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Crohn Disease: HELP
Articles by Raquel Franco Leal
Based on 8 articles published since 2009
(Why 8 articles?)
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Between 2009 and 2019, R. F. Leal wrote the following 8 articles about Crohn Disease.
 
+ Citations + Abstracts
1 Guideline Crohn's disease - treatment with biological medication. 2019

Zaltman, Cyrla / Amarante, Heda / Brenner, Marta Machado / Costa, Marcia Henriques Magalhaes / Flores, Cristina / Leal, Raquel Franco / Grain, Jair Francisco de Santana / Zeroncio, Marco. ·Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil. · Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 100 Andar - Jardim Paulistano, São Paulo - SP, Brasil. · Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil. ·Rev Assoc Med Bras (1992) · Pubmed #31066809.

ABSTRACT: The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

2 Review THERAPIES FOR CROHN'S DISEASE: a clinical update. 2016

Sobrado, Carlos Walter / Leal, Raquel Franco / Sobrado, Lucas Faraco. ·Disciplina de Coloproctologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brasil. · Departamento de Cirurgia, Unidade de Coloproctologia, Universidade de Campinas (UNICAMP), Brasil. ·Arq Gastroenterol · Pubmed #27438429.

ABSTRACT: The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.

3 Article Serum Levels of Infliximab and Anti-Infliximab Antibodies in Brazilian Patients with Crohn's Disease. 2019

Gomes, Luis Eduardo Miani / da Silva, Francesca Aparecida Ramos / Pascoal, Lívia Bitencourt / Ricci, Renato Lazarin / Nogueira, Guilherme / Camargo, Michel Gardere / Lourdes Setsuko Ayrizono, Maria de / Fagundes, João José / Leal, Raquel Franco. ·Laboratorio de Investigacao em Doencas Inflamatorias Intestinais, Servico de Coloproctologia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR. · Laboratorio de Sinalizacao Celular, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR. ·Clinics (Sao Paulo) · Pubmed #30994711.

ABSTRACT: OBJECTIVES: The aim of this study was to evaluate the quantitative serum level of infliximab (IFX) as well as the detection of anti-infliximab antibodies (ATIs) in patients with Crohn's disease (CD). METHOD: Forty patients with CD under treatment at a tertiary center in southeastern Brazil were evaluated. Their use of infliximab was continuous and regular. We analyzed and compared the differences in the IFX and ATI levels between the patients with active CD (CDA) and those with CD in remission (CDR). RESULTS: There was no difference in the IFX level between the CDA and CDR groups (p>0.05). Eighty percent of all patients had IFX levels above the therapeutic concentration (6-10 μg/mL). Two (9%) of the 22 patients with active disease and four (22.2%) of the 18 patients in remission had undetectable levels of IFX. Four (66.6%) of the six patients with undetectable levels of IFX had positive ATI levels; three of these patients were in remission, and one had active disease. In addition, the other two patients with undetectable levels of IFX presented ATI levels close to positivity (2.7 and 2.8 AU/ml). None of the patients with therapeutic or supratherapeutic IFX levels had positive ATI levels. CONCLUSIONS: The undetectable levels of IFX correlated with the detection of ATIs, which was independent of disease activity. Immunogenicity was not the main factor for the loss of response to IFX in our study, and the majority of patients in both groups (CDA and CDR) had supratherapeutic levels of IFX.

4 Article Intestinal paracoccidioidomycosis resembling Crohn's disease in a teenager: a case report. 2018

Lomazi, Elizete Aparecida / de Negreiros, Leandro Minatel Vidal / Magalhães, Pedro Vitor Veiga Silva / Togni, Raquel de Castro Siqueira / de Paiva, Nielce Maria / Ribeiro, Antonio Fernando / Leal, Raquel Franco. ·Department of Pediatrics, University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil. · Inflammatory Bowel Disease Research Laboratory, University of Campinas, UNICAMP, João Lopes Vieira Street, no 108, 61, Tower 2, Campinas, Sao Paulo, 13087-734, Brazil. · Inflammatory Bowel Disease Research Laboratory, University of Campinas, UNICAMP, João Lopes Vieira Street, no 108, 61, Tower 2, Campinas, Sao Paulo, 13087-734, Brazil. rafranco.unicamp@gmail.com. ·J Med Case Rep · Pubmed #29706133.

