1
|
Baldassarre M, Naldi M, Zaccherini G, Bartoletti M, Antognoli A, Laggetta M, Gagliardi M, Tufoni M, Domenicali M, Waterstradt K, Paterini P, Baldan A, Leoni S, Bartolini M, Viale P, Trevisani F, Bernardi M, Caraceni P. Determination of Effective Albumin in Patients With Decompensated Cirrhosis: Clinical and Prognostic Implications. Hepatology 2021; 74:2058-2073. [PMID: 33710623 PMCID: PMC8518406 DOI: 10.1002/hep.31798] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/21/2021] [Accepted: 02/11/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Circulating albumin in cirrhosis can be dysfunctional because of accumulating structural damages, leading to the concept of effective albumin concentration (eAlb), referring to the albumin portion presenting structural and functional integrity. We aimed to estimate eAlb in patients with decompensated cirrhosis and analyze its relationships with albumin function and clinical outcomes as compared to total albumin concentration (tAlb). APPROACH AND RESULTS We evaluated 319 patients with cirrhosis hospitalized for acute decompensation (AD) with and without acute-on-chronic liver failure (ACLF) and 18 age- and sex-comparable outpatients with compensated cirrhosis. tAlb was quantified by standard assay, whereas eAlb was estimated combining liquid chromatography/electrospray ionization/mass spectrometry and standard methods. Albumin binding and detoxification efficiency were evaluated by electron paramagnetic resonance analysis. Circulating albumin in patients with decompensated cirrhosis displayed multiple structural abnormalities, with reversible oxidation and glycation being the most frequent. As a result, eAlb progressively declined with the worsening of cirrhosis and was superior to tAlb in stratifying patients between compensated cirrhosis, AD, and ACLF, as well as patients with and without complications. Moreover, eAlb, but not tAlb, was closely associated with binding capacities in ACLF. Finally, eAlb at admission predicted the occurrence of ACLF within 30 days and mortality at 90 days better than tAlb. CONCLUSIONS This large, observational study provides the evidence in patients with decompensated cirrhosis that eAlb can be quantified and differentiated from tAlb routinely measured in clinical practice. As compared to tAlb, eAlb is more closely associated with disease severity and albumin dysfunction and carries a greater prognostic power. These results prompt future research assessing eAlb as a biomarker for predicting prognosis and treatment response.
Collapse
Affiliation(s)
- Maurizio Baldassarre
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly
| | - Marina Naldi
- Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly,Department of Pharmacy and BiotechnologyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Giacomo Zaccherini
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Michele Bartoletti
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Agnese Antognoli
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Maristella Laggetta
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Martina Gagliardi
- Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Manuel Tufoni
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly
| | - Marco Domenicali
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly,Department of Internal MedicineS. Maria delle Croci HospitalAUSL RomagnaRavennaItaly
| | | | - Paola Paterini
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Centre for Applied Biomedical Research–CRBAAlma Mater Studiorum University of BolognaSt. Orsola HospitAlbolognaItaly
| | - Anna Baldan
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly
| | - Simona Leoni
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly
| | - Manuela Bartolini
- Department of Pharmacy and BiotechnologyAlma Mater Studiorum University of BolognaBolognaItaly
| | - Pierluigi Viale
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Franco Trevisani
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Mauro Bernardi
- Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| | - Paolo Caraceni
- IRCSS Azienda Ospedaliero–Universitaria di BolognaBolognaItaly,Department of Medical and Surgical SciencesAlma Mater Studiorum University of BolognaBolognaItaly
| |
Collapse
|
2
|
Trebicka J, Fernandez J, Papp M, Caraceni P, Laleman W, Gambino C, Giovo I, Uschner FE, Jansen C, Jimenez C, Mookerjee R, Gustot T, Albillos A, Bañares R, Jarcuska P, Steib C, Reiberger T, Acevedo J, Gatti P, Shawcross DL, Zeuzem S, Zipprich A, Piano S, Berg T, Bruns T, Danielsen KV, Coenraad M, Merli M, Stauber R, Zoller H, Ramos JP, Solé C, Soriano G, de Gottardi A, Gronbaek H, Saliba F, Trautwein C, Kani HT, Francque S, Ryder S, Nahon P, Romero-Gomez M, Van Vlierberghe H, Francoz C, Manns M, Garcia-Lopez E, Tufoni M, Amoros A, Pavesi M, Sanchez C, Praktiknjo M, Curto A, Pitarch C, Putignano A, Moreno E, Bernal W, Aguilar F, Clària J, Ponzo P, Vitalis Z, Zaccherini G, Balogh B, Gerbes A, Vargas V, Alessandria C, Bernardi M, Ginès P, Moreau R, Angeli P, Jalan R, Arroyo V, Semela D, Elkrief L, Elsharkawy A, Tornai T, Tornai I, Altorjay I, Antognoli A, Baldassarre M, Gagliardi M, Bertoli E, Mareso S, Brocca A, Campion D, Saracco GM, Rizzo M, Lehmann J, Pohlmann A, Brol MJ, Chang J, Schierwagen R, Solà E, Amari N, Rodriguez M, Nevens F, Clemente A, Janicko M, Markwardt D, Mandorfer M, Welsch C, Welzel TM, Ciraci E, Patel V, Ripoll C, Herber A, Horn P, Bendtsen F, Gluud LL, Schaapman J, Riggio O, Rainer F, Moritz JT, Mesquita M, Alvarado-Tapias E, Akpata O, Aamann L, Samuel D, Tresson S, Strnad P, Amathieu R, Simón-Talero M, Smits F, van den Ende N, Martinez J, Garcia R, Rupprechter H, Engelmann C, Özdogan OC. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. J Hepatol 2021; 74:1097-1108. [PMID: 33227350 DOI: 10.1016/j.jhep.2020.11.019] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. METHODS The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. RESULTS Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90-day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. CONCLUSIONS This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. LAY SUMMARY Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes.
Collapse
Affiliation(s)
- Jonel Trebicka
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany.
| | - Javier Fernandez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Maria Papp
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Wim Laleman
- Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic disorders, University of Leuven, Leuven, Belgium
| | | | - Ilaria Giovo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Frank Erhard Uschner
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Cesar Jimenez
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Agustin Albillos
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, University of Alcalá, CIBEREHD, Madrid, Spain
| | - Rafael Bañares
- Hospital General Universitario Gregorio Marañón. Facultad de Medicina (Universidad Complutense of Madrid), CIBERehd, Madrid, Spain
| | - Peter Jarcuska
- Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Christian Steib
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | | | - Juan Acevedo
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Pietro Gatti
- Internal Medicine PO Ostuni, ASL Brindisi, Italy
| | | | - Stefan Zeuzem
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | | | | | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University, Medical Center, Leipzig, Germany
| | - Tony Bruns
- Jena University Hospital, Jena, Germany; Aachen University Hospital, Aachen, Germany
| | - Karen Vagner Danielsen
- Gastrounit, Medical Section, Hvidovre Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Heinz Zoller
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Cristina Solé
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Germán Soriano
- Hospital de la Santa Creu i Sant Pau and CIBERehd, Barcelona, Spain
| | - Andrea de Gottardi
- University Clinic of Visceral Surgery and Medicine-Inselspital, Bern and Ente Ospedaliero Cantonale, Universita della Svizzera Italiana, Lugano, Switzerland
| | | | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Universite Paris Saclay, INSERM Unit 1193, Villejuif, France
| | | | | | | | - Stephen Ryder
- NIHR Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis, France; Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", Paris, France
| | | | | | - Claire Francoz
- APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | | | | | | | - Alex Amoros
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Marco Pavesi
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Cristina Sanchez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Anna Curto
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Carla Pitarch
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Esau Moreno
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Ferran Aguilar
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Joan Clària
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Paola Ponzo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Zsuzsanna Vitalis
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Boglarka Balogh
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | - Alexander Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | - Victor Vargas
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Pere Ginès
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Richard Moreau
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | - Paolo Angeli
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; University of Padova, Padova, Italy
| | - Rajiv Jalan
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; UCL Medical School,Royal Free Hospital, London, UK
| | - Vicente Arroyo
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Bartoletti M, Baldassarre M, Domenicali M, Lewis RE, Giannella M, Antognoli A, Rinaldi M, Zaccherini G, Verucchi G, Marconi L, Tamè M, Berardi S, Napoli L, Siniscalchi A, Fabbri A, Biselli M, Tufoni M, Pavarin RM, Trevisani F, Viale P, Bernardi M, Caraceni P. Prognostic Role of Bacterial and Fungal Infections in Patients With Liver Cirrhosis With and Without Acute-on-Chronic Liver Failure: A Prospective 2-Center Study. Open Forum Infect Dis 2020; 7:ofaa453. [PMID: 33209950 PMCID: PMC7652102 DOI: 10.1093/ofid/ofaa453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bacterial and fungal infections (BFIs) are frequent in patients with cirrhosis and often trigger acute-on-chronic liver failure (ACLF). This prospective observational study aims to describe the interactions between BFI and ACLF in terms of mortality and related risk factors. METHODS We performed a 2-center prospective observational study enrolling hospitalized patients with cirrhosis admitted for acute decompensation. Data were recorded at admission and during hospitalization. Survival was recorded up to 1 year. RESULTS Among the 516 patients enrolled, 108 (21%) were infected at admission, while an additional 61 patients (12%) developed an infection during hospital stay. In the absence of ACLF, the 1-year mortality rate of patients with BFI did not differ from that of patients without BFI (33% vs 31%; P = .553). In contrast, those with ACLF triggered or complicated by BFI had a significantly higher mortality rate than those who remained free from BFI (75% vs 54%; P = .011). Competing risk analysis showed that the negative impact of ACLF-related BFI on long-term prognosis was independent from Model for End-stage Liver Disease (MELD) incorporating serum sodium concentration score, comorbidity, and basal C-reactive protein level. Finally, multivariable logistic regression showed that higher MELD score (P < .001), QuickSOFA score ≥2 points (P = .007), and secondary bloodstream (P = .022) and multidrug-resistant pathogen isolation (P = .030) were independently associated with ACLF in patients with BFI. CONCLUSIONS This large prospective study indicated that the adverse impact of BFI on long-term survival in decompensated cirrhosis is not universal but is limited to those patients who also develop ACLF. Both disease severity and microbiological factors predispose infected decompensated patients to ACLF.
Collapse
Affiliation(s)
- Michele Bartoletti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Russell E Lewis
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Agnese Antognoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| | - Matteo Rinaldi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gabriella Verucchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lorenzo Marconi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mariarosa Tamè
- U.O. Gastroenterology, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sonia Berardi
- U.O. Internal Medicine and Organ Failure, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lucia Napoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- S.S.D. Intensive Care of Abdominal Transplantation and Liver Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Angela Fabbri
- U.O. Internal Medicine, Infermi Hospital of Rimini, Area Vasta Romagna (AVR) Rimini, Rimini, Italy
| | - Maurizio Biselli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Raimondo M Pavarin
- Epidemiological Monitoring Center on Addiction, Mental Health DSM DP, Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Infectious Disease, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- U.O. Medical Semiotics, S. Orsola-Malpighi University Hospital, Bologna, Italy
- Centre for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
Bossi MM, Tufoni M, Zaccherini G, Antognoli A, Domenicali M, Caraceni P. A web-based group treatment for patients with alcoholic liver diseases at the time of the COVID-19 pandemic. Dig Liver Dis 2020; 52:956-957. [PMID: 32513630 PMCID: PMC7200346 DOI: 10.1016/j.dld.2020.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | - Paolo Caraceni
- Coreesponding author at: U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
| |
Collapse
|
5
|
Abstract
Purpose of Review Albumin administration is recommended to prevent or treat specific complications of decompensated cirrhosis based on its capacity to expand plasma volume. However, the molecule also has many other biological properties that are unrelated to the oncotic activity. The purpose of this review is to examine the hemodynamic and systemic effects of albumin administration in patients with decompensated cirrhosis. Recent Findings Besides plasma expansion, albumin appears to act against inflammation, facilitate immunocompetence, and improve cardiac and endothelial function, thus antagonizing critical steps in the pathophysiological cascade underlying decompensated cirrhosis. Summary Increasing knowledge of the pathophysiological mechanisms of the disease, as well the pleiotropic properties of the molecule, provides the rationale for considering albumin as a multi-target disease-modifying agent in decompensated cirrhosis. Both oncotic and non-oncotic properties likely concur with the clinical benefits of long-term albumin administration recently demonstrated in these patients.
Collapse
Affiliation(s)
- Manuel Tufoni
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.,Center for Applied Medical Research (CRBA), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Agnese Antognoli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.,Center for Applied Medical Research (CRBA), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.,Center for Applied Medical Research (CRBA), Alma Mater Studiorum University of Bologna, Bologna, Italy
| |
Collapse
|
6
|
Zaccherini G, Baldassarre M, Bartoletti M, Tufoni M, Berardi S, Tamè M, Napoli L, Siniscalchi A, Fabbri A, Marconi L, Antognoli A, Iannone G, Domenicali M, Viale P, Trevisani F, Bernardi M, Caraceni P. Prediction of nosocomial acute-on-chronic liver failure in patients with cirrhosis admitted to hospital with acute decompensation. JHEP Rep 2019; 1:270-277. [PMID: 32039378 PMCID: PMC7001573 DOI: 10.1016/j.jhepr.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/04/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Nosocomial acute-on-chronic liver failure (nACLF) develops in at least 10% of patients with cirrhosis hospitalized for acute decompensation (AD), greatly worsening their prognosis. In this prospective observational study, we aimed to identify rapidly obtainable predictors at admission, which allow for the early recognition and stratification of patients at risk of nACLF. Methods A total of 516 consecutive patients hospitalized for AD of cirrhosis were screened: those who did not present ACLF at admission (410) were enrolled and surveilled for the development of nACLF. Results Fifty-nine (14%) patients developed nALCF after a median of 7 (IQR 4-18) days. At admission, they presented a more severe disease and higher degrees of systemic inflammation and anemia than those (351; 86%) who remained free from nACLF. Competing risk multivariable regression analysis showed that baseline MELD score (sub-distribution hazard ratio [sHR] 1.15; 95% CI 1.10-1.21; p ≪0.001), hemoglobin level (sHR 0.81; 95% CI 0.68-0.96; p = 0.018), and leukocyte count (sHR 1.11; 95% CI 1.06-1.16; p ≪0.001) independently predicted nACLF. Their optimal cut-off points, determined by receiver-operating characteristic curve analysis, were: 13 points for MELD score, 9.8 g/dl for hemoglobin, and 5.6x109/L for leukocyte count. These thresholds were used to stratify patients according to the cumulative incidence of nACLF, being 0, 6, 21 and 59% in the presence of 0, 1, 2 or 3 risk factors (p ≪0.001). Nosocomial bacterial infections only increased the probability of developing nACLF in patients with at least 1 risk factor, rising from 3% to 29%, 16% to 50% and 52% to 83% in patients with 1, 2 or 3 risk factors, respectively. Conclusions Easily available laboratory parameters, related to disease severity, systemic inflammation, and anemia, can be used to identify, at admission, hospitalized patients with AD at increased risk of developing nACLF. Lay summary More than 10% of patients with cirrhosis hospitalized because of an acute decompensation develop acute-on-chronic liver failure, which is associated with high short-term mortality, during their hospital stay. We found that the combination of 3 easily obtainable variables (model for end-stage liver disease score, leukocyte count and hemoglobin level) help to identify and stratify patients according to their risk of developing nosocomial acute-on-chronic liver failure, from nil to 59%. Moreover, if a nosocomial bacterial infection occurs, such an incidence proportionally increases from nil to 83%. This simple approach helps to identify patients at risk of developing nosocomial acute-on-chronic liver failure at admission to hospital, enabling clinicians to put in place preventive measures.
Collapse
Affiliation(s)
- Giacomo Zaccherini
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences - University of Bologna, Italy.,Centre for Applied Biomedical Research (CRBA), University of Bologna, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Sonia Berardi
- U.O. Internal Medicine and Organ Failure - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Mariarosa Tamè
- U.O. Gastroenterology - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lucia Napoli
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Antonio Siniscalchi
- S.S.D. Intensive Care of Abdominal Transplantation and Liver Surgery - S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Angela Fabbri
- U.O. Internal Medicine, Infermi Hospital of Rimini, Area Vasta Romagna (AVR) Rimini, Italy
| | - Lorenzo Marconi
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Agnese Antognoli
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Giulia Iannone
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences - University of Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences - University of Bologna, Italy.,Centre for Applied Biomedical Research (CRBA), University of Bologna, Italy
| |
Collapse
|
7
|
Meneghello A, Antognoli A, Sonato A, Zacco G, Ruffato G, Cretaio E, Romanato F. Label-free efficient and accurate detection of cystic fibrosis causing mutations using an azimuthally rotated GC-SPR platform. Anal Chem 2014; 86:11773-81. [PMID: 25359284 DOI: 10.1021/ac503272y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Plasmonic nanosensors are candidates for the development of new sensors with low detection limits, high sensitivity, and specificity for target detection: these characteristics are of critical importance in the screening of mutations responsible for inherited diseases. In this work, we focused our study on the detection of some of the most frequent mutations responsible for cystic fibrosis (CF) among the Italian population. For the detection of the CF mutations we adopted a recently developed and highly sensitive Grating Coupled-Surface Plasmon Resonance (GC-SPR) enhanced spectroscopy method for label-free molecular identification exploiting a conical illumination configuration. Gold sinusoidal gratings functionalized with heterobifunctional PEG were used as sensing surfaces, and the specific biodetection was achieved through the coupling with DNA hairpin probes designed for single nucleotide discrimination. Such substrates were used to test unlabeled PCR amplified homozygous wild type (wt) and heterozygous samples, deriving from clinical samples, for the screened mutations. Hybridization conditions were optimized to obtain the maximum discrimination ratio (DR) between the homozygous wild type and the heterozygous samples. SPR signals obtained from hybridizing wild type and heterozygous samples show DRs able to identify univocally the correct genotypes, as confirmed by fluorescence microarray experiments run in parallel. Furthermore, SPR genotyping was not impaired in samples containing unrelated DNA, allowing the platform to be used for the concomitant discrimination of several alleles also scalable for a high throughput screening setting.
Collapse
Affiliation(s)
- Anna Meneghello
- Veneto Nanotech S.C.p.A. , Via S. Crispino 106, Padova, Italy , c/o Nanofab, Via delle Industrie 5, 30175 Marghera (VE), Italy
| | | | | | | | | | | | | |
Collapse
|
8
|
Sosic A, Meneghello A, Antognoli A, Cretaio E, Gatto B. Development of a multiplex sandwich aptamer microarray for the detection of VEGF165 and thrombin. Sensors (Basel) 2013; 13:13425-38. [PMID: 24097233 PMCID: PMC3859071 DOI: 10.3390/s131013425] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/20/2013] [Accepted: 09/29/2013] [Indexed: 02/07/2023]
Abstract
In this work we have developed a multiplex microarray system capable of detecting VEGF165 and thrombin. We recently described a Sandwich Aptamer Microarray (SAM) for thrombin detection feasible for use in multiplex microarrays; here we describe a new aptasensor for VEGF165 detection employing Vap7 and VEa5, two DNA aptamers recognizing different sites of the protein. The aptamers were modified to be adapted to the solid phase platform of SAM and their capability to simultaneously recognize VEGF165 by forming a ternary complex was analyzed in solution. Having so defined the best tandem arrangement of modified aptamers, we set up the aptasensor for VEGF165, and finally analyzed the multiplex system with the two aptasensors for the simultaneous detection of VEGF165 and thrombin. The results indicate that each sandwich is specific, even when the two proteins are mixed. The system performance is consistent with the behavior evidenced by the biochemical analysis, which proves to be valuable to drive the evaluation and refinement of aptamers prior to or along the development of a detection platform. Since thrombin upregulates VEGF expression, the simultaneous recognition of these two proteins could be useful in the analysis of biomarkers in pathologies characterized by neo-angiogenesis.
Collapse
Affiliation(s)
- Alice Sosic
- Dipartimento di Scienze del Farmaco, Università di Padova, via Marzolo 5, 35131 Padova, Italy; E-Mail:
| | - Anna Meneghello
- Veneto Nanotech S.C.p.A., Via S. Crispino 106, I -35129 Padova, Italy; E-Mails: (A.M.); (A.A.); (E.C.)
| | - Agnese Antognoli
- Veneto Nanotech S.C.p.A., Via S. Crispino 106, I -35129 Padova, Italy; E-Mails: (A.M.); (A.A.); (E.C.)
| | - Erica Cretaio
- Veneto Nanotech S.C.p.A., Via S. Crispino 106, I -35129 Padova, Italy; E-Mails: (A.M.); (A.A.); (E.C.)
| | - Barbara Gatto
- Dipartimento di Scienze del Farmaco, Università di Padova, via Marzolo 5, 35131 Padova, Italy; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-049-827-5717; Fax: +39-049-827-5366
| |
Collapse
|
9
|
Meneghello A, Sosic A, Antognoli A, Cretaio E, Gatto B. Development and Optimization of a Thrombin Sandwich Aptamer Microarray. Microarrays (Basel) 2012; 1:95-106. [PMID: 27605338 PMCID: PMC5003437 DOI: 10.3390/microarrays1020095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/26/2012] [Accepted: 08/07/2012] [Indexed: 11/17/2022]
Abstract
A sandwich microarray employing two distinct aptamers for human thrombin has been optimized for the detection of subnanomolar concentrations of the protein. The aptamer microarray demonstrates high specificity for thrombin, proving that a two-site binding assay with the TBA1 aptamer as capture layer and the TBA2 aptamer as detection layer can ensure great specificity at times and conditions compatible with standard routine analysis of biological samples. Aptamer microarray sensitivity was evaluated directly by fluorescent analysis employing Cy5-labeled TBA2 and indirectly by the use of TBA2-biotin followed by detection with fluorescent streptavidin. Sub-nanomolar LODs were reached in all cases and in the presence of serum, demonstrating that the optimized aptamer microarray can identify thrombin by a low-cost, sensitive and specific method.
Collapse
Affiliation(s)
- Anna Meneghello
- Associazione CIVEN, Via delle Industrie 9, I-30175 Venezia-Marghera, Italy.
| | - Alice Sosic
- Dipartimento di Scienze del Farmaco, University of Padova, Via F. Marzolo 5, I-35131 Padova, Italy.
| | - Agnese Antognoli
- Veneto Nanotech S.C.p.A., Via S. Crispino 106, I -35129 Padova, Italy.
| | - Erica Cretaio
- Associazione CIVEN, Via delle Industrie 9, I-30175 Venezia-Marghera, Italy.
| | - Barbara Gatto
- Dipartimento di Scienze del Farmaco, University of Padova, Via F. Marzolo 5, I-35131 Padova, Italy.
| |
Collapse
|
10
|
Nanni P, Nicoletti G, Palladini A, Croci S, Murgo A, Ianzano ML, Grosso V, Stivani V, Antognoli A, Lamolinara A, Landuzzi L, di Tomaso E, Iezzi M, De Giovanni C, Lollini PL. Multiorgan metastasis of human HER-2+ breast cancer in Rag2-/-;Il2rg-/- mice and treatment with PI3K inhibitor. PLoS One 2012; 7:e39626. [PMID: 22737248 PMCID: PMC3380859 DOI: 10.1371/journal.pone.0039626] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/29/2012] [Indexed: 01/26/2023] Open
Abstract
In vivo studies of the metastatic process are severely hampered by the fact that most human tumor cell lines derived from highly metastatic tumors fail to consistently metastasize in immunodeficient mice like nude mice. We describe a model system based on a highly immunodeficient double knockout mouse, Rag2−/−;Il2rg−/−, which lacks T, B and NK cell activity. In this model human metastatic HER-2+ breast cancer cells displayed their full multiorgan metastatic potential, without the need for selections or additional manipulations of the system. Human HER-2+ breast cancer cell lines MDA-MB-453 and BT-474 injected into Rag2−/−;Il2rg−/− mice faithfully reproduced human cancer dissemination, with multiple metastatic sites that included lungs, bones, brain, liver, ovaries, and others. Multiorgan metastatic spread was obtained both from local tumors, growing orthotopically or subcutaneously, and from cells injected intravenously. The problem of brain recurrencies is acutely felt in HER-2+ breast cancer, because monoclonal antibodies against HER-2 penetrate poorly the blood-brain barrier. We studied whether a novel oral small molecule inhibitor of downstream PI3K, selected for its penetration of the blood-brain barrier, could affect multiorgan metastatic spread in Rag2−/−; Il2rg−/− mice. NVP-BKM120 effectively controlled metastatic growth in multiple organs, and resulted in a significant proportion of mice free from brain and bone metastases. Human HER-2+ human breast cancer cells in Rag2−/−;Il2rg−/− mice faithfully reproduced the multiorgan metastatic pattern observed in patients, thus allowing the investigation of metastatic mechanisms and the preclinical study of novel antimetastatic agents.
Collapse
Affiliation(s)
- Patrizia Nanni
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | | | - Arianna Palladini
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | - Stefania Croci
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | - Annalisa Murgo
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | - Marianna L. Ianzano
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | - Valentina Grosso
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | - Valeria Stivani
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | - Agnese Antognoli
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | | | | | - Emmanuelle di Tomaso
- Novartis Institutes for BioMedical Research, Inc., Cambridge, Massachusetts, United States of America
| | - Manuela Iezzi
- Aging Research Centre, “G. D'Annunzio” University, Chieti, Italy
| | - Carla De Giovanni
- Section of Cancer Research, Department of Experimental Pathology, University of Bologna, Bologna, Italy
- * E-mail:
| | - Pier-Luigi Lollini
- Department of Hematology and Oncological Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
11
|
Landuzzi L, Antognoli A, Nicoletti G, Croci S, Palladini A, Ianzano ML, Murgo A, Stivani V, Grosso V, Nanni P, De Giovanni C, Lollini PL. HER-2/neu tolerant and non-tolerant mice for fine assessment of antimetastatic potency of dendritic cell-tumor cell hybrid vaccines. Vaccine 2011; 29:4690-7. [PMID: 21569812 DOI: 10.1016/j.vaccine.2011.04.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 03/24/2011] [Accepted: 04/26/2011] [Indexed: 01/20/2023]
Abstract
Main obstacles to cancer vaccine efficacy are pre-existing antigenic load and immunoescape mechanisms, including tolerance against self tumor-associated antigens. Here we explored the role of tolerance in an antimetastatic vaccine approach based on dendritic cell-tumor cell (DC-TC) hybrids, thanks to the comparison between BALB-neuT mice, transgenic for and tolerant to rat HER-2/neu, with their non-tolerant strain of origin BALB/c. Allogeneic DC-TC hybrid vaccine displayed a high antimetastatic activity in non-tolerant mice, but was far less effective in tolerant mice, even with intensified vaccine schedule. Tolerant BALB-neuT mice revealed a reduced ability to mount polarized Th1 responses. A further attempt to increase the antimetastatic activity by using LPS-matured DC hybrids failed. Allogeneic LPS-matured DC-TC hybrids induced high IFN-γ levels, but concomitantly also the highest production of IL-4 and IL-10 suggesting activation of mechanisms sustaining regulatory cells able to blunt vaccine efficacy. Our data in tolerant versus non-tolerant hosts suggest that clinical translation of effective DC-based strategies could benefit from more extensive investigations in tolerant transgenic models.
Collapse
Affiliation(s)
- Lorena Landuzzi
- Laboratory of Experimental Oncology, Rizzoli Orthopedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Palladini A, Nicoletti G, Pappalardo F, Murgo A, Grosso V, Stivani V, Ianzano ML, Antognoli A, Croci S, Landuzzi L, De Giovanni C, Nanni P, Motta S, Lollini PL. In silico modeling and in vivo efficacy of cancer-preventive vaccinations. Cancer Res 2010; 70:7755-63. [PMID: 20924100 DOI: 10.1158/0008-5472.can-10-0701] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancer vaccine feasibility would benefit from reducing the number and duration of vaccinations without diminishing efficacy. However, the duration of in vivo studies and the huge number of possible variations in vaccination protocols have discouraged their optimization. In this study, we employed an established mouse model of preventive vaccination using HER-2/neu transgenic mice (BALB-neuT) to validate in silico-designed protocols that reduce the number of vaccinations and optimize efficacy. With biological training, the in silico model captured the overall in vivo behavior and highlighted certain critical issues. First, although vaccinations could be reduced in number without sacrificing efficacy, the intensity of early vaccinations was a key determinant of long-term tumor prevention needed for predictive utility in the model. Second, after vaccinations ended, older mice exhibited more rapid tumor onset and sharper decline in antibody levels than young mice, emphasizing immune aging as a key variable in models of vaccine protocols for elderly individuals. Long-term studies confirmed predictions of in silico modeling in which an immune plateau phase, once reached, could be maintained with a reduced number of vaccinations. Furthermore, that rapid priming in young mice is required for long-term antitumor protection, and that the accuracy of mathematical modeling of early immune responses is critical. Finally, that the design and modeling of cancer vaccines and vaccination protocols must take into account the progressive aging of the immune system, by striving to boost immune responses in elderly hosts. Our results show that an integrated in vivo-in silico approach could improve both mathematical and biological models of cancer immunoprevention.
Collapse
Affiliation(s)
- Arianna Palladini
- Cancer Research Section, Department of Experimental Pathology, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Triulzi C, Vertuani S, Curcio C, Antognoli A, Seibt J, Akusjärvi G, Wei WZ, Cavallo F, Kiessling R. Antibody-Dependent Natural Killer Cell–Mediated Cytotoxicity Engendered by a Kinase-Inactive Human HER2 Adenovirus-Based Vaccination Mediates Resistance to Breast Tumors. Cancer Res 2010; 70:7431-41. [DOI: 10.1158/0008-5472.can-10-0493] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
14
|
De Giovanni C, Nicoletti G, Palladini A, Croci S, Landuzzi L, Antognoli A, Murgo A, Astolfi A, Ferrini S, Fabbi M, Orengo AM, Amici A, Penichet ML, Aurisicchio L, Iezzi M, Musiani P, Nanni P, Lollini PL. A multi-DNA preventive vaccine for p53/Neu-driven cancer syndrome. Hum Gene Ther 2010; 20:453-64. [PMID: 19215191 DOI: 10.1089/hum.2008.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The highly aggressive cancer syndrome of female mice carrying a p53 knockout allele and a rat HER-2/neu (Neu) transgene (BALB-p53Neu) can be prevented by a cell vaccine presenting three components: Neu, interleukin (IL)-12 production, and allogeneic major histocompatibility complex (MHC) alleles (Triplex cell vaccine). Here we tested a second-generation Triplex DNA-based vaccine (Tri-DNA), consisting of the combination of three gene components (a transmembrane-extracellular domain fragment of the Neu gene, IL-12 genes, and the H-2D(q) allogeneic MHC gene), carried by separate plasmids. The Tri-DNA vaccine was at least as effective as the Triplex cell vaccine for cancer immunoprevention, giving a similar delay in the onset of mammary cancer and complete protection from salivary cancer. Both vaccines induced anti-Neu antibodies of the murine IgG2a isotype at similar levels. The Tri-DNA vaccine gave more restricted immunostimulation, consisting of a fully helper T cell type 1 (Th1)-polarized response, with effective production of interferon (IFN)-gamma in response to the vaccine but no spontaneous production, and no induction of anti-Neu IgG3 antibodies. On the other hand, the Triplex cell vaccine induced both Th1 and Th2 cytokines, a strong increase in spontaneous IFN-gamma production, and high levels of IgG3 antibodies recognizing Neu-positive syngeneic cells. In conclusion, the Tri-DNA vaccine is as effective as Triplex cell vaccine, exploiting a more restricted immune stimulation.
Collapse
Affiliation(s)
- C De Giovanni
- Cancer Research Section, Department of Experimental Pathology, Alma Mater Studiorum, University of Bologna, I-40126 Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Nanni P, Nicoletti G, Landuzzi L, Croci S, Murgo A, Palladini A, Antognoli A, Ianzano ML, Stivani V, Grosso V, Maira SM, García-Echeverría C, Scotlandi K, De Giovanni C, Lollini PL. High metastatic efficiency of human sarcoma cells in Rag2/gammac double knockout mice provides a powerful test system for antimetastatic targeted therapy. Eur J Cancer 2009; 46:659-68. [PMID: 20031388 DOI: 10.1016/j.ejca.2009.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 11/13/2009] [Accepted: 11/19/2009] [Indexed: 11/20/2022]
Abstract
Immunodeficient animal models are invaluable tools to investigate the metastatic propensity of human tumours. However residual immune responses, in particular natural killer (NK) cells, severely hamper the traffic and growth of human tumour cells. We studied whether a genetically modified mouse host lacking T, B and NK immunity allowed an improved expression of the metastatic phenotype of malignant human tumours. Metastatic spread of a panel of human sarcoma cell lines was studied in double knockout Rag2(-/-);gammac(-/-) mice in comparison with NK-depleted nude mice. Rag2(-/-);gammac(-/-) mice receiving intravenous (i.v.) or subcutaneous (s.c.) human sarcoma cell lines developed extensive multiorgan metastases. Metastatic efficiency in Rag2(-/-);gammac(-/-) was superior than in nude mice in terms of both metastatic sites and metastasis number. Metastatic growth in Rag2(-/-);gammac(-/-) mice was faster than that in nude mice, thus allowing an earlier metastasis evaluation. Most human sarcomas metastasised in the liver of Rag2(-/-);gammac(-/-) mice, a kind of organ preference undetectable in nude mice and specific of sarcomas, as several carcinoma cell lines failed to colonise the liver of Rag2(-/-);gammac(-/-) mice, independently of their metastatic spread to other sites. In vitro analysis of the molecular mechanisms of liver metastasis of sarcomas implicated liver-produced growth and motility factors, in particular the insulin-like growth factor (IGF) axis. NVP-BEZ235, a specific inhibitor of downstream signal transduction targeting PI3K and mTOR, strongly inhibited liver metastasis of human sarcoma cells. In conclusion, the Rag2(-/-);gammac(-/-) mouse model allowed the expression of human metastatic phenotypes inapparent in conventional immunodeficient mice and the preclinical testing of appropriate targeted therapies.
Collapse
Affiliation(s)
- Patrizia Nanni
- Cancer Research Section, Department of Experimental Pathology, Viale Filopanti 22, University of Bologna, 40126 Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Nanni P, Nicoletti G, Palladini A, Astolfi A, Rinella P, Croci S, Landuzzi L, Monduzzi G, Stivani V, Antognoli A, Murgo A, Ianzano M, De Giovanni C, Lollini PL. Opposing control of rhabdomyosarcoma growth and differentiation by myogenin and interleukin 4. Mol Cancer Ther 2009; 8:754-61. [PMID: 19372547 DOI: 10.1158/1535-7163.mct-08-0678] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rhabdomyosarcoma is a tumor of striated muscle origin that displays defective myogenic differentiation. Terminal myogenesis switches off cell proliferation and migration, hence, the promotion of rhabdomyosarcoma differentiation should antagonize tumor growth and metastasis. Terminal myogenesis is controlled by cell-intrinsic myogenic transcription factors like myogenin and environmental mediators like interleukin 4 (IL-4). We studied whether the expression of myogenin or exposure to IL-4 could promote the myogenesis of poorly differentiating human rhabdomyosarcoma cells RD/12. Forced expression of myogenin amplified myosin expression and the formation of myotube-like elements, inhibited cell migration, and reduced the growth of local tumors and liver metastases in immunodepressed mice. In contrast, exposure to IL-4 promoted cell proliferation and survival, especially at high cell density, inhibited myogenin expression, and myogenesis. Moreover, IL-4 stimulated the directed migration of cells with low myogenin levels, but not of cells with higher (spontaneous or forced) levels. Thus, IL-4, which was known to promote late stages of normal myogenesis, favors growth and migration, and inhibits further differentiation of the myogenic stages attained by rhabdomyosarcoma cells. Strategies to increase myogenin expression and block IL-4 could simultaneously reduce growth and migration, and enhance terminal differentiation of rhabdomyosarcoma, thus contributing to the control of tumor growth and metastatic spread.
Collapse
Affiliation(s)
- Patrizia Nanni
- Section of Cancer Research, Department of Hematology and Oncological Sciences, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Nanni P, Nicoletti G, Palladini A, Croci S, Murgo A, Antognoli A, Landuzzi L, Fabbi M, Ferrini S, Musiani P, Iezzi M, De Giovanni C, Lollini PL. Antimetastatic activity of a preventive cancer vaccine. Cancer Res 2007; 67:11037-44. [PMID: 18006850 DOI: 10.1158/0008-5472.can-07-2499] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of prophylactic cancer vaccines that protect healthy hosts from tumor development leaves open the question whether such vaccines are also effective against established tumors and metastases. We tested the therapeutic activity of a proven prophylactic anti-HER-2/neu vaccine against successive stages of mammary carcinoma progression in HER-2/neu transgenic mice. The vaccine consisted of transgenic mammary carcinoma cells expressing HER-2/neu and two adjuvants: allogeneic class I histocompatibility antigens and interleukin (IL)-12. Vaccination of mice bearing lung micrometastases resulted in a 90% inhibition of metastasis development, whereas vaccination of mice with incipient local tumors was ineffective. The antimetastatic response was hampered by immune tolerance, as the protection of transgenic mice was lower than that of wild-type congenics not tolerant to HER-2/neu. A significant gain in immunotherapeutic activity in transgenic mice was obtained through the coadministration of anti-CD25 monoclonal antibody targeting regulatory T cells, which resulted in a >99% inhibition of metastasis. The immune responses elicited in transgenic mice comprised the activation of lung granulocytes and macrophages and of systemic adaptive responses based on helper T cells and their cytokines (IFN-gamma and IL-4) and anti-HER-2/neu antibodies. Dissection of relevant antimetastatic mechanisms by means of knockout mice and of depleting antibodies revealed a major difference between tumor prevention, which was completely dependent on anti-HER-2/neu antibodies, and metastasis therapy, which was antibody independent. In conclusion, a vaccine successfully developed for cancer immunoprevention showed a strong therapeutic activity against lung metastases mediated by protective immune mechanisms distinct from those preventing the onset of primary mammary carcinoma.
Collapse
Affiliation(s)
- Patrizia Nanni
- Section of Cancer Research, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Leone F, Allori B, Antognoli A, Catania S, Cerri B, Cicalini S, Lanzalone CM, Miglietta AS, Rossi F, Ilardi I. Toxoplasmosis in pregnancy: research on 2295 women in Rome and its province. Riv Eur Sci Med Farmacol 1996; 18:191-5. [PMID: 9177621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors report the data concerning 2295 women tested for toxoplasmosis immunodiagnosis, in the Department of Infectious and Tropical Diseases of "La Sapienza" University of Rome in the years 1993-1994. Four hundred eleven cases (17.9%) were positive for IgG only; 2 cases (0.1%) for IgM only; 15 cases (0.6%) for both IgG and IgM while 1867 cases (81.4%) were negative. 1668 women were pregnant. In this group 260 (15.6%) were positive for IgG only, 2 (0.1%) for IgM only, and 10 (10.6%) for both IgG and IgM; in one case there was a spontaneous absorption in the 10th week of pregnancy, in another case a still-birth in the 20th week with brain lesions; a child was born with phocomelia of the right arm and one with a clubfoot. While it is possible to explain the absorption and the still-birth with the toxoplasma infection, it is difficult to understand the causes of the abnormality of the limbs.
Collapse
Affiliation(s)
- F Leone
- Department of Infectious and Tropical Diseases, La Sapienza University, Rome, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Neisseria gonorrhoeae was isolated from 53 young females (6-14 years old) in a Somali orphanage. A male guardian was found to be the effective transmitter having sexually abused the children. All the bacterial isolates were of the same serogroup WI and the same serovar Aedih. This presents an unusual example of a tight geographic cluster of infected people which is often characteristic of gonorrhoea epidemics.
Collapse
Affiliation(s)
- H J Ahmed
- Faculty of Medicine, Somali National University, Mogadishu
| | | | | | | | | | | |
Collapse
|
20
|
Ilardi I, Errera G, De Sanctis GM, Barbacini IG, Madera A, Leone F, Nderingo A, Antognoli A, Chircu LV. Prevalence of anti-HCV in two Tanzanian villages. Arch Virol Suppl 1992; 4:347-8. [PMID: 1333331 DOI: 10.1007/978-3-7091-5633-9_83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The presence of anti-HCV antibodies was investigated in sera from a total of 123 inhabitants of two Tanzanian villages. In one of the villages, 72.2% of the sera and in the other village, 82.6% of the sera were found to be anti-HCV positive. These values are dramatically higher than other reported prevalences, whereby cross-reactivity between HCV and Flaviviruses as well as possible transmission by arthropod vectors cannot be ruled out.
Collapse
Affiliation(s)
- I Ilardi
- Istituto Malattie Infettive. Università di Roma, La Sapienza, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Teggi A, Lanzalone CM, De Rinaldis ML, Antognoli A, Dezzi S, De Zorzi C, Traditi F, De Rosa F. [A case of lead poisoning in a drug addict. Observations on etiopathogenetic peculiarities]. Clin Ter 1988; 124:223-6. [PMID: 2974335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
22
|
Capozzi A, Teggi A, Lanzalone CM, Antognoli A. [Human hydatidosis caused by Echinococcus granulosus: studies on patients hospitalized at the Umberto I Polyclinic (Rome 1980-1984)]. Nuovi Ann Ig Microbiol 1987; 38:145-57. [PMID: 3504273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|