Vitamina D e LL-37 em Pacientes com Doença de Chagas
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Data
2018-02-23
Autores
Oliveira Junior, Luiz Roberto de
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O texto apresentado faz parte dos estudos sobre doença de Chagas (DC), suas formas clínicas e correlação com morbidades associadas à obesidade e envelhecimento e confeccionado para obtenção do título de Mestre em Doenças Tropicais. Ele é dividido em dois capítulos, no qual o primeiro texto compreende uma revisão bibliográfica sobre a doença de Chagas, vitamina D3 e catelicidina LL-37; e, no segundo capítulo, um artigo com dados descritivos da população de estudo intitulado de “FATORES DE RISCO CARDIOVASCULAR ASSOCIADOS À DOENÇA DE CHAGAS CRÔNICA” e um artigo intitulado de “VITAMINA D3, CATELICIDINA LL-37 E POLIMORFISMOS DO GENE VDR EM PACIENTES COM A FORMA INDETERMINADA E CARDÍACA DA DOENÇA DE CHAGAS”. Atualmente a DC é uma doença tropical negligenciada em todo o mundo e endêmica em 21 países latino-americanos, com mais de 25 milhões de pessoas em área de risco de transmissão. Afeta de 8 a 10 milhões de pessoas, sendo que no Brasil estima-se que existam 3 milhões de infectados, com 6 mil mortes por ano. Em sua fase crônica, tem a forma cardíaca como a manifestações mais importante da doença, tanto por sua frequência quanto por sua gravidade, com impacto social e financeiro, já que afetam os indivíduos na fase mais produtiva da vida (entre 30 e 50 anos), com altos índices de morbimortalidade. Além dos distúrbios no sistema de condução cardíaco, pode evoluir para manifestações mais graves como cardiomegalia, falência cardíaca e morte súbita. A inexistência de drogas eficazes para tratamento da doença em sua fase crônica requer o uso de terapias auxiliares que controlem os sintomas e melhorem a qualidade de vida dos pacientes, evitando complicações graves, progressão da doença e aumento da sobrevida. Mesmo existindo muitos trabalhos sobre a patogênese, cura e prevenção da DC, poucos associam esses pacientes com o risco de afecções que acometem a população geral. O envelhecimento dessa população tem favorecido aumento de fatores de risco cardiovasculares associados, como hipertensão arterial, diabetes mellitus, dislipidemias, hipotireoidismos, sobrepeso e outras cardiopatias. Essas comorbidades podem dificultar o tratamento e elevar seus gastos, além de afetar a qualidade de vida desses indivíduos infectados e acompanhados nos serviços de saúde. Dessa forma, o primeiro artigo investiga dos dados clínicos dos pacientes atendidos no Ambulatório de Doenças Tropicais do Hospital das Clínicas da Faculdade de Medicina de Botucatu com o objetivo de verificar as comorbidades associadas ao risco cardíaco. No segundo artigo foi realizada uma abordagem da hipovitaminose D3 e seu papel na produção de peptídeos antimicrobianos como a catelicidina LL-37 e suas associações com a obesidade que os acompanha. Essa condição foi escolhida devido à sua constante associação com a obesidade e seu papel na resposta imune contra diversos agentes infecciosos, e por ter se tornado um problema de saúde mundial. Esta deficiência pode estar relacionada ao sequestro da mesma pelo tecido adiposo com consequentes efeitos na resposta imune contra o T. cruzi e surgimento de manifestações clínicas mais graves da DC.
