Antimicrobial screening of several lichen species and subsequent isolation and structure elucidat... more Antimicrobial screening of several lichen species and subsequent isolation and structure elucidation of active compounds revealed that the hydrolysis products of certain lichen metabolites, i.e., depsides, were active against gram-negative bacteria and fungi as well as gram-positive bacteria. The active constituents isolated from Stereocaulon alpinum and Peltigera aphthosa were identified, respectively, as methyl beta-orsellinate and a mixture of methyl and ethyl orsellinates. MIC determinations indicated that activity of these compounds was superior to that of the commonly used preservative agents methyl and propyl p-hydroxybenzoates and was of the same order as that of chlorocresol.
Resumo Introdução: O carácter sistémico das doenças auto-imunes, aliado à dificuldade diagnóstica... more Resumo Introdução: O carácter sistémico das doenças auto-imunes, aliado à dificuldade diagnóstica que por vezes apresentam, tornam-nas patologias tipicamente do foro da Medicina Interna. Apesar de se conhecer que muitos internistas portugueses se dedicam de forma especial à ...
We describe the clinical case of a 32-year-old woman with a previous diagnosis of thyroiditis, me... more We describe the clinical case of a 32-year-old woman with a previous diagnosis of thyroiditis, medicated with levothyroxin, and with a family history of hypothyroidism (sister). During the first term of pregnancy, a clinical state of worsening asthenia began, with inability to gain weight (3Kg throughout the pregnancy), alopecia, and hyperpigmentation of the skin and mucosal surfaces. These symptoms persisted after delivery, and the weight loss became worse (about 20%). Hypotension was also observed by this time. Laboratory tests showed hyponatremia and hypochloremia, very high plasma ACTH levels, and very low levels of plasma cortisol and plasma aldosterone. Other hormonal plasma levels were within the normal range. CT scans of the adrenal and pituitary glands were also normal. Study of autoantibodies revealed positive antithyroid antibodies. Diabetes mellitus was not present. After hydrocortisone was initiated, there was an improvement in the clinical state and laboratory results. We discuss polyglandular autoimmune syndrome type 2 in the context of the reported clinical case, bearing in mind the rarity of appearance of symptoms during pregnancy.
Abstract Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune hom... more Abstract Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis and preventing autoimmunity. Therefore, defects in Treg development, maintenance or function have been associated with several human autoimmune diseases including Systemic Lupus Erythematosus (SLE), a systemic autoimmune disease characterized by loss of tolerance to nuclear components and significantly more frequent in females. Results To investigate the involvement of Treg in SLE pathogenesis, we determined the frequency of CD4+CD25+CD45RO+ T cells, which encompass the majority of Treg activity, in the PBMC of 148 SLE patients (76 patients were part of 54 families), 166 relatives and 117 controls. SLE patients and their relatives were recruited in several Portuguese hospitals and through the Portuguese Lupus Association. Control individuals were blood donors recruited from several regional blood donor centers. Treg frequency was significantly lower in SLE patients than healthy ...
Aerococcus urinae is rarely reported as a human pathogen. The pathogenesis of this gram-positive ... more Aerococcus urinae is rarely reported as a human pathogen. The pathogenesis of this gram-positive coccus is not fully understood. It has been identified as a cause of urinary tract infections but may be associated with severe infections such as endocarditis and septicaemia. This paper presents a case of lymphadenitis caused by A. urinae.
In human systemic lupus erythematosus (SLE), diverse autoantibodies accumulate over years before ... more In human systemic lupus erythematosus (SLE), diverse autoantibodies accumulate over years before disease manifestation. Unaffected relatives of SLE patients frequently share a sustained production of autoantibodies with indiscriminable specificity, usually without ever acquiring the disease. We studied relations of IgG autoantibody profiles and peripheral blood activated regulatory T-cells (aTregs), represented by CD4(+)CD25(bright) T-cells that were regularly 70-90% Foxp3(+). We found consistent positive correlations of broad-range as well as specific SLE-associated IgG with aTreg frequencies within unaffected relatives, but not patients or unrelated controls. Our interpretation: unaffected relatives with shared genetic factors compensated pathogenic effects by aTregs engaged in parallel with the individual autoantibody production. To study this further, we applied a novel analytic approach named coreferentiality that tests the indirect relatedness of parameters in respect to multi...
