1
|
Trégouët DA, Morange PE. Next-generation sequencing strategies in venous thromboembolism: in whom and for what purpose? J Thromb Haemost 2024; 22:1826-1834. [PMID: 38641321 DOI: 10.1016/j.jtha.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/21/2024]
Abstract
This invited review follows the oral presentation "To Sequence or Not to Sequence, That Is Not the Question; But 'When, Who, Which and What For?' Is" given during the State of the Art session "Translational Genomics in Thrombosis: From OMICs to Clinics" of the International Society on Thrombosis and Haemostasis 2023 Congress. Emphasizing the power of next-generation sequencing technologies and the diverse strategies associated with DNA variant analysis, this review highlights the unresolved questions and challenges in their implementation both for the clinical diagnosis of venous thromboembolism and in translational research.
Collapse
Affiliation(s)
- David-Alexandre Trégouët
- University of Bordeaux, Institut National de la Santé et de la Recherche Médicale, Bordeaux Population Health Research Center, Unité Mixte de Recherche 1219, Bordeaux, France.
| | - Pierre-Emmanuel Morange
- Cardiovascular and Nutrition Research Center (Centre de Recherche en CardioVasculaire et Nutrition), Institut National de la Santé et de la Recherche Médicale, Institut National de Recherche pour l'agriculture, l' Alimentation et l'Environnement, Aix-Marseille University, Marseille, France
| |
Collapse
|
2
|
Castelli R, Berzuini A, Manetti R, Delitala AP, Castro D, Sanna G, Sircana MC, Profili NI, Bartoli A, La Cava L, Lambertenghi Deliliers G, Donadoni M, Gidaro A. ADAMTS13, von Willebrand Factor, Platelet Microparticles, Factor VIII, and Impact of Somatic Mutations in the Pathogenesis of Splanchnic Vein Thrombosis Associated with BCR-ABL-Negative Myeloproliferative Neoplasms. Life (Basel) 2024; 14:486. [PMID: 38672756 PMCID: PMC11051276 DOI: 10.3390/life14040486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Myeloproliferative neoplasms (MPNs) are often associated with splanchnic vein thrombosis (SVT). Not all the factors involved in the thrombotic tendency are currently known. OBJECTIVES This study aims to evaluate a possible association between ADAMTS13, von Willebrand factor (VWF), platelet microvesicles (MV), and factor VIII activity (FVIII:C) with thrombotic events in MPN patients. MATERIALS AND METHODS In total, 36 consecutive MPN patients with SVT were enrolled. The MPNs were diagnosed based on clinical characteristics and one or more gene mutations among JAK-2, CALR, and MPL. As controls, 50 randomly selected patients with MPN without thrombosis, 50 patients with deep vein thrombosis without MPNs, and 50 healthy blood donors were evaluated. Complete blood count, ADAMTS13, VWF, MV, and FVIII:C in plasma were measured in all the subjects. RESULTS The JAK-2 mutation was found in 94% of the patients with SVT, but none were triple-negative for genetic mutations (JAK2 V617F, CALR, MPL, and exon 12). Compared to the normal subjects, in all the MPN patients (with or without SVT), the levels of ADAMTS13 were found to be significantly lower (p < 0.001) and the MV concentrations were significantly higher (p < 0.001). Among the MPN patients, the VWF and FVIII:C levels were significantly higher in the patients with SVT than those without thrombosis (p = 0.007 and p = 0.04, respectively). Splenomegaly was present in 78% of MPN patients with SVT and in 30% of those without SVT (p < 0.001). The ADAMTS13/VWF ratio was reduced in all the patients, but not in the healthy blood donors (p < 0.001). CONCLUSIONS The significant increase in circulating MV, VWF, and FVIII:C in the MPN patients and in the patients with thrombosis supports the role of endothelium damage in promoting thrombotic events. In particular, a significant increase in VWF and FVIII:C levels was found in the MPN patients with SVT.
Collapse
Affiliation(s)
- Roberto Castelli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (R.M.); (D.C.); (G.S.); (M.C.S.); (N.I.P.)
| | | | - Roberto Manetti
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (R.M.); (D.C.); (G.S.); (M.C.S.); (N.I.P.)
| | - Alessandro Palmerio Delitala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (R.M.); (D.C.); (G.S.); (M.C.S.); (N.I.P.)
| | - Dante Castro
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (R.M.); (D.C.); (G.S.); (M.C.S.); (N.I.P.)
| | - Giuseppe Sanna
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (R.M.); (D.C.); (G.S.); (M.C.S.); (N.I.P.)
| | - Marta Chiara Sircana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (R.M.); (D.C.); (G.S.); (M.C.S.); (N.I.P.)
| | - Nicia Isabella Profili
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (R.M.); (D.C.); (G.S.); (M.C.S.); (N.I.P.)
| | - Arianna Bartoli
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.B.); (L.L.C.); (M.D.)
| | - Leyla La Cava
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.B.); (L.L.C.); (M.D.)
| | | | - Mattia Donadoni
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.B.); (L.L.C.); (M.D.)
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy; (A.B.); (L.L.C.); (M.D.)
| |
Collapse
|
3
|
Lunghi B, Ziliotto N, Balestra D, Rossi L, Della Valle P, Pignatelli P, Pinotti M, D’Angelo A, Marchetti G, Bernardi F. Whole-Exome Sequencing in a Family with an Unexplained Tendency for Venous Thromboembolism: Multicomponent Prediction of Low-Frequency Variant Deleteriousness and of Individual Protein Interaction. Int J Mol Sci 2023; 24:13809. [PMID: 37762110 PMCID: PMC10530467 DOI: 10.3390/ijms241813809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Whole-exome sequencing (WES) in families with an unexplained tendency for venous thromboembolism (VTE) may favor detection of low-frequency variants in genes with known contribution to hemostasis or associated with VTE-related phenotypes. WES analysis in six family members, three of whom affected by documented VTE, filtered for MAF < 0.04 in 192 candidate genes, revealed 22 heterozygous (16 missense and six synonymous) variants in patients. Functional prediction by multi-component bioinformatics tools, implemented by a database/literature search, including ClinVar annotation and QTL analysis, prioritized 12 missense variants, three of which (CRP Leu61Pro, F2 Asn514Lys and NQO1 Arg139Trp) were present in all patients, and the frequent functional variants FGB Arg478Lys and IL1A Ala114Ser. Combinations of prioritized variants in each patient were used to infer functional protein interactions. Different interaction patterns, supported by high-quality evidence, included eight proteins intertwined in the "acute phase" (CRP, F2, SERPINA1 and IL1A) and/or in the "fibrinogen complex" (CRP, F2, PLAT, THBS1, VWF and FGB) significantly enriched terms. In a wide group of candidate genes, this approach highlighted six low-frequency variants (CRP Leu61Pro, F2 Asn514Lys, SERPINA1 Arg63Cys, THBS1 Asp901Glu, VWF Arg1399His and PLAT Arg164Trp), five of which were top ranked for predicted deleteriousness, which in different combinations may contribute to disease susceptibility in members of this family.
Collapse
Affiliation(s)
- Barbara Lunghi
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (B.L.); (D.B.); (L.R.); (M.P.)
| | - Nicole Ziliotto
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy;
| | - Dario Balestra
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (B.L.); (D.B.); (L.R.); (M.P.)
| | - Lucrezia Rossi
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (B.L.); (D.B.); (L.R.); (M.P.)
| | - Patrizia Della Valle
- Unit of Coagulation Service and Thrombosis Research, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (P.D.V.); (A.D.)
