Pathophysiology of Bradykinin-Mediated Angioedema: The Role of the Complement System

The “complement system” is one of the effector pathways of the immune system against microorganisms and tumor cells. The complement system can be activated through three major pathways: classical, lectin, and alternative. The sequential activation through the generation of complex enzymes from inactive zymogens produces a cascade in which a capable enzyme generates a large number of active downstream molecules

Short‐Term Prophylaxis in Odontostomatological, Maxillofacial and ENT Procedures in Patients with Hereditary Angioedema Due to C1‐Inhibitor Deficiency

Oestrogens, trauma, infections or stress has been described as triggers for angioedema (AE) attacks in patients with hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE). Microtrauma can precipitate the onset of acute AE attacks, and thus, dental-oral procedures carry a high risk of triggering them and also an increased risk of death from asphyxiation due to the AE location. In the past, without proper specific treatment, the overall mortality after dental surgery in patients with C1-INH-HAE was up to 30–40%. Some dental-oral, medical and/or surgical procedures are susceptible to receive “short-term prophylaxis” (STP) in order to reduce the risk of AE. We describe the published case reports of dental-oral, maxillofacial and ear, nose and throat (ENT) procedures in patients with C1-INH-HAE. Different consensus algorithms and clinical guidelines have been published for managing dental-oral, maxillofacial and otolaryngological procedures (DOMFOPs) and will be reviewed below. Based on the clinical experience of the Department of Allergology of the University Hospital La Paz (Madrid) and the University General Hospital Nuestra Señora del Prado (Talavera de la Reina), these algorithms have been updated and modified. We advise to classify procedures according to the risk of producing AE as minor, intermediate and major risks

Eficacia y seguridad de la profilaxis a corto plazo con andrógenos atenuados y/o concentrado plasmático de C1 inhibidor en la relación de procedimientos odontoestomatológicos, maxilofaciales y otorrinolaringológicos en pacientes con angiodema hereditario por déficit de la proteína inhibidor de la C1 Esterasa funcionalmente activa

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 17-10-2017Esta tesis tiene embargado el acceso al texto completo hasta el 17-04-201

Current and Future Asthma Treatments: Phenotypical Approach on the Path to Personalized Medicine in Asthma

Despite widely available and effective treatments, achieving asthma control is still an unmet need for many patients. One of the explanations resides perhaps in the heterogeneity of the disease. Asthma is in fact, as we understand it today, a complex syndrome made up of numerous disease variants or asthma phenotypes; when the different underlying mechanisms are identified, the more ambitious term “endotype” is used, with consequent therapeutic implications. Remarkable efforts have been made to identify the features of difficult-to-control (usually severe) asthma, which are different from those described for mild-to-moderate asthma, setting the stage for the development of new and even individualized therapies. As different drugs target different pathways, it is necessary to determine the individual profile of pathophysiological abnormalities for each patient. The most fascinating options of the new asthma treatments are the monoclonal antibodies targeted against key inflammatory cytokines, and the most proximately available treatments within the next years are discussed here. Also, current evidence and understanding of somehow older therapeutic options, such as anticholinergics, thermoplasty, or omalizumab, are reviewed from a phenotypical approach

Bradykinin-Mediated Angioedema Across the History

The origins of the discovery of the “Complement System” date from the second half of the nineteenth century. The official paternity of the Complement System is attributed to Jules Bordet. The complement system can be activated through three major pathways. The classical pathway, the alternative pathway, and the lectin pathway converge in a common final lytic pathway. Hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency (C1-INH-HAE) was first described by Robert Graves in his clinical lectures. The autosomal dominant pattern of HAE was recognized by Sir William Osler. The pathophysiologic basis of C1-INH-HAE as a deficiency of a plasma inhibitor was discovered in the early 1960s. In 1986, the C1NH gene was identified, which encodes the C1-INH protein. Although the possible relationship between angioedema and estrogens in women was described as early as 1986, it was not until the first decade of the twenty-first century when several series of patients with HAE were described with normal levels of the fractions of the complement system. In the last decade, several drugs have been approved and marketed in Europe, in the United States, and in other countries, contributing to the improved management of C1-INH-HAE and patient’s quality of life

Caracterización de variantes somaclonales de olivo obtenidos tras la exposición al filtrado crudo del hongo Rosellinia necatrix.

Líneas embriogénicas de olivo tolerantes al filtrado crudo (FC) del hongo Rosellinia necatrix, un patógeno muy extendido por el sur de España y que afecta al aguacate y al olivo, fueron previamente obtenidas (Palomo-Ríos et al. 2017). Dos de estas líneas fueron seleccionadas para la regeneración de plantas, R2-L3 y R2-L4, ambas tolerantes al 60% (v/v) del FC del hongo. En este trabajo se ha llevado a cabo una caracterización del crecimiento de estas plantas y de su comportamiento tras la inoculación con R. necatrix.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech