Reggio Emilia (Northern Italy) Interdisciplinary Uveitis Clinic: What We Have Learned in the Last 20 Years

PURPOSE

To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center.

METHODS

Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center.

RESULTS

Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs.

CONCLUSIONS

The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.

Children with perinatally acquired HIV exhibit distinct immune responses to 4CMenB vaccine

Children with perinatally acquired HIV (PHIV) have special vaccination needs, as they make suboptimal immune responses. Here, we evaluated safety and immunogenicity of 2 doses of 4-component group B meningococcal vaccine in antiretroviral therapy-treated children with PHIV and healthy controls (HCs). Assessments included the standard human serum bactericidal antibody (hSBA) assay and measurement of IgG titers against capsular group B Neisseria meningitidis antigens (fHbp, NHBA, NadA). The B cell compartment and vaccine-induced antigen-specific (fHbp+) B cells were investigated by flow cytometry, and gene expression was investigated by multiplexed real-time PCR. A good safety and immunogenicity profile was shown in both groups; however, PHIV demonstrated a reduced immunogenicity compared with HCs. Additionally, PHIV showed a reduced frequency of fHbp+ and an altered B cell subset distribution, with higher fHbp+ frequency in activated memory and tissue-like memory B cells. Gene expression analyses on these cells revealed distinct mechanisms between PHIV and HC seroconverters. Overall, these data suggest that PHIV presents a diverse immune signature following vaccination. The impact of such perturbation on long-term maintenance of vaccine-induced immunity should be further evaluated in vulnerable populations, such as people with PHIV.

How CD4+ T Cells Transcriptional Profile Is Affected by Culture Conditions: Towards the Design of Optimal In Vitro HIV Reactivation Assays

Most of the current assays directed at the investigation of HIV reactivation are based on cultures of infected cells such as Peripheral Blood Mononuclear Cells (PBMCs) or isolated CD4+ T cells, stimulated in vitro with different activator molecules. The culture media in these in vitro tests lack many age- and donor-specific immunomodulatory components normally found within the autologous plasma. This triggered our interest in understanding the impact that different matrices and cell types have on T cell transcriptional profiles following in vitro culture and stimulation.

METHODS

Unstimulated or stimulated CD4+ T cells of three young adults with perinatal HIV-infection were isolated from PBMCs before or after culture in RPMI medium or autologous plasma. Transcriptomes were sequenced using Oxford Nanopore technologies.

RESULTS

Transcriptional profiles revealed the activation of similar pathways upon stimulation in both media with a higher magnitude of TCR cascade activation in CD4+ lymphocytes cultured in RPMI.

CONCLUSIONS

These results suggest that for studies aiming at quantifying the magnitude of biological mechanisms under T cell activation, the autologous plasma could better approximate the in vivo environment. Conversely, if the study aims at defining qualitative aspects, then RPMI culture could provide more evident results.

Preliminary assessment of persistent organic pollutants (POPs) in tissues of Risso's dolphin (Grampus griseus) specimens stranded along the Italian coasts

Ecotoxicological and pathological research on Grampus griseus (Cuvier, 1812) (Risso's dolphins) is scarce both globally and in the Mediterranean Sea. This species has been classified as "Vulnerable" by the International Union for Conservation of Nature (IUCN) in the Mediterranean Sea. To evaluate the presence of "persistent organic pollutants" (POPs), especially organochlorine compounds (OCs), in the animals, chemical analyses were performed on tissues and organs of Risso's dolphin stranded along the Italian coasts between 1998 and 2021. Toxic contaminants such as hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane and its metabolites (DDTs) were examined in the blubber, liver, muscle, and brain of 20 animals, and data was correlated with sex, age, and stranding locations.

Transcriptomic landscape of TIMP3 oncosuppressor activity in thyroid carcinoma

BACKGROUND

Papillary thyroid cancer (PTC) is the most frequent thyroid tumor. The tissue inhibitor of metalloproteinase-3 (TIMP3) gene encodes a matrix metalloproteinases inhibitor that exerts a tumor suppressor role in several tumor types. TIMP3 is frequently downregulated in PTC by promoter methylation. We have previously functionally demonstrated that TIMP3 exerts an oncosuppressor role in PTC: TIMP3 restoration in the PTC-derived NIM1 cell line affects in vitro migration, invasion and adhesive capability, while reduces tumor growth, angiogenesis and macrophage recruitment in vivo. To get a deeper insight on the mediators of TIMP3 oncosuppressor activity in thyroid tumors, here we focused on the TIMP3 related transcriptome.