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Mirko Pinotti
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (B.L.); (D.B.); (L.R.); (M.P.)
| | - Armando D’Angelo
- Unit of Coagulation Service and Thrombosis Research, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (P.D.V.); (A.D.)
| | - Giovanna Marchetti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy;
| | - Francesco Bernardi
- Department of Life Sciences and Biotechnology, University of Ferrara, 44121 Ferrara, Italy; (B.L.); (D.B.); (L.R.); (M.P.)
| |
Collapse
|
4
|
Edvardsen MS, Hansen ES, Ueland T, Aukrust P, Brækkan SK, Morelli VM, Hansen JB. Impact of the von Willebrand factor-ADAMTS-13 axis on the risk of future venous thromboembolism. J Thromb Haemost 2023; 21:1227-1237. [PMID: 36736832 DOI: 10.1016/j.jtha.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND von Willebrand factor (VWF) and its cleaving protease, ADAMTS-13, form a pivotal axis that regulates hemostasis. However, the role of the VWF-ADAMTS-13 axis in the risk of future venous thromboembolism (VTE) is unknown. OBJECTIVES To investigate whether plasma ADAMTS-13 levels and an imbalance with VWF levels, assessed as the VWF/ADAMTS-13 ratio, are associated with the risk of future VTE. PATIENTS/METHODS A population-based nested case-control study, comprising 383 incident VTE cases and 780 age- and sex-matched controls, was derived from the Tromsø study cohort (1994-2007). Antigen levels of ADAMTS-13 and VWF were measured in plasma samples obtained at cohort baseline. Odds ratios (ORs) with 95% CIs were estimated according to quartile cutoffs of ADAMTS-13 and VWF/ADAMTS-13 ratio determined in controls. RESULTS In age- and sex-adjusted analysis, ADAMTS-13 levels were inversely associated with the VTE risk, with an OR of 1.40 (95% CI, 0.99-1.99) for the lowest vs highest quartiles. The VWF/ADAMTS-13 ratio was linearly associated with the VTE risk (P for trend = .001), with an OR of 1.70 (95% CI, 1.19-2.43) for the highest vs lowest quartiles, and the association was particularly pronounced for unprovoked VTE (OR, 2.81; 95% CI, 1.65-4.81). The ORs were only slightly attenuated after additional adjustments for body mass index and C-reactive protein. CONCLUSIONS Lowered ADAMTS-13 levels and an imbalance between ADAMTS-13 and VWF levels, reflected by an increased VWF/ADAMTS-13 ratio, were associated with an increased risk of future VTE. Our findings suggest that the VWF-ADAMTS-13 axis is involved in the pathogenesis of VTE.
Collapse
Affiliation(s)
- Magnus S Edvardsen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ellen-Sofie Hansen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Thor Ueland
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sigrid K Brækkan
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Vânia M Morelli
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - John-Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
5
|
Gómez-Seguí I, Pascual Izquierdo C, Mingot Castellano ME, de la Rubia Comos J. An update on the pathogenesis and diagnosis of thrombotic thrombocytopenic purpura. Expert Rev Hematol 2023; 16:17-32. [PMID: 36537217 DOI: 10.1080/17474086.2023.2159803] [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: 12/24/2022]
Abstract
INTRODUCTION Severe ADAMTS13 deficiency defines thrombotic thrombocytopenic purpura (TTP). ADAMTS13 is responsible for VWF cleavage. In the absence of this enzyme, widespread thrombi formation occurs, causing microangiopathic anemia and thrombocytopenia and leading to ischemic organ injury. Understanding ADAMTS13 function is crucial to diagnose and manage TTP, both in the immune and hereditary forms. AREAS COVERED The role of ADAMTS13 in coagulation homeostasis and the consequences of its deficiency are detailed. Other factors that modulate the consequences of ADAMTS13 deficiency are explained, such as complement system activation, genetic predisposition, or the presence of an inflammatory status. Clinical suspicion of TTP is crucial to start prompt treatment and avoid mortality and sequelae. Available techniques to diagnose this deficiency and detect autoantibodies or gene mutations are presented, as they have become faster and more available in recent years. EXPERT OPINION A better knowledge of TTP pathophysiology is leading to an improvement in diagnosis and follow-up, as well as a customized treatment in patients with TTP. This scenario is necessary to define the role of new targeted therapies already available or coming soon and the need to better diagnose and monitor at the molecular level the evolution of the disease.