ABSTRACT: BACKGROUND: Differential diagnosis of inflammatory bowel disease is often very challenging. Paracoccidioidomycosis is a fungal disease that can mimic manifestations of Crohn's disease. CASE PRESENTATION: We report a case of a 13-year-old Caucasian boy with abdominal pain for 1.5 years associated with nausea, diarrhea, and weight loss of 10 kg. He presented increased C-reactive protein and an increased erythrocyte sedimentation rate. A colonoscopy showed deep serpiginous ulcers throughout his entire colon and rectum, which suggested Crohn's disease. He received one dose of infliximab, which is an anti-tumor necrosis factor-α, and showed no improvement. After the second dose, he got worse and started to have bloody diarrhea. A new colonoscopy was performed and pathological examination revealed ulcerative chronic inflammation with non-caseating granulomas and fungal structures (budding forms) compatible with Paracoccidioides brasiliensis. He underwent intravenously administered and then orally administered trimethoprim-sulfamethoxazole treatment. Due to drug intolerance, he was treated with amphotericin B and itraconazole, then he showed clinical improvement and mucosal healing with good outcome. CONCLUSION: Paracoccidioidomycosis must be part of the differential diagnosis of inflammatory bowel diseases in endemic areas and must be excluded before starting immunosuppressive therapy.

5 Article Identification of inflammatory mediators in patients with Crohn's disease unresponsive to anti-TNFα therapy. 2015

Leal, Raquel Franco / Planell, Núria / Kajekar, Radhika / Lozano, Juan J / Ordás, Ingrid / Dotti, Isabella / Esteller, Miriam / Masamunt, M Carme / Parmar, Harsukh / Ricart, Elena / Panés, Julián / Salas, Azucena. ·Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain Postdoctoral CAPES fellow, Brazil. · Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain Bioinformatics Platform, CIBERehd, Barcelona, Spain. · Hoffmann-La Roche, Nutley, New Jersey, USA Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA. · Bioinformatics Platform, CIBERehd, Barcelona, Spain. · Department of Gastroenterology, IDIBAPS, Hospital Clínic, CIBERehd, Barcelona, Spain. · Hoffmann-La Roche, Nutley, New Jersey, USA EMD Serono Research & Development Institute, Boston, Massachusetts, USA. ·Gut · Pubmed #24700437.

ABSTRACT: BACKGROUND: Anti-tumour necrosis factor α (TNFα) therapy effectively induces and maintains remission in Crohn's disease (CD). Up to 40% of patients, however, fail to respond to anti-TNFα. OBJECTIVE: To identify the mechanisms underlying the persistence of mucosal lesions in patients who fail to respond to anti-TNFα therapy. DESIGN: An observational study based on whole-genome transcriptional analysis was carried out using intestinal biopsy specimens from patients with CD receiving (n=12) or not (n=10) anti-TNFα therapy. The transcriptional signature of responders was compared with that of non-responders after anti-TNFα therapy. Controls with non-inflammatory bowel disease (non-IBD) (n=17) were used for comparisons. Genes of interest were validated by real-time RT-PCR in an independent cohort of patients with CD receiving (n=17) or not (n=16) anti-TNFα and non-IBD controls (n=7). RESULTS: We confirmed that response to anti-TNFα is accompanied by significant regulation of a large number of genes, including IL1B, S100A8, CXCL1, which correlated with endoscopic activity. Remarkably, patients who failed to respond to anti-TNFα showed a mixed signature, maintaining increased expression of IL1B, IL17A and S100A8, while showing significant modulation of other genes commonly upregulated in active CD, including IL6 and IL23p19. CONCLUSIONS: Our results show that anti-TNFα therapy significantly downregulates a subset of inflammatory genes even in patients who fail to achieve endoscopic remission, suggesting that these genes may not be dominant in driving inflammation in non-responders. On the other hand, we identified IL1B and IL17A as genes that remained altered in non-responders, pointing to potentially more relevant targets for modulating mucosal damage in refractory patients.

6 Article Defective apoptosis in intestinal and mesenteric adipose tissue of Crohn's disease patients. 2014

Dias, Cilene Bicca / Milanski, Marciane / Portovedo, Mariana / Horita, Vivian / Ayrizono, Maria de Lourdes Setsuko / Planell, Núria / Coy, Cláudio Saddy Rodrigues / Velloso, Lício Augusto / Meirelles, Luciana Rodrigues / Leal, Raquel Franco. ·Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil; Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil; Doctoral CAPES fellowship, Post graduate Program in Surgery Sciences, Faculty of Medical School, University of Campinas, Sao Paulo, Brazil. · Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil. · Department of Pathology, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil. · Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil. · Department of Gastroenterology and Bioinformatics Platform, CIBERehd, Barcelona, Spain. · Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil; Laboratory of Cell Signaling, Internal Medicine Department, University of Campinas (UNICAMP), Medical School, Sao Paulo, Brazil. ·PLoS One · Pubmed #24887376.

ABSTRACT: BACKGROUND: Crohn's disease (CD) is associated with complex pathogenic pathways involving defects in apoptosis mechanisms. Recently, mesenteric adipose tissue (MAT) has been associated with CD ethiopathology, since adipose thickening is detected close to the affected intestinal area. However, the potential role of altered apoptosis in MAT of CD has not been addressed. AIMS: To evaluate apoptosis in the intestinal mucosa and MAT of patients with CD. METHODS: Samples of intestinal mucosa and MAT from patients with ileocecal CD and from non-inflammatory bowel diseases patients (controls) were studied. Apoptosis was assessed by TUNEL assay and correlated with the adipocytes histological morphometric analysis. The transcriptional and protein analysis of selected genes and proteins related to apoptosis were determined. RESULTS: TUNEL assay showed fewer apoptotic cells in CD, when compared to the control groups, both in the intestinal mucosa and in MAT. In addition, the number of apoptotic cells (TUNEL) correlated significantly with the area and perimeter of the adipose cells in MAT. Transcriptomic and proteomic analysis reveal a significantly lower transcript and protein levels of Bax in the intestinal mucosa of CD, compared to the controls; low protein levels of Bax were found localized in the lamina propria and not in the epithelium of this tissue. Furthermore, higher level of Bcl-2 and low level of Caspase 3 were seen in the MAT of CD patients. CONCLUSION: The defective apoptosis in MAT may explain the singular morphological characteristics of this tissue in CD, which may be implicated in the pathophysiology of the disease.

7 Article Serum levels and mesenteric fat tissue expression of adiponectin and leptin in patients with Crohn's disease. 2012

Rodrigues, V S / Milanski, M / Fagundes, J J / Torsoni, A S / Ayrizono, M L S / Nunez, C E C / Dias, C B / Meirelles, L R / Dalal, S / Coy, C S R / Velloso, L A / Leal, R F. ·Coloproctology Unit, Surgery Department, University of Campinas (UNICAMP), Sao Paulo, Brazil. ·Clin Exp Immunol · Pubmed #23121676.

ABSTRACT: Crohn's disease (CD) is characterized by inflammation and an aetiology that is still unknown. Hypertrophy of mesenteric fat is a reflection of disease activity, as this fat covers the entire length of the affected area. Adipocytes synthesize leptin and adiponectin, adipocytokines responsible for pro- and anti-inflammatory effects. Therefore, we evaluated serum levels of adiponectin and leptin, as well as mesenteral expression of adiponectin in active CD and those in remission. Sixteen patients with ileocaecal CD followed at the Outpatient Clinic, Coloproctology Unit of University of Campinas Clinical Hospital, participated in the study. Analysis of serum adiponectin and leptin by enzyme-linked immunosorbent assay was performed in patients with active CD (ACD group), remission CD (RCD group) and in six healthy controls. Ten patients with active ileocaecal CD (FCD group) and eight patients with non-inflammatory disease selected for surgery were also studied. The specimens were snap-frozen and the expression of adiponectin was determined by immunoblot of protein extracts. Serum C-reactive protein levels were higher in the ACD group when compared to the others and no difference of body mass index was observed between the groups. Serum adiponectin was lower in the ACD group when compared to control, but no differences were seen when comparing the ACD and RCD groups. Mesenteric adiponectin expression was lower in the FCD group when compared to the FC group. Serum leptin was similar in all groups. The lower levels of serum and mesenteric adiponectin in active CD suggest a defective regulation of anti-inflammatory pathways in CD pathogenesis.

8 Article Autophagy is decreased in mesenteric fat tissue but not in intestinal mucosae of patients with Crohn's disease. 2012

Leal, Raquel F / Coy, Cláudio S R / Velloso, Lício A / Dalal, Sushila / Portovedo, Mariana / Rodrigues, Viviane S / Coope, Andressa / Ayrizono, Maria L S / Fagundes, João J / Milanski, Marciane. ·Coloproctology Unit, Surgery Department, University of Campinas, Medical School, São Paulo, Brazil. raquelleal@mpc.com.br ·Cell Tissue Res · Pubmed #22948252.

ABSTRACT: Crohn's disease (CD) is a chronic intestinal disease with a multifactorial etiology. Recently, a role for mesenteric fat has been proposed in CD pathophysiology, since fat hypertrophy is detected close to the affected intestinal area; however, there are few studies regarding autophagy and the hypertrophied mesenteric tissue in CD. To evaluate autophagy-related proteins in intestinal mucosae and mesenteric fat of patients with CD and controls, patients with ileocecal CD (CD Group) and with non-inflammatory disease (FC Group) selected for surgery were studied. Expression of LC3-II was determined by immunoblotting of protein extracts. In addition, beclin-1, LC3 and Atg16-L1 RNA levels were measured using RT-PCR. The expression of LC3-II was significantly lower in the mesenteric tissue and higher in intestinal mucosae of CD when compared to controls. However, mRNA expression of autophagy-related proteins was similar when comparing the mesenteric fat groups. These findings suggest a defect in autophagy activation in the mesenteric fat tissue of CD individuals, which could be involved in the maintenance of the inflammatory process.