METHODS

TCGA database was used for investigating the genes differentially expressed in PTC samples with low and high TIMP3 expression. Genome wide expression analysis of clones NIM1-T23 (expressing a high level of TIMP3 protein) and NIM1-EV (control empty vector) was performed. Gene sets and functional enrichment analysis with clusterProfiler were applied to identify the modulated biological processes and pathways. CIBERSORT was used to evaluate the distribution of different immunological cell types in TCGA-PTC tumor samples with different TIMP3 expression levels. Real time PCR was performed for the validation of selected genes.

RESULTS

Thyroid tumors with TIMP3-high expression showed a down-modulation of inflammation-related gene sets, along with a reduced protumoral hematopoietic cells fraction; an enrichment of cell adhesion functions was also identified. Similar results were obtained in the TIMP3-overexpessing NIM1 cells in vitro model, where a down-regulation of immune-related function gene sets, some of which also identified in tumor samples, was observed. Interestingly, through enrichment analysis, were also recognized terms related to cell adhesion, extracellular matrix organization, blood vessel maintenance and vascular process functions that have been found modulated in our previous in vitro and in vivo functional studies.

CONCLUSIONS

Our results highlight the correlation of TIMP3 expression levels with the regulation of inflammatory functions and the immune infiltration composition associated with different PTC prognosis, thus providing a broader view on the oncosuppressor role of TIMP3 in PTC.

Cast iron street furniture: A historical review

The term "street furniture" indicates objects mostly made of cast iron alloys and aimed to improve the quality of life in urban settlements, such as street lamps, fountains and gazebos. These objects are often ancient and relevant as cultural heritage. Despite the constant presence of street furniture in urban settlements, studies of its evolution along centuries are limited. Since functional aspects have been often considered prevalent against artistic and historical values, many objects have been considered obsolete, thus replaced or re-melted. Street furniture rarely received attention by scholars, and studies on this topic have been often incomplete. This study reviews the history of street furniture made of cast iron (CI street furniture), first examining the reasons behind the choice of this material, closely related to its diffusion during the First Industrial Revolution. The review discusses the relationship between CI street furniture and cultural heritage based on artistic, aesthetic and ethical issues, also examining historical catalogs. The development of CI street furniture in United Kingdom, France and Italy is reported, together with their local aspects. The production technique is discussed and the importance of preservation of CI street furniture is highlighted, emphasizing the need for globally planned interventions in this field.

Is there a relationship between stature and age of onset of type 2 Diabetes?

AIMS

MSP1A and MSP1B polymorphic sites located in the GH genomic area have been found associated with GH response to insulin stimulation, with familiar short stature and with age at onset of Type 2 Diabetes (T2D). These observations prompted us to search for a possible relationship between stature and age at onset of the disease.

METHODS

We have reexamined the data of 272 subjects with T2D mellitus.

RESULTS

There is a highly significant negative correlation between stature and age at onset in non obese females (p < 0.001) but not in obese females and in males. In non obese females with stature within the first quartile the mean age at onset is 62 years while in those with a stature greater than the first quartlile the mean age at onset is 52 yesrs (p < 0.001). No difference is observed in obese females and males.

CONCLUSIONS

These observations suggest the existence of different mechanisms underlying susceptibility to T2D. In addition to the well known increased risk due to obesity, endocrine dysfunctions related to genetic variability within the GH genomic area could represent another mechanism operating in non obese females. A cluster of non obese women characterized by short stature and late onset of diabetes seems to be separated by this mechanism from other women.