To describe the clinical and immunologic characteristics of patients with adrenal involvement and... more To describe the clinical and immunologic characteristics of patients with adrenal involvement and antiphospholipid syndrome (APS), we conducted a computer-assisted (PubMed) search of the literature to identify all cases of primary adrenal insufficiency associated with antiphospholipid antibodies published in English, French, and Spanish from 1983 (when APS was first defined) through March 2002. We reviewed 86 patients (80 from the literature plus 6 from our cohort); 55% were male, and the mean age at presentation was 43 +/- 16 years. Sixty-one (71%) patients had primary APS, and 14 (16%) had systemic lupus erythematosus. In 31 (36%) patients, adrenal insufficiency was the first clinical manifestation of APS. Abdominal pain was present in 55% of patients, followed by hypotension (54%), fever (40%), nausea or vomiting (31%), weakness or fatigue (31%), and lethargy or altered mental status (19%). The main finding in imaging techniques was compatible with adrenal hemorrhage (59%) and in histopathologic study was a hemorrhagic infarction with vessel thrombosis (55%). Lupus anticoagulant was detected in 97% of patients and the anticardiolipin antibodies titer was positive in 93% of patients. Most patients (95%) were positive for the IgG isotype of anticardiolipin antibodies, whereas 40% were positive for the IgM isotype. Baseline cortisol levels were decreased in 98% of patients, ACTH hormone levels were increased in 96% of patients, and the cosyntropin stimulation test was positive in 100% of patients tested. Steroid replacement therapy was the most frequent treatment (84%), followed by anticoagulation (52%) and aspirin (6%). Thirty-two of 35 (91%) patients with prolonged anticoagulant therapy were in good health with a mean follow-up of 25 months, whereas 25 of the 69 (36%) patients with outcome data available had died. The results of the present review stress the clinical importance of systematic screening for lupus anticoagulant and anticardiolipin antibodies in all cases of adrenal hemorrhage or infarction. An initial screening for hypoadrenalism is mandatory in any antiphospholipid antibody-positive patient who complains of abdominal pain and undue weakness or asthenia.
Several lines of evidence implicate the Cytotoxic T Lymphocyte Antigen 4 (CTLA4) gene in suscepti... more Several lines of evidence implicate the Cytotoxic T Lymphocyte Antigen 4 (CTLA4) gene in susceptibility to autoimmune disease. We have examined the association of systemic lupus erythematosus (SLE) with polymorhisms within the CTLA4 gene that were previously proposed to regulate CTLA-4 function: a single nucleotide polymorphism (SNP) in position þ 49 of exon 1 and a dinucleotide repeat in the 3 0 untranslated region (3'UTR). The 3 0 UTR repeat showed a significant association with SLE, with one allele conferring susceptibility and another conferring protection to the disease. The associated alleles do not support previous suggestions of an allele size-dependent effect of the 3' UTR polymorphism in autoimmunity development and instead suggest that it is in linkage disequilibrium with a true causative locus. No association of the exon 1 SNP with SLE was found in our population. Given the conflicting results obtained in different studies on the association of SLE with this polymorphism, we performed a meta-analysis including seven previously published studies and the present one. Significantly increased and decreased risks for SLE were found for carriers of the G allele and the A allele, respectively. The functional characterization of disease-associated CTLA4 gene variants is now required to elucidate their role in the pathogenesis of SLE and other autoimmune diseases.
Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis ... more Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis and preventing autoimmunity. Therefore, defects in Treg development, maintenance or function have been associated with several human autoimmune diseases including Systemic Lupus Erythematosus (SLE), a systemic autoimmune disease characterized by loss of tolerance to nuclear components and significantly more frequent in females. Results To investigate the involvement of Treg in SLE pathogenesis, we determined the frequency of CD4+CD25+CD45RO+ T cells, which encompass the majority of Treg activity, in the PBMC of 148 SLE patients (76 patients were part of 54 families), 166 relatives and 117 controls. SLE patients and their relatives were recruited in several Portuguese hospitals and through the Portuguese Lupus Association. Control individuals were blood donors recruited from several regional blood donor centers. Treg frequency was significantly lower in SLE patients than healthy controls ...
