New prophylactic and therapeutic treatments to combat pathogenic Enterohaemorrhagic Escherichia coli

Bacterial diarrhoeal diseases have significant influence on global human health, and are a leading cause of preventable death in the developing world. Enterohaemorrhagic Escherichia coli (EHEC), pathogenic strains of E. coli that carry potent toxins, have been associated with a high number of large-scale outbreaks caused by contaminated food and water sources. This pathotype produces diarrhoea and haemorrhagic colitis in infected humans, and in some patients leads to the development of haemolytic uremic syndrome (HUS), which can result in mortality and chronic kidney disease. A major obstacle to the treatment of EHEC infections is the increased risk of HUS development that is associated with antibiotic treatment, and rehydration and renal support are often the only options available. New treatments designed to prevent or clear E. coli infections and reduce symptoms of illness would therefore have large public health and economic impacts. The three main aims of this thesis were: to explore mouse models for pre-clinical evaluation in vivo of small compounds that inhibit a major EHEC colonisation factor, to assess the production and role of two proteins considered promising candidates for a broad-spectrum vaccine against pathogenic E. coli, and to investigate a novel compound that has recently been identified as a potential inhibitor of EHEC toxin production. As EHEC cannot be safely tested in humans due to the risk of HUS development, appropriate small animal models are required for in vivo testing of new drugs. A number of different mouse models have been developed to replicate different features of EHEC pathogenesis, several of which we investigated with a focus on colonisation mediated by the Type III Secretion System (T3SS), a needle-like structure that translocates bacterial proteins into host cells, resulting in a tight, intimate attachment between pathogen and host, aiding colonisation of the gastrointestinal tract. As E. coli models were found not to depend significantly on the T3SS for colonisation, the Citrobacter rodentium model, a natural mouse pathogen closely related to E. coli, was deemed the most suitable mouse model currently available for in vivo testing of T3SS-targeting compounds. Two bacterial proteins, EaeH (an outer membrane adhesin) and YghJ (a putative secreted lipoprotein), highly conserved surface-associated proteins recently identified as III protective antigens against E. coli infection of mice, were explored in order to determine their suitability as candidates for a human vaccine against pathogenic E. coli. We focused on the expression and function of these proteins in the EHEC O157:H7 EDL933 strain and the adherent-invasive E. coli (AIEC) LF82 strain. Although expression of EaeH by other E. coli pathotypes has recently been shown to be upregulated upon contact with host intestinal cells, no evidence of this upregulation could be demonstrated in our strains. Additionally, while YghJ was produced by the AIEC strain, it was not secreted by bacteria under conditions that other YghJ-expressing E. coli pathotypes do, despite the AIEC strain carrying all the genes required to encode the secretion system it is associated with. While our findings indicate that a vaccine that raises antibodies against EaeH and YghJ may have limited effect on the EHEC and AIEC strains we used, recent studies into these proteins in different E. coli pathogens have suggested they are still excellent candidates for a broadly effective vaccine against E. coli. Finally, we characterised a small lead compound, identified by high-throughput screening as a possible inhibitor of Shiga toxin expression. Shiga toxin production causes both the symptoms of illness and development of HUS, and thus reduction of toxin production, release, or binding to host receptors could therefore be an effective way to treat infections and decrease the risk of HUS. Inhibition of Shiga toxin production by this compound was confirmed, and was shown to be caused by an inhibitory effect on activation of the bacterial SOS response rather than on the Shiga toxin genes themselves. The bacterial target of this compound was identified as RecA, a major regulator of the SOS response, and we hypothesise that the compound binds covalently to its target, preventing oligomerisation of RecA into an activated filament. Altogether, the results presented here provide an improved understanding of these different approaches to combating EHEC infection, which will aid the development of safe and effective vaccines and anti-virulence treatments against EHEC.

Pharmacological and Toxicological Studies of Essential Oil of Lavandula stoechas subsp. luisieri.

The present study was carried out to evaluate the chemical and pharmacological properties of essential oil (EO) of Lavandula stoechas L. subsp. luisieri that is a spontaneous shrub widespread in Alentejo (Portugal). Oxygenated monoterpenes, as 1,8-cineole, lavandulol and necrodane derivatives are the main components of essential oil. It revealed important antioxidant activity with high ability to inhibit the lipid peroxidation and showed an outstanding effect against a wide spectrum of microorganisms, such as Gram-positive and Gram-negative bacteria and pathogenic yeasts. The analgesic effect studied in rats was dose dependent, reaching a maximum of 67 % at 60 min. with the dose of 200 mg/kg and the anti-inflammatory activity with this dose caused an inhibition in carrageenan-induced rat paw oedema (83 %) that is higher than dexamethasone 1 mg/Kg (69 %). Besides, animals exhibited a normal behaviour after EO administration revealing low toxicity. Essential oil of L. luisieri from Alentejo that presents important pharmacological properties and low toxicity is a promised candidate to be used as food supplement or in pharmaceutical applications.

An integrated approach for assessing the bioreceptivity of glazed tiles to phototrophic microorganisms

A laboratory-based methodology was designed to assess the bioreceptivity of glazed tiles. The experimental set-up consisted of multiple steps: manufacturing of pristine and artificially aged glazed tiles, enrichment of phototrophic microorganisms, inoculation of phototrophs on glazed tiles, incubation under optimal conditions and quantification of biomass. In addition, tile intrinsic properties were assessed to determine which material properties contributed to tile bioreceptivity. Biofilm growth and biomass were appraised by digital image analysis, colorimetry and chlorophyll a analysis. SEM, micro-Raman and micro-particle induced X-ray emission analyses were carried out to investigate the biodeteriorating potential of phototrophic microorganisms on the glazed tiles. This practical and multidisciplinary approach showed that the accelerated colonization conditions allowed different types of tile bioreceptivity to be distinguished and to be related to precise characteristics of the material. Aged tiles showed higher bioreceptivity than pristine tiles due to their higher capillarity and permeability. Moreover, biophysical deterioration caused by chasmoendolithic growth was observed on colonized tile surfaces.

Rock paintings and microorganisms: a new insight on Escoural cave

European cave art is of tremendous importance to understand the cultural traditions of the Upper Palaeolithic (35 000 – 10 000 BP) populations. Indeed, Prehistoric communities performed numerous cave paintings all over Western Europe. Understanding these artworks should provide a better knowledge of these early cultural aspects. Although numerous studies have been carried out to analyse the materials used by those communities, nothing has been done on the techniques’ palette of Escoural Cave’s representations. The present work aims at providing the very first data about the techniques and materials used by the Prehistoric to perform the cave paintings of Escoural (Alentejo, Portugal), and the microorganisms possibly endangering this unique parietal art. In situ observations coupled with an extensive micro-sampling and micro-destructive analyses allowed to characterize the coloured material and the way they were applied on the walls of the cave. Both red and black pigments present major composition’s disparities among the different paintings and drawings, supporting a more complex occupations’ chronology than what was earlier thought. The Palaeolithic paintings have suffered deterioration from environmental conditions and include chemical, mechanical and aesthetic alterations, possibly as a result of fungal activity. The standard techniques for biological assessments used in these contexts provided important insights on the diversity of the microbial population, though they have accuracy limitations. To understand the extent and viability of the existing microbiota, DNA quantification and biomarkers analyses, such as desidrogenase activity were performed and correlated with ergosterol amounts; RESUMO: A Arte Rupestre Europeia é de grande importância para compreender as tradições culturais da população do Paleolítico Superior (35 000 - 10 000 BP). De fato, as comunidades Pré-históricas realizaram inúmeras pinturas rupestres em toda a Europa Ocidental, sendo crucial compreender estas obras de forma a proporcionar um melhor conhecimento destes ancestrais aspectos culturais. Embora vários estudos tenham sido realizados para analisar os materiais utilizados por estas comunidades, nada foi efetuado sobre a técnica de execução das representações presentes na Gruta do Escoural. O presente trabalho visa fornecer os primeiros dados sobre as técnicas e materiais utilizados na Pré-História para executar as pinturas rupestres de Escoural (Alentejo, Portugal) bem como caracterização dos microorganismos possivelmente associados aos danos deste bem único. Observações in situ, juntamente com uma extensa micro-amostragem e análises micro-destrutivas permitiu caracterizar os pigmentos utilizados e a forma como eles foram aplicados nas paredes da caverna. Tanto os pigmentos vermelhos como os pretos apresentam composição distinta nas diversas pinturas e desenhos aí representados, apoiando a presença de diferentes ocupações contrariamente ao que se pensava até então. As pinturas Paleolíticas têm sofrido deterioração, devido às condições ambientais, nomeadamente alterações químicas, mecânicas e, possivelmente como resultado da atividade fúngica. As técnicas usualmente utilizadas para a avaliação de contaminação biológica fornecem informação importante sobre a diversidade da população microbiana, embora apresentem algumas limitações. Para entender a extensão e a viabilidade da microbiota existente, a quantificação de DNA e análise de biomarcadores como actividade de desidrogenases foram realizadas e correlacionadas com o conteúdo em ergosterol.

Inimigos naturais da parte aérea da cultura de milho tratada com EM (Eficient Microorganisms), na região de Guaíra-SP.

As pragas da parte aérea da cultura de milho na regiao de Guaira-SP sao atacadas pelos inimigos naturais Doru luteipes Cycloneda sanguinea, Chrysoperla externa, Callida sp., Zelus sp., Geocoris sp., varias especies de aranhas e parasitoides. Este trabalho teve como objetivo avaliar o efeito do EM (efficient microorganisms) sobre a fauna benéfica dessa cultura. Foram avaliados 5 campos sendo 3 deles conduzidos pelo sistema de plantio convencional e 2 deles sob sistema de plantio direto. Cada campo foi divido em 4 faixas (parcelas), sendo 2 delas tratadas com EM e duas sem aplicação do produto, que serviram de testemunhas. No campo 1 foram feitas 3 avaliações, nos estágios de 4-6 folhas, 8-10 folhas de espigamento, tendo sido constatado no tratamento PCEM (plantio convencional com EM), 7,56%, 43,99% e 32,83% de inimigos naturais; no tratamento PC (testemunha) foram encontrados 14,22%, 52,07% e 28,19%, respectivamente. No campo 2 foram feitas 2 avaliações nos estágios de 12-14 folhas e no de espigamento, tendo sido obtidos no tratamento PCEM, 21,90% e 31,79%; em PC, 19,53% e 25,53%. No campo 3 foram feitas 2 avaliações, ambas no estagio de espigamento, tendo sido encontrados em PCEM 18,81% e 13,78; em PC, 26,28% e 16,71%. No campo 4 , sob plantio direto, foram feitas 3 avaliações nos estágios de 6-8 folhas, e 2 avaliações no estagio espigamento, tendo sido obtidos em PDEM 13,71%,31,44% e 18,00%; em PD, 11,41%, 28,15% e 18,74%. No campo 5 teve 2 avaliações, nos estágios de 8-10 folhas e no de espigamento, obtendo-se em PDEM 17,22% e 30,96%; em PD, 20,24% e 30,38. A medida que a cultura envelhece, em ambos os sistemas de condução da cultura as parcelas tratadas com EM tendem a apresentar maior proporção de inimigos naturais.

Inimigos naturais da parte aérea da cultura de feijão tratada co EM (Efficient Microorganisms), na região de Guaíra.

