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Pitocco D, Popolla V, Rizzi A, Lancellotti S, Tartaglione L, Sacco M, Viti L, Mazzotta FA, Iezzi R, Santoliquido A, Caputo S, Flex A, Pontecorvi A, De Cristofaro R. Von Willebrand factor hyperactivity affects the outcome of lower limb revascularization in subjects with type 2 diabetes mellitus complicated by diabetic foot vasculopathy: An observational pilot study. J Diabetes Complications 2024; 38:108653. [PMID: 38039934 DOI: 10.1016/j.jdiacomp.2023.108653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/08/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
Aim of this study is to evaluate any differences in VWF antigen, VWF activity and ADAMTS-13 activity before and after successful and non-successful Percutaneous Transluminal Angioplasty (PTA) in subjects with type 2 diabetes (T2DM) complicated by Chronic limb-threatening ischemia (CLTI) in diabetic foot vasculopathy. METHODS In this prospective observational pilot study, we enrolled 35 T2DM subjects who underwent lower limb PTA. Transcutaneous oximetry was performed in all patients before and 6 weeks after PTA. The change in oxygen partial pressure (TcpO2) before and after PTA was expressed as TcpO2-delta (ΔTcpO2). VWF antigen, VWF activity and ADAMTS-13 activity were measured before and 6 weeks after PTA; changes were expressed as delta and ratio from baseline. RESULTS Subjects with ∆TcpO2 < 15 mmHg presented higher ΔVWF activity (p = 0.050) and lower ADAMTS-13 activity ratio (p = 0.080). Subjects with ∆TcpO2 < 30 mmHg showed lower ADAMTS-13 activity Δ and ratio (p = 0.028). CONCLUSIONS VWF antigen levels and VWF activity may potentially affect PTA outcome. Higher levels of VWF could derive from VWF release as consequence of PTA-induced mechanical endothelial damage and/or oxidative stress-induced modifications of VWF structure with impairment of VWF-ADAMTS13 interactions.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy.
| | - Valentina Popolla
- Diabetes Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Stefano Lancellotti
- Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Monica Sacco
- Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Luca Viti
- Diabetes Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Francesco Antonio Mazzotta
- Department of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Roberto Iezzi
- Diagnostic Radiology and General Interventional Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Angelo Santoliquido
- Department of cardiovascular sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Salvatore Caputo
- Diabetes Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Andrea Flex
- Department of Internal Medicine, Medical Clinic and Vascular Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Alfredo Pontecorvi
- Department of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
| | - Raimondo De Cristofaro
- Hemorrhagic and Thrombotic Diseases Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Italy
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Gurgoglione FL, Pitocco D, Montone RA, Rinaldi R, Bonadonna RC, Magnani G, Calvieri C, Solinas E, Rizzi A, Tartaglione L, Flex A, Viti L, Trani C, Ardissino D, Crea F, Niccoli G. Microvascular Complications Are Associated With Coronary Collateralization in Type 2 Diabetes and Chronic Occlusion. J Clin Endocrinol Metab 2023; 109:237-244. [PMID: 37417706 DOI: 10.1210/clinem/dgad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/15/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
CONTEXT Coronary collateral (CC) vessel development appears to be protective with regard to adverse cardiovascular events and survival in patients with coronary chronic total occlusion (CTO). The influence of type 2 diabetes mellitus (T2DM) on CC growth has been controversial. In particular, the role of diabetic microvascular complications (DMC) in determining coronary collateralization has not been elucidated. OBJECTIVE To investigate whether patients with DMC presented differences in CC vessel presence and grading as compared with patients without DMC. METHODS We conducted a single-center observational study, including consecutive T2DM patients, without previous cardiovascular history, undergoing a clinically indicated coronary angiography for chronic coronary syndrome (CCS) and angiographic evidence of at least one CTO. Patients were subdivided into 2 study groups according to the presence/absence of at least one DMC (neuropathy, nephropathy, or retinopathy). The presence and grading of angiographically visible CC development from the patent vessels to the occluded artery were assessed using the Rentrop classification. RESULTS We enrolled 157 patients (mean age 68.6 ± 9.8 years; 120 [76.4%] men). Patients with DMC (75 [47.8%]) had a higher prevalence of CC (69 [92.0%] vs 62 [75.6%], P = .006) and high-grade CC (55 [73.3%] vs 39 [47.6%], P = .001) compared with those without, and we found a positive association between the number of DMC in each patient and the prevalence of high-grade CC. CONCLUSION Among T2DM patients with coronary CTO, the presence of DMC was associated with a high CC development.
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Affiliation(s)
- Filippo Luca Gurgoglione
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Dario Pitocco
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo C Bonadonna
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Division of Endocrinology and Metabolic Diseases, University of Parma, 43126 Parma, Italy
| | - Giulia Magnani
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Camilla Calvieri
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University, 00185 Rome, Italy
| | - Emilia Solinas
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro Rizzi
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Linda Tartaglione
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Andrea Flex
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Viti
- Diabetology Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Diego Ardissino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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3
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Mazza A, Iafrancesco M, Bruno P, Chiariello GA, Trani C, Burzotta F, Cammertoni F, Pasquini A, Diana G, Rosenhek R, Liuzzo G, Rabini A, Flex A, Raweh A, Crea F, Massetti M. The multidisciplinary Heart Team approach for patients with cardiovascular disease: a step towards personalized medicine. J Cardiovasc Med (Hagerstown) 2023; 24:906-913. [PMID: 37577876 DOI: 10.2459/jcm.0000000000001511] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
AIMS Despite general agreement on the benefits of the Heart Team approach for patients with cardiac diseases, few data are available on its real impact on the decision-making process. The aim of the study is to define the evolution over time of the level of agreement with the systematic discussion of patients in the Heart Team and to evaluate the adherence to the Heart Team recommendations and the impact of the Heart Team on the clinical outcome of the patients. METHODS In 2015--2016, an experienced cardiac surgeon and a cardiologist independently reviewed clinical data of a series of 100 patients (Group 1, G1) and subsequently for each patient recommended treatment (surgical, percutaneous, hybrid or medical therapy) or further diagnostic investigations. The next day, each case was discussed by the Hospital Heart Team. The Heart Team recommendation, the subsequent treatment received by the patient and the in-hospital outcome were recorded. The same study procedure was repeated in 2017 in a second (G2) and in 2018 in a third (G3) group, both of them including 100 patients. RESULTS Complete agreement in treatment selection by the cardiac surgeon, cardiologist and the Heart Team was observed in 43% of cases in G1 and in 70% and 68% in G2 and G3, respectively (G1 vs. G2: P < 0.001, G1 vs. G3: P = 0.01, G2 vs. G3: P = 0.30). Agreement was less frequent in patients with a higher risk profile and in patients with aortic valve stenosis. The Heart Team decision was implemented in 95% of cases with a 30-day mortality of 0.67%. CONCLUSION Agreement in treatment selection among the cardiac surgeon, cardiologist and Heart Team appears to be low in the initial experience. Subsequently, it seems to steadily increase over time up to a limit, when it reaches a plateau of stable results. Heart Team clinical cases discussion, based on both guidelines and multidisciplinary experience, represents a key step in defining the best patient treatment pathway, potentially improving the decision-making process and clinical results.
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Affiliation(s)
- Andrea Mazza
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Mauro Iafrancesco
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Giovanni Alfonso Chiariello
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Carlo Trani
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Federico Cammertoni
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Annalisa Pasquini
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Giovanni Diana
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Raphael Rosenhek
- Catholic University of The Sacred Heart, Rome, Italy
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Giovanna Liuzzo
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Alessia Rabini
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Andrea Flex
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Abdallah Raweh
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Filippo Crea
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Cardiovascular Sciences Department, Agostino Gemelli Foundation Polyclinic IRCCS
- Catholic University of The Sacred Heart, Rome, Italy
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Cecchini AL, Biscetti F, Manzato M, Lo Sasso L, Rando MM, Nicolazzi MA, Rossini E, Eraso LH, Dimuzio PJ, Massetti M, Gasbarrini A, Flex A. Current Medical Therapy and Revascularization in Peripheral Artery Disease of the Lower Limbs: Impacts on Subclinical Chronic Inflammation. Int J Mol Sci 2023; 24:16099. [PMID: 38003290 PMCID: PMC10671371 DOI: 10.3390/ijms242216099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Peripheral artery disease (PAD), coronary artery disease (CAD), and cerebrovascular disease (CeVD) are characterized by atherosclerosis and inflammation as their underlying mechanisms. This paper aims to conduct a literature review on pharmacotherapy for PAD, specifically focusing on how different drug classes target pro-inflammatory pathways. The goal is to enhance the choice of therapeutic plans by considering their impact on the chronic subclinical inflammation that is associated with PAD development and progression. We conducted a comprehensive review of currently published original articles, narratives, systematic reviews, and meta-analyses. The aim was to explore the relationship between PAD and inflammation and evaluate the influence of current pharmacological and nonpharmacological interventions on the underlying chronic subclinical inflammation. Our findings indicate that the existing treatments have added anti-inflammatory properties that can potentially delay or prevent PAD progression and improve outcomes, independent of their effects on traditional risk factors. Although inflammation-targeted therapy in PAD shows promising potential, its benefits have not been definitively proven yet. However, it is crucial not to overlook the pleiotropic properties of the currently available treatments, as they may provide valuable insights for therapeutic strategies. Further studies focusing on the anti-inflammatory and immunomodulatory effects of these treatments could enhance our understanding of the mechanisms contributing to the residual risk in PAD and pave the way for the development of novel therapies.
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Affiliation(s)
- Andrea Leonardo Cecchini
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Federico Biscetti
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Matteo Manzato
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lorenzo Lo Sasso
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Margherita Rando
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Anna Nicolazzi
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Enrica Rossini
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Luis H. Eraso
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Paul J. Dimuzio
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Massimo Massetti
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Flex
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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5
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Rando MM, Biscetti F, Masciocchi C, Savino M, Nicolazzi MA, Nardella E, Cecchini AL, Rossini E, Massetti M, Gasbarrini A, Flex A. Impact of COVID-19 pandemic on patients affected by peripheral arterial disease: an Italian single-center study. Eur Rev Med Pharmacol Sci 2023; 27:10144-10155. [PMID: 37916384 DOI: 10.26355/eurrev_202310_34194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) has evolved into a global pandemic, affecting a wide range of medical and surgical specialties. During COVID-19, we assisted in the reallocation of medical resources and services, as well as social distancing measures, and many patients with chronic diseases and comorbidities may have experienced difficulties in obtaining the correct medical care. The aim of the study was to investigate the impact of the COVID-19 pandemic on major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in patients with peripheral arterial disease (PAD) and chronic limb-threatening ischemia (CLTI), compared to previous years. PATIENTS AND METHODS We evaluated 1,335 hospital admissions of 877 patients with PAD admitted to Policlinico A. Gemelli Hospital between January 2017 and February 2020 and 368 hospital admissions of 272 patients with PAD admitted to the Policlinico A. Gemelli Hospital between March 2020 and March 2021. Data on demographic characteristics, comorbidities, symptoms, physical and radiological findings, laboratory tests, and routine visits before or after discharge were collected from electronic medical records. RESULTS Emergency room (ER) admissions among PAD patients during COVID-19 were higher than before the pandemic [190 (51.63%) vs. 579 (43.37%), p = 0.01]. A MACE was found in 78 (5.84%) pre-pandemic hospitalizations and 126 (34.24%) pandemic hospitalizations (p < 0.01). A MALE was identified in 942 (70.56%) pre-pandemic hospitalizations and 331 (89.95%) pandemic hospitalizations (p < 0.01). Amputation rates during the pandemic were higher than before the pandemic [80 (21.74%) vs. 191 (14.31%), p < 0.01]. The number of in-hospital deaths did not differ between the pandemic and pre-pandemic periods [11 (2.99%) vs. 51 (3.82%), p = 0.55]. CONCLUSIONS In patients with PAD and CLTI, the number of MACE, MALE, and amputations was higher during the COVID-19 period compared to the three years before the pandemic.