Antimicrobial screening of several lichen species and subsequent isolation and structure elucidat... more Antimicrobial screening of several lichen species and subsequent isolation and structure elucidation of active compounds revealed that the hydrolysis products of certain lichen metabolites, i.e., depsides, were active against gram-negative bacteria and fungi as well as gram-positive bacteria. The active constituents isolated from Stereocaulon alpinum and Peltigera aphthosa were identified, respectively, as methyl beta-orsellinate and a mixture of methyl and ethyl orsellinates. MIC determinations indicated that activity of these compounds was superior to that of the commonly used preservative agents methyl and propyl p-hydroxybenzoates and was of the same order as that of chlorocresol.
Resumo Introdução: O carácter sistémico das doenças auto-imunes, aliado à dificuldade diagnóstica... more Resumo Introdução: O carácter sistémico das doenças auto-imunes, aliado à dificuldade diagnóstica que por vezes apresentam, tornam-nas patologias tipicamente do foro da Medicina Interna. Apesar de se conhecer que muitos internistas portugueses se dedicam de forma especial à ...
We describe the clinical case of a 32-year-old woman with a previous diagnosis of thyroiditis, me... more We describe the clinical case of a 32-year-old woman with a previous diagnosis of thyroiditis, medicated with levothyroxin, and with a family history of hypothyroidism (sister). During the first term of pregnancy, a clinical state of worsening asthenia began, with inability to gain weight (3Kg throughout the pregnancy), alopecia, and hyperpigmentation of the skin and mucosal surfaces. These symptoms persisted after delivery, and the weight loss became worse (about 20%). Hypotension was also observed by this time. Laboratory tests showed hyponatremia and hypochloremia, very high plasma ACTH levels, and very low levels of plasma cortisol and plasma aldosterone. Other hormonal plasma levels were within the normal range. CT scans of the adrenal and pituitary glands were also normal. Study of autoantibodies revealed positive antithyroid antibodies. Diabetes mellitus was not present. After hydrocortisone was initiated, there was an improvement in the clinical state and laboratory results. We discuss polyglandular autoimmune syndrome type 2 in the context of the reported clinical case, bearing in mind the rarity of appearance of symptoms during pregnancy.
Abstract Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune hom... more Abstract Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis and preventing autoimmunity. Therefore, defects in Treg development, maintenance or function have been associated with several human autoimmune diseases including Systemic Lupus Erythematosus (SLE), a systemic autoimmune disease characterized by loss of tolerance to nuclear components and significantly more frequent in females. Results To investigate the involvement of Treg in SLE pathogenesis, we determined the frequency of CD4+CD25+CD45RO+ T cells, which encompass the majority of Treg activity, in the PBMC of 148 SLE patients (76 patients were part of 54 families), 166 relatives and 117 controls. SLE patients and their relatives were recruited in several Portuguese hospitals and through the Portuguese Lupus Association. Control individuals were blood donors recruited from several regional blood donor centers. Treg frequency was significantly lower in SLE patients than healthy ...
Aerococcus urinae is rarely reported as a human pathogen. The pathogenesis of this gram-positive ... more Aerococcus urinae is rarely reported as a human pathogen. The pathogenesis of this gram-positive coccus is not fully understood. It has been identified as a cause of urinary tract infections but may be associated with severe infections such as endocarditis and septicaemia. This paper presents a case of lymphadenitis caused by A. urinae.
In human systemic lupus erythematosus (SLE), diverse autoantibodies accumulate over years before ... more In human systemic lupus erythematosus (SLE), diverse autoantibodies accumulate over years before disease manifestation. Unaffected relatives of SLE patients frequently share a sustained production of autoantibodies with indiscriminable specificity, usually without ever acquiring the disease. We studied relations of IgG autoantibody profiles and peripheral blood activated regulatory T-cells (aTregs), represented by CD4(+)CD25(bright) T-cells that were regularly 70-90% Foxp3(+). We found consistent positive correlations of broad-range as well as specific SLE-associated IgG with aTreg frequencies within unaffected relatives, but not patients or unrelated controls. Our interpretation: unaffected relatives with shared genetic factors compensated pathogenic effects by aTregs engaged in parallel with the individual autoantibody production. To study this further, we applied a novel analytic approach named coreferentiality that tests the indirect relatedness of parameters in respect to multi...
