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Ahmed AA, Said D, Sami MM. Growth arrest-specific protein 6 as a marker of nephritis in systemic sclerosis and juvenile systemic lupus erythematosus patients. Lupus 2024:9612033241257321. [PMID: 38809681 DOI: 10.1177/09612033241257321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Background: Renal impairments commonly occur as a complication of autoimmune connective tissue diseases (CTDs). Therefore, early nephritis prediction is vital for patient outcomes. Growth Arrest-Specific Protein 6 (GAS6) was found to be upregulated in many types of inflammatory renal disease, including diabetic nephropathy.Aim: To evaluate GAS6 as a predictor of renal impairment in adults with systemic sclerosis (SSc) and children with systemic lupus Erythematosus (SLE).Methods: The study included 60 patients with SSc and 40 children with SLE. The serum level of GAS6 was measured using the ELISA technique. In adults with SSc, total proteins in 24-h urine concentration of >300 mg/24 h indicated renal inflammation, while in children with SLE, nephritis was diagnosed by abnormal renal pathology.Results: In SSc patients, GAS6 significantly increased in patients with proteinuria. GAS6 is an independent predictor of nephritis with an odds ratio (OR) of 1.06 and a 95% confidence interval (CI) of 1.0-1.1. at cutoff 12.2 ng/mL GAS6 predicted proteinuria with sensitivity 86.7% (95% CI: 59.5% to 98.3%), specificity 57.8% (95% CI: 42.1% to 72.3%), positive predictive value 40.6% (95% CI: 31.5% to 50.4%), negative predictive value 92.9% (95% CI: 77.7% to 97.73%), and accuracy 65.0% (95% CI: 51.6% to 76.9%). In SLE patients, Serum GAS6 did not differ significantly between children with and without lupus nephritis.Conclusion: GAS6 is an independent predictor of nephritis in patients with SSc. However, there is no association between GAS6 and nephritis in juvenile patients with SLE.
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Affiliation(s)
- Alshymaa A Ahmed
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dina Said
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - May M Sami
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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2
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Rizzi M, D'Onghia D, Tonello S, Minisini R, Colangelo D, Bellan M, Castello LM, Gavelli F, Avanzi GC, Pirisi M, Sainaghi PP. COVID-19 Biomarkers at the Crossroad between Patient Stratification and Targeted Therapy: The Role of Validated and Proposed Parameters. Int J Mol Sci 2023; 24:ijms24087099. [PMID: 37108262 PMCID: PMC10138390 DOI: 10.3390/ijms24087099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Clinical knowledge about SARS-CoV-2 infection mechanisms and COVID-19 pathophysiology have enormously increased during the pandemic. Nevertheless, because of the great heterogeneity of disease manifestations, a precise patient stratification at admission is still difficult, thus rendering a rational allocation of limited medical resources as well as a tailored therapeutic approach challenging. To date, many hematologic biomarkers have been validated to support the early triage of SARS-CoV-2-positive patients and to monitor their disease progression. Among them, some indices have proven to be not only predictive parameters, but also direct or indirect pharmacological targets, thus allowing for a more tailored approach to single-patient symptoms, especially in those with severe progressive disease. While many blood test-derived parameters quickly entered routine clinical practice, other circulating biomarkers have been proposed by several researchers who have investigated their reliability in specific patient cohorts. Despite their usefulness in specific contexts as well as their potential interest as therapeutic targets, such experimental markers have not been implemented in routine clinical practice, mainly due to their higher costs and low availability in general hospital settings. This narrative review will present an overview of the most commonly adopted biomarkers in clinical practice and of the most promising ones emerging from specific population studies. Considering that each of the validated markers reflects a specific aspect of COVID-19 evolution, embedding new highly informative markers into routine clinical testing could help not only in early patient stratification, but also in guiding a timely and tailored method of therapeutic intervention.