Smoking and hypertension: Effect of adenosine deaminase polymorphism

Adenosine modulates cardiovascular functions reducing blood pressure and heart rate. Adenosine deaminase (ADA) by the irreversible deamination of adenosine to inosine contributes to the regulation of adenosine concentration in body fluids. We have studied the interaction between smoking and ADA genetic variability concerning their effects on blood pressure. We have studied 344 subjects admitted to the hospital for cardiovascular diseases. The genotypes of two polymorphic loci within the ADA gene were determined: ADA₁ and ADA₂. Both loci show two alleles: ADA₁*1 and ADA₁*2 in ADA₁ locus and ADA₂*1 and ADA₂*2 in ADA₂ locus. In the absence of smoking, the proportion of subjects with hypertension tends to be lower in carriers of the ADA₁*2 allele. In smoking subjects, the pattern is reversed and the proportion of those with hypertension tends to be higher in carriers of the ADA₁*2 allele. A similar pattern is observed for ADA₂ locus. Smoking increases the proportion of subjects showing hypertension: such effect is more marked in those carrying the ADA₁*2 allele as compared to subjects with ADA₁*1/*1 genotype. The same pattern of association is observed for ADA₂ locus. The two loci show an additive effect. The odds ratio for hypertension in smokers vs nonsmokers is 1.450 in subjects carrying ADA₁*1/*1 and ADA₂*1/*1 genotypes, while it is 11.200 in subjects carrying the *2 alleles in both loci. From a practical point, a view of our results suggest that smokers carrying both ADA₁*2 and ADA₂*2 alleles have a higher risk of hypertension.

An outbreak of severe invasive meningococcal disease due to a capsular switched Neisseria meningitidis hypervirulent strain B:cc11

OBJECTIVES

The aim was to investigate an outbreak of invasive meningococcal disease (IMD) in Southern Sardinia.

METHODS

Epidemiological and microbiological investigations were performed. The latter included antimicrobial susceptibility testing and whole-genome sequencing (WGS).

RESULTS

Seven individuals with severe IMD were found to be infected with serogroup B (MenB) Neisseria meningitidis in the first quarter of 2018. Five of the seven cases (five males; mean age 19 years; range 18-21 years; CFR 40%) were due to a unique strain B:P1.5-1,10-8:F3-6:ST-11(cc11), probably switched from the hypervirulent C-cc11, as confirmed by WGS. All five patients had attended the same nightclub in the 2 weeks prior to symptom onset. Public health measures, including chemoprophylaxis of contacts and active immunization against MenB, were implemented.

CONCLUSIONS

We observed five IMD cases due to the same switched MenB strain. The hypervirulent B:P1.5-1,10-8:F3-6:ST-11(cc11) strain, probably switched from C-cc11, is of concern due to the observed high virulence and case fatality rates. All the patients shared the same place of probable exposure. The molecular characterization of the invasive strain allowed the outbreak to be confirmed, which was then controlled through timely public health action.

Measuring public knowledge, attitudes, and behaviors related to radon to inform cancer control activities and practices

Radon exposure is the second leading risk factor for lung cancer among smokers and the leading risk factor among non-smokers. Radon concentrated in lower levels of homes/buildings can be reduced if found, thus lowering lung cancer risk. The objective of this study was to measure radon knowledge in diverse populations, with varying radon-related laws, to inform radon-related cancer control practices and activities. A survey was mailed to 3000 homebuyers who purchased single-family homes; 995 responses (33%) were received. Overall, 86% of respondents heard of radon-related health issues. Real estate agents (69%) or home inspectors (65%) were the most common sources of information. Respondents were more likely to test their home for radon if they reported previously hearing of radon-related health issues or understanding of how radon-related health issues affect the home-buying process. Respondents in states with notification policies were twice as likely as those without policies to have heard about radon-related health issues (OR 2.01, 95% CI: 1.27-3.17). This study provides useful information for cancer control activities including that education is positively associated with home testing for radon. It also suggests partnering with real estate agents to further radon education and testing efforts to reduce radon exposure and lung cancer risk.

Non-Hodgkin's Lymphoma Associated with Sickle Cell Disease: A Case Report

A case of non-Hodgkin's lymphoma with leukemic spread in a patient affected with homozygous sickle cell disease is reported. This association has not been previously described. A correlation between the malignancy and the hemoglobinopathy could not be etiologically ascertained; therefore, an alternative explanation to a chance event cannot be offered.