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Mariotto S, Ferrari S, Gastaldi M, Franciotta D, Sechi E, Capra R, Mancinelli C, Schanda K, Alberti D, Orlandi R, Bombardi R, Zuliani L, Zoccarato M, Benedetti MD, Tanel R, Calabria F, Rossi F, Pavone A, Grazian L, Sechi G, Batzu L, Murdeu N, Janes F, Fetoni V, Fulitano D, Stenta G, Federle L, Cantalupo G, Reindl M, Monaco S, Gajofatto A. Neurofilament light chain serum levels reflect disease severity in MOG-Ab associated disorders. J Neurol Neurosurg Psychiatry 2019; 90:1293-1296. [PMID: 30952681 DOI: 10.1136/jnnp-2018-320287] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/03/2022]
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Mariotto S, Gajofatto A, Batzu L, Delogu R, Sechi G, Leoni S, Pirastru MI, Bonetti B, Zanoni M, Alberti D, Schanda K, Monaco S, Reindl M, Ferrari S. Relevance of antibodies to myelin oligodendrocyte glycoprotein in CSF of seronegative cases. Neurology 2019; 93:e1867-e1872. [PMID: 31645473 DOI: 10.1212/wnl.0000000000008479] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/20/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the diagnostic relevance of myelin oligodendrocyte glycoprotein antibodies (MOG-Abs) in CSF of seronegative cases by retrospectively analyzing consecutive time-matched CSF of 80 MOG-Ab-seronegative patients with demyelinating disease. METHODS The cohort included 44 patients with NMOSD and related disorders and 36 patients with multiple sclerosis (MS). Two independent neurologists blinded to diagnosis analyzed MOG-Abs by live cell-based immunofluorescence assay with goat anti-human immunoglobulin (Ig) G (whole molecule) antibody. Sera were tested at dilutions of 1:20 and 1:40, and a cutoff of 1:160 was considered for serum positivity. CSF specimens were tested undiluted and at 1:2 dilution with further titrations in case of positivity. Anti-IgG-Fc and anti-IgM-µ secondary antibodies were used to confirm the exclusive presence of MOG-IgG in positive cases. CSF of 13 MOG-Abs seropositive cases and 36 patients with neurodegenerative conditions was analyzed as controls. RESULTS Three seronegative cases had CSF MOG-Abs (4% of the whole cohort or 7% of cases excluding patients with MS, in which MOG-Abs seem to lack diagnostic relevance). In particular, 2 patients with neuromyelitis optica spectrum disorder (NMOSD) and 1 with acute disseminated encephalomyelitis had MOG-Abs in CSF. Analysis with anti-IgG-Fc and anti-IgM confirmed the exclusive presence of MOG-IgG in the CSF of these patients. Among the control group, MOG-Abs were detectable in the CSF of 8 of 13 MOG-Ab-seropositive cases and in none of the patients with neurodegenerative disorders. CONCLUSION Although serum is the optimal specimen for MOG-Ab testing, analyzing CSF could improve diagnostic sensitivity in seronegative patients. This observation has relevant diagnostic impact and might provide novel insight into the biological mechanisms of MOG-Ab synthesis.
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Bongianni M, Ladogana A, Capaldi S, Klotz S, Baiardi S, Cagnin A, Perra D, Fiorini M, Poleggi A, Legname G, Cattaruzza T, Janes F, Tabaton M, Ghetti B, Monaco S, Kovacs GG, Parchi P, Pocchiari M, Zanusso G. α-Synuclein RT-QuIC assay in cerebrospinal fluid of patients with dementia with Lewy bodies. Ann Clin Transl Neurol 2019; 6:2120-2126. [PMID: 31599499 PMCID: PMC6801172 DOI: 10.1002/acn3.50897] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/26/2019] [Indexed: 12/13/2022] Open
Abstract
We applied RT-QuIC assay to detect α-synuclein aggregates in cerebrospinal fluid (CSF) of patients with suspected Creutzfeldt-Jakob disease who had a neuropathological diagnosis of dementia with Lewy bodies (DLB) (n = 7), other neurodegenerative diseases with α-synuclein mixed pathology (n = 20), or without Lewy-related pathology (n = 49). The test had a sensitivity of 92.9% and specificity of 95.9% in distinguishing α-synucleinopathies from non-α-synucleinopathies. When performed in the CSF of patients with DLB (n = 36), RT-QuIC was positive in 17/20 with probable DLB, 0/6 with possible DLB, and 0/10 with Alzheimer disease. These results indicate that RT-QuIC for α-synuclein is an accurate test for DLB diagnosis.