Os inimigos naturais de pragas da cultura de feijão constituídas por aranhas, Chrysoperla externa, Cycloneda sanguínea, Zelus sp., Geocoris sp. e Nabis sp. são importantes controladores de pragas dessa cultura. Este trabalho teve como objetivo testar o efeito de EM (efficient microorganisms) sobre a fauna de organismos benéficos. Foram avaliados 5 campos, sendo três deles conduzidos pelo sistema de plantio convencional (campos 1,2 e 3) e dois deles pelo sistema de plantio direto (campos 4 e 5). No campo 1 foram feitas 3 avaliações com a cultura nos estágios V4, R6 e R7, tendo sido encontrados nas parcelas tratadas com EM (PCEM), 19,735, 17,89%, 7,87% de inimigos naturais, enquanto nas parcelas testemunhas sem aplicação de EM (PC), 25,70%, 15,94% e 13,54%. No campo 2 foram feitas 2 avaliações nos estágios R6 e R7, tendo sido encontrados nas parcelas PCEM 20,20% e 15,84%; nas parcelas PC esses percentuais foram de 18,83, e 13,66. No campo 3 foram feitas 2 avaliações nos estagios R7 e R9, obtendo-se em PCEM, 18,16% e 20,37%, enquanto em PC, 22,59% e 14,90% de inimigos naturais. No campo 4 foi feita uma única avaliação no estagio R7 e os resultados foram de 21,47% (PDEM) e 22,89% (PD). No campo 5 foram feitas duas avaliações nos estágios R6 e R7, obtendo-se em PDEM 22,05% e 18,89%; no tratamento PD, 28,80 e 24,54%. Estes resultados se referem ao primeiro ano de aplicacao de EM, devendo ser repetidas nos anos seguintes, nos quais se espera maior percentual de inimigos naturais nas parcelas tratadas com EM que na parcelas testemunhas, o que já esta ocorrendo nos campos 2 e 3.

Erythropoietin reduces pathogenic humoral immunity by inhibiting T Follicular Helper cell differentiation and function

A large fraction of organ transplant recipients develop anti-donor antibodies (DSA), with accelerated graft loss and increased mortality. We tested the hypothesis that erythropoietin (EPO) reduces DSA formation by inhibiting T follicular helper (TFH) cells. We measured DSA levels, splenic TFH, TFR cells, germinal center (GC), and class switched B cells, in murine models of allogeneic sensitization, allogeneic transplantation and in parent-to-F1 models of graft versus host disease (GVHD). We quantified the same cell subsets and specific antibodies, upon EPO or vehicle treatment, in wild type mice and animals lacking EPO receptor selectively on T or B cells, immunized with T-independent or T-dependent stimuli. In vitro, we tested the EPO effect on TFH induction. We isolated TFH and TFR cells to perform in vitro assay and clarify their role. EPO reduced DSA levels, GC, class switched B cells, and increased the TFR/TFH ratio in the heart transplanted mice and in two GVHD models. EPO did also reduce TFH and GC B cells in SRBC-immunized mice, while had no effect in TNP-AECM-FICOLL-immunized animals, indicating that EPO inhibits GC B cells by targeting TFH cells. EPO effects were absent in T cells EPOR conditional KO mice, confirming that EPO affects TFH in vivo through EPOR. In vitro, EPO affected TFH induction through an EPO-EPOR-STAT5-dependent pathway. Suppression assay demonstrated that the reduction of IgG antibodies was dependent on TFH cells, sustaining the central role of the subset in this EPO-mediated mechanism. In conclusion, EPO prevents DSA formation in mice through a direct suppression of TFH. Development of DSA is associated with high risk of graft rejection, giving our data a strong rationale for studies testing the hypothesis that EPO administration prevents their formation in organ transplant recipients. Our findings provide a foundation for testing EPO as a treatment of antibody mediated disease processes.

Microbiome and resitome and foods of animal origin

To ensure food safety and to prevent food-borne illnesses, rapid and accurate detection of pathogenic agents is essential. It has already been demonstrated that shotgun metagenomic sequencing can be used to detect pathogens and their antibiotic resistance genes in food. In the studies presented in this thesis, the application shotgun metagenomic sequencing has been applied to investigate both the microbiome and resistome of foods of animal origin in order to assess advantages and disadvantages of shotgun metagenomic sequencing in comparison to the cultural methods. In the first study, it has been shown that shotgun metagenomics can be applied to detect microorganisms experimentally spiked in cold-smoked salmon. Nevertheless, a direct correlation between cell concentration of each spiked microorganism and number of corresponding reads cannot be established yet. In the second and third studies, the microbiomes and resistomes characterizing caeca and the corresponding carcasses of the birds reared in the conventional and antibiotic free farms were compared. The results highlighted the need to reduce sources of microbial contamination and antimicrobial resistance not only at the farm level but also at the post-harvest one. In the fourth study, it has been demonstrated that testing a single aliquot of a food homogenate is representative of the whole homogenate because biological replicates displayed overlapping taxonomic and functional composition. All in all, the results obtained confirmed that the application of shotgun metagenomic sequencing represents a powerful tool that can be used in the identification of both spoilage and pathogenic microorganism, and their resistome in foods of animal origin. However, a robust relationship between sequence read abundance and concentration of colony-forming unit must be still established.