To describe the clinical and immunologic characteristics of patients with adrenal involvement and... more To describe the clinical and immunologic characteristics of patients with adrenal involvement and antiphospholipid syndrome (APS), we conducted a computer-assisted (PubMed) search of the literature to identify all cases of primary adrenal insufficiency associated with antiphospholipid antibodies published in English, French, and Spanish from 1983 (when APS was first defined) through March 2002. We reviewed 86 patients (80 from the literature plus 6 from our cohort); 55% were male, and the mean age at presentation was 43 +/- 16 years. Sixty-one (71%) patients had primary APS, and 14 (16%) had systemic lupus erythematosus. In 31 (36%) patients, adrenal insufficiency was the first clinical manifestation of APS. Abdominal pain was present in 55% of patients, followed by hypotension (54%), fever (40%), nausea or vomiting (31%), weakness or fatigue (31%), and lethargy or altered mental status (19%). The main finding in imaging techniques was compatible with adrenal hemorrhage (59%) and in histopathologic study was a hemorrhagic infarction with vessel thrombosis (55%). Lupus anticoagulant was detected in 97% of patients and the anticardiolipin antibodies titer was positive in 93% of patients. Most patients (95%) were positive for the IgG isotype of anticardiolipin antibodies, whereas 40% were positive for the IgM isotype. Baseline cortisol levels were decreased in 98% of patients, ACTH hormone levels were increased in 96% of patients, and the cosyntropin stimulation test was positive in 100% of patients tested. Steroid replacement therapy was the most frequent treatment (84%), followed by anticoagulation (52%) and aspirin (6%). Thirty-two of 35 (91%) patients with prolonged anticoagulant therapy were in good health with a mean follow-up of 25 months, whereas 25 of the 69 (36%) patients with outcome data available had died. The results of the present review stress the clinical importance of systematic screening for lupus anticoagulant and anticardiolipin antibodies in all cases of adrenal hemorrhage or infarction. An initial screening for hypoadrenalism is mandatory in any antiphospholipid antibody-positive patient who complains of abdominal pain and undue weakness or asthenia.
Several lines of evidence implicate the Cytotoxic T Lymphocyte Antigen 4 (CTLA4) gene in suscepti... more Several lines of evidence implicate the Cytotoxic T Lymphocyte Antigen 4 (CTLA4) gene in susceptibility to autoimmune disease. We have examined the association of systemic lupus erythematosus (SLE) with polymorhisms within the CTLA4 gene that were previously proposed to regulate CTLA-4 function: a single nucleotide polymorphism (SNP) in position þ 49 of exon 1 and a dinucleotide repeat in the 3 0 untranslated region (3'UTR). The 3 0 UTR repeat showed a significant association with SLE, with one allele conferring susceptibility and another conferring protection to the disease. The associated alleles do not support previous suggestions of an allele size-dependent effect of the 3' UTR polymorphism in autoimmunity development and instead suggest that it is in linkage disequilibrium with a true causative locus. No association of the exon 1 SNP with SLE was found in our population. Given the conflicting results obtained in different studies on the association of SLE with this polymorphism, we performed a meta-analysis including seven previously published studies and the present one. Significantly increased and decreased risks for SLE were found for carriers of the G allele and the A allele, respectively. The functional characterization of disease-associated CTLA4 gene variants is now required to elucidate their role in the pathogenesis of SLE and other autoimmune diseases.
Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis ... more Background CD4+CD25+ regulatory T cells play an essential role in maintaining immune homeostasis and preventing autoimmunity. Therefore, defects in Treg development, maintenance or function have been associated with several human autoimmune diseases including Systemic Lupus Erythematosus (SLE), a systemic autoimmune disease characterized by loss of tolerance to nuclear components and significantly more frequent in females. Results To investigate the involvement of Treg in SLE pathogenesis, we determined the frequency of CD4+CD25+CD45RO+ T cells, which encompass the majority of Treg activity, in the PBMC of 148 SLE patients (76 patients were part of 54 families), 166 relatives and 117 controls. SLE patients and their relatives were recruited in several Portuguese hospitals and through the Portuguese Lupus Association. Control individuals were blood donors recruited from several regional blood donor centers. Treg frequency was significantly lower in SLE patients than healthy controls ...
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Papers by Eugenia Santos