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Affiliation(s)
- M M Rando
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Rando MM, Biscetti F, Masciocchi C, Capocchiano ND, Nicolazzi MA, Nardella E, Cecchini AL, Pecorini G, Colosimo C, Sanguinetti M, Massetti M, Gasbarrini A, Flex A. Identification of early predictors of clinical outcomes of COVID-19 outbreak in an Italian single center using a machine-learning approach. Eur Rev Med Pharmacol Sci 2023; 27:9454-9469. [PMID: 37843358 DOI: 10.26355/eurrev_202310_33974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE SARS-CoV-2 disease (COVID-19) has become a pandemic disease, determining a public health emergency. The use of artificial intelligence in identifying easily available biomarkers capable of predicting the risk for severe disease may be helpful in guiding clinical decisions. The aim of the study was to investigate the ability of interleukin (IL)-6, troponin I, and D-dimer to identify patients with COVID-19 at risk for intensive care unit (ICU)-admission and death by using a machine-learning predictive model. PATIENTS AND METHODS Data on demographic characteristics, underlying comorbidities, symptoms, physical and radiological findings, and laboratory tests have been retrospectively collected from electronic medical records of patients admitted to Policlinico A. Gemelli Foundation from March 1, 2020, to September 15, 2020, by using artificial intelligence techniques. RESULTS From an initial cohort of 425 patients, 146 met the inclusion criteria and were enrolled in the study. The in-hospital mortality rate was 15%, and the ICU admission rate was 41%. Patients who died had higher troponin I (p-value<0.01) and IL-6 values (p-value=0.04), compared to those who survived. Patients admitted to ICU had higher levels of troponin I (p-value<0.01) and IL-6 (p-value<0.01), compared to those not admitted to ICU. Threshold values to predict in-hospital mortality and ICU admission have been identified. IL-6 levels higher than 15.133 ng/L have been associated with a 22.91% risk of in-hospital mortality, and IL-6 levels higher than 25.65 ng/L have been associated with a 56.16% risk of ICU admission. Troponin I levels higher than 12 ng/L have been associated with a 26.76% risk of in-hospital mortality and troponin I levels higher than 12 ng/L have been associated with a 52.11% risk of ICU admission. CONCLUSIONS Levels of IL-6 and troponin I are associated with poor COVID-19 outcomes. Cut-off values capable of predicting in-hospital mortality and ICU admission have been identified. Building a predictive model using a machine-learning approach may be helpful in supporting clinical decisions in a more precise and personalized way.
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Affiliation(s)
- M M Rando
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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7
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De Matteis G, Biscetti F, Della Polla DA, Serra A, Burzo ML, Fuorlo M, Nicolazzi MA, Novelli A, Santoliquido A, Gambassi G, Gasbarrini A, Flex A, Franceschi F, Covino M. Sex-Based Differences in Clinical Characteristics and Outcomes among Patients with Peripheral Artery Disease: A Retrospective Analysis. J Clin Med 2023; 12:5094. [PMID: 37568498 PMCID: PMC10420161 DOI: 10.3390/jcm12155094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Peripheral arterial disease (PAD) is a prevalent medical condition associated with high mortality and morbidity rates. Despite the high clinical burden, sex-based differences among PAD patients are not well defined yet, in contrast to other atherosclerotic diseases. This study aimed to describe sex-based differences in clinical characteristics and outcomes among hospitalized patients affected by PAD. This was a retrospective study evaluating all patients with a diagnosis of PAD admitted to the Emergency Department from 1 December 2013 to 31 December 2021. The primary endpoint of the study was the difference between male and female PAD patients in cumulative occurrence of Major Adverse Cardiovascular Events (MACEs) and Major Adverse Limb Events. A total of 1640 patients were enrolled. Among them, 1103 (67.3%) were males while females were significantly older (median age of 75 years vs. 71 years; p =< 0.001). Females underwent more angioplasty treatments for revascularization than men (29.8% vs. 25.6%; p = 0.04); males were treated with more amputations (19.9% vs. 15.3%; p = 0.012). A trend toward more MALEs and MACEs reported in the male group did not reach statistical significance (OR 1.27 [0.99-1.64]; p = 0.059) (OR 0.75 [0.50-1.11]; p = 0.153). However, despite lower extremity PAD severity seeming similar between the two sexes, among these patients males had a higher probability of undergoing lower limb amputations, of cardiovascular death and of myocardial infarction. Among hospitalized patients affected by PAD, even if there was not a sex-based significant difference in the incidence of MALEs and MACEs, adverse clinical outcomes were more common in males.
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Affiliation(s)
- Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
| | - Federico Biscetti
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | | | - Amato Serra
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
| | - Maria Livia Burzo
- Department of Internal Medicine, Ospedale Santo Spirito in Sassia, 00193 Rome, Italy
| | - Mariella Fuorlo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Maria Anna Nicolazzi
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Angela Novelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Angelo Santoliquido
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Giovanni Gambassi
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.D.M.)
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Andrea Flex
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Faculty of Medicine and Surgery, Rome Campus, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
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Nardella E, Biscetti F, Rando MM, Cecchini AL, Nicolazzi MA, Rossini E, Angelini F, Iezzi R, Eraso LH, Dimuzio PJ, Pitocco D, Massetti M, Gasbarrini A, Flex A. Development of a biomarker panel for assessing cardiovascular risk in diabetic patients with chronic limb-threatening ischemia (CLTI): a prospective study. Cardiovasc Diabetol 2023; 22:136. [PMID: 37308885 DOI: 10.1186/s12933-023-01872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Lower-extremity endovascular revascularization (LER) is often required for diabetic patients with chronic limb threatening ischemia (CLTI). During the post-revascularization period patients may unpredictably experience major adverse cardiac events (MACE) and major adverse limb events (MALE). Several families of cytokines are involved in the inflammatory process that underlies the progression of atherosclerosis. According to current evidence, we have identified a panel of possible biomarkers related with the risk of developing MACE and MALE after LER. The aim was to study the relationship between a panel of biomarkers - Interleukin-1 (IL-1) and 6 (IL-6), C-Reactive Protein (CRP), Tumor Necrosis Factor-α (TNF-α), High-Mobility Group Box-1 (HMGB-1), Osteoprotegerin (OPG), Sortilin and Omentin-1- at baseline, with cardiovascular outcomes (MACE and MALE) after LER in diabetic patients with CLTI. METHODS In this prospective non-randomized study, 264 diabetic patients with CLTI undergoing endovascular revascularization were enrolled. Serum levels of each biomarker were collected before revascularization and outcomes' incidence was evaluated after 1, 3, 6 and 12 months. RESULTS During the follow-up period, 42 cases of MACE and 81 cases of MALE occurred. There was a linear association for each biomarker at baseline and incident MACE and MALE, except Omentin-1 levels that were inversely related to the presence of MACE or MALE. After adjusting for traditional cardiovascular risk factors, the association between each biomarker baseline level and outcomes remained significant in multivariable analysis. Receiver operating characteristics (ROC) models were constructed using traditional clinical and laboratory risk factors and the inclusion of biomarkers significantly improved the prediction of incident events. CONCLUSIONS Elevated IL-1, IL-6, CRP, TNF-α, HMGB-1, OPG and Sortilin levels and low Omentin-1 levels at baseline correlate with worse vascular outcomes in diabetic patients with CLTI undergoing LER. Assessment of the inflammatory state with this panel of biomarkers may support physicians to identify a subset of patients more susceptible to the procedure failure and to develop cardiovascular adverse events after LER.
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Affiliation(s)
- Elisabetta Nardella
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Federico Biscetti
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy.
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy.
| | - Maria Margherita Rando
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | | | - Maria Anna Nicolazzi
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Enrica Rossini
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Flavia Angelini
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
| | - Roberto Iezzi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Luis H Eraso
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul J Dimuzio
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dario Pitocco
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Massimo Massetti
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
- Department of Medical and Surgical sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
| | - Andrea Flex
- Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italy
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9
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Covino M, De Vita A, d'Aiello A, Ravenna SE, Ruggio A, Genuardi L, Simeoni B, Piccioni A, De Matteis G, Murri R, Leone AM, Flex A, Gasbarrini A, Liuzzo G, Massetti M, Franceschi F. A New Clinical Prediction Rule for Infective Endocarditis in Emergency Department Patients With Fever: Definition and First Validation of the CREED Score. J Am Heart Assoc 2023; 12:e027650. [PMID: 37119081 PMCID: PMC10227214 DOI: 10.1161/jaha.122.027650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/23/2023] [Indexed: 04/30/2023]
Abstract
Background Infective endocarditis (IE) could be suspected in any febrile patients admitted to the emergency department (ED). This study was aimed at assessing clinical criteria predictive of IE and identifying and prospectively validating a sensible and easy-to-use clinical prediction score for the diagnosis of IE in the ED. Methods and Results We conducted a retrospective observational study, enrolling consecutive patients with fever admitted to the ED between January 2015 and December 2019 and subsequently hospitalized. Several clinical and anamnestic standardized variables were collected and evaluated for the association with IE diagnosis. We derived a multivariate prediction model by logistic regression analysis. The identified predictors were assigned a score point value to obtain the Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score. To validate the CREED score we conducted a prospective observational study between January 2020 and December 2021, enrolling consecutive febrile patients hospitalized after the ED visit, and evaluating the association between the CREED score values and the IE diagnosis. A total of 15 689 patients (median age, 71 [56-81] years; 54.1% men) were enrolled in the retrospective cohort, and IE was diagnosed in 267 (1.7%). The CREED score included 12 variables: male sex, anemia, dialysis, pacemaker, recent hospitalization, recent stroke, chest pain, specific infective diagnosis, valvular heart disease, valvular prosthesis, previous endocarditis, and clinical signs of suspect endocarditis. The CREED score identified 4 risk groups for IE diagnosis, with an area under the receiver operating characteristic curve of 0.874 (0.849-0.899). The prospective cohort included 13 163 patients, with 130 (1.0%) IE diagnoses. The CREED score had an area under the receiver operating characteristic curve of 0.881 (0.848-0.913) in the validation cohort, not significantly different from the one calculated in the retrospective cohort (P=0.578). Conclusions In this study, we propose and prospectively validate the CREED score, a clinical prediction rule for the diagnosis of IE in patients with fever admitted to the ED. Our data reflect the difficulty of creating a meaningful tool able to identify patients with IE among this general and heterogeneous population because of the complexity of the disease and its low prevalence in the ED setting.
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Affiliation(s)
- Marcello Covino
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
| | - Antonio De Vita
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Alessia d'Aiello
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | | | - Aureliano Ruggio
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Lorenzo Genuardi
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Benedetta Simeoni
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Andrea Piccioni
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Giuseppe De Matteis
- Department of Internal MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Rita Murri
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Infectious DiseaseFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Antonio Maria Leone
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Andrea Flex
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Antonio Gasbarrini
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Internal MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Giovanna Liuzzo
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Massimo Massetti
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Francesco Franceschi
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
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10
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Biscetti F, Rando MM, Cecchini AL, Nicolazzi MA, Rossini E, Angelini F, Iezzi R, Eraso LH, Dimuzio PJ, Pitocco D, Gasbarrini A, Massetti M, Flex A. The role of Klotho and FGF23 in cardiovascular outcomes of diabetic patients with chronic limb threatening ischemia: a prospective study. Sci Rep 2023; 13:6150. [PMID: 37061530 PMCID: PMC10105766 DOI: 10.1038/s41598-023-33190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/08/2023] [Indexed: 04/17/2023] Open
Abstract
Cardiovascular complications after lower extremity revascularization (LER) are common in diabetic patients with peripheral arterial disease (PAD) and chronic limb threatening ischemia (CLTI). The Klotho-fibroblast growth factor 23 (FGF23) axis is associated with endothelial injury and cardiovascular risk. We aimed to analyze the relationship between Klotho and FGF23 serum levels and the incidence of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after LER in diabetic patients with PAD and CLTI. Baseline levels of Klotho and FGF23, and their association with subsequent incidence of MACE and MALE were analyzed in a prospective, non-randomized study in a population of diabetic patients with PAD and CLTI requiring LER. A total of 220 patients were followed for 12 months after LER. Sixty-three MACE and 122 MALE were recorded during follow-up period. Baseline lower Klotho serum levels (295.3 ± 151.3 pg/mL vs. 446.4 ± 171.7 pg/mL, p < 0.01), whereas increased serum levels FGF23 (75.0 ± 11.8 pg/mL vs. 53.2 ± 15.4 pg/mL, p < 0.01) were significantly associated with the development of MACE. Receiver operating characteristic (ROC) analysis confirmed the predictive power of Klotho and FGF23 baseline levels. Furthermore, decreased Klotho levels were associated with the occurrence of MALE after LER (329.1 ± 136.8 pg/mL vs 495.4 ± 183.9 pg/mL, p < 0.01). We found that Klotho and FGF23 baseline levels are a potential biomarker for increased cardiovascular risk after LER in diabetic patients with PAD and CLTI.
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Affiliation(s)
- Federico Biscetti
- Cardiovascular Internal Medicine, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Maria Margherita Rando
- Cardiovascular Internal Medicine, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Maria Anna Nicolazzi
- Cardiovascular Internal Medicine, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Enrica Rossini
- Cardiovascular Internal Medicine, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Flavia Angelini
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Roberto Iezzi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luis H Eraso
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul J Dimuzio
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dario Pitocco
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Massimo Massetti
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Andrea Flex
- Cardiovascular Internal Medicine, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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11
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Cecchini AL, Biscetti F, Rando MM, Flex A. Editorial: Diagnosis, prevention and treatment in diabetic nephropathy, volume II. Front Endocrinol (Lausanne) 2023; 14:1142285. [PMID: 36742398 PMCID: PMC9893494 DOI: 10.3389/fendo.2023.1142285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
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12
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Rando MM, Biscetti F, Cecchini AL, Nardella E, Nicolazzi MA, Angelini F, Iezzi R, Eraso LH, Dimuzio PJ, Pitocco D, Gasbarrini A, Massetti M, Flex A. Serum high mobility group box-1 levels associated with cardiovascular events after lower extremity revascularization: a prospective study of a diabetic population. Cardiovasc Diabetol 2022; 21:214. [PMID: 36244983 PMCID: PMC9571458 DOI: 10.1186/s12933-022-01650-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is one of the most disabling cardiovascular complications of type 2 diabetes mellitus and is indeed associated with a high risk of cardiovascular and limb adverse events. High mobility group box-1 (HMGB-1) is a nuclear protein involved in the inflammatory response that acts as a pro-inflammatory cytokine when released into the extracellular space. HMBG-1 is associated with PAD in diabetic patients. The aim of this study was to evaluate the association between serum HMGB-1 levels and major adverse cardiovascular events (MACE) and major adverse limb events (MALE) after lower-extremity endovascular revascularization (LER) in a group of diabetic patients with chronic limb-threatening ischemia (CLTI). Methods We conducted a prospective observational study of 201 diabetic patients with PAD and CLTI requiring LER. Baseline serum HMGB-1 levels were determined before endovascular procedure. Data on cardiovascular and limb outcomes were collected in a 12-month follow-up. Results During the follow-up period, 81 cases of MACE and 93 cases of MALE occurred. Patients who subsequently developed MACE and MALE had higher serum HMGB-1 levels. Specifically, 7.5 ng/mL vs 4.9 ng/mL (p < 0.01) for MACE and 7.2 ng/mL vs 4.8 ng/mL (p < 0.01) for MALE. After adjusting for traditional cardiovascular risk factors, the association between serum HMGB-1 levels and cardiovascular outcomes remained significant in multivariable analysis. In our receiver operating characteristic (ROC) curve analysis, serum HMGB-1 levels were a good predictor of MACE incidence (area under the curve [AUC] = 0.78) and MALE incidence (AUC = 0.75). Conclusions This study demonstrates that serum HMGB-1 levels are associated with the incidence of MACE and MALE after LER in diabetic populations with PAD and CLTI.
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13
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Bianchetti G, Rizzo GE, Serantoni C, Abeltino A, Rizzi A, Tartaglione L, Caputo S, Flex A, De Spirito M, Pitocco D, Maulucci G. Spatial Reorganization of Liquid Crystalline Domains of Red Blood Cells in Type 2 Diabetic Patients with Peripheral Artery Disease. Int J Mol Sci 2022; 23:ijms231911126. [PMID: 36232429 PMCID: PMC9570208 DOI: 10.3390/ijms231911126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
In this work, we will investigate if red blood cell (RBC) membrane fluidity, influenced by several hyperglycemia-induced pathways, could provide a complementary index of HbA1c to monitor the development of type 2 diabetes mellitus (T2DM)-related macroangiopathic complications such as Peripheral Artery Disease (PAD). The contextual liquid crystalline (LC) domain spatial organization in the membrane was analysed to investigate the phase dynamics of the transition. Twenty-seven patients with long-duration T2DM were recruited and classified in DM, including 12 non-PAD patients, and DM + PAD, including 15 patients in any stage of PAD. Mean values of RBC generalized polarization (GP), representative of membrane fluidity, together with spatial organization of LC domains were compared between the two groups; p-values < 0.05 were considered statistically significant. Although comparable for anthropometric characteristics, duration of diabetes, and HbA1c, RBC membranes of PAD patients were found to be significantly more fluid (GP: 0.501 ± 0.026) than non-PAD patients (GP: 0.519 ± 0.007). These alterations were shown to be triggered by changes in both LC microdomain composition and distribution. We found a decrease in Feret diameter from 0.245 ± 0.281 μm in DM to 0.183 ± 0.124 μm in DM + PAD, and an increase in circularity. Altered RBC membrane fluidity is correlated to a spatial reconfiguration of LC domains, which, by possibly altering metabolic function, are associated with the development of T2DM-related macroangiopathic complications.
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Affiliation(s)
- Giada Bianchetti
- Department of Neuroscience, Biophysics Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “A. Gemelli”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | | | - Cassandra Serantoni
- Department of Neuroscience, Biophysics Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “A. Gemelli”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Alessio Abeltino
- Department of Neuroscience, Biophysics Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “A. Gemelli”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Salvatore Caputo
- Fondazione Policlinico Universitario “A. Gemelli”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Andrea Flex
- Diabetes Care Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco De Spirito
- Department of Neuroscience, Biophysics Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “A. Gemelli”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Maulucci
- Department of Neuroscience, Biophysics Section, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “A. Gemelli”, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4265
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14
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Biscetti F, Cecchini AL, Rando MM, Nardella E, Gasbarrini A, Massetti M, Flex A. Principal predictors of major adverse limb events in diabetic peripheral artery disease: A narrative review. Atheroscler Plus 2021; 46:1-14. [PMID: 36643723 PMCID: PMC9833249 DOI: 10.1016/j.athplu.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/29/2021] [Revised: 10/10/2021] [Accepted: 10/28/2021] [Indexed: 01/18/2023]
Abstract
Background and aims The increasing prevalence of diabetes mellitus is causing a massive growth of peripheral artery disease incidences, a disabling complication of diabetic atherosclerosis, which leads often to the amputation of the affected limb. Critical limb ischemia is the terminal disease stage, which requires a prompt intervention to relieve pain and save limbs. However, patients undergoing revascularization often suffer from cardiovascular, cerebrovascular and major adverse limb events with poor outcomes. Furthermore, the same procedure performed in apparently similar patients has various outcomes and lack of an outcome predictive support causes a high lower limb arterial revascularization rate with disastrous effects for patients. We collected the main risk factors of major adverse limb events in a more readable and immediate format of the topic, to propose an overview of parameters to manage effectively peripheral artery disease patients and to propose basics of a new predictive tool to prevent from disabling vascular complications of the disease. Methods Most recent and updated literature about the prevalence of major adverse limb events in peripheral artery disease was reviewed to identify possible main predictors. Results In this article, we summarized major risk factors of limb revascularization failure and disabling vascular complications collecting those parameters principally responsible for major adverse limb events, which provides physio-pathological explanation of their role in peripheral artery disease. Conclusion We evaluated and listed a panel of possible predictors of MALE (Major Adverse Limb Event) in order to contribute to the development of a predictive score, based on a summary of the main risk factors reported in scientific articles, which could improve the management of peripheral artery disease by preventing vascular accidents.
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Affiliation(s)
- Federico Biscetti
- Internal and Cardiovascular Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy,Corresponding author. Internal and Cardiovascular Medicine Unit. Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome, 00168, Italy.
| | | | - Maria Margherita Rando
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elisabetta Nardella
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Andrea Flex
- Internal and Cardiovascular Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Department of Medical and Surgical Sciences, Universitá Cattolica del Sacro Cuore, Roma, Italy
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15
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Biscetti F, Tinelli G, Rando MM, Nardella E, Cecchini AL, Angelini F, Straface G, Filipponi M, Arena V, Pitocco D, Gasbarrini A, Massetti M, Flex A. Correction to: Association between carotid plaque vulnerability and high mobility group box‑1 serum levels in a diabetic population. Cardiovasc Diabetol 2021; 20:184. [PMID: 34503518 PMCID: PMC8431924 DOI: 10.1186/s12933-021-01376-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 01/17/2023] Open
Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy. .,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy. .,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Giovanni Tinelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Vascular Surgery, Fondazione Policlinico Univer-Sitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Margherita Rando
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisabetta Nardella
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Straface
- Department of Internal Medicine, St. M. Goretti Hospital, Roma, Italy
| | | | - Vincenzo Arena
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Cardiovascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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16
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Biscetti F, Tinelli G, Rando MM, Nardella E, Cecchini AL, Angelini F, Straface G, Filipponi M, Arena V, Pitocco D, Gasbarrini A, Massetti M, Flex A. Association between carotid plaque vulnerability and high mobility group box-1 serum levels in a diabetic population. Cardiovasc Diabetol 2021; 20:114. [PMID: 34044825 PMCID: PMC8161555 DOI: 10.1186/s12933-021-01304-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/25/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Carotid atherosclerosis represents one of the complications of diabetes mellitus. In particular, plaque instability contributes to disease progression and stroke incidence. High mobility group box-1 (HMGB1) is a nuclear protein involved in promotion and progression of atherosclerosis and cardiovascular diseases. The aim of this study was to analyze the relationship between HMGB1 serum levels, main inflammatory cytokines, the presence of internal carotid stenosis and unstable plaque in a diabetic population. Research design and methods We studied 873 diabetic patients, including 347 patients with internal carotid artery stenosis (ICAS) who underwent carotid endarterectomy and 526 diabetic patients without internal carotid artery stenosis (WICAS). At baseline, HMGB1 and the main inflammatory cytokines serum levels were evaluated. For ICAS patients, the histological features of carotid plaque were also collected to differentiate them in patients with stable or unstable atherosclerotic lesions. Results We found that HMGB1 serum levels, osteoprotegerin, high-sensitivity C-reactive protein, tumor necrosis factor-alpha and interleukin-6, were significantly higher in diabetic ICAS patients compared to diabetic WICAS patients. Among ICAS patients, individuals with unstable plaque had higher levels of these cytokines, compared to patients with stable plaque. A multivariable stepwise logistic regression analysis showed that HMGB1 and osteoprotegerin remained independently associated with unstable plaque in ICAS patients. Conclusions The present study demonstrated that HMGB1 is an independent risk factor for carotid plaque vulnerability in an Italian population with diabetes mellitus, representing a promising biomarker of carotid plaque instability and a possible molecular target to treat unstable carotid plaques and to prevent stroke.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy. .,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy. .,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Giovanni Tinelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Margherita Rando
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy
| | - Elisabetta Nardella
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Straface
- Department of Internal Medicine, St. M. Goretti Hospital, Roma, Italy
| | | | - Vincenzo Arena
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.,Cardiovascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Cardiovascular Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Roma, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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17
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Bianchetti G, Viti L, Scupola A, Di Leo M, Tartaglione L, Flex A, De Spirito M, Pitocco D, Maulucci G. Erythrocyte membrane fluidity as a marker of diabetic retinopathy in type 1 diabetes mellitus. Eur J Clin Invest 2021; 51:e13455. [PMID: 33210748 DOI: 10.1111/eci.13455] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/31/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND A high level of glycosylated haemoglobin (HbA1c), which is a nonenzymatic glycosylation product, is correlated with an increased risk of developing microangiopathic complications in Diabetes Mellitus (DM). Erythrocyte membrane fluidity could provide a complementary index to monitor the development of complications since it is influenced by several hyperglycaemia-induced pathways and other independent risk factors. MATERIALS AND METHODS 15 healthy controls and 33 patients with long-duration (≥20 years) type 1 Diabetes Mellitus (T1DM) were recruited. Diabetic subjects were classified into two groups: T1DM, constituted by 14 nonretinopathic patients, and T1DM + RD, constituted by 19 patients in any stage of diabetic retinopathy. Red blood cells (RBC) were incubated with the fluorescent Laurdan probe and median values of Generalized Polarization (GP), representative of membrane fluidity, were compared between the two groups. Baseline characteristics among groups have been compared with Student's t test or ANOVA. Values of P < .05 were considered statistically significant. RESULTS All the participants were comparable for age, Body Mass Index (BMI), creatinine and lipid profile. The duration of diabetes was similar for T1DM (34.4 ± 7.8 years) and T1DM + RD (32.8 ± 7.5 years) subjects as well as values of HbA1c: (55.6 ± 8.1) mmol/mol for T1DM and (61.2 ± 11.0) mmol/mol for T1DM + RD, respectively. Erythrocyte plasmatic membranes of RD patients were found to be more fluid (GP: 0.40 ± 0.04) than non-RD patients (GP: 0.43 ± 0.03) with a statistically significant difference (P = .035). CONCLUSIONS Altered erythrocyte membrane fluidity may therefore represent a marker of retinopathy in T1DM patients as a result of post-translational modifications of multifactorial aetiology (nonenzymatic glycosylation of proteins, generation of reactive oxygen species, lipid peroxidation).
