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Vita S, Mascia C, Kertusha B, Marocco R, Sauzullo I, Mengoni F, Pozzetto I, Scalzi A, Nijhawan P, Savinelli S, Fondaco L, Carraro A, Del Borgo C, Mastroianni CM, Lichtner M. TB specific intracellular cytokines production in Synovial liquid for diagnosis of tuberculous arthritis. J Infect Dev Ctries 2023; 17:1829-1833. [PMID: 38252716 DOI: 10.3855/jidc.12618] [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: 03/03/2020] [Accepted: 02/20/2021] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Skeletal tuberculosis (TB) accounts for about 10 to 35% of extrapulmonary cases and the knee is the most frequent site after the spine and hip. The diagnosis is difficult and largely clinical. CASE PRESENTATION This is a case of a young Pakistani man with a history of joint pain for about 4 years, who was diagnosed with chronic arthritis of the right knee. Microscopy of synovial fluid and conventional diagnostic tests to identify Mycobacterium tuberculosis were negative, while a non-classical method based on intracellular cytokine flow cytometry response of CD4 T-cells in synovial fluid helped us to address the diagnosis, which was subsequently confirmed by Polymerase Chain Reaction (PCR). CONCLUSIONS Thanks to an innovative immunological approach, supported by PCR for detection of M. tuberculosis DNA, we were able to diagnose tuberculous arthritis of the knee, which allowed prompt initiation of treatment to reduce morbidity and mortality.
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Affiliation(s)
- Serena Vita
- Infectious Disease Unit, Santa Maria Goretti Hospital, Latina, Italy
| | | | | | - Raffaella Marocco
- Infectious Disease Unit, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Fabio Mengoni
- Infectious Disease Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Irene Pozzetto
- Infectious Disease Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Alessandro Scalzi
- Orthopedics and Traumatology, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | | | | | - Cosmo Del Borgo
- Infectious Disease Unit, Santa Maria Goretti Hospital, Latina, Italy
| | | | - Miriam Lichtner
- Infectious Disease Unit, Santa Maria Goretti Hospital, Latina, Italy
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Cervo A, Russo A, Di Carlo D, De Vito A, Fabeni L, D'Anna S, Duca L, Colpani A, Fois M, Zauli B, Mancarella G, Carraro A, Bezenchek A, Cozzi-Lepri A, Santoro MM. Long-acting combination of cabotegravir plus rilpivirine: A picture of potential eligible and ineligible HIV-positive individuals from the Italian ARCA cohort. J Glob Antimicrob Resist 2023; 34:141-144. [PMID: 37453495 DOI: 10.1016/j.jgar.2023.07.006] [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: 01/25/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the prevalence and characteristics of people living with HIV (PLWH) eligible for the long-acting injectable (LAI) regimen with cabotegravir (CAB) and rilpivirine (RPV), in comparison with ineligible individuals. METHODS This was an observational, cross-sectional study from the ARCA cohort, including virologically suppressed PLWH with at least one genotypic resistance testing (GRT) for reverse transcriptase and integrase from plasma and/or PBMCs. Eligibility criteria for LAI CAB+RPV were: negative HBsAg, absence of previous virological failures and/or resistance-associated mutations for non-nucleoside reverse transcriptase inhibitors (NNRTIs) and/or integrase strand transfer inhibitors. Potential differences between eligible and ineligible individuals were investigated by univariable and multivariable analyses. RESULTS A total of 514 individuals were included: 377 (73.3%) were male, median age was 51 (IQR: 43-58), on ART for 9 years (IQR: 4-17), virologically suppressed for 63 months (IQR: 35-105). Eligible individuals for CAB+RPV were 229 (44.5%, 95%CI: 40.8-48.8); compared with ineligible individuals, they received a lower number of previous regimens (aOR 0.76, 95% CI 0.71-0.83, P < 0.001) and were on current NNRTIs (aOR 2.16, 95% CI 1.38-3.37, P = 0.001). CONCLUSIONS Less than half of virologically suppressed PLWH in the ARCA cohort were potentially eligible for CAB+RPV. They seem to be "less complicated" with shorter exposure to ART and preferably already on NNRTIs.
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Affiliation(s)
- Adriana Cervo
- University Hospital of Modena, Infectious Diseases Clinic, Modena, Italy.
| | - Antonio Russo
- University Hospital of Modena, Infectious Diseases Clinic, Modena, Italy; University of Campania "Luigi Vanvitelli", Infectious Diseases Unit, Department of Mental Health, Naples, Italy
| | - Domenico Di Carlo
- University of Milan, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Department of Biomedical and Clinical Sciences "L. Sacco", Milan, Italy
| | - Andrea De Vito
- University of Sassari, Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, Sassari, Italy
| | - Lavinia Fabeni
- National Institute for Infectious Diseases, L. Spallanzani, Rome, Italy
| | | | | | - Agnese Colpani
- University of Sassari, Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, Sassari, Italy
| | - Marco Fois
- University of Sassari, Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, Sassari, Italy
| | - Beatrice Zauli
- University of Sassari, Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, Sassari, Italy
| | - Giulia Mancarella
- Sapienza University of Rome - Polo Pontino, Unit of Infectious Diseases, Latina, Italy
| | - Anna Carraro
- Sapienza University of Rome - Polo Pontino, Unit of Infectious Diseases, Latina, Italy
| | | | - Alessandro Cozzi-Lepri
- Institute for Global Health, Centre for Clinical Research, Epidemiology, Modelling and Evaluation, London, UK
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Tortellini E, Fosso Ngangue YC, Dominelli F, Guardiani M, Falvino C, Mengoni F, Carraro A, Marocco R, Pasculli P, Mastroianni CM, Ciardi MR, Lichtner M, Zingaropoli MA. Immunogenicity and Efficacy of Vaccination in People Living with Human Immunodeficiency Virus. Viruses 2023; 15:1844. [PMID: 37766251 PMCID: PMC10534440 DOI: 10.3390/v15091844] [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: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
People living with HIV (PLWH) remain at high risk of mortality and morbidity from vaccine-preventable diseases, even though antiretroviral therapy (ART) has restored life expectancy and general well-being. When, which, and how many doses of vaccine should be administered over the lifetime of PLWH are questions that have become clinically relevant. Immune responses to most vaccines are known to be impaired in PLWH. Effective control of viremia with ART and restored CD4+ T-cell count are correlated with an improvement in responsiveness to routine vaccines. However, the presence of immune alterations, comorbidities and co-infections may alter it. In this article, we provide a comprehensive review of the literature on immune responses to different vaccines in the setting of HIV infection, emphasizing the potential effect of HIV-related factors and presence of comorbidities in modulating such responses. A better understanding of these issues will help guide vaccination and prevention strategies