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Fiorini M, Bongianni M, Benedetti MD, Monaco S, Zanusso G. Reappraisal of Aβ40 and Aβ42 Peptides Measurements in Cerebrospinal Fluid of Patients with Alzheimer's Disease. J Alzheimers Dis 2019; 66:219-227. [PMID: 30282368 DOI: 10.3233/jad-180616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cerebrospinal fluid (CSF) biomarkers are currently included in the diagnostic criteria for Alzheimer's disease (AD), in particular, decreased concentrations of amyloid-β peptide 1-42 (Aβ42) in the CSF, coupled with increased levels of tau and phosphorylated tau proteins, are supportive of AD diagnosis. To date, the quantification of Aβ42 levels with antibody-dependent immunoassay shows a marked variability among different laboratories and is also affected by different pre-analytical factors, suggesting that part of Aβ42 peptides might be aggregated and thus undetected by antibodies. To bypass an antibody-dependent measurement, we determined the Aβ40 and Aβ42 levels by immunoblot. We analyzed CSF samples from 35 patients with clinical diagnosis of probable AD and from 15 age-matched normal controls; CSF Aβ levels were determined by two different ELISA kits and by immunoblot analysis. Aβ40 levels measured by ELISA were comparable to those obtained by immunoblot, whereas CSF concentrations of Aβ42 measured by ELISA were significantly lower compared to values obtained by immunoblot quantification. Biochemical analysis, following 1D- and 2D-PAGE analysis, showed that the qualitative composition of Aβ peptides in the CSF is similar in AD and controls but different from that of AD brain tissues. Moreover, sedimentation velocity in sucrose gradient of CSF and brain homogenate from AD demonstrated that Aβ42 in CSF is different from Aβ42 in brain in terms of solubility and aggregation state.
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Sopo SM, Cerchiara G, Bersani G, Monaco S, Romano A, Poscia A. The unpredictability of seasonal variations in serum vitamin D levels in children with asthma and/or rhinitis. Allergol Immunopathol (Madr) 2019; 47:411-416. [PMID: 30940418 DOI: 10.1016/j.aller.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Some studies have showed that seasonality is an important determinant of vitamin D (vitD) status. OBJECTIVE We evaluated whether there are differences in individual trends of serum vitD level over one year in asthmatic and rhinitic children. MATERIALS AND METHODS Ninety-two asthmatic and rhinitic paediatric patients were followed up for one year and their serum vitD level was detected at three-month intervals, once in each season. RESULTS We observed higher vitD levels at the end of summer and lower at the end of winter. However, the individual seasonal trend was very variable and unpredictable. If it is true that in a given season the majority of patients followed one direction (increase or decrease of serum vitD levels), nevertheless a substantial percentage behaved differently and unpredictably. For example, at the end of spring, 70% of patients showed an increase in serum vitD levels, but 30% showed a decrease. In addition, five individuals had a value ≥50ng/ml in September and showed serum vitD levels ≥30ng/ml throughout the year; 16 patients presented vitD value ≥40ng/ml in September and always had ≥20ng/ml in the other months. CONCLUSIONS The wide and unpredictable variability of the individual trend of serum vitD levels should be taken into account before deciding whether or not a drug supplementation is appropriate.
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Magliozzi R, Howell OW, Nicholas R, Cruciani C, Castellaro M, Romualdi C, Rossi S, Pitteri M, Benedetti MD, Gajofatto A, Pizzini FB, Montemezzi S, Rasia S, Capra R, Bertoldo A, Facchiano F, Monaco S, Reynolds R, Calabrese M. Inflammatory intrathecal profiles and cortical damage in multiple sclerosis. Ann Neurol 2019. [PMID: 29518260 DOI: 10.1002/ana.25197] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Gray matter (GM) damage and meningeal inflammation have been associated with early disease onset and a more aggressive disease course in multiple sclerosis (MS), but can these changes be identified in the patient early in the disease course? METHODS To identify possible biomarkers linking meningeal inflammation, GM damage, and disease severity, gene and protein expression were analyzed in meninges and cerebrospinal fluid (CSF) from 27 postmortem secondary progressive MS and 14 control cases. Combined cytokine/chemokine CSF profiling and 3T magnetic resonance imaging (MRI) were performed at diagnosis in 2 independent cohorts of MS patients (35 and 38 subjects) and in 26 non-MS patients. RESULTS Increased expression of proinflammatory cytokines (IFNγ, TNF, IL2, and IL22) and molecules related to sustained B-cell activity and lymphoid-neogenesis (CXCL13, CXCL10, LTα, IL6, and IL10) was detected in the meninges and CSF of postmortem MS cases with high levels of meningeal inflammation and GM demyelination. Similar proinflammatory patterns, including increased levels of CXCL13, TNF, IFNγ, CXCL12, IL6, IL8, and IL10, together with high levels of BAFF, APRIL, LIGHT, TWEAK, sTNFR1, sCD163, MMP2, and pentraxin III, were detected in the CSF of MS patients with higher levels of GM damage at diagnosis. INTERPRETATION A common pattern of intrathecal (meninges and CSF) inflammatory profile strongly correlates with increased cortical pathology, both at the time of diagnosis and at death. These results suggest a role for detailed CSF analysis combined with MRI as a prognostic marker for more aggressive MS. Ann Neurol 2018 Ann Neurol 2018;83:739-755.
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Marastoni D, Buriani A, Pisani AI, Crescenzo F, Zuco C, Fortinguerra S, Sorrenti V, Marenda B, Romualdi C, Magliozzi R, Monaco S, Calabrese M. Increased NK Cell Count in Multiple Sclerosis Patients Treated With Dimethyl Fumarate: A 2-Year Longitudinal Study. Front Immunol 2019; 10:1666. [PMID: 31379857 PMCID: PMC6658905 DOI: 10.3389/fimmu.2019.01666] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/03/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Dimethyl fumarate (DMF) is a disease-modifying drug for relapsing-remitting multiple sclerosis. Among others, DMF impedes immune activation by shifting the balance between inflammatory and regulatory cell types and by inducing apoptosis-triggered lymphopenia. Although the decrease in lymphocyte count is an early effect of the drug in several patients, the long-term impact on lymphocyte subsets is largely unknown. Methods: We performed a 2-years observational study on total lymphocyte count and subsets thereof by flow cytometry of peripheral blood of 38 multiple sclerosis patients in treatment with DMF. Data were collected at the beginning and after 3, 6, 12, and 24 months of therapy. Results: Total lymphocyte count decreased in relation to time of exposure to DMF. Mean absolute B cell count decreased by 34.1% (p < 0.001) within the first 3 months of therapy and then remained stable over time. Mean absolute CD3+ T cells count decrement reached 47.5% after 12 months of treatment (p < 0.001). NK cells count showed a heterogeneous trend, increasing by 85.9% (p < 0.001) after 2 years of treatment. CD4+ T cells and CD8+ T cells substantially decreased, with a significant increase of CD4+/CD8+ ratio during the first year of therapy. Conclusions: NK cells showed a heterogeneous behavior during DMF treatment with a significant increase over time. Since NK cells may also have a regulatory effect on immune system modulation, their increase during DMF treatment might play a role in the efficacy and safety of the drug.
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Monaco S, Russo G, Romano A, Liotti L, Verga MC, Miceli Sopo S. Yogurt is tolerated by the majority of children with IgE-mediated cow's milk allergy. Allergol Immunopathol (Madr) 2019; 47:322-327. [PMID: 30573322 DOI: 10.1016/j.aller.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/14/2018] [Accepted: 10/26/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Children with IgE-mediated cow's milk allergy (IgE-CMA) with gastrointestinal symptoms tolerate yogurt at 100%. Yogurt tolerance in children with IgE-CMA with urticaria and anaphylaxis was 7%. METHODS We enrolled children with IgE-CMA with cutaneous, respiratory, gastrointestinal and anaphylactic symptoms. All performed prick by prick (PbP) and oral food challenge (OFC) with yogurt. Some children performed also an OFC with CM mixed with wheat flour and baked, baked liquid CM, parmesan. RESULTS 34 children were enrolled, 31/34 (91%) with systemic adverse reaction after ingestion of CM (systemic CMA), 3/34 (9%) with isolated contact urticaria (ICU CMA). PbP with yogurt was negative only in one patient. OFC with yogurt was passed (that is, the OFC was negative) by 20/31 (64%) of the children with systemic CMA. 10/11 (91%) of the patients who failed OFC (that is, the OFC was positive) with yogurt were positive to SPT with casein vs. 8/20 (40%) of the patients who passed it (p=0.018). None of the 19 children who passed OFC with yogurt failed all OFC with processed CM forms other than yogurt that tested vs. 4/8 among those who failed OFC with yogurt (p=0.006). The rub test with yogurt was negative in 1/3 (33%) of the patients with ICU CMA. CONCLUSIONS The results of our study are placed alongside others already present in the literature and concerning other methods of processing CM proteins and help to reduce the dietary restrictions of the majority of children with systemic IgE-CMA.
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Hofer LS, Mariotto S, Wurth S, Ferrari S, Mancinelli CR, Delogu R, Monaco S, Gajofatto A, Schwaiger C, Rostasy K, Deisenhammer F, Höftberger R, Berger T, Reindl M. Distinct serum and cerebrospinal fluid cytokine and chemokine profiles in autoantibody-associated demyelinating diseases. Mult Scler J Exp Transl Clin 2019; 5:2055217319848463. [PMID: 31205739 PMCID: PMC6537078 DOI: 10.1177/2055217319848463] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background Demyelinating diseases of the central nervous system associated with
autoantibodies against aquaporin-4 and myelin-oligodendrocyte-glycoprotein
are mediated by different immunopathological mechanisms compared to multiple
sclerosis. Objective The purpose of this study was to evaluate serum and cerebrospinal fluid
cytokine/chemokine profiles in patients with autoantibodies against
aquaporin-4 or autoantibodies against
myelin-oligodendrocyte-glycoprotein-associated demyelination compared to
multiple sclerosis and autoimmune encephalitis. Methods Serum and cerebrospinal fluid cytokine/chemokine levels were analysed using
Procartaplex Multiplex Immunoassays. First, we analysed a panel of 32
cytokines/chemokines in a discovery group (nine aquaporin-4-antibody
seropositive, nine myelin oligodendrocyte glycoprotein-antibody
seropositive, eight encephalitis, 10 multiple sclerosis). Significantly
dysregulated cytokines/chemokines were validated in a second cohort (11
aquaporin-4-antibody seropositive, 18 myelin oligodendrocyte
glycoprotein-antibody seropositive, 18 encephalitis, 33 multiple
sclerosis). Results We found 11 significantly altered cytokines/chemokines in cerebrospinal fluid
and serum samples in the discovery group (a proliferation-inducing ligand,
fractalkine=CX3CL1, growth-regulated oncogene-α, interleukin-1 receptor
antagonist, interleukin-6, interleukin-8=CXCL8, interleukin-10,
interleukin-21, interferon-ɣ-induced protein-10=CXCL10, monokine induced by
interferon-ɣ=CXCL9, macrophage inflammatory protein-1ß=CCL4). Most of these
cytokines/chemokines were up-regulated in autoantibodies against aquaporin-4
or autoantibodies against myelin-oligodendrocyte-glycoprotein positive
patients compared to multiple sclerosis. We confirmed these results for
cerebrospinal fluid interleukin-6 and serum interleukin-8, growth-regulated
oncogene-α, a proliferation-inducing ligand and macrophage inflammatory
protein-1β in the validation set. Receiver-operating characteristic analysis
revealed increased levels of cerebrospinal fluid interleukin-6, serum
interleukin-8 and growth-regulated oncogene-α in most patients with
autoantibody-associated neurological diseases. Conclusion This study suggests that distinctive cerebrospinal fluid and serum
cytokine/chemokine profiles are associated with autoantibody-mediated
demyelination, but not with multiple sclerosis.
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Mariotto S, Tecchio C, Sorio M, Bertolasi L, Turatti M, Tozzi MC, Benedetti F, Cavaletti G, Monaco S, Ferrari S. Clinical and neurophysiological serial assessments of brentuximab vedotin-associated peripheral neuropathy. Leuk Lymphoma 2019; 60:2806-2809. [DOI: 10.1080/10428194.2019.1605068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Miceli Sopo S, Gurnari G, Monaco S, Romano A, Liotti L, Cuomo B, Dello Iacono I, Badina L, Longo G, Calvani M, Giannone A, Calabrò C, Scala G, Verga MC. Predictive value of the number of adverse reaction episodes for the IgE-mediated food allergy diagnosis. Allergol Immunopathol (Madr) 2019; 47:277-281. [PMID: 30573320 DOI: 10.1016/j.aller.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The reproducibility of the adverse reaction increases the suggestiveness of a history of food allergy. However, the positive predictive value (PPV) of multiple adverse reaction episodes for the diagnosis of IgE-mediated food allergy is not known. This evaluation was the objective of our study. PATIENTS AND METHODS We retrospectively studied 180 children with a history of non-anaphylactic adverse reactions after the ingestion of a food. All children had the prick test positive for the offending food and performed the oral food challenge (OFC) within 12 months after the last adverse reaction episode (ARE). We have evaluated whether increasing the number of ARE increased the probability that the OFC would be positive (failed). RESULTS 93 patients (52%) presented one ARE, 49 (27%) presented two ARE, 24 (13%) presented three ARE, 14 (8%) patients presented≥four ARE. The OFC was positive in 94/180 (52%). The outcome of the OFC was found to be positively correlated with the number of ARE (OR=1.56; 95% CI=1.16-2.09; p=0.003). A PPV=100% was observed with a number of ARE≥five. CONCLUSIONS The number of ARE is an important predictor of the diagnosis of food allergy, although less than we would have imagined. The number of ARE could be used to increase the predictability of the diagnostic tests currently in use, to define clinical prediction rules alternative to OFC and easy to use in clinical practice.
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Buonsenso D, Plosnic M, Bersani G, Monaco S, Ferrara P, Chiaretti A. Paroxysmal non-epileptic events in the pediatric emergency department. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2019; 23:2188-2193. [PMID: 30915765 DOI: 10.26355/eurrev_201903_17265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Paroxysmal non-epileptic events (PNEs), or pseudoseizures (PS) resemble epileptic seizures. They are considered part of a personality disorder and have a higher incidence among adolescents. Patients describe episodes (lasting up to 20 minutes) of loss of consciousness, twitching or jerking and unusual emotional states. Unlike epileptic seizures, they are not associated with electroencephalographic abnormalities. Distinguishing epileptic seizures from PNEs is not easy. 20% of patients with seizures have a final PNEs diagnosis but recognizing them on the first examination is difficult. Due to the severe initial clinical presentation, these patients are often admitted in the Pediatric Intensive Care Unit (PICU) and may be over-treated. We report two cases admitted to our PICU for apparent status epilepticus, in which the final diagnosis was PNEs.
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Miceli Sopo S, Bersani G, Fantacci C, Romano A, Monaco S. Diagnostic criteria for acute food protein-induced enterocolitis syndrome. Is the work in progress? Allergol Immunopathol (Madr) 2018; 46:607-611. [PMID: 29456036 DOI: 10.1016/j.aller.2017.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 11/15/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES.
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Miceli Sopo S, Fantacci C, Bersani G, Romano A, Liotti L, Monaco S. Is food protein induced enterocolitis syndrome only a non IgE-mediated food allergy? Allergol Immunopathol (Madr) 2018; 46:499-502. [PMID: 29472022 DOI: 10.1016/j.aller.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
Food protein induced enterocolitis syndrome (FPIES) is classified as non-IgE-mediated or cell-mediated food allergy, although there is an atypical phenotype so defined for the presence of specific IgEs. All diagnostic criteria for FPIES include the absence of skin or respiratory symptoms of IgE-mediated type. We present four cases that suggest that specific IgEs may have a pathogenic role, resulting in the existence of different FPIES phenotypes. This could be important from a diagnostic and therapeutic point of view.
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Marafioti V, Turri G, Monaco S. Response to Association of Prolonged QTc Interval With Takotsubo Cardiomyopathy: A Neurocardiac Syndrome Inside the Mystery of the Insula of Reil. Clin Cardiol 2018; 41:1409-1410. [PMID: 30098036 DOI: 10.1002/clc.23045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 11/07/2022] Open
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Mariotto S, Farinazzo A, Magliozzi R, Alberti D, Monaco S, Ferrari S. Serum and cerebrospinal neurofilament light chain levels in patients with acquired peripheral neuropathies. J Peripher Nerv Syst 2018; 23:174-177. [PMID: 29974556 DOI: 10.1111/jns.12279] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/28/2022]
Abstract
Neurofilament light chain (NFL) levels reflect axonal damage in different inflammatory and neurodegenerative central nervous system conditions, in correlation with disease severity. Our aim was to determine the possible diagnostic and prognostic value of serum and cerebrospinal fluid (CSF) NFL levels in subjects with different forms of acquired peripheral neuropathies (PN). Paired serum and CSF samples of 25 patients with acquired PN were analysed for NFL using an ultrasensitive technique (Quanterix, Simoa, Lexington, MA, USA) and compared with a group of 25 age-matched healthy subjects. Demographic, clinical, CSF and neurophysiological data were reviewed. Cases with Guillain-Barré syndrome (N = 5), multifocal motor neuropathy (N = 3), chronic inflammatory demyelinating polyneuropathy (CIDP) and variants (N = 12), anti-myelin-associated glycoprotein (MAG) neuropathy (N = 3), both CIDP and anti-MAG neuropathy (N = 1), and non-systemic vasculitic neuropathy (N = 1) were studied. NFL levels were significantly (P < 0.001) increased in patients with PN and were higher in the CSF (median: 1407 pg/mL, range: 140.2-12 661) than in serum (median: 31.52 pg/mL, range: 4.33-1178). A statistically significant correlation was observed between serum and CSF levels in cases with blood-nerve-barrier damage (r = 0.71, P < 0.01), and between serum NFL levels and disease activity at sampling (r = 0.52, P < 0.01) and at last follow-up (r = 0.53, P < 0.01) in all subjects. The increase of NFL values in both serum and CSF of patients with acquired PN and the significant correlation between serum NFL levels, disease severity and final outcome support the possible role of NFL as disease activity and prognostic biomarker also in peripheral nervous system disorders.
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Danese A, Cappellari M, Pancheri E, Mugnai G, Micheletti N, Tomelleri G, Carletti M, Turri G, Marafioti V, Monaco S, Bonetti B, Bovi P. The dispersion of myocardial repolarization in ischemic stroke and intracranial hemorrhage. J Electrocardiol 2018; 51:691-695. [PMID: 29997015 DOI: 10.1016/j.jelectrocard.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/06/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Markers of dispersion of myocardial repolarization have been proposed to identify the patients at higher risk of malignant arrhythmic events. The aim of the present study is to assess a possible association of the electrocardiografic (ECG) markers of the dispersion of repolarization with the type of stroke, involvement of insula, neurological severity (National Institutes of Health Stroke Scale, NIHSS score), and disability (modified Rankin Scale, mRS score) in patients with a cerebrovascular event. METHODS We conducted a retrospective analysis based on data prospectively collected from consecutive patients with a cerebrovascular event who underwent 12‑lead ECG at admission to the Verona Stroke Unit. RESULTS Of the 63 patients included in the study, 55 had ischemic stroke and 8 intracranial hemorrhage. TpTe (time between the peak and the end of the T wave) and TpTe/QTc (TpTe/corrected time between the start of the Q wave and the end of the T wave) in lead V5 were higher in intracranial hemorrhage than in ischemic stroke (p = 0.03 and p = 0.04, respectively) and QT max (the longest QT calculated in the 12 leads) was higher in patients with involvement of insula (p ≤ 0.01). A correlation was found between QTc max and NIHSS score at admission (p = 0.02), QT max and NIHSS score at discharge (p = 0.05), and QT max and mRS score at discharge (p = 0.02). CONCLUSIONS TpTe and TpTe/QTc in V5 lead were associated with intracranial hemorrhage and QT max was associated with involvement of insula. The prolongation of QT was correlated with neurological severity and disability.
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Marafioti V, Turri G, Monaco S, Carbone V. Response to Association of Prolonged QTc Interval With Takotsubo Cardiomyopathy: A Neurocardiac Syndrome Inside the Mystery of the Insula of Reil. Clin Cardiol 2018; 41:884. [DOI: 10.1002/clc.22983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/11/2022] Open
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Miceli Sopo S, Fantacci C, Bersani G, Romano A, Monaco S. Loss of tolerance for fishes previously tolerated in children with fish food protein induced enterocolitis syndrome. Allergol Immunopathol (Madr) 2018; 46:394-396. [PMID: 29338963 DOI: 10.1016/j.aller.2017.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/13/2017] [Indexed: 11/28/2022]
Abstract
We describe two case reports presenting some novel information on fish FPIES. Fish FPIES to one fish does not always start at the same time to other fish. Additionally, development of tolerance to the index fish do not necessarily imply tolerance to other reactive fish. This reflects on the best management of children with FPIES fish.
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Bajrami A, Pitteri M, Castellaro M, Pizzini F, Romualdi C, Montemezzi S, Monaco S, Calabrese M. The effect of fingolimod on focal and diffuse grey matter damage in active MS patients. J Neurol 2018; 265:2154-2161. [PMID: 29938336 DOI: 10.1007/s00415-018-8952-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The mechanism of action of fingolimod within the central nervous system and its efficacy in reducing/preventing both focal and diffuse grey matter (GM) damage in active multiple sclerosis (MS) are not completely understood. METHODS In this longitudinal, 2-year prospective, phase IV, single-blind study, 40 MS patients treated with fingolimod and 39 untreated age, gender, and disability-matched MS patients were enrolled. Each patient underwent a neurological examination every 6 months and a 3T MRI at the beginning of the treatment and after 24 months. The accumulation of new cortical lesions (CLs) and the progression of regional GM atrophy were compared between the two groups. RESULTS At the end of the study (T24), the percentage of patients with new CLs (13.5 vs. 89%, p < 0.001) and the percentage of GM volume change was lower in the treated group (p < 0.001). The regional analysis revealed that the treated group had also less volume loss in thalamus, caudatus, globus pallidus, cingulate cortex, and hippocampus (p < 0.001), as well as in, cerebellum, superior frontal gyrus, and insular-long gyrus (p < 0.05). Patients with no evidence of disease activity were 60% in the treated group and 10% in the untreated group (p < 0.001). CONCLUSIONS These results suggest a possible protective effect of fingolimod on focal and diffuse GM damage.
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Scalfari A, Romualdi C, Nicholas RS, Mattoscio M, Magliozzi R, Morra A, Monaco S, Muraro PA, Calabrese M. The cortical damage, early relapses, and onset of the progressive phase in multiple sclerosis. Neurology 2018; 90:e2107-e2118. [PMID: 29769373 DOI: 10.1212/wnl.0000000000005685] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship among cortical radiologic changes, the number of early relapses (ERs), and the long-term course of multiple sclerosis (MS). METHODS In this cohort study, we assessed the number of cortical lesions (CLs) and white matter (WM) lesions and the cortical thickness (Cth) at clinical onset and after 7.9 mean years among 219 patients with relapsing remitting (RR) MS with 1 (Low-ER), 2 (Mid-ER), and ≥3 (High-ER) ERs during the first 2 years. Kaplan-Meier and Cox regression analyses investigated early factors influencing the risk of secondary progressive (SP) MS. RESULTS Fifty-nine patients (27%) converted to SPMS in 6.1 mean years. A larger number of CLs at onset predicted a higher risk of SPMS (hazard ratio [HR] 2.16, 4.79, and 12.3 for 2, 5, and 7 CLs, respectively, p < 0.001) and shorter latency to progression. The High-ER compared to the Low-ER and Mid-ER groups had a larger volume of WM lesions and CLs at onset, accrued more CLs, experienced more severe cortical atrophy over time, and entered the SP phase more rapidly. In the multivariate model, older age at onset (HR 1.97, p < 0.001), a larger baseline CL (HR 2.21, p = 0.005) and WM lesion (HR 1.32, p = 0.03) volume, early changes of global Cth (HR 1.36, p = 0.03), and ≥3 ERs (HR 6.08, p < 0.001) independently predicted a higher probability of SP. CONCLUSIONS Extensive cortical damage at onset is associated with florid inflammatory clinical activity and predisposes to a rapid occurrence of the progressive phase. Age at onset, the number of early attacks, and the extent of baseline focal cortical damage can identify groups at high risk of progression who may benefit from more active therapy.
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Arru G, Mameli G, Deiana GA, Rassu AL, Piredda R, Sechi E, Caggiu E, Bo M, Nako E, Urso D, Mariotto S, Ferrari S, Zanusso G, Monaco S, Sechi G, Sechi LA. Humoral immunity response to human endogenous retroviruses K/W differentiates between amyotrophic lateral sclerosis and other neurological diseases. Eur J Neurol 2018; 25:1076-e84. [PMID: 29603839 DOI: 10.1111/ene.13648] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/26/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Human endogenous retroviruses (HERV) K/W seem to play a role in fostering and exacerbation of some neurological diseases, including amyotrophic lateral sclerosis (ALS). Given these findings, the immunity response against HERV-K and HERV-W envelope surface (env-su) glycoprotein antigens in serum and cerebrospinal fluid (CSF) was investigated for ALS, multiple sclerosis (MS) and Alzheimer's disease patients and in healthy controls. METHODS Four antigenic peptides derived respectively from HERV-K and HERV-W env-su proteins were studied in 21 definite or probable ALS patients, 26 possible or definite relapsing-remitting MS patients, 18 patients with Alzheimer's disease and 39 healthy controls. An indirect enzyme-linked immunosorbent assay was set up to detect specific antibodies (Abs) against env-su peptides. RESULTS Amongst the measured levels of Abs against the four different HERV-K peptide fragments, only HERV-K env-su19-37 was significantly elevated in ALS compared to other groups, both in serum and CSF. Instead, amongst the Abs levels directed against the four different HERV-W peptide fragments, only HERV-W env-su93-108 and HERV-W env-su248-262 were significantly elevated, in the serum and CSF of the MS group compared to other groups. In ALS patients, the HERV-K env-su19-37 Abs levels were significantly correlated with clinical measures of disease severity, both in serum and CSF. CONCLUSIONS Increased circulating levels of Abs directed against the HERV-W env-su93-108 and HERV-W env-su248-262 peptide fragments could serve as possible biomarkers in patients with MS. Similarly, increased circulating levels of Abs directed against the HERV-K env-su19-37 peptide fragment could serve as a possible early novel biomarker in patients with ALS.
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Alò PL, Visca P, Trombetta G, Mangoni A, Lenti L, Monaco S, Botti C, Serpieri DE, Di Tondo U. Fatty Acid Synthase (Fas) Predictive Strength in Poorly Differentiated Early Breast Carcinomas. TUMORI JOURNAL 2018; 85:35-40. [PMID: 10228495 DOI: 10.1177/030089169908500108] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Many normal and human cancer tissues express fatty acid synthase (FAS), the major enzyme required for endogenous fatty acid biosynthesis. Strong expression of FAS seems to be associated with a poor prognosis. This study examines the strength of FAS and other common markers of relapse in poorly differentiated breast carcinoma. Materials and methods Fifty-one patients with poorly differentiated ductal infiltrating breast carcinomas were followed up for more than 10 years. Immunohistochemical detection of FAS was associated with morphological features of the tumors, with immunohistochemical expression of c-erbB-2, cathepsin D, estrogen and progesterone receptor status and with DNA ploidy in order to detect a statistical correlation. Results The chi-square test revealed a correlation between FAS and peritumoral lymphatic vessel invasion (PLVI) (P = 0.001). Univariate analysis showed that FAS was correlated with disease-free survival (DFS) (P = 0.0001). Other prognosticators associated with DFS were PLVI (P = 0.002), estrogen (P = 0.008) and progesterone receptor status (P = 0.007). Bivariate analysis showed that FAS was a further prognostic discriminant of DFS within the ER, PgR and PLVI subsets. Discussion FAS is a reliable prognosticator of recurrence in poorly differentiated early breast carcinomas. Association of FAS with PLVI may be useful to plan a correct follow-up in patients with breast neoplasms.
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Cagnin A, Mariotto S, Fiorini M, Gaule M, Bonetto N, Tagliapietra M, Buratti E, Zanusso G, Ferrari S, Monaco S. Microglial and Neuronal TDP-43 Pathology in Anti-IgLON5-Related Tauopathy. J Alzheimers Dis 2018; 59:13-20. [PMID: 28550263 DOI: 10.3233/jad-170189] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A novel neuronal tauopathy, mainly confined to hypothalamus and brainstem tegmentum, has recently been reported in patients with autoantibodies to the neuronal cell-adhesion molecule IgLON5. We describe a patient with anti-IgLON5 syndrome, who presented with dysautonomia and sleep disorder, followed by subacute dementia. Postmortem brain examination disclosed neuronal tau pathology prevailing in the hippocampus, amygdala, and locus coeruleus, in addition to microglial/neuronal TDP-43 pathology, with overexpression of aberrantly phosphorylated forms and neurotoxic truncated fragments, in basal ganglia, nucleus basalis, thalamus, and midbrain. These findings suggest that neurodegeneration in anti-IgLON5 syndrome might also occur via a microglia-triggered non-cell autonomous pathway.
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Marafioti V, Turri G, Carbone V, Monaco S. Association of prolonged QTc interval with Takotsubo cardiomyopathy: A neurocardiac syndrome inside the mystery of the insula of Reil. Clin Cardiol 2018; 41:551-555. [PMID: 29663451 PMCID: PMC6490097 DOI: 10.1002/clc.22910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/16/2022] Open
Abstract
The Takotsubo cardiomyopathy is often considered autochthonous to the heart, although the primary problem may be not in the heart muscle itself. Instead, similar to several Takotsubo-like cardiac pathologies seen in acute neurological diseases, it may reflect the capacity of the nervous system to injure the heart. Persuasive evidence exists that shocking emotional stress promotes direct heart injuries. Moreover, clinical and laboratory research shows that cardiac structural damage can occur in the presence of a normal heart, especially in the context of seizures, stroke, and traumatic brain injury or under conditions of psychological stress. The aim of this review is to summarize the clinical implications of these observations, several of which focus on the pivotal role of the insula of Reil in the brain-heart connection, to unravel the mystery of Takotsubo cardiomyopathy pathogenesis.
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