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Affiliation(s)
- Giada Bianchetti
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Department of Neuroscience, Section of Biophysics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Viti
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Scupola
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Mauro Di Leo
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Linda Tartaglione
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Cardiovascular Disease Division, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marco De Spirito
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Department of Neuroscience, Section of Biophysics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Maulucci
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Department of Neuroscience, Section of Biophysics, Università Cattolica Del Sacro Cuore, Rome, Italy
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18
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Giovannini S, Carter CS, Leeuwenburgh C, Flex A, Biscetti F, Morgan D, Laudisio A, Coraci D, Maccauro G, Zuccalà G, Caliandro P, Bernabei R, Marzetti E. Effects of aging and life-long moderate calorie restriction on IL-15 signaling in the rat white adipose tissue. Eur Rev Med Pharmacol Sci 2021; 24:2738-2749. [PMID: 32196625 DOI: 10.26355/eurrev_202003_20547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Phosphorylation of insulin receptor substrate (IRS) 1 by tumor necrosis factor alpha (TNF-α) has been implicated as a factor contributing to insulin resistance. Administration of IL-15 reduces adipose tissue deposition in young rats and stimulates secretion of adiponectin, an insulin sensitizing hormone that inhibits the production and activity of TNF-α. We aimed at investigating the effects of age life-long moderate calorie restriction (CR) on IL-15 and TNF-α signaling in rat white adipose tissue (WAT). MATERIALS AND METHODS Thirty-six 8-month-old, 18-month-old, and 29-month-old male Fischer344´Brown Norway F1 rats (6 per group) were either fed ad libitum (AL) or calorie restricted by 40%. The serum levels of IL-15 and IL-15 receptor α-chain (IL-15Rα) were increased by CR controls regardless of age. An opposite pattern was detected in WAT. In addition, CR reduced gene expression of TNF-α and cytosolic IRS1 serine phosphorylation in WAT, independently from age. RESULTS IL-15 signaling in WAT is increased over the course of aging in AL rats compared with CR rodents. Protein levels of IL-15Rα are greater in WAT of AL than in CR rats independently from age. This adaptation was paralleled by increased IRS1 phosphorylation through TNF-α-mediated insulin resistance. Adiponectin decreased at old age in AL rats, while no changes were evident in CR rats across age groups. CONCLUSIONS IL-15 signaling could therefore represent a potential target for interventions to counteract metabolic alterations and the deterioration of body composition during aging.
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Affiliation(s)
- S Giovannini
- Department of Geriatrics, Neurosciences, and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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19
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Biscetti F, Nardella E, Rando MM, Cecchini AL, Gasbarrini A, Massetti M, Flex A. Outcomes of Lower Extremity Endovascular Revascularization: Potential Predictors and Prevention Strategies. Int J Mol Sci 2021; 22:2002. [PMID: 33670461 PMCID: PMC7922574 DOI: 10.3390/ijms22042002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/02/2023] Open
Abstract
Peripheral artery disease (PAD) is a manifestation of atherosclerosis, which may affect arteries of the lower extremities. The most dangerous PAD complication is chronic limb-threatening ischemia (CLTI). Without revascularization, CLTI often causes limb loss. However, neither open surgical revascularization nor endovascular treatment (EVT) ensure long-term success and freedom from restenosis and revascularization failure. In recent years, EVT has gained growing acceptance among all vascular specialties, becoming the primary approach of revascularization in patients with CLTI. In clinical practice, different clinical outcomes after EVT in patients with similar comorbidities undergoing the same procedure (in terms of revascularization technique and localization of the disease) cause unsolved issues that need to be addressed. Nowadays, risk management of revascularization failure is one of the major challenges in the vascular field. The aim of this literature review is to identify potential predictors for lower extremity endovascular revascularization outcomes and possible prevention strategies.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Elisabetta Nardella
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
| | - Maria Margherita Rando
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Andrea Leonardo Cecchini
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (M.M.R.); (A.G.); (M.M.); (A.F.)
- Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (E.N.); (A.L.C.)
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20
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Biscetti F, Rando MM, Nardella E, Cecchini AL, Bruno P, Landolfi R, Flex A. Cardiovascular Disease and SARS-CoV-2: the Role of Host Immune Response Versus Direct Viral Injury. Int J Mol Sci 2020; 21:ijms21218141. [PMID: 33143371 PMCID: PMC7663579 DOI: 10.3390/ijms21218141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
The 2019 novel coronavirus [2019-nCoV], which started to spread from December 2019 onwards, caused a global pandemic. Besides being responsible for the severe acute respiratory syndrome 2 [SARS-CoV-2], the virus can affect other organs causing various symptoms. A close relationship between SARS-CoV-2 and the cardiovascular system has been shown, demonstrating an epidemiological linkage between SARS-CoV-2 and cardiac injury. There are emerging data regarding possible direct myocardial damage by 2019-nCoV. In this review, the most important available evidences will be discussed to clarify the precise mechanisms of cardiovascular injury in SARS-CoV-2 patients, even if further researches are needed.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-06-3015-4518
| | - Maria Margherita Rando
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | - Elisabetta Nardella
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | | | - Piergiorgio Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Cardiac Surgery Unit, 00168 Roma, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Cardiac Surgery Unit, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (P.B.); (R.L.); (A.F.)
- Internal Medicine and Vascular Diseases Unit, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, 00168 Roma, Italy
- Cardiac Surgery Unit, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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21
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Biscetti F, Nardella E, Rando MM, Cecchini AL, Angelini F, Cina A, Iezzi R, Filipponi M, Santoliquido A, Pitocco D, Landolfi R, Flex A. Association between omentin-1 and major cardiovascular events after lower extremity endovascular revascularization in diabetic patients: a prospective cohort study. Cardiovasc Diabetol 2020; 19:170. [PMID: 33028322 PMCID: PMC7542958 DOI: 10.1186/s12933-020-01151-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/22/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022] Open
Abstract
Background Cardiovascular complications represent the major cause of morbidity and mortality of type 2 diabetes mellitus (T2DM) patients. In particular, peripheral artery disease (PAD) represents a frequent T2DM vascular complication and a risk factor for the development of major adverse cardiovascular events (MACE). Among adipokines, omentin-1 serum levels are reduced in T2DM patients with PAD and are inversely related to disease severity. Objective To study the relationship between omentin-1 levels, at baseline, with outcomes after endovascular procedures in T2DM patients with PAD and chronic limb-threatening ischemia (CLTI). Research design and methods We enrolled for our prospective non-randomized study, 207 T2DM patients with PAD and CLTI, requiring revascularization. Omentin-1 serum levels were collected before revascularization and patients incidence outcomes were evaluated at 1, 3, 6 and 12 months. Results Omentin-1 was reduced in patients with more severe disease (27.24 ± 4.83 vs 30.82 ± 5.48 ng/mL, p < 0.001). Overall, 84 MACE and 96 major adverse limb events (MALE) occurred during the 12-month follow-up. We observed that omentin-1 levels were lower in patients with MACE (26.02 ± 4.05 vs 31.33 ± 5.29 ng/mL, p < 0.001) and MALE (26.67 ± 4.21 vs 31.34 ± 5.54 ng/mL, p < 0.001). The association between omentin-1, MACE and MALE remained significant after adjusting for major risk factors in a multivariate analysis. Receiver operating characteristics (ROC) curve using omentin-1 levels predicted incidence events (area under the curve = 0.80). Conclusions We demonstrated that reduced omentin-1 levels, at baseline, are related with worse vascular outcomes in T2DM patients with PAD and CLTI undergoing an endovascular procedure.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Internal Medicine and Vascular Diseases Unit, Rome, Italy. .,Department of Translational Medicine and Surgery, Laboratory of Vascular Biology and Genetics, Rome, Italy. .,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University School of Medicine, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | | | | | | | - Flavia Angelini
- Department of Translational Medicine and Surgery, Laboratory of Vascular Biology and Genetics, Rome, Italy
| | | | | | | | - Angelo Santoliquido
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Angiology Unit, Rome, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.,Diabetology Unit, Rome, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Internal Medicine and Vascular Diseases Unit, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Internal Medicine and Vascular Diseases Unit, Rome, Italy.,Department of Translational Medicine and Surgery, Laboratory of Vascular Biology and Genetics, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Biscetti F, Nardella E, Rando MM, Cecchini AL, Bonadia N, Bruno P, Angelini F, Di Stasi C, Contegiacomo A, Santoliquido A, Pitocco D, Landolfi R, Flex A. Sortilin levels correlate with major cardiovascular events of diabetic patients with peripheral artery disease following revascularization: a prospective study. Cardiovasc Diabetol 2020; 19:147. [PMID: 32977814 PMCID: PMC7519536 DOI: 10.1186/s12933-020-01123-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/26/2020] [Accepted: 09/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral artery disease (PAD) represents one of the most relevant vascular complications of type 2 diabetes mellitus (T2DM). Moreover, T2DM patients suffering from PAD have an increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Sortilin, a protein involved in apolipoproteins trafficking, is associated with lower limb PAD in T2DM patients. Objective To evaluate the relationship between baseline serum levels of sortilin, MACE and MALE occurrence after revascularization of T2DM patients with PAD and chronic limb-threatening ischemia (CLTI). Research design and methods We performed a prospective non-randomized study including 230 statin-free T2DM patients with PAD and CLTI. Sortilin levels were measured before the endovascular intervention and incident outcomes were assessed during a 12 month follow-up. Results Sortilin levels were significantly increased in individuals with more aggressive PAD (2.25 ± 0.51 ng/mL vs 1.44 ± 0.47 ng/mL, p < 0.001). During follow-up, 83 MACE and 116 MALE occurred. In patients, who then developed MACE and MALE, sortilin was higher. In particular, 2.46 ± 0.53 ng/mL vs 1.55 ± 0.42 ng/mL, p < 0.001 for MACE and 2.10 ± 0.54 ng/mL vs 1.65 ± 0.65 ng/mL, p < 0.001 for MALE. After adjusting for traditional atherosclerosis risk factors, the association between sortilin and vascular outcomes remained significant in a multivariate analysis. In our receiver operating characteristics (ROC) curve analysis using sortilin levels the prediction of MACE incidence improved (area under the curve [AUC] = 0.94) and MALE (AUC = 0.72). Conclusions This study demonstrates that sortilin correlates with incidence of MACE and MALE after endovascular revascularization in a diabetic population with PAD and CLTI.
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Affiliation(s)
- Federico Biscetti
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia. .,Internal Medicine and Vascular Diseases Unit, Roma, Italia. .,Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia.
| | | | | | | | - Nicola Bonadia
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Emergency Medicine, Roma, Italia
| | - Piergiorgio Bruno
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Cardiac Surgery Unit, Roma, Italia
| | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia
| | | | | | - Angelo Santoliquido
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia.,Angiology Unit, Roma, Italia
| | - Dario Pitocco
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia.,Diabetology Unit, Roma, Italia
| | - Raffaele Landolfi
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Internal Medicine and Vascular Diseases Unit, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Andrea Flex
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.,Internal Medicine and Vascular Diseases Unit, Roma, Italia.,Laboratory of Vascular Biology and Genetics, Department of Translational Medicine and Surgery, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
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23
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Pitocco D, Spanu T, Di Leo M, Vitiello R, Rizzi A, Tartaglione L, Fiori B, Caputo S, Tinelli G, Zaccardi F, Flex A, Galli M, Pontecorvi A, Sanguinetti M. Diabetic foot infections: a comprehensive overview. Eur Rev Med Pharmacol Sci 2020; 23:26-37. [PMID: 30977868 DOI: 10.26355/eurrev_201904_17471] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diabetic foot ulcers (DFUs), a micro-vascular complication, are associated with a substantial increase in morbidity and mortality. DFUs are a complicated mixture of neuropathy, peripheral arterial diseases, foot deformities, and infections. Foot infections are frequent and potentially devastating complications. Infection prospers in more than half of all foot ulcers and is the factor that most often leads to lower extremity amputation. The complications of microbial flora span the spectrum from superficial cellulitis to chronic osteomyelitis and gangrenous extremity lower limb amputations. Wounds without confirmed soft tissue or bone infections do not require antibiotic therapy. Mild and moderate infections need empiric therapy covering Gram-positive cocci, while severe infections caused by drug-resistant organisms require broad-spectrum anti-microbials targeting aggressive Gram-negative aerobes and obligate anaerobes.
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Affiliation(s)
- D Pitocco
- Diabetes Care Unit, Endocrinology, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy.
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Biscetti F, Nardella E, Cecchini AL, Flex A, Landolfi R. Biomarkers of vascular disease in diabetes: the adipose-immune system cross talk. Intern Emerg Med 2020; 15:381-393. [PMID: 31919781 DOI: 10.1007/s11739-019-02270-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/21/2019] [Indexed: 12/21/2022]
Abstract
Experimental and clinical studies aimed at investigating the mechanism(s) underlying vascular complications of diabetes indicate that a great number of molecules are involved in the pathogenesis of these complications. Most of these molecules are inflammatory mediators or markers generated by immune or adipose tissue. Some of them, i.e. resistin and sortilin, have been shown to be involved in the cross talk between adipocytes and inflammatory cells. This interaction is an attractive area of research, particularly in type 2 diabetes and obesity. Other proteins, such as adiponectin and visfatin, appear to be more promising as possible vascular markers. In addition, some molecules involved in calcium/phosphorus metabolism, such as klotho and FGF23, have an involvement in the pathogenesis of diabetic vasculopathy, which appears to be dependent on the degree of vascular impairment. Inflammatory markers are a promising tool for treatment decisions while measuring plasma levels of adipokines, sortilin, Klotho and FGF23 in adequately sized longitudinal studies is expected to allow a more precise characterization of diabetic vascular disease and the optimal use of personalized treatment strategies.
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Affiliation(s)
- Federico Biscetti
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Nardella
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Andrea Leonardo Cecchini
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Andrea Flex
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.S.A Medicina delle Malattie Vascolari Periferiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Raffaele Landolfi
- U.O.C. Clinica Medica e Malattie Vascolari, Catholic University School of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
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25
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Biscetti F, Nicolazzi MA, Flex A, Landolfi R. Internists feel the rhythm. Intern Emerg Med 2020; 15:183-185. [PMID: 31598829 DOI: 10.1007/s11739-019-02202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Federico Biscetti
- UOC Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia
| | - Maria Anna Nicolazzi
- UOC Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia
| | - Andrea Flex
- UOC Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italia
| | - Raffaele Landolfi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Roma, 00168, Italia.
- Direttore UOC Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Roma, 00168, Italia.
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D'Amario D, Restivo A, Leone AM, Vergallo R, Migliaro S, Canonico F, Galli M, Trani C, Burzotta F, Aurigemma C, Niccoli G, Buffon A, Montone RA, Flex A, Franceschi F, Tinelli G, Limbruno U, Francese F, Ceccarelli I, Borovac JA, Porto I, Crea F. Ticagrelor and preconditioning in patients with stable coronary artery disease (TAPER-S): a randomized pilot clinical trial. Trials 2020; 21:192. [PMID: 32066489 PMCID: PMC7027127 DOI: 10.1186/s13063-020-4116-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/29/2020] [Indexed: 02/18/2023] Open
Abstract
Background Ticagrelor is a reversibly binding, direct-acting, oral, P2Y12 antagonist used for the prevention of atherothrombotic events in patients with coronary artery disease (CAD). Ticagrelor blocks adenosine reuptake through the inhibition of equilibrative nucleoside transporter 1 (ENT-1) on erythrocytes and platelets, thereby facilitating adenosine-induced physiological responses such as an increase in coronary blood flow velocity. Meanwhile, adenosine plays an important role in triggering ischemic preconditioning through the activation of the A1 receptor. Therefore, an increase in ticagrelor-enhanced adenosine bioavailability may confer beneficial effects through mechanisms related to preconditioning activation and improvement of coronary microvascular dysfunction. Methods To determine whether ticagrelor can trigger ischemic preconditioning and influence microvascular function, we designed this prospective, open-label, pilot study that enrolled patients with stable multivessel CAD requiring staged, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI). Participants will be randomized in 1:1 ratios either to ticagrelor (loading dose (LD) 180 mg, maintenance dose (MD) 90 mg bid) or to clopidogrel (LD 600 mg, MD 75 mg) from 3 to 1 days before the scheduled PCI. The PCI operators will be blinded to the randomization arm. The primary endpoint is the delta (difference) between ST segment elevations (in millimeters, mm) as assessed by intracoronary electrocardiogram (ECG) during the two-step sequential coronary balloon inflation in the culprit vessel. Secondary endpoints are 1) changes in coronary flow reserve (CFR), index of microvascular resistance (IMR), and FFR measured in the culprit vessel and reference vessel at the end of PCI, and 2) angina score during inflations. This study started in 2018 with the aim of enrolling 100 patients. Based on the rate of negative FFR up to 30% and a drop-out rate up to 10%, we expect to detect an absolute difference of 4 mm among the study arms in the mean change of ST elevation following repeated balloon inflations. All study procedures were reviewed and approved by the Ethical Committee of the Catholic University of Sacred Heart. Discussion Ticagrelor might improve ischemia tolerance and microvascular function compared to clopidogrel, and these effects might translate to better long-term clinical outcomes. Trial registration EudraCT No. 2016–004746-28. No. NCT02701140. Trial status Information provided in this manuscript refers to the definitive version (n. 3.0) of the study protocol, dated 31 October 2017, and includes all protocol amendments. Recruitment started on 18 September 2018 and is currently ongoing. The enrollment is expected to be completed by the end of 2019. Trial sponsor Fondazione Policlinico Universitario A. Gemelli – Roma, Polo di Scienze Cardiovascolari e Toraciche, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Affiliation(s)
- D D'Amario
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - A Restivo
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - A M Leone
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - R Vergallo
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - S Migliaro
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - F Canonico
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - M Galli
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - C Trani
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - F Burzotta
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - C Aurigemma
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - G Niccoli
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - A Buffon
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - R A Montone
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - A Flex
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - F Franceschi
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - G Tinelli
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - U Limbruno
- Dipartimento Cardio neuro vascolare, Azienda USL Toscana Sud-est, Ospedale di Grosseto, Grosseto, Italy
| | - F Francese
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - I Ceccarelli
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - J A Borovac
- Department of Pathophysiology, University of Split School of Medicine (USSM) and University Hospital Center Split (UHC Split), Split, Croatia
| | - I Porto
- Ospedale Policlinico San Martino IRCCS, Università degli Studi di Genova, Genoa, Italy.
| | - F Crea
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
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27
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Biscetti F, Rando MM, Nardella E, Cecchini AL, Pecorini G, Landolfi R, Flex A. High Mobility Group Box-1 and Diabetes Mellitus Complications: State of the Art and Future Perspectives. Int J Mol Sci 2019; 20:ijms20246258. [PMID: 31835864 PMCID: PMC6940913 DOI: 10.3390/ijms20246258] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022] Open
Abstract
Diabetes mellitus (DM) is an endemic disease, with growing health and social costs. The complications of diabetes can affect potentially all parts of the human body, from the heart to the kidneys, peripheral and central nervous system, and the vascular bed. Although many mechanisms have been studied, not all players responsible for these complications have been defined yet. High Mobility Group Box-1 (HMGB1) is a non-histone nuclear protein that has been implicated in many pathological processes, from sepsis to ischemia. The purpose of this review is to take stock of all the most recent data available on the role of HMGB1 in the complications of DM.
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Affiliation(s)
- Federico Biscetti
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-06-3015-4335; Fax: +39-06-3550-7232
| | | | - Elisabetta Nardella
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | | | - Giovanni Pecorini
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | - Raffaele Landolfi
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
| | - Andrea Flex
- U.O.C. Clinica Medica e Malattie Vascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (G.P.); (R.L.); (A.F.)
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (M.M.R.); (E.N.); (A.L.C.)
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28
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Santoro L, Flex A, Nesci A, Ferraro PM, De Matteis G, Di Giorgio A, Giupponi B, Saviano L, Gambaro G, Franceschi F, Gasbarrini A, Landolfi R, Santoliquido A. Association between peripheral arterial disease and cardiovascular risk factors: role of ultrasonography versus ankle-brachial index. Eur Rev Med Pharmacol Sci 2019; 22:3160-3165. [PMID: 29863271 DOI: 10.26355/eurrev_201805_15076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Most studies on atherosclerotic processes include peripheral arterial disease diagnosis only if patients report symptoms suggestive of peripheral arterial disease and/or an instrumental demonstration of lower limbs perfusion deficit is provided, rather than the sole presence of atherosclerotic lesions localized at lower limbs, this attitude leading to ignore early stages of the disease. To overcome these limitations, we have proposed a new ultrasonographic semiquantitative score to better identify all disease stages. The aim of this study is to compare ultrasonography versus ankle-brachial index in the association between peripheral arterial disease and cardiovascular risk factors. PATIENTS AND METHODS This cross-sectional observational study included subjects undergoing lower limbs evaluation through ultrasonography and ankle-brachial index determination because of symptoms suggestive of peripheral arterial disease or presence of known cardiovascular risk factors. Associations between ultrasonography and ankle-brachial index with cardiovascular risk factors were assessed by first fitting logistic regression models and then comparing the respective areas under the Receiver Operating Characteristic and 95% confidence intervals. RESULTS The areas under the Receiver Operating Characteristic for each cardiovascular risk factors were consistently larger in magnitude for ultrasonography compared with ankle-brachial index, this comparison being statistically significant for age, male gender, smoking status, hypertension, diabetes mellitus and previous cardiovascular events. CONCLUSIONS Our study demonstrates that ultrasonography is a better method to screen peripheral arterial disease respect to ankle-brachial index in order to identify all disease stages. These findings are useful in particular when including peripheral arterial disease as organ damage marker in cardiovascular risk stratification.
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Affiliation(s)
- L Santoro
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy.
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Antonelli M, Burzo ML, Pecorini G, Massi G, Landolfi R, Flex A. Scurvy as cause of purpura in the XXI century: a review on this "ancient" disease. Eur Rev Med Pharmacol Sci 2019; 22:4355-4358. [PMID: 30024630 DOI: 10.26355/eurrev_201807_15433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Scurvy is defined as a deficiency of ascorbic acid, which is an essential exogenous vitamin in humans. Vitamin C is involved in collagen synthesis and its deficit can cause disorders of connective tissue. The most frequent symptoms are weakness, arthralgias, anorexia and depression, commonly associated with follicular hyperkeratosis and perifollicular hemorrhage, with purpura. PATIENTS AND METHODS A young woman, with a history of malnutrition, manifested purpura and hematoma of the left lower limb. The laboratory tests didn't detect alterations either in coagulation, the platelet count or in the autoimmunity. The total body TC scan didn't show neoplasia or other suspected lesions. Excluding the most important causes of purpura, in consideration of malnutrition, scurvy was suspected. RESULTS A skin biopsy confirmed the diagnosis. Accordingly to this finding, a treatment with a daily intravenous infusion of vitamin C was started with consequent improvement of hematoma and purpura. CONCLUSIONS Scurvy is a re-emerging disease, also in western countries. When purpura appears in young adults, scurvy has to be investigated, especially when a history of malnutrition is present. The treatment with vitamin C infusions should be started as soon as possible in order to prevent any complications.
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Affiliation(s)
- M Antonelli
- Institute of Internal Medicine, Catholic University of the Sacred Heart, A. Gemelli, Hospital Foundation, School of Medicine, Rome, Italy.
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30
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Bianchetti G, Di Giacinto F, Pitocco D, Rizzi A, Rizzo GE, De Leva F, Flex A, di Stasio E, Ciasca G, De Spirito M, Maulucci G. Red blood cells membrane micropolarity as a novel diagnostic indicator of type 1 and type 2 diabetes. Anal Chim Acta X 2019; 3:100030. [PMID: 33117983 PMCID: PMC7587021 DOI: 10.1016/j.acax.2019.100030] [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] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 01/06/2023] Open
Abstract
Classification of the category of diabetes is extremely important for clinicians to diagnose and select the correct treatment plan. Glycosylation, oxidation and other post-translational modifications of membrane and transmembrane proteins, as well as impairment in cholesterol homeostasis, can alter lipid density, packing, and interactions of Red blood cells (RBC) plasma membranes in type 1 and type 2 diabetes, thus varying their membrane micropolarity. This can be estimated, at a submicrometric scale, by determining the membrane relative permittivity, which is the factor by which the electric field between the charges is decreased relative to vacuum. Here, we employed a membrane micropolarity sensitive probe to monitor variations in red blood cells of healthy subjects (n=16) and patients affected by type 1 (T1DM, n=10) and type 2 diabetes mellitus (T2DM, n=24) to provide a cost-effective and supplementary indicator for diabetes classification. We find a less polar membrane microenvironment in T2DM patients, and a more polar membrane microenvironment in T1DM patients compared to control healthy patients. The differences in micropolarity are statistically significant among the three groups (p<0.01). The role of serum cholesterol pool in determining these differences was investigated, and other factors potentially altering the response of the probe were considered in view of developing a clinical assay based on RBC membrane micropolarity. These preliminary data pave the way for the development of an innovative assay which could become a tool for diagnosis and progression monitoring of type 1 and type 2 diabetes. Dynamic flux of cholesterol is differentially altered in T1DM and T2DM. Red blood cell senses the dynamic flux of lipids by changing its micropolarity. Laurdan can measure micropolarity in red blood cells membranes. Differences in micropolarity between the three groups are statistically significant. Red blood cell Micropolarity is an innovative assay for diabetes classification.
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Key Words
- DMPC, dimyristoylphosphatidylcholine
- DPPC, dipalmitoilphosphatidylcholine
- Diabetes mellitus
- Fluorescence lifetime microscopy
- HDL, high-density lipoproteins
- HDL-C, high-density lipoprotein cholesterol
- HbA1c, glycated Haemoglobin
- LDL, low-density lipoproteins
- LDL-C, low-density lipoprotein cholesterol
- Membrane micropolarity
- Metabolic imaging
- PC, phosphatydilcholine
- Personalized medicine
- RBC, red blood cells
- Red blood cells
- T1DM, Type 1 Diabetes Mellitus
- T2DM, Type 2 diabetes Mellitus
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Affiliation(s)
- Giada Bianchetti
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Istituto di Fisica, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Flavio Di Giacinto
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Istituto di Fisica, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Dario Pitocco
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Alessandro Rizzi
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gaetano Emanuele Rizzo
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesca De Leva
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Diabetes Care Unit, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Cardiovascular Disease Division, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Enrico di Stasio
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Istituto di Biochimica Clinica, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gabriele Ciasca
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Istituto di Fisica, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Marco De Spirito
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Istituto di Fisica, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Maulucci
- Fondazione Policlinico Universitario A, Gemelli IRCSS, Rome, Italy.,Istituto di Fisica, Università Cattolica Del Sacro Cuore, Rome, Italy
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31
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Biscetti F, Ferraro PM, Hiatt WR, Angelini F, Nardella E, Cecchini AL, Santoliquido A, Pitocco D, Landolfi R, Flex A. Inflammatory Cytokines Associated With Failure of Lower-Extremity Endovascular Revascularization (LER): A Prospective Study of a Population With Diabetes. Diabetes Care 2019; 42:1939-1945. [PMID: 31371431 DOI: 10.2337/dc19-0408] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/11/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Peripheral artery disease (PAD) is one of the most relevant complications of diabetes. Although several pharmacological and revascularization approaches are available for treating patients with diabetes and PAD, an endovascular approach is often associated with postprocedural complications that can increase the risk for acute limb ischemia or amputation. However, no definitive molecular associations have been described that could explain the difference in outcomes after endovascular treatment in patients with diabetes, PAD, and chronic limb-threatening ischemia (CLTI). RESEARCH DESIGN AND METHODS We evaluated the relationship between the levels of the main cytokines associated with diabetic atherosclerosis and the outcomes after endovascular procedures in patients with diabetes, PAD, and CLTI. RESULTS A total of 299 patients with below-the-knee occlusive disease who were undergoing an angioplasty procedure were enrolled. The levels of key cytokines-osteoprotegerin (OPG), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP)-were measured, and major adverse limb events (MALE) and major adverse cardiovascular events (MACE) were assessed 1, 3, 6, and 12 months after the procedure. There was a linear trend from the lowest to the highest quartile for each cytokine at baseline and incident MALE. A linear association was also observed between increasing levels of each cytokine and incident MACE. Receiver operating characteristics models were constructed using clinical and laboratory risk factors, and the inclusion of cytokines significantly improved the prediction of incident events. CONCLUSIONS We demonstrated that elevated OPG, TNF-α, IL-6, and CRP levels at baseline correlate with worse vascular outcomes in patients with diabetes, PAD, and CLTI undergoing an endovascular procedure.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy .,UOC Clinica Medica e Malattie Vascolari, Rome, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Manuel Ferraro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,UOC Nefrologia, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - William R Hiatt
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, and CPC Clinical Research, Aurora, CO
| | - Flavia Angelini
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Nardella
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Angelo Santoliquido
- Università Cattolica del Sacro Cuore, Rome, Italy.,UOS Angiologia CIC, Rome, Italy
| | - Dario Pitocco
- Università Cattolica del Sacro Cuore, Rome, Italy.,UOSA Diabetologia, Rome, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,UOC Clinica Medica e Malattie Vascolari, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Rome, Italy.,UOSA Medicina delle Malattie Vascolari Periferiche, Rome, Italy
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Biscetti F, Nardella E, Bonadia N, Angelini F, Pitocco D, Santoliquido A, Filipponi M, Landolfi R, Flex A. Association between plasma omentin-1 levels in type 2 diabetic patients and peripheral artery disease. Cardiovasc Diabetol 2019; 18:74. [PMID: 31167666 PMCID: PMC6549359 DOI: 10.1186/s12933-019-0880-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 03/29/2019] [Accepted: 05/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background Type-2 diabetes mellitus is one of the major risk factors of atherosclerosis, particularly in peripheral artery disease (PAD). Several studies have documented a correlation between omentin-1 serum levels, atherosclerosis, and cardiovascular diseases. However, a clear link between circulating omentin-1 and PAD in diabetic patients has yet to be established. The aim of this study was to investigate the potential role of omentin-1 in PAD in type-2 diabetic patients. Methods In this cross-sectional study, we analyzed omentin-1 serum levels by ELISA in 600 type-2 diabetic patients with (n = 300) and without (n = 300) PAD at Fontaine’s stage II, III, or IV. Results We found that omentin-1 serum levels were significantly lower in diabetic patients with PAD than in diabetic controls (29.46 vs 49.24 ng/mL, P < 0.001) and that the levels gradually decreased in proportion to disease severity (P < 0.05). The association between omentin-1 levels and PAD remained significant after adjusting for major risk factors in a multivariate analysis. Conclusions Our results suggest that omentin-1 is reduced in type 2 diabetic patients with PAD and that omentin-1 levels are related to disease severity.
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Affiliation(s)
- Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italy. .,Clinica Medica e Malattie Vascolari, Roma, Italy. .,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Elisabetta Nardella
- Clinica Medica e Malattie Vascolari, Roma, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Nicola Bonadia
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy.,Medicina d'Urgenza e Pronto Soccorso, Roma, Italy
| | - Flavia Angelini
- Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Dario Pitocco
- Diabetologia, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Angelo Santoliquido
- Università Cattolica del Sacro Cuore, Roma, Italy.,Angiologia Columbus, Roma, Italia
| | | | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italy.,Clinica Medica e Malattie Vascolari, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Andrea Flex
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Roma, Italy.,Clinica Medica e Malattie Vascolari, Roma, Italy.,Laboratorio di Biologia e Genetica Vascolare, Università Cattolica del Sacro Cuore, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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Biscetti F, Bonadia N, Santini F, Angelini F, Nardella E, Pitocco D, Santoliquido A, Filipponi M, Landolfi R, Flex A. Sortilin levels are associated with peripheral arterial disease in type 2 diabetic subjects. Cardiovasc Diabetol 2019; 18:5. [PMID: 30634965 PMCID: PMC6329108 DOI: 10.1186/s12933-019-0805-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 11/07/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background Sortilin is a 95-kDa protein which has recently been linked to circulating cholesterol concentration and lifetime risk of developing significant atherosclerotic disease. Sortilin is found inside different cell types and circulating in blood. Higher circulating sortilin concentration has been found in patients with coronary atherosclerosis compared to control subjects. Sortilin concentration is influenced by statin therapy. Methods We enrolled statin-naïve subjects with type 2 diabetes mellitus and we performed a cross-sectional study to evaluate the association between sortilin levels and the presence of clinically significant lower limb peripheral artery disease (PAD) in a population of statin-free diabetic subjects. Results Out of the 154 patients enrolled in our study, 80 patients were free from PAD, while 74 had clinically significant PAD. Sortilin concentration was significantly higher in the latter group compared to the former (1.61 ± 0.54 ng/mL versus 0.67 ± 0.30 ng/mL, P < 0.01) and there was a trend toward increased sortilin levels as disease severity increased. The association of sortilin levels with PAD remained after adjusting for major risk factors in a multivariate analysis. Conclusions We showed that sortilin is significantly and independently associated with the presence of lower limb PAD in a statin-free diabetic population and it may be a promising marker for clinically significant atherosclerosis of the lower limbs. Further studies are needed to confirm this finding and to evaluate its clinical usefulness.
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Affiliation(s)
- Federico Biscetti
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy. .,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Nicola Bonadia
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy.,U.O.C. Medicina d'Urgenza e Pronto Soccorso, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Santini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Nardella
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Pitocco
- U.O.S.A. di Diabetologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Santoliquido
- Università Cattolica del Sacro Cuore, Rome, Italy.,U.O.S. Angiologia Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Landolfi
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Flex
- U.O.C. Clinica Medica e Malattie Vascolari, Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Laboratory of Vascular Biology and Genetics, Università Cattolica del Sacro Cuore, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Pitocco D, Scavone G, Di Leo M, Vitiello R, Rizzi A, Tartaglione L, Costantini F, Flex A, Galli M, Caputo S, Ghirlanda G, Pontecorvi A. Charcot Neuroarthropathy: From the Laboratory to the Bedside. Curr Diabetes Rev 2019; 16:62-72. [PMID: 31057120 DOI: 10.2174/1573399815666190502121945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/26/2019] [Accepted: 04/17/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The diabetic Charcot foot syndrome is a serious and potentially limbthreatening lower-extremity complication of diabetes. INTRODUCTION The present review provides a concise account of the advances made over the last twentyfive years in understanding the pathogenesis and management of Charcot neuroarthropathy (CN). METHODS In this study, the widely known pathogenetic mechanisms underpinning CN are brought into focus, particularly the role of RANKL/RANK/OPG system and advanced glycation end production in the pathogenesis of CN. Furthermore, other potential triggering factors, namely nitric oxide, endothelial dysfunction, macro calcifications and body weight that influence CN have also been discussed. RESULTS The wide range of diagnostic tools available to clinicians for accurate staging of this pathology has been examined, particularly radiological and nuclear medicine imaging. Additionally, the difficult differential diagnosis between osteomyelitis and CN is also elucidated. CONCLUSION The review concludes with the comprehensive summary of the major promising therapeutic strategies, including conservative treatment involving orthopedic devices, pharmacological approach, and the most common surgical techniques currently employed in the diagnosis and treatment of this acute disease.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Scavone
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Di Leo
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Raffaele Vitiello
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Costantini
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Flex
- Institute of Internal Medicine, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Galli
- Institute of Orthopedic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Caputo
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Ghirlanda
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Diabetes Care Unit, Institute of Endocrinology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Galli M, Scavone G, Vitiello R, Flex A, Caputo S, Pitocco D. Surgical treatment for chronic Charcot neuroarthropathy. Foot (Edinb) 2018; 36:59-66. [PMID: 30368193 DOI: 10.1016/j.foot.2018.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/12/2017] [Revised: 01/27/2018] [Accepted: 02/14/2018] [Indexed: 02/04/2023]
Abstract
Charcot Neuro-arthropathy (CN) is a condition characterized by a progressive derangement of the joints, in individuals affected with sensitive and autonomic neuropathy. The pathogenesis of CN is multifactorial as neuropathy is a necessary, but insufficient condition for the onset of the disease. The most important indication for surgical treatment of Charcot foot is a severe deformity that compromises the functionality of the limb, causing a high risk for ulceration, infection and amputation. The goal in Charcot foot treatment is to obtain and maintain the correction of a severe deformity and/or prevent its development. There are many surgical approach to the CN, such as exostectomy, arthrodesis with internal or external fixation and amputation. Every method has a different indication and specific complication. The right surgical approach in the CN is a real challenge for orthopedic surgeon that need a complete knowing of technique, material and complication.
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Affiliation(s)
- Marco Galli
- Università Cattolica del Sacro Cuore, Italy.
| | | | | | - Andrea Flex
- Università Cattolica del Sacro Cuore, Italy.
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Tinelli G, Minelli F, De Nigris F, Vincenzoni C, Filipponi M, Bruno P, Massetti M, Flex A, Iezzi R. The potential role of quantitative digital subtraction angiography in evaluating type B chronic aortic dissection during TEVAR: preliminary results. Eur Rev Med Pharmacol Sci 2018; 22:516-522. [PMID: 29424912 DOI: 10.26355/eurrev_201801_14204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the role of quantitative digital subtraction angiography (Q-DSA) with parametric color coding (PCC) in assessing patients with type B chronic thoracic aortic dissection (TBCAD) during thoracic endovascular aortic repair (TEVAR) procedures. PATIENTS AND METHODS A total of 11 patients electively treated in our Department for a TBCAD were retrospectively enrolled. All cases were treated with TEVAR for false lumen aneurysm of the thoracic descending aorta. For digital subtraction angiography (DSA) series post-processing, a newly implemented PCC algorithm was used to turn consecutive two-dimensional images into a single color-coded picture (syngo iFLOW, Siemens AG, Forchheim, Germany). In consensus reading, two clinicians experienced in vascular imaging evaluated the DSA series in blinded assessment and compared them to the color-coded images. PCC was assessed for its accuracy in identifying the true and false lumen as well as whether it could provide improved visualization in pre-deployment stent grafting and the final evaluation of treatment. RESULTS PCC facilitated the visualization of the aortic dissection angioarchitecture in terms of contemporary true and false lumen vision in 81.8% of the cases. In 72.7% of the procedures, Q-DSA was estimated to improve aorta information assessment in terms of false lumen viewing, and it was possible to identify the proximal entry tear position in 45.4% of the cases. After stent graft deployment, in 72.7% of the cases (all 8 patients in which the aortic arch false lumen was visible in pre-treatment), Q-DSA confirmed the absence of early false lumen reperfusion. CONCLUSIONS Our results indicate that Q-DSA could be useful in the intraprocedural evaluation of patients with aortic dissection during TEVAR procedures without additional x-ray costs and contrast exposure.
