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Vitamina D e Immunità - F. Alebardi

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Vitamina D e immunità

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Vitamina D e Immunità - F. Alebardi

  1. 1. 3 luglio 2015, Bologna Dott. Fabrizio Alebardi Vit D e immunità Il vecchio dottor sole
  2. 2. Dott. Fabrizio Alebardi Saint John White Hospital Brembana valley
  3. 3. Dott. Fabrizio Alebardi Saint John White Hospital
  4. 4. San Giovanni Bianco ( Bg )
  5. 5. La realtà che incontro ogni giorno
  6. 6. Un tempo c’era la tubercolosi . Oggi stanno aumentando le patologie tumorali,…e non solo
  7. 7. ci stanno facendo credere che sia scientifico e molto terapeutico ciò che forse non lo è ?
  8. 8. Dott. Fabrizio Alebardi Saint John White Hospital Il motto che mi sono prefisso
  9. 9. “Bimbi sani in Val Brembana”
  10. 10. Dott. Fabrizio Alebardi Saint John White Hospital E allora… se vogliamo iniziare a guarire i bambini dobbiamo pensare anche al dott. Finsen
  11. 11. Nel 1903 il Nobel per la medicina viene assegnato a Niels Ryberg Finsen (1860-1904)
  12. 12. Niels Ryberg Finsen (1860-1904) Il Nobel nel 1903 gli viene dato Per i suoi studi sull’uso della luce per la cura delle lesioni cutanee da vaiolo e successivamente del lupus volgare
  13. 13. I medici non lo conoscono, ma gli astronomi si, e gli hanno dedicato un Cratere lunare (dedicato a Finsen)
  14. 14. Il vaiolo e il lupus vulgaris a fine 800’ erano un problema grave e diffuso
  15. 15. Perché ci è arrivato proprio il dott. Finsen ?
  16. 16. Le sue macchine della luce si diffonderanno in tutto il Nord Europa
  17. 17. Dott. Fabrizio Alebardi Saint John White Hospital
  18. 18. Come al solito, un medico italiano aveva forse anticipato Finsen il dott. Antonino Sciascia
  19. 19. Antonino Sciascia (Canicattì, 1839 – 1925) Viene ritenuto da vari studiosi pioniere e precursore nel campo della fototerapia, di cui descrisse l'utilizzo nel 1892 al XIII Congresso Oftalmologico di Palermo e nel 1894 all'XI Congresso Medico Internazionale di Roma.
  20. 20. Il macchinario originale, che l’inventore costruì per applicare i trattamenti cromatici, fu chiamato Fotocauterio e venne brevettato : nel 1894.
  21. 21. Niels Ryberg Finsen (1860-1904) si era procurato dei lontani discepoli.
  22. 22. Erano due medici sulle Alpi svizzere
  23. 23. Il dott. Oskar Bernhard lavorava a Samedan e St. Moritz
  24. 24. dott. Oskar Bernhard 1861 Samedan – 1939 St. Moritz
  25. 25. Il dott. Oskar Bernhard si era infatuato di Finsen e conosceva il proverbio dei montanari italiani: “dove entra il sole non entra il medico”
  26. 26. L’altro medico svizzero era Auguste Rollier ( 1874-1954)
  27. 27. Auguste Rollier ( 1874-1954) A Berna aveva studiato chirurgia con Emil Theodor Kocher (Berna 1841 -1917) uno dei più abili chirurghi dell’epoca, Nobel 1909
  28. 28. La storia del dott. Rollier Un giorno un amico di Auguste Rollier, inizia ad avere dei bubboni...
  29. 29. Tubercolosi dell’anca
  30. 30. Successivamente anche la sua fidanzata si ammalò di tubercolosi
  31. 31. Auguste Rollier ( 1874-1954) Nel 1903 a 29 aa lascia la chirurgia : si era convinto che i bisturi, i sieri e la chimica non potessero nulla contro la tubercolosi …in confronto alla semplice e non costosa luce del sole
  32. 32. Aveva osservato che la luce del sole sa attivare le attività anti-microbiche nei corpi martoriati e distrutti dalla tubercolosi.
