Mucopolysaccharidosis I, II, and VI: Brief review and guidelines for treatment

Mucopolysaccharidoses (MPS) are rare genetic diseases caused by the deficiency of one of the lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. This metabolic block leads to the accumulation of GAG in various organs and tissues of the affected patients, resulting in a multisystemic clinical picture, sometimes including cognitive impairment. Until the beginning of the XXI century, treatment was mainly supportive. Bone marrow transplantation improved the natural course of the disease in some types of MPS, but the morbidity and mortality restricted its use to selected cases. The identification of the genes involved, the new molecular biology tools and the availability of animal models made it possible to develop specific enzyme replacement therapies (ERT) for these diseases. At present, a great number of Brazilian medical centers from all regions of the country have experience with ERT for MPS I, II, and VI, acquired not only through patient treatment but also in clinical trials. Taking the three types of MPS together, over 200 patients have been treated with ERT in our country. This document summarizes the experience of the professionals involved, along with the data available in the international literature, bringing together and harmonizing the information available on the management of these severe and progressive diseases, thus disclosing new prospects for Brazilian patients affected by these conditions

Evolution of post-weaning skull ontogeny in New World opossums (Didelphidae)

Quantification of mammalian skull development has received much attention in the recent literature. Previous results in different lineages have shown an effect of historical legacy on patterns of skull growth. In marsupials, the skull of adults exhibits high variation across species, principally along a size axis. The development keys of the marsupial skull are fundamental to understanding the evolution of skull function in this clade. Its generally well-resolved phylogeny makes the group ideal for studying macroevolution of skull ontogeny. Here, we tested the hypothesis that ontogenetic similarity is correlated with phylogeny in New World marsupials, so that developmental patterns are expected to be conserved from ancestral opossums. We concatenated our previously published ontogenetic cranial data from several opossum species with new ontogenetic sequences and constructed an allometric space on the basis of a set of comparable cranial linear measurements. In this ontogenetic space, we determined the degree of correspondence of developmental patterns and the phylogeny of the group. In addition, we mapped ontogenetic trajectories onto the opossum phylogeny, treating the trajectories as composite, continuously varying characters. Didelphids differed widely in the magnitude of skull allometry across species. Splanchnocranial components exhibited all possible patterns of inter-specific variation, whereas mandibular variables were predominantly allometrically “positive” and neurocranial components were predominantly allometrically “negative.” The distribution of species in allometric space reflected the compounded effect of phylogeny and size variation characteristic of didelphids. The terminal morphology of related species differed in shape, so their ontogenetic trajectories deviated with respect to that of reconstructed common ancestors in varying degree. Phylogeny was the main factor structuring the allometric space of New World marsupials. Didelphids inherited an ancestral constellation of allometry coefficients without change and retained much of it throughout their lineage history. Conserved allometric values on the nodes splitting placental outgroups and marsupials suggest a developmental basis common to all therians.Fil: Flores, David A.. Fundación Miguel Lillo; ArgentinaFil: Giannini, Norberto Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - Tucumán. Unidad Ejecutora Lillo; ArgentinaFil: Abdala, Nestor Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - Tucumán. Unidad Ejecutora Lillo; Argentin

Blockade of the Renin-Angiotensin system in hypertensive patients with atherosclerotic renal artery stenosis.

Renin angiotensin system (RAS) blockers are generally considered as contraindicated when an atheromatous renal artery stenosis (ARAS) is diagnosed. The main reason is the fear of inducing renal ischemia and, hence, accelerating renal fibrosis and the progression towards end stage renal disease, albeit RAS blocker have been shown to be highly effective in controlling blood pressure. Part of the solution came by the development of the revascularization. There is now growing evidence showing no superiority of angioplasty over medical treatment on cardiovascular events and mortality, renal function and blood pressure control. Hence, RAS blockers resurfaced based on their proven beneficial effects on blood pressure control and cardiovascular prevention in high risk atherosclerotic patients. Thus, RAS blockers belong today to the standard treatment of hypertensive patients with ARAS. However they were not systematically prescribed in trials focusing on ARAS. The ongoing CORAL trial will give us further information on the place of this class of antihypertensive drugs in patients with ARAS