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Affiliation(s)
- Manuela Rizzi
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Davide D'Onghia
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Donato Colangelo
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
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Rizzi M, Tonello S, D’Onghia D, Sainaghi PP. Gas6/TAM Axis Involvement in Modulating Inflammation and Fibrosis in COVID-19 Patients. Int J Mol Sci 2023; 24:ijms24020951. [PMID: 36674471 PMCID: PMC9861142 DOI: 10.3390/ijms24020951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/06/2023] Open
Abstract
Gas6 (growth arrest-specific gene 6) is a widely expressed vitamin K-dependent protein that is involved in many biological processes such as homeostatic regulation, inflammation and repair/fibrotic processes. It is known that it is the main ligand of TAMs, a tyrosine kinase receptor family of three members, namely MerTK, Tyro-3 and Axl, for which it displays the highest affinity. Gas6/TAM axis activation is known to be involved in modulating inflammatory responses as well as fibrotic evolution in many different pathological conditions. Due to the rapidly evolving COVID-19 pandemic, this review will focus on Gas6/TAM axis activation in SARS-CoV-2 infection, where de-regulated inflammatory responses and fibrosis represent a relevant feature of severe disease manifestation. Furthermore, this review will highlight the most recent scientific evidence supporting an unsuspected role of Axl as a SARS-CoV-2 infection driver, and the potential therapeutic advantages of the use of existing Axl inhibitors in COVID-19 management. From a physiological point of view, the Gas6/TAM axis plays a dual role, fostering the tissue repair processes or leading to organ damage and loss of function, depending on the prevalence of its anti-inflammatory or profibrotic properties. This review makes a strong case for further research focusing on the Gas6/TAM axis as a pharmacological target to manage different disease conditions, such as chronic fibrosis or COVID-19.
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Bellan M, Murano F, Ceruti F, Piccinino C, Tonello S, Minisini R, Giubertoni A, Sola D, Pedrazzoli R, Maglione V, Manfredi GF, Acquaviva A, Piffero R, Patti G, Pirisi M, Sainaghi PP. Increased Levels of ICOS and ICOSL Are Associated to Pulmonary Arterial Hypertension in Patients Affected by Connective Tissue Diseases. Diagnostics (Basel) 2022; 12:diagnostics12030704. [PMID: 35328257 PMCID: PMC8947069 DOI: 10.3390/diagnostics12030704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 12/07/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is a life-threatening complication of connective tissue diseases (CTD); in this study, we aimed at investigating the potential role of inducible co-stimulator (ICOS) and its ligand (ICOS-L) as biomarkers of PH in CTD. Materials and Methods: We recruited 109 patients: 84 CTD patients, 13 patients with CTD complicated by pulmonary arterial hypertension (PAH), and 12 subjects with PAH alone. All recruited patients underwent a complete clinical and instrumental assessment along with quantitative measurement of serum ICOS and ICOS-L. Results: Independently of the underlying cause, patients with PAH were older and had a lower glomerular filtration rate. Interestingly, patients with both CTD-related and CTD-unrelated PAH had higher ICOS and ICOS-L serum concentrations than CTD patients (0.0001 for both). When compared to CTD patients, those affected by CTD-PAH showed higher ICOS (440 (240–600) vs. 170 (105–275) pg/mL, p = 0.0001) and ICOS-L serum concentrations (6000 (4300–7000) vs. 2450 (1500–4100) pg/mL; p = 0.0001). In a logistic regression, ICOS and ICOS-L were associated with a diagnosis of PAH, independently from age, gender, and renal function. The corresponding receiver operating characteristic (ROC) curves demonstrated a good diagnostic performance for both ICOS and ICOS-L. Conclusions: ICOS and ICOS-L are increased in patients with PAH, irrespectively from the underlying cause, and represent promising candidate biomarkers for the diagnostic screening for PAH among CTDs patients.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3737512
| | - Francesco Murano
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Federico Ceruti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | | | - Stelvio Tonello
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Rosalba Minisini
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Ailia Giubertoni
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardiology, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Daniele Sola
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Roberta Pedrazzoli
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Veronica Maglione
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Giulia Francesca Manfredi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Antonio Acquaviva
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Roberto Piffero