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Affiliation(s)
- G Tinelli
- Department of Cardiovascular Sciences, Vascular Unit, Gemelli Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
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Abstract
RATIONALE Fever of unknown origin (FUO) can be determined by different conditions among which infectious diseases represent the main cause. PATIENT CONCERNS A young woman, with a history of aortic stenosis, was admitted to our unit for a month of intermittent fever associated with a new diastolic heart murmur and splenomegaly. Laboratory tests were negative for infectious screening. The total body computed tomography (CT) scan excluded abscesses, occulted neoplasia, or lymphadenopathy. DIAGNOSES The transthoracic and transesophageal echocardiogram showed an aortic valve vegetation. Three sets of blood cultures were negative for all microorganisms tested. According to these findings, Bartonella endocarditis was suspected and the serology tests performed were positive. Finally, real-time polymerase chain reaction (RT-PCR) detected Bartonella henselae DNA on tissue valve. INTERVENTIONS The patient underwent heart valve surgery and a treatment of Ampicillin, Gentamicin, and oral Doxycycline was prescribed for 16 days and, successively, with Doxycycline and Ceftriaxone for 6 weeks. OUTCOMES After surgery and antibiotic therapy, patient continued to do well. LESSONS Bartonella species are frequently the cause of negative blood culture endocarditis. Molecular biology techniques are the only useful tool for diagnosis. Valvular replacement is often necessary and antibiotic regimen with Gentamicin and either Ceftriaxone or Doxycycline is suggested as treatment.Echocardiogram and blood cultures must be performed in all cases of FUO. When blood cultures are negative and echocardiographic tools are indicative, early use of Bartonella serology is recommended.
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Affiliation(s)
| | | | - Giovanni Pecorini
- Institute of Internal Medicine
- Laboratory of Vascular Biology and Genetics, Catholic University of the Sacred Heart, Fondazione University Hospital A. Gemelli, Rome, Italy
| | | | | | - Andrea Flex
- Institute of Internal Medicine
- Laboratory of Vascular Biology and Genetics, Catholic University of the Sacred Heart, Fondazione University Hospital A. Gemelli, Rome, Italy
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Tinelli G, De Nigris F, Minelli F, Vincenzoni C, Flex A. Images in Vascular Medicine: Quantitative digital subtraction angiography during type B chronic aortic dissection endovascular repair. Vasc Med 2017; 23:181-182. [PMID: 29065789 DOI: 10.1177/1358863x17737167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giovanni Tinelli
- 1 Vascular Surgery Unit - Cardiovascular Area, Fondazione Policlinico Universitario A Gemelli, Rome, Italy
| | - Francesca De Nigris
- 1 Vascular Surgery Unit - Cardiovascular Area, Fondazione Policlinico Universitario A Gemelli, Rome, Italy
| | - Fabrizio Minelli
- 1 Vascular Surgery Unit - Cardiovascular Area, Fondazione Policlinico Universitario A Gemelli, Rome, Italy
| | - Claudio Vincenzoni
- 1 Vascular Surgery Unit - Cardiovascular Area, Fondazione Policlinico Universitario A Gemelli, Rome, Italy
| | - Andrea Flex
- 2 Department of Internal Medicine, Fondazione Policlinico Universitario A Gemelli, Rome, Italy
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Biscetti F, Gentileschi S, Bertucci F, Servillo M, Arena V, Angelini F, Stigliano E, Bonanno G, Scambia G, Sacchetti B, Pierelli L, Landolfi R, Flex A. The angiogenic properties of human adipose-derived stem cells (HASCs) are modulated by the High mobility group box protein 1 (HMGB1). Int J Cardiol 2017; 249:349-356. [PMID: 28967436 DOI: 10.1016/j.ijcard.2017.09.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 04/08/2017] [Revised: 09/04/2017] [Accepted: 09/18/2017] [Indexed: 12/16/2022]
Abstract
Peripheral arterial disease (PAD), is a major health problem. Many studies have been focused on the possibilities of treatment offered by vascular regeneration. Human adipose-derived stem cells (HASCs), multipotent CD34+ stem cells found in the stromal-vascular fraction of adipose tissues, which are capable to differentiate into multiple mesenchymal cell types. The High mobility group box 1 protein (HMGB1) is a nuclear protein involved in angiogenesis. The aim of the study was to define the role of HMGB1 in cell therapy with HASCs, in an animal model of PAD. We induced unilateral ischemia in mice and we treated them with HASCs, with the specific HMGB1-inihibitor BoxA, with HMGB1 protein, and with the specific VEGF inhibitor sFlt1, alternately or concurrently. We measured the blood flow recovery in all mice. Immunohistochemical and ELISA analyses was performed to evaluate the number of vessels and the VEGF tissue content. None auto-amputation occurred and there have been no rejection reactions to the administration of HASCs. Animals co-treated with HASCs and HMGB1 protein had an improved blood flow recovery, compared to HASCs-treated mice. The post-ischemic angiogenesis was reduced when the HMGB1 pathway was blocked or when the VEGF activity was inhibited, in mice co-treated with HASCs and HMGB1. In conclusion, the HASCs treatment can be used in a mouse model of PAD to induce post-ischemic angiogenesis, modulating angiogenesis by HMGB1. This effect is mediated by VEGF activity. Although further data are needed, these findings shed light on possible new cell treatments for patients with PAD.
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Affiliation(s)
- Federico Biscetti
- Division of Rheumatology, Institute of Rheumatology & Related Sciences, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy; Laboratory of Vascular Biology and Genetics, Department of Medicine, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy.
| | - Stefano Gentileschi
- Division of Plastic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Flavio Bertucci
- Laboratory of Vascular Biology and Genetics, Department of Medicine, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Maria Servillo
- Division of Plastic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Vincenzo Arena
- Department of Pathology, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Department of Medicine, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Egidio Stigliano
- Department of Pathology, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Giuseppina Bonanno
- Division of Gynecology, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecology, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | | | - Luca Pierelli
- Immunohematology and Transfusion Medicine, San Camillo Forlanini Hospital, Rome, Italy; Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Raffaele Landolfi
- Department of Internal Medicine, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
| | - Andrea Flex
- Laboratory of Vascular Biology and Genetics, Department of Medicine, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy; Department of Internal Medicine, Fondazione Policlinico Universitario "A. Gemelli", Catholic University School of Medicine, Rome, Italy
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Giovannini S, Tinelli G, Biscetti F, Straface G, Angelini F, Pitocco D, Mucci L, Landolfi R, Flex A. Serum high mobility group box-1 and osteoprotegerin levels are associated with peripheral arterial disease and critical limb ischemia in type 2 diabetic subjects. Cardiovasc Diabetol 2017; 16:99. [PMID: 28789654 PMCID: PMC5549317 DOI: 10.1186/s12933-017-0581-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 06/05/2017] [Accepted: 07/28/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND High mobility group box-1 (HMGB-1) is a nuclear protein also acting as inflammatory mediator, whilst osteoprotegerin (OPG), member of tumor necrosis factor receptor superfamily, is indicated as marker of vascular calcification. Peripheral artery disease (PAD) and type 2 diabetes (T2D) are clinical conditions characterized by elevated serum inflammatory markers and vascular calcification enhancement. The aim of this study was to investigate the potential role of HMGB-1, OPG and several inflammatory mediators such as C-reactive protein (HsCRP), tumor necrosis factor-alpha and interleukin-6 (IL-6) on the presence and severity of peripheral artery disease in patients with T2D. METHODS In this retrospective observational study, we have analyzed HMGB-1, OPG and inflammatory cytokines serum levels in 1393 type 2 diabetic patients with PAD and without PAD (WPAD). RESULTS HMGB-1 (7.89 ± 15.23 ng/mL), OPG (6.54 ± 7.76 pmol/L), HsCRP (15.6 ± 14.4 mg/L) and IL-6 (56.1 ± 28.6 pg/mL) serum levels were significantly higher in patients with PAD than in those WPAD (3.02 ± 8.12 ng/mL, P ˂ 0.001; 2.98 ± 2.01 pmol/L, P < 0.001; 7.05 ± 4.4 mg/L, P < 0.001; 37.5 ± 20.2 pg/mL, P < 0.001 respectively). Moreover HMGB-1 (P < 0.001), OPG (P < 0.001), HsCRP (P < 0.001) and IL-6 (P < 0.001) serum levels were positively correlated with clinical severity of PAD. HMGB-1 (adjusted OR 12.32; 95% CI 3.56-23.54, P = 0.023) and OPG (adjusted OR 3.53; 95% CI 1.54-6.15, P = 0.019) resulted independent determinants of PAD in patients with T2D after adjusting for the conventional cardiovascular risk factor and established inflammatory mediators. CONCLUSIONS In T2D patients HMGB-1 and OPG serum levels are higher in patients affected by PAD and independently associated with its occurrence and clinical severity.
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Affiliation(s)
- Silvia Giovannini
- Department of Gerontology and Geriatrics, A. Gemelli Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy
| | - Giovanni Tinelli
- Department of Vascular Surgery, A. Gemelli Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy
| | - Federico Biscetti
- Rheumatology and Affine Sciences Institute, A. Gemelli Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.,Laboratory of Vascular Biology and Genetics, Catholic University School of Medicine, Rome, Italy
| | - Giuseppe Straface
- Vascular Medicine and Atherothrombosis Laboratory, Department of Experimental Medicine, Sapienza University of Rome, Polo Pontino, Italy
| | - Flavia Angelini
- Laboratory of Vascular Biology and Genetics, Catholic University School of Medicine, Rome, Italy
| | - Dario Pitocco
- Department of Medicine, A. Gemelli Foundation, Catholic University School of Medicine, Rome, Italy
| | - Luciana Mucci
- Laboratory of Vascular Biology and Genetics, Catholic University School of Medicine, Rome, Italy.,Department of Medicine, A. Gemelli Foundation, Catholic University School of Medicine, Rome, Italy
| | - Raffaele Landolfi
- Department of Medicine, A. Gemelli Foundation, Catholic University School of Medicine, Rome, Italy
| | - Andrea Flex
- Laboratory of Vascular Biology and Genetics, Catholic University School of Medicine, Rome, Italy. .,Department of Medicine, A. Gemelli Foundation, Catholic University School of Medicine, Rome, Italy.
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Rizzo P, Pitocco D, Zaccardi F, Di Stasio E, Strollo R, Rizzi A, Scavone G, Costantini F, Galli M, Tinelli G, Flex A, Caputo S, Pozzilli P, Landolfi R, Ghirlanda G, Nissim A. Autoantibodies to post-translationally modified type I and II collagen in Charcot neuroarthropathy in subjects with type 2 diabetes mellitus. Diabetes Metab Res Rev 2017; 33. [PMID: 27454862 DOI: 10.1002/dmrr.2839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/05/2016] [Accepted: 07/18/2016] [Indexed: 11/07/2022]
Abstract
AIMS Charcot neuroarthropathy (CN) is a disabling complication, culminating in bone destruction and involving joints and articular cartilage with high inflammatory environment. Its real pathogenesis is as yet unknown. In autoinflammatory diseases, such as rheumatoid arthritis, characterized by inflammation and joint involvement, autoantibodies against oxidative post-translationally modified (oxPTM) collagen type I (CI) and type II (CII) were detected. Therefore, the aim of our study was to assess the potential involvement of autoimmunity in charcot neuroarthropathy, investigating the presence of autoantibodies oxPTM-CI and oxPTM-CII, in participants with charcot neuroarthropathy. METHODS In this case-control study, we enrolled 124 participants with type 2 diabetes mellitus (47 with charcot neuroarthropathy, 37 with diabetic peripheral neuropathy without charcot neuroarthropathy, and 40 with uncomplicated diabetes), and 32 healthy controls. The CI and CII were modified with ribose and other oxidant species, and the modifications were evaluated with sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Binding of sera from the participants was analyzed with enzyme-linked immunosorbent assay. RESULTS Age, body mass index, waist and hip circumferences, and lipid profile were similar across the 4 groups, as well as glycated hemoglobin and duration of diabetes among people with diabetes. An increased binding to both native and all oxidation-modified forms of CII was found in participants with CN and diabetic neuropathy. Conversely, for CI, an aspecific increased reactivity was noted. CONCLUSIONS Our results detected the presence of autoantibodies against oxidative post-translational modified collagen, particularly type 2 collagen, in participants with charcot neuroarthropathy and diabetic neuropathy, suggesting the possible involvement of autoimmunity. Further studies are required to understand the role of autoimmunity in the pathogenesis of charcot neuroarthropathy.