  33. 33. Auguste Rollier ( 1874-1954) Nel 1889 osservò come i figli dei contadini con cui giocava avessero un corpo più robusto e gagliardo. ”Erano superiori a me in modo umiliante”
  34. 34. Anche il suo cane gli diede una proficua lezione. Gli era cresciuto un tumore sulla schiena : L’aveva operato e gli aveva applicato un accurato bendaggio,
  35. 35. Ma il cane ogni volta si strappava le bende ed esponeva la sua ferita aperta al sole: la ferità guarì perfettamente
  36. 36. Auguste Rollier ( 1874-1954) Si trasferì a Leysin
  37. 37. Leysin
  38. 38. Nel 1909 a 35 aa fonda lo stabilimento di Frênes, la prima grande clinica aperta del Dr. Rollier
  39. 39. Era una specie di hôtel confortevole con una sala dove venivano proiettati ai pazienti dei film , eseguiti concerti e altri divertimenti.
  40. 40. I pazienti arrivavano alla stazione di Territet vicino a Montreux dove all’epoca arrivavano i treni internazionali come l'Orient-Express;
  41. 41. prendevano la cremagliera che dopo 1900 metri arrivava alla stazione di Leysin
  42. 42. Le case di cura avevano ampi terrazzi
  43. 43. Les frenes cresceva e vi arrivava sempre più gente
  44. 44. chalet per l’esposizione al sole, finirà per possederne 18
  45. 45. Grande attenzione venne rivolta alla cura dei bambini Bagni di sole a Leysin
  46. 46. Anche il tetto era occupato da un ampio solarium accessibile tramite un ascensore.
  47. 47. Ora di ricreazione Oggi lo avrebbero denunciato
  48. 48. Auguste Rollier ( 1874-1954) “I bambini iniziavano a guarire quando la pelle diventava color marrone”
  49. 49. In un epoca in cui non esistevano altri rimedi, i pazienti arrivavano da tutta Europa…perché guarivano
  50. 50. A proposito di qualità della vita e bontà delle cure
  51. 51. Mentre guariscono ascoltano la musica..
  52. 52. Convalescenza dal dott. Rollier Anche gli adulti dovevano giocare con perizoma
  53. 53. Leysin Il pomeriggio tutti a «La cremerie moderne»
  54. 54. finezze… Urinari a Leysin ciascuno con il posacenere
  55. 55. A Leysin la gente restava mesi
  56. 56. Quando eravamo più saggi i costi della sanità era inferiori
  57. 57. Attrezzatura per guarire dalla tubercolosi, e da altre numerose malattie infettive…
  58. 58. Nel 1943 venne scoperta la streptomicina , da parte di Albert Schatz (assistente di Selman Waksman) il primo antibiotico utile (1946) contro la tubercolosi .
  59. 59. Fu il primo trial ufficiale in doppio cieco
  60. 60. Sir Austin Bradford Hill 8 July 1897 – 18 April 1991 ritenuto colui che validò il primo studio in doppio cieco
  61. 61. Isoniazide (1952) idrazide dell’ac.isonicotinico
  62. 62. Ora assisterete a un “miracolo” del sole
  63. 63. Tubercolosi vertebrale
  64. 64. Tubercolosi morbo di Pott
  65. 65. Crollo vertebrale da tubercolosi cosa farebbe oggi la nostra medicina?
  66. 66. a questo bimbo hanno tagliato longitudinalmente la schiena ….
  67. 67. Interventi altamente scientifici pubblicati sulle migliori riviste internazionali
  68. 68. Questa schiena è stata ricostruita dal sole
  69. 69. Dott. Fabrizio Alebardi Saint John White Hospital Ma perché quelle persone guarivano ?
  70. 70. Perché il sole e la vitamina D erano in grado di ridurre le infezioni ?
  71. 71. 1997 Le catelicidine
  72. 72. Ma cosa sono le catelicidine? scrive Richard.L. Gallo dermatologo califoniano in un articolo pubblicato su Nature : "Abbiamo osservato una spiccata attività antibiotica in una famiglia di proteine chiamate catelicidine, che sono presenti sulla superficie degli epiteli e nei neutrofili".
