruben; Sandino, Sayonara; Fuentes-Silva, Yurilis; Soriano, Enrique R.
    Background/Objective Demand for rheumatology care has steadily increased in recent years. The number of specialists in this field, however, seems insufficient. No recent studies have diagnosed the attributes of rheumatology training in Latin America. Methods This is a descriptive cross-sectional study. We obtained data on each country through local rheumatologists of the Pan-American League Against Rheumatism, who acted as principal investigators for participating countries. Our sample was analyzed and described through means and standard deviations or through frequencies and percentages, depending on the variable. Results Countries with the most rheumatology-training programs were Brazil (n = 50), Argentina (n = 18), and Mexico (n = 15). Ecuador, Honduras, and Nicaragua do not have rheumatology-training programs. The countries with the most available slots for rheumatology residents were Brazil (n = 126) and Argentina (n = 36). To be admitted into rheumatology training, candidates were required to have completed graduate studies in internal medicine in 42.1% of the programs. In 8 countries (42.1%), residents are not required to pay tuition; the median cost of tuition in the remaining countries is US $528 (interquartile range, US $2153). Conclusions Conditions associated with rheumatology training in Latin America vary. Significant differences exist in income and tuition fees for residents, for example, and 4 countries in Latin America do not currently offer programs. Information collected in this study will be useful when comparing the status of rheumatology services offered in Latin America with those in other countries. Most countries require a wider offering of rheumatology-training programs, as well as more available slots.
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    Smoking promotes exacerbated inflammatory features in dendritic cells of Chilean rheumatoid arthritis patients
    (2018) Prado, Carolina; Iruretagoyena, Mirentxu; Burgos, Paula, I; Pacheco, Rodrigo
    Background: The dual potential to promote tolerance or inflammation when facing self-antigens makes dendritic cells (DCs) fundamental players in autoimmunity. There is an association between smoking and DCs maturation in patients with rheumatoid arthritis (RA). However, ethnicity is a key factor in autoimmune disorders. Aim: To evaluate phenotypic and functional alterations of DCs obtained from Chilean patients with RA as compared to healthy controls (HC). In second term, to compare the inflammatory behaviour of DCs between smoker and non-smoker patients. Material and Methods: Monocyte-derived DCs and T-cells were obtained from blood samples isolated from 30 HC and 32 RA-patients, 14 of which were currently smokers and 18 non-smokers. Several maturation surface markers were evaluated in DCs, including HLA-DR, CD40, CD80, CD83 and CD86. Furthermore, autologous co-cultures of DCs and T-cells were carried out and then T-cell proliferation, and expansion of Th1, Th17 and Tregs were analysed. Results: Compared with HC, RA-patients displayed increased HLA-DR expression in DCs, which was manifested mainly in patients with moderate-to- high disease activity scores (DAS28). Furthermore, RA-patients presented a stronger Th17-expansion and a correlation between DAS28 and Th1-expansion. Both effects were mainly observed in patients in remission or with a low DAS28. Moreover, smoker RA-patients displayed enhanced HLA-DR and CD83 expression in DCs as well as an exacerbated Th17-expansion and a correlation between DAS28 and Th1-expansion. Conclusions: These findings suggest that smoking enhances the inflammatory behaviour of DCs and the consequent Th1 and Th17-mediated response in patients with RA