Epilepsies Associated With Hippocampal Sclerosis.

Hippocampal sclerosis (HS) is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy (MTLE). Hippocampal specimens of pharmacoresistant MTLE patients that underwent epilepsy surgery for seizure control reveal the characteristic pattern of segmental neuronal cell loss and concomitant astrogliosis. However, classification issues of hippocampal lesion patterns have been a matter of intense debate. International consensus classification has only recently provided significant progress for comparisons of neurosurgical and clinic-pathological series between different centers. The respective four-tiered classification system of the International League Against Epilepsy subdivides HS into three types and includes a term of gliosis only, no-HS. Future studies will be necessary to investigate whether each of these subtypes of HS may be related to different etiological factors or with postoperative memory and seizure outcome. Molecular studies have provided potential deeper insights into the pathogenesis of HS and MTLE on the basis of epilepsy-surgical hippocampal specimens and corresponding animal models. These include channelopathies, activation of NMDA receptors, and other conditions related to Ca(2+) influx into neurons, the imbalance of Ca(2+)-binding proteins, acquired channelopathies that increase neuronal excitability, paraneoplastic and non-paraneoplastic inflammatory events, and epigenetic regulation promoting or facilitating hippocampal epileptogenesis. Genetic predisposition for HS is clearly suggested by the high incidence of family history in patients with HS, and by familial MTLE with HS. So far, it is clear that HS is multifactorial and there is no individual pathogenic factor either necessary or sufficient to generate this intriguing histopathological condition. The obvious variety of pathogenetic combinations underlying HS may explain the multitude of clinical presentations, different responses to clinical and surgical treatment. We believe that the stratification of neuropathological patterns can help to characterize specific clinic-pathological entities and predict the postsurgical seizure control in an improved fashion.

Microbial Evaluation Of Traumatized Teeth Treated With Triple Antibiotic Paste Or Calcium Hydroxide With 2% Chlorhexidine Gel In Pulp Revascularization.

Revascularization outcome depends on microbial elimination because apical repair will not happen in the presence of infected tissues. This study evaluated the microbial composition of traumatized immature teeth and assessed their reduction during different stages of the revascularization procedures performed with 2 intracanal medicaments. Fifteen patients (7-17 years old) with immature teeth were submitted to the revascularization procedures; they were divided into 2 groups according to the intracanal medicament used: TAP group (n = 7), medicated with a triple antibiotic paste, and CHP group (n = 8), dressed with calcium hydroxide + 2% chlorhexidine gel. Samples were taken before any treatment (S1), after irrigation with 6% NaOCl (S2), after irrigation with 2% chlorhexidine (S3), after intracanal dressing (S4), and after 17% EDTA irrigation (S5). Cultivable bacteria recovered from the 5 stages were counted and identified by means of polymerase chain reaction assay (16S rRNA). Both groups had colony-forming unit counts significantly reduced after S2 (P < .05); however, no significant difference was found between the irrigants (S2 and S3, P = .99). No difference in bacteria counts was found between the intracanal medicaments used (P = .95). The most prevalent bacteria detected were Actinomyces naeslundii (66.67%), followed by Porphyromonas endodontalis, Parvimonas micra, and Fusobacterium nucleatum, which were detected in 33.34% of the root canals. An average of 2.13 species per canal was found, and no statistical correlation was observed between bacterial species and clinical/radiographic features. The microbial profile of infected immature teeth is similar to that of primarily infected permanent teeth. The greatest bacterial reduction was promoted by the irrigation solutions. The revascularization protocols that used the tested intracanal medicaments were efficient in reducing viable bacteria in necrotic immature teeth.

Inhibitory Effects Of A Cured Antibacterial Bonding System On Viability And Metabolic Activity Of Oral Bacteria.

To evaluate the antimicrobial efficacy of Clearfil SE Protect (CP) and Clearfil SE Bond (CB) after curing and rinsed against five individual oral microorganisms as well as a mixture of bacterial culture prepared from the selected test organisms. Bacterial suspensions were prepared from single species of Streptococcus mutans, Streptococcus sobrinus, Streptococcus gordonii, Actinomyces viscosus and Lactobacillus lactis, as well as mixed bacterial suspensions from these organisms. Dentin bonding system discs (6 mm×2 mm) were prepared, cured, washed and placed on the bacterial suspension of single species or multispecies bacteria for 15, 30 and 60 min. MTT, Live/Dead bacterial viability (antibacterial effect), and XTT (metabolic activity) assays were used to test the two dentin system's antibacterial effect. All assays were done in triplicates and each experiment repeated at least three times. Data were submitted to ANOVA and Scheffe's f-test (5%). Greater than 40% bacteria killing was seen within 15 min, and the killing progressed with increasing time of incubation with CP discs. However, a longer (60 min) period of incubation was required by CP to achieve similar antimicrobial effect against mixed bacterial suspension. CB had no significant effect on the viability or metabolic activity of the test microorganisms when compared to the control bacterial culture. CP was significantly effective in reducing the viability and metabolic activity of the test organisms. The results demonstrated the antimicrobial efficacy of CP both on single and multispecies bacterial culture. CP may be beneficial in reducing bacterial infections in cavity preparations in clinical dentistry.

Defective Apoptosis In Intestinal And Mesenteric Adipose Tissue Of Crohn's Disease Patients.

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. To evaluate apoptosis in the intestinal mucosa and MAT of patients with CD. 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. 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. 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.

Mucopolysaccharidosis Type Ii: Identification Of 30 Novel Mutations Among Latin American Patients.

In this study, 103 unrelated South-American patients with mucopolysaccharidosis type II (MPS II) were investigated aiming at the identification of iduronate-2-sulfatase (IDS) disease causing mutations and the possibility of some insights on the genotype-phenotype correlation The strategy used for genotyping involved the identification of the previously reported inversion/disruption of the IDS gene by PCR and screening for other mutations by PCR/SSCP. The exons with altered mobility on SSCP were sequenced, as well as all the exons of patients with no SSCP alteration. By using this strategy, we were able to find the pathogenic mutation in all patients. Alterations such as inversion/disruption and partial/total deletions of the IDS gene were found in 20/103 (19%) patients. Small insertions/deletions/indels (<22 bp) and point mutations were identified in 83/103 (88%) patients, including 30 novel mutations; except for a higher frequency of small duplications in relation to small deletions, the frequencies of major and minor alterations found in our sample are in accordance with those described in the literature.

Chronic Telogen Effluvium And Female Pattern Hair Loss Are Separate And Distinct Forms Of Alopecia: A Histomorphometric And Immunohistochemical Analysis.

Chronic telogen effluvium (CTE), a poorly understood condition, can be confused with or may be a prodrome to female pattern hair loss (FPHL). The pathogenesis of both is related to follicle cycle shortening and possibly to blood supply changes. To analyze a number of histomorphometric and immunohistochemical findings through vascular endothelial growth factor (VEGF), Ki-67, and CD31 immunostaining in scalp biopsies of 20 patients with CTE, 17 patients with mild FPHL and 9 controls. Ki-67 index and VEGF optical density were analyzed at the follicular outer sheath using ImageJ software. CD31 microvessel density was assessed by a Chalkley grid. Significant follicle miniaturization and higher density of nonanagen follicles were found in FPHL, compared with patients with CTE and controls. Ki-67+ index correlated positively with FPHL histological features. The FPHL group showed the highest VEGF optical density, followed by the CTE and control groups. No differences were found in CD31 microvessel density between the three groups. Histomorphometric results establish CTE as a distinct disorder, separate from FPHL from its outset. Its pathogenic mechanisms are also distinct. These findings support the proposed mechanism of 'immediate telogen release' for CTE, leading to cycle synchronization. For FPHL, accelerated anagen follicular mitotic rates and, thus, higher Ki-67 and VEGF values, would leave less time for differentiation, resulting in hair miniaturization.