Collapse
Affiliation(s)
- Inés Gómez-Seguí
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Avda, Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Cristina Pascual Izquierdo
- Servicio de Hematología y Hemoterapia, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Calle Dr. Esquerdo 46, 28007, Madrid, Spain
| | - María Eva Mingot Castellano
- Servicio de Hematología, Área de Banco de Sangre y Establecimiento de Tejidos, Hospital Universitario Virgen del Rocío, Calle Manuel Siurot s/n, 41013, Sevilla, Spain
| | - Javier de la Rubia Comos
- Servicio de Hematología y Hemoterapia, Hospital Universitari i Politècnic La Fe, Avda, Fernando Abril Martorell, 106, 46026, Valencia, Spain.,School of Medicine and Dentistry, Catholic University of Valencia, Valencia, Spain
| |
Collapse
|
6
|
Sachs UJ, Kirsch-Altena A, Müller J. Markers of Hereditary Thrombophilia with Unclear Significance. Hamostaseologie 2022; 42:370-380. [PMID: 36549289 DOI: 10.1055/s-0042-1757562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Thrombophilia leads to an increased risk of venous thromboembolism. Widely accepted risk factors for thrombophilia comprise deficiencies of protein C, protein S, and antithrombin, as well as the factor V "Leiden" mutation, the prothrombin G20210A mutation, dysfibrinogenemia, and, albeit less conclusive, increased levels of factor VIII. Besides these established markers of thrombophilia, risk factors of unclear significance have been described in the literature. These inherited risk factors include deficiencies or loss-of-activity of the activity of ADAMTS13, heparin cofactor II, plasminogen, tissue factor pathway inhibitor (TFPI), thrombomodulin, protein Z (PZ), as well as PZ-dependent protease inhibitor. On the other hand, thrombophilia has been linked to the gain-of-activity, or elevated levels, of α2-antiplasmin, angiotensin-converting enzyme, coagulation factors IX (FIX) and XI (FXI), fibrinogen, homocysteine, lipoprotein(a), plasminogen activator inhibitor-1 (PAI-1), and thrombin-activatable fibrinolysis inhibitor (TAFI). With respect to the molecular interactions that may influence the thrombotic risk, more complex mechanisms have been described for endothelial protein C receptor (EPCR) and factor XIII (FXIII) Val34Leu. With focus on the risk for venous thrombosis, the present review aims to give an overview on the current knowledge on the significance of the aforementioned markers for thrombophilia screening. According to the current knowledge, there appears to be weak evidence for a potential impact of EPCR, FIX, FXI, FXIII Val34Leu, fibrinogen, homocysteine, PAI-1, PZ, TAFI, and TFPI on the thrombotic risk.
Collapse
Affiliation(s)
- Ulrich J Sachs
- Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany.,Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus Liebig University, Giessen, Germany
| | - Anette Kirsch-Altena
- Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany
| | - Jens Müller
- Institute for Experimental Haematology and Transfusion Medicine, Bonn University Hospital, Bonn, Germany
| |
Collapse
|
7
|
Zguro K, Baldassarri M, Fava F, Beligni G, Daga S, Leoncini R, Galasso L, Cirianni M, Rusconi S, Siano M, Francisci D, Schiaroli E, Luchi S, Morelli G, Martinelli E, Girardis M, Busani S, Parisi SG, Panese S, Piscopo C, Capasso M, Tacconi D, Spertilli Raffaelli C, Giliberti A, Gori G, Katsikis PD, Lorubbio M, Calzoni P, Ognibene A, Bocchia M, Tozzi M, Bucalossi A, Marotta G, Furini S, Renieri A, Fallerini C. Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19. Viruses 2022; 14:v14061185. [PMID: 35746657 PMCID: PMC9227269 DOI: 10.3390/v14061185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/08/2023] Open
Abstract
Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF–platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage.