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Giuseppe Patti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardiology, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Mario Pirisi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
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5
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Bellan M, Piccinino C, Tonello S, Minisini R, Giubertoni A, Sola D, Pedrazzoli R, Gagliardi I, Zecca E, Calzaducca E, Mazzoleni F, Piffero R, Patti G, Pirisi M, Sainaghi PP. Role of Osteopontin as a Potential Biomarker of Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis and Other Connective Tissue Diseases (CTDs). Pharmaceuticals (Basel) 2021; 14:ph14050394. [PMID: 33919476 PMCID: PMC8143460 DOI: 10.3390/ph14050394] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue diseases (CTD). Its early diagnosis is essential to start effective treatment. In the present paper, we aimed to evaluate the role of plasma osteopontin (OPN) as a candidate biomarker of PAH in a cohort of CTD patients. OPN is a pleiotropic protein involved in inflammation and fibrogenesis and, therefore, potentially promising in this specific clinical context. We performed a cross-sectional observational study on a cohort of 113 CTD patients (females N = 101, 89.4%) affected by systemic sclerosis N = 88 (77.9%), mixed connective tissue disease N = 10 (8.8%), overlap syndrome N = 10 (8.8%) or undifferentiated connective tissue disease N = 5 (4.4%). CTD-PAH patients showed significantly higher OPN plasma values than patients with CTD alone (241.0 (188.8–387.2) vs. 200.7 (133.5–281.6) ng/mL; p = 0.03). Although OPN levels were directly correlated with age and inversely with glomerular filtration rate, they remained associated with PAH at multivariate analysis. In conclusion, OPN was significantly associated with PAH among patients with CTD, suggesting it may have a role as a non-invasive disease biomarker of PAH.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD (Center for Translational Research on Autoimmune and Allergic Disease), Maggiore della Carità Hospital, 28100 Novara, Italy
- Correspondence:
| | - Cristina Piccinino
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Ailia Giubertoni
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Daniele Sola
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Roberta Pedrazzoli
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Ileana Gagliardi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Elisa Calzaducca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Federica Mazzoleni
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Roberto Piffero
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD (Center for Translational Research on Autoimmune and Allergic Disease), Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD (Center for Translational Research on Autoimmune and Allergic Disease), Maggiore della Carità Hospital, 28100 Novara, Italy
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6
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Bellan M, Giubertoni A, Piccinino C, Buffa M, Cromi D, Sola D, Pedrazzoli R, Gagliardi I, Calzaducca E, Zecca E, Patrucco F, Patti G, Sainaghi PP, Pirisi M. Cardiopulmonary Exercise Testing Is an Accurate Tool for the Diagnosis of Pulmonary Arterial Hypertension in Scleroderma Related Diseases. Pharmaceuticals (Basel) 2021; 14:ph14040342. [PMID: 33917930 PMCID: PMC8068386 DOI: 10.3390/ph14040342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
The early diagnosis of pulmonary arterial hypertension (PAH) is a major determinant of prognosis in patients affected by connective tissue diseases (CTDs) complicated by PAH. In the present paper we investigated the diagnostic accuracy of cardiopulmonary exercise testing (CPET) in this specific setting. We recorded clinical and laboratory data of 131 patients who underwent a CPET at a pulmonary hypertension clinic. Out of them, 112 (85.5%) had a diagnosis of CTDs; 8 (6.1%) received a diagnosis of CTDs-PAH and 11 (8.4%) were affected PH of different etiology. Among CPET parameters the following parameters showed the best diagnostic performance for PAH: peak volume of oxygen uptake (VO2; AUC: 0.845, CI95% 0.767-0.904), ratio between ventilation and volume of exhaled carbon dioxide (VE/VCO2 slope; AUC: 0.888, CI95%: 0.817-0.938) and end-tidal partial pressures (PetCO2; AUC: 0.792, CI95%: 0.709-0.861). These parameters were comparable among CTDs-PAH and PH of different etiology. The diagnostic performance was even improved by creating a composite score which included all the three parameters identified. In conclusion, CPET is a very promising tool for the stratification of risk of PAH among CTDs patients; the use of composite measures may improve diagnostic performance.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital and Università del Piemonte Orientale UPO, 28100 Novara, Italy
- Correspondence:
| | - Ailia Giubertoni
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Cristina Piccinino
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Mariachiara Buffa
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Debora Cromi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Daniele Sola
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Roberta Pedrazzoli
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Ileana Gagliardi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Elisa Calzaducca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Filippo Patrucco
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital and Università del Piemonte Orientale UPO, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital and Università del Piemonte Orientale UPO, 28100 Novara, Italy
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Di Stasi R, De Rosa L, D'Andrea LD. Therapeutic aspects of the Axl/Gas6 molecular system. Drug Discov Today 2020; 25:2130-2148. [PMID: 33002607 DOI: 10.1016/j.drudis.2020.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/14/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022]
Abstract
Axl receptor tyrosine kinase (RTK) and its ligand, growth arrest-specific protein 6 (Gas6), are involved in several biological functions and participate in the development and progression of a range of malignancies and autoimmune disorders. In this review, we present this molecular system from a drug discovery perspective, highlighting its therapeutic implications and challenges that need to be addressed. We provide an update on Axl/Gas6 axis biology, exploring its role in fields ranging from angiogenesis, cancer development and metastasis, immune response and inflammation to viral infection. Finally, we summarize the molecules that have been developed to date to target the Axl/Gas6 molecular system for therapeutic and diagnostic applications.
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Affiliation(s)
- Rossella Di Stasi
- Istituto di Biostrutture e Bioimmagini, CNR, Via Mezzocannone 16, 80134 Napoli, Italy
| | - Lucia De Rosa
- Istituto di Biostrutture e Bioimmagini, CNR, Via Mezzocannone 16, 80134 Napoli, Italy
| | - Luca D D'Andrea
- Istituto di Biostrutture e Bioimmagini, CNR, Via Nizza 52, 10126 Torino, Italy.
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8
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Tutusaus A, Marí M, Ortiz-Pérez JT, Nicolaes GAF, Morales A, García de Frutos P. Role of Vitamin K-Dependent Factors Protein S and GAS6 and TAM Receptors in SARS-CoV-2 Infection and COVID-19-Associated Immunothrombosis. Cells 2020; 9:E2186. [PMID: 32998369 PMCID: PMC7601762 DOI: 10.3390/cells9102186] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 02/07/2023] Open
Abstract
The vitamin K-dependent factors protein S (PROS1) and growth-arrest-specific gene 6 (GAS6) and their tyrosine kinase receptors TYRO3, AXL, and MERTK, the TAM subfamily of receptor tyrosine kinases (RTK), are key regulators of inflammation and vascular response to damage. TAM signaling, which has largely studied in the immune system and in cancer, has been involved in coagulation-related pathologies. Because of these established biological functions, the GAS6-PROS1/TAM system is postulated to play an important role in SARS-CoV-2 infection and progression complications. The participation of the TAM system in vascular function and pathology has been previously reported. However, in the context of COVID-19, the role of TAMs could provide new clues in virus-host interplay with important consequences in the way that we understand this pathology. From the viral mimicry used by SARS-CoV-2 to infect cells, to the immunothrombosis that is associated with respiratory failure in COVID-19 patients, TAM signaling seems to be involved at different stages of the disease. TAM targeting is becoming an interesting biomedical strategy, which is useful for COVID-19 treatment now, but also for other viral and inflammatory diseases in the future.
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Affiliation(s)
- Anna Tutusaus
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, 08036 Barcelona, Spain; (A.T.); (M.M.)
| | - Montserrat Marí
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, 08036 Barcelona, Spain; (A.T.); (M.M.)
| | - José T. Ortiz-Pérez
- Clinic Cardiovascular Institute, Hospital Clinic Barcelona, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red sobre Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Gerry A. F. Nicolaes
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Albert Morales
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, 08036 Barcelona, Spain; (A.T.); (M.M.)
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic, CIBEREHD, 08036 Barcelona, Spain
| | - Pablo García de Frutos
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, 08036 Barcelona, Spain; (A.T.); (M.M.)
- Centro de Investigación Biomédica en Red sobre Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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