  73. 73. Le catelicidine sono peptidi, contenuti nei granuli dei polimorfonucleati neutrofili dei mammiferi (Ganz T. et al, 1997), uomo compreso, che presentando un'attività antimicrobica nei confronti di batteri, funghi, protozoi e virus dotati di peplos, rivestono un importante ruolo nella difesa dell'ospite (Bals R. et al., 1999).
  74. 74. L'attività delle catelicidine e la loro localizzazione nei neutrofili, negli epiteli e nelle mucose (Frohm Nilsson M. et al., 1999), induce a ipotizzare un loro contributo nell'immunità naturale innata.
  75. 75. Sono una famiglia di polipeptidi trovati nei lisosomi dei macrofagi e dei leucociti polimorfonucleati
  76. 76. Le catelicidine sono dei peptidi formati da 12 a 80 AA (in media 23-37 AA) ed hanno una struttura variabile
  77. 77. Richard.L. Gallo le catelicidine "Questa proteina è riscontrabile in grandi quantità vicino alle ferite esterne, perché viene rilasciata con la degranulazione dei neutrofili e dai cheratinociti".
  78. 78. Catelicidine sono state trovate anche nelle cellule epiteliali
  79. 79. Cathelicidin Antimicrobial Peptides are Expressed in Salivary Glands and Saliva M. Murakami, T. Ohtake, R.A. Dorschner and Richard.L. Gallo* Division of Dermatology, University of California San Diego; and VA San Diego Healthcare Center, San Diego, CA 92161, USA;
  80. 80. Le cellule mieloidi non sono l'unico sito di espressione delle catelicidine. La catelicidina umana LL-37, ad es., si trova nei testicoli (Agerberth B. et al., 1995) e in vari epiteli dove aumenta quantitativamente nel corso di stati infiammatori (Frohm Nilsson M. et al., 1999).
  81. 81. Le catelicidine rapidamente distruggono le membrane lipoproteiche dei microbi fagocitati dai macrofagi
  82. 82. I peptidi derivati dalle catelicidine presentano un ampio spettro d'azione e la capacità di legare e neutralizzare le endotossine.
  83. 83. Ma chi regola la produzione di catelicidine ?
  84. 84. E chi fa produrre le catelicidine? Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25- dihydroxyvitamin D3 Adrian F. Gombart*,1, Niels Borregaard and H. Phillip Koeffler* * Department of Medicine, Division of Hematology/Oncology, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; and The Granulocyte Research Laboratory, Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark 1 Correspondence: Division of Hematology/Oncology, Cedars-Sinai Medical Center, Davis Bldg. 5019, 8700 Beverly Blvd., Los Angeles, CA 90048, USA.
  85. 85. Meccanismo di azione della 1,25 OH vit D sul DNA nucleare:
  86. 86. la 1,25 OH vit D si lega ad una proteina nucleare (recettore VDR) formando un complesso che a sua volta si lega ad un'altra proteina nucleare (recettore per retinoidi RXR):
  87. 87. questo nuovo complesso si lega ad una regione del DNA (VDRE responsiva alla vitamina D) adiacente al gene da attivare:
  88. 88. viene così innescato il processo di trascrizione del DNA - mRNA che migrando nel citoplasma sintetizza la catelicidina mediante i ribosomi: la proteina viene così messa a disposizione dell'organismo.
  89. 89. Abbiamo l’Interpretazione della relazione: tubercolosi, radiazione solare, vit D guarigione:
  90. 90. catelicidina:proteina con proprietà di antibiotico
  91. 91. Qualcuno dirà: ma oggi non c’è più tanta tubercolosi
  92. 92. Tubercolosi: assurdo iniziare una protocollo farmacologico internazionale con tre farmaci, e non controllare vit D e paratormone,
  93. 93. Ma questo vale anche per lo streptococco !!!
  94. 94. Conclusioni Vit D è un importante regolatore del sistema immunologico, controlla centinaia di geni
  95. 95. Immunità La vit D che influenza il sistema immunitario è prevalentemente la 1-25 Oh vit D
  96. 96. Grazie dell’attenzione

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