The text presented is part of the studies on Chagas disease (CD), its clinical forms and correlation with morbidities associated with obesity and aging and made for the title of Masters in Tropical Diseases. It is divided into two chapters, in which the first text comprises a literature review on Chagas disease, vitamin D3 and catatelicidin LL-37; and in the second chapter an article with descriptive data from the study population entitled "CARDIOVASCULAR RISK FACTORS ASSOCIATED WITH CHRONIC CHAGAS DISEASE" and an article entitled "VITAMIN D3, CATELICIDINE LL-37 AND VDR GENE POLYMORPHOSMS IN PATIENTS WITH THE UNDETERMINED AND HEART CHAGAS DISEASE FORM". Currently, CD is a neglected tropical disease worldwide and endemic in 21 Latin American countries, with more than 25 million people at risk of transmission. It affects 8 to 10 million people, and in Brazil it is estimated that there are 3 million infected, with 6 thousand deaths a year. In its chronic phase, it has the cardiac form as the most important manifestations of the disease, as much by its frequency as by its gravity, with social and financial impact, since they affect the individuals in the most productive phase of the life (between 30 and 50 years), with high morbidity and mortality rates. In addition to disturbances in the cardiac conduction system, it can progress to more serious manifestations such as cardiomegaly, heart failure and sudden death. The lack of effective drugs to treat the disease in its chronic phase requires the use of auxiliary therapies that control the symptoms and improve the patients quality of life, avoiding serious complications, disease progression and increased survival. Although there are many works on the pathogenesis, cure and prevention of CD, few associate these patients with the risk of affections that affect the general population. The aging of this population has favored an increase in associated cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, hypothyroidism, overweight and other heart diseases. These comorbidities may make it difficult to treat and increase their expenses, as well as affecting the quality of life of these infected individuals and being followed up at the health services. Thus, the first article investigates the clinical data of the patients treated at the Clinical for Tropical Diseases of the Medical School of Botucatu with the objective of verifying the comorbidities associated with cardiac risk. In the second article, an approach was performed on hypovitaminosis D3 and its role in the production of antimicrobial peptides such as cathelicidin LL-37 and its associations with accompanying obesity. This condition was chosen because of its constant association with obesity and its role in the immune response against various infectious agents, and because it has become a global health problem. This deficiency may be related to the kidnapping of the same by adipose tissue with consequent effects on the immune response against T. cruzi and onset of more severe clinical manifestations of CD
The text presented is part of the studies on Chagas disease (CD), its clinical forms and correlation with morbidities associated with obesity and aging and made for the title of Masters in Tropical Diseases. It is divided into two chapters, in which the first text comprises a literature review on Chagas disease, vitamin D3 and catatelicidin LL-37; and in the second chapter an article with descriptive data from the study population entitled "CARDIOVASCULAR RISK FACTORS ASSOCIATED WITH CHRONIC CHAGAS DISEASE" and an article entitled "VITAMIN D3, CATELICIDINE LL-37 AND VDR GENE POLYMORPHOSMS IN PATIENTS WITH THE UNDETERMINED AND HEART CHAGAS DISEASE FORM". Currently, CD is a neglected tropical disease worldwide and endemic in 21 Latin American countries, with more than 25 million people at risk of transmission. It affects 8 to 10 million people, and in Brazil it is estimated that there are 3 million infected, with 6 thousand deaths a year. In its chronic phase, it has the cardiac form as the most important manifestations of the disease, as much by its frequency as by its gravity, with social and financial impact, since they affect the individuals in the most productive phase of the life (between 30 and 50 years), with high morbidity and mortality rates. In addition to disturbances in the cardiac conduction system, it can progress to more serious manifestations such as cardiomegaly, heart failure and sudden death. The lack of effective drugs to treat the disease in its chronic phase requires the use of auxiliary therapies that control the symptoms and improve the patients quality of life, avoiding serious complications, disease progression and increased survival. Although there are many works on the pathogenesis, cure and prevention of CD, few associate these patients with the risk of affections that affect the general population. The aging of this population has favored an increase in associated cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, hypothyroidism, overweight and other heart diseases. These comorbidities may make it difficult to treat and increase their expenses, as well as affecting the quality of life of these infected individuals and being followed up at the health services. Thus, the first article investigates the clinical data of the patients treated at the Clinical for Tropical Diseases of the Medical School of Botucatu with the objective of verifying the comorbidities associated with cardiac risk. In the second article, an approach was performed on hypovitaminosis D3 and its role in the production of antimicrobial peptides such as cathelicidin LL-37 and its associations with accompanying obesity. This condition was chosen because of its constant association with obesity and its role in the immune response against various infectious agents, and because it has become a global health problem. This deficiency may be related to the kidnapping of the same by adipose tissue with consequent effects on the immune response against T. cruzi and onset of more severe clinical manifestations of CD
Descrição
Palavras-chave
Doença de Chagas, Vitamina D, Catelicidina, Gene VDR