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Affiliation(s)
- Paola Rizzo
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Dario Pitocco
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Zaccardi
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Di Stasio
- Institute of Biochemistry, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Rocky Strollo
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Endocrinology & Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Scavone
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Costantini
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Galli
- Institute of Orthopedic Surgery, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Tinelli
- Department of Vascular Surgery, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Flex
- Institute of Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Caputo
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Paolo Pozzilli
- Department of Endocrinology & Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
- Centre for Diabetes, Queen Mary University of London, London, UK
| | - Raffaele Landolfi
- Institute of Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Ghirlanda
- Diabetes Care Unit, Internal Medicine, University Hospital "A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Ahuva Nissim
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
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Biscetti F, Straface G, Angelini F, Pitocco D, Landolfi R, Flex A. Association of RANK/RANKL/OPG gene polymorphisms with risk of peripheral arterial disease (PAD) and critical limb ischemia in the general Italian population. Meta Gene 2017. [DOI: 10.1016/j.mgene.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pfestorf R, Flex A. Vergleichende thermodynamische Untersuchungen der Exzeßcharakteristik an den Systemen n-Butylamin/Toluen und n-Butylamin/Cyclohexan. Z PHYS CHEM 2017. [DOI: 10.1515/zpch-1983-26432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Biscetti F, Giovannini S, Straface G, Bertucci F, Angelini F, Porreca C, Landolfi R, Flex A. RANK/RANKL/OPG pathway: genetic association with history of ischemic stroke in Italian population. Eur Rev Med Pharmacol Sci 2016; 20:4574-4580. [PMID: 27874938] [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: 06/06/2023]
Abstract
OBJECTIVE RANKL is a member of the TNF superfamily that stimulates chemokine release, monocyte/macrophage matrix migration and matrix metalloproteinase activity and plays an important role in atherosclerosis. In our study, we have evaluated whether RANKL gene polymorphisms are involved in ischemic stroke in Italian subjects. PATIENTS AND METHODS In a retrospective study we have included 487 patients (242 males, 245 females) with history of ischemic stroke and 543 control subjects without history of ischemic stroke (277 males, 276 females). The rs9533156, and rs2277438 gene polymorphisms of the RANKL gene were analyzed by PCR and restriction fragment length polymorphism. RESULTS We found that the rs9533156 gene polymorphism of the RANKL gene was significantly (55.0% versus 36.5%, p < 0.0001) and independently (adjusted OR 6.28 [2.34-4.21]) associated with history of ischemic stroke. No statistically significant difference was found between the two groups in our population for the rs2277438 gene polymorphism (p = 439). Furthermore, we have confirmed that rs 3134069, rs 2073617 and rs 2073618 polymorphisms of the OPG gene were significantly and independently associated with cerebrovascular disorders. CONCLUSIONS The present study identifies, for the first time, the genetic variant of RANKL as an independent risk factor for ischemic stroke.
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Affiliation(s)
- F Biscetti
- Rheumatology and Affine Sciences Institute, A. Gemelli Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
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Biscetti F, Straface G, Pitocco D, Angelini F, Tinelli G, Landolfi R, Flex A. Fibroblast growth factor 23 serum level in type 2 diabetic italian subjects with peripheral arterial disease and critical limb ischemia. Eur Rev Med Pharmacol Sci 2016; 20:4048-4054. [PMID: 27775794] [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: 06/06/2023]
Abstract
OBJECTIVE Fibroblast growth factor 23 (FGF23) was demonstrated to be involved in the occurrence and development of cardiovascular disease (CVD). The aim of this study was to investigate the potential role of FGF23 on presence and severity of peripheral arterial disease (PAD) in type 2 diabetic patients. PATIENTS AND METHODS In this study, we analyzed FGF23 serum levels in 413 type 2 diabetic patients with PAD and in 598 diabetic controls without lower limbs atherosclerosis. RESULTS We found that FGF23 median serum levels were significantly higher in patients than in diabetic controls (69.3 (58.8-75.1) pg/mL in PAD and 42.98 (37.1-49.8) pg/mL in subjects without PAD (p < 0.001) and were significantly and independently associated with critical limb ischemia (CLI) [OR, 7.69 (2.64-16.31); p = 0.001]. CONCLUSIONS We have found, for the first time, that FGF23 could be associated with presence and severity of PAD in Italian patients with type 2 diabetes.
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Affiliation(s)
- F Biscetti
- Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, School of Medicine, Foundation A. Gemelli University Hospital, Rome, Italy.
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Santoro L, Ferraro PM, Flex A, Nesci A, De Matteis G, Di Giorgio A, Zaccone V, Gambaro G, Gasbarrini A, Santoliquido A. New semiquantitative ultrasonographic score for peripheral arterial disease assessment and its association with cardiovascular risk factors. Hypertens Res 2016; 39:868-873. [PMID: 27412797 PMCID: PMC5506242 DOI: 10.1038/hr.2016.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/16/2016] [Accepted: 05/16/2016] [Indexed: 01/19/2023]
Abstract
The data concerning the distribution, extent and progression of peripheral arterial disease (PAD), as well as its association with traditional cardiovascular (CV) risk factors, have generally been obtained from studies of patients in advanced stages of the disease undergoing surgical or endovascular treatment. In this study, we have introduced a new semiquantitative ultrasonographic score (ultrasonographic lower limb atherosclerosis (ULLA) score) that is able to categorize lower limb atherosclerotic lesions at all stages of PAD. We then associated these ultrasonographic categories with a CV risk profile. We enrolled 320 consecutive subjects with symptoms suggestive of PAD or with known CV risk factors referring to our angiology unit between 1 July 2014 and 30 June 2015 for ultrasonographic evaluation of the lower limb arteries. Femoropopliteal and run-off segments were categorized together and separately based on their ultrasonographic characteristics. In univariate and multivariate analyses, the ULLA scores were significantly associated with the main CV risk factors, that is, age, male gender, cigarette smoking, arterial hypertension, diabetes, dyslipidemia, sedentary lifestyle, previous CV events and family history of CV disease, and also confirming the specific association of single risk factors with different segments of lower limb arteries. The proposed ULLA score enables a complete evaluation of the entire lower limb atherosclerotic burden, extending the results concerning the association of PAD with CV risk factors to all stages of the disease, including the early stages. It can be feasible that this new score will facilitate better evaluation of the progression of PAD and its prospective role in CV risk stratification.
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Affiliation(s)
- Luca Santoro
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | | | - Andrea Flex
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - Antonio Nesci
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | | | - Angela Di Giorgio
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - Vincenzo Zaccone
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Catholic University of Rome, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
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Flex A, Biscetti F, Iachininoto MG, Nuzzolo ER, Orlando N, Capodimonti S, Angelini F, Valentini CG, Bianchi M, Larocca LM, Martini M, Teofili L. Human cord blood endothelial progenitors promote post-ischemic angiogenesis in immunocompetent mouse model. Thromb Res 2016; 141:106-11. [PMID: 26994683 DOI: 10.1016/j.thromres.2016.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/05/2016] [Accepted: 03/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Human cord blood (CB) endothelial colony forming cells (ECFCs) are endowed with high vascular regenerative ability in immunodeficient mice, but their immunogenicity and susceptibility to rejection in immunocompetent models has yet to be explored. METHODS We injected CB ECFCs in non-immuno-suppressed C57BL/6J mice after having induced the hindlimb ischemia and we investigated their contribution to the recovery from the ischemic injury. Human ECFCs (hECFCs) were administered by intramuscular injection and hindlimb blood perfusion was measured by laser Doppler analysis at 7-day intervals for 28days after treatment. Mice were sacrificed after 7 and 28days and immunohistochemistry for specific human (CD31) and mouse (von Willebrand factor) endothelial antigens was carried out. Before euthanasia, blood samples to assess cytokines and angiogenic growth factor levels were collected. RESULTS Mice injected with hECFCs showed a prompter and greater recovery of blood flow than controls. Several endothelial cells of human origin were detected at day7 after injection and their number declined progressively. Likewise, a progressive increase of mouse-derived vascular structures were observed, paralleled by the amplified endogenous production of various soluble mediators of angiogenesis, including Vascular Endothelial Growth Factor and Fibroblast Growth Factor. CONCLUSIONS Overall, our findings are consistent with the hypothesis that human ECFCs might expand the endogenous vascular repair potential of recipients and support their possible HLA-independent unconventional use.
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Affiliation(s)
- Andrea Flex
- Department of Internal Medicine, Catholic University, Rome, Italy
| | | | | | | | | | | | - Flavia Angelini
- Department of Internal Medicine, Catholic University, Rome, Italy
| | | | - Maria Bianchi
- Institute of Hematology, Catholic University, Rome, Italy
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Biscetti F, Flex A, Pecorini G, Angelini F, Arena V, Stigliano E, Gremese E, Tolusso B, Ferraccioli G. The role of high-mobility group box protein 1 in collagen antibody-induced arthritis is dependent on vascular endothelial growth factor. Clin Exp Immunol 2016; 184:62-72. [PMID: 26671547 DOI: 10.1111/cei.12758] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022] Open
Abstract
High-mobility group box 1 (HMGB1) has been implicated in angiogenesis and rheumatoid arthritis (RA). The aim of this study was to define more clearly the role of HMGB1 in the synovial angiogenesis and pathogenesis of an immune model of arthritis. BALB/c mice were injected with monoclonal anti-collagen antibody cocktail followed by lipopolysaccharide to induce arthritis. HMGB1 and vascular endothelial growth factor (VEGF) were over-expressed in the areas of the synovium where more inflammation and neoangiogenesis were present. The selective blockade of HMGB1 or VEGF resulted alternatively in a lower severity of arthritis evaluated by the arthritis index. Furthermore, exogenous HMGB1 administration caused a worsening of arthritis, associated with VEGF up-regulation and increased synovial angiogenesis. The selective inhibition of VEGF also resulted in no induction of arthritis in mice receiving exogenous HMGB1. Cytokine enzyme-linked immunosorbent assay (ELISA) analyses performed on peripheral blood and synovial fluid demonstrated a significant reduction of interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α in mice where HMGB1 and VEGF pathways were blocked. Interestingly, the selective blockade of HMGB1 and VEGF resulted in an increase of the peripheral IL-17A concentration. The development of arthritis mediated by HMGB1 and the synovial angiogenesis can be blocked by inhibiting the VEGF activity. The proinflammatory and proangiogenic cytokine IL-17A was increased when HMGB1 is inhibited, but the synovial angiogenesis was nevertheless reduced in this model of arthritis. Taken together, these findings shed new light on the role of this nuclear protein in the pathogenesis of arthritis in an RA-like model.
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Affiliation(s)
- F Biscetti
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart.,Laboratory of Vascular Biology and Genetics, Department of Medicine, Catholic University School of Medicine
| | - A Flex
- Laboratory of Vascular Biology and Genetics, Department of Medicine, Catholic University School of Medicine
| | - G Pecorini
- Laboratory of Vascular Biology and Genetics, Department of Medicine, Catholic University School of Medicine
| | - F Angelini
- Laboratory of Vascular Biology and Genetics, Department of Medicine, Catholic University School of Medicine
| | - V Arena
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - E Stigliano
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - E Gremese
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart
| | - B Tolusso
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart
| | - G Ferraccioli
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart
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Iezzi R, Posa A, Santoro M, Nestola M, Contegiacomo A, Tinelli G, Paolini A, Flex A, Pitocco D, Snider F, Bonomo L. Cutting Balloon Angioplasty in the Treatment of Short Infrapopliteal Bifurcation Disease. J Endovasc Ther 2015; 22:485-92. [PMID: 26187973 DOI: 10.1177/1526602815594250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the safety, feasibility, and effectiveness of cutting balloon angioplasty in the management of infrapopliteal bifurcation disease. METHODS Between November 2010 and March 2013, 23 patients (mean age 69.6±9.01 years, range 56-89; 16 men) suffering from critical limb ischemia were treated using cutting balloon angioplasty (single cutting balloon, T-shaped double cutting balloon, or double kissing cutting balloon technique) for 47 infrapopliteal artery bifurcation lesions (16 popliteal bifurcation and 9 tibioperoneal bifurcation) in 25 limbs. Follow-up consisted of clinical examination and duplex ultrasonography at 1 month and every 3 months thereafter. RESULTS All treatments were technically successful. No 30-day death or adverse events needing treatment were registered. No flow-limiting dissection was observed, so no stent implantation was necessary. The mean postprocedure minimum lumen diameter and acute gain were 0.28±0.04 and 0.20±0.06 cm, respectively, with a residual stenosis of 0.04±0.02 cm. Primary and secondary patency rates were estimated as 89.3% and 93.5% at 6 months and 77.7% and 88.8% at 12 months, respectively; 1-year primary and secondary patency rates of the treated bifurcation were 74.2% and 87.0%, respectively. The survival rate estimated by Kaplan-Meier analysis was 82.5% at 1 year. CONCLUSION Cutting balloon angioplasty seems to be a safe and effective tool in the routine treatment of short/ostial infrapopliteal bifurcation lesions, avoiding procedure-related complications, overcoming the limitations of conventional angioplasty, and improving the outcome of catheter-based therapy.
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Affiliation(s)
- Roberto Iezzi
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Alessandro Posa
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Marco Santoro
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Massimiliano Nestola
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Andrea Contegiacomo
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Giovanni Tinelli
- Institute of Vascular Surgery, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Alessandra Paolini
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Andrea Flex
- Department of Medicine, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Dario Pitocco
- Department of Medicine, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Francesco Snider
- Institute of Vascular Surgery, "A. Gemelli" Hospital, Catholic University, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital, Catholic University, Rome, Italy
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Biscetti F, Ferraccioli G, Flex A. New therapeutic effects of cilostazol in patients with ischemic disorders. Curr Vasc Pharmacol 2015; 13:399-404. [DOI: 10.2174/1570161112666141125123743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/07/2014] [Accepted: 11/14/2014] [Indexed: 11/22/2022]
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