Collapse
Affiliation(s)
- Kristina Zguro
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
| | - Margherita Baldassarri
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
| | - Francesca Fava
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Giada Beligni
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
| | - Sergio Daga
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
| | - Roberto Leoncini
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Lucrezia Galasso
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Michele Cirianni
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, 20025 Legnano, Italy;
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy;
| | - Matteo Siano
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy;
| | - Daniela Francisci
- Infectious Diseases Clinic, “Santa Maria della Misericordia” Hospital, University of Perugia, 06124 Perugia, Italy; (D.F.); (E.S.)
| | - Elisabetta Schiaroli
- Infectious Diseases Clinic, “Santa Maria della Misericordia” Hospital, University of Perugia, 06124 Perugia, Italy; (D.F.); (E.S.)
| | - Sauro Luchi
- Infectious Disease Unit, Hospital of Lucca, 55100 Lucca, Italy; (S.L.); (G.M.)
| | - Giovanna Morelli
- Infectious Disease Unit, Hospital of Lucca, 55100 Lucca, Italy; (S.L.); (G.M.)
| | - Enrico Martinelli
- Department of Respiratory Diseases, Azienda Ospedaliera di Cremona, 26100 Cremona, Italy;
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, 41124 Modena, Italy; (M.G.); (S.B.)
| | - Stefano Busani
- Department of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, 41124 Modena, Italy; (M.G.); (S.B.)
| | | | - Sandro Panese
- Clinical Infectious Diseases, Mestre Hospital, 30171 Venezia, Italy;
| | - Carmelo Piscopo
- Medical Genetics and Laboratory Genetics Unit, “Antonio Cardarelli” hospital, 80131 Naples, Italy;
| | - Mario Capasso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80138 Naples, Italy;
- CEINGE Biotecnologie Avanzate, 80145 Naples, Italy
| | - Danilo Tacconi
- Department of Specialized and Internal Medicine, Infectious Diseases Unit, San Donato Hospital Arezzo, 52100 Arezzo, Italy; (D.T.); (C.S.R.)
| | - Chiara Spertilli Raffaelli
- Department of Specialized and Internal Medicine, Infectious Diseases Unit, San Donato Hospital Arezzo, 52100 Arezzo, Italy; (D.T.); (C.S.R.)
| | - Annarita Giliberti
- Medical Genetics Unit, Meyer Children’s University Hospital, 50134 Florence, Italy; (A.G.); (G.G.)
| | - Giulia Gori
- Medical Genetics Unit, Meyer Children’s University Hospital, 50134 Florence, Italy; (A.G.); (G.G.)
| | - Peter D. Katsikis
- Department of Immunology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Maria Lorubbio
- UOC Laboratorio Analisi Chimico Cliniche, 52100 Arezzo, Italy; (M.L.); (A.O.)
| | - Paola Calzoni
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Agostino Ognibene
- UOC Laboratorio Analisi Chimico Cliniche, 52100 Arezzo, Italy; (M.L.); (A.O.)
| | - Monica Bocchia
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Monica Tozzi
- Stem Cell Transplant and Cellular Therapy Unit, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (A.B.); (G.M.)
| | - Alessandro Bucalossi
- Stem Cell Transplant and Cellular Therapy Unit, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (A.B.); (G.M.)
| | - Giuseppe Marotta
- Stem Cell Transplant and Cellular Therapy Unit, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (A.B.); (G.M.)
| | - Simone Furini
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
| | | | - Alessandra Renieri
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Correspondence:
| | - Chiara Fallerini
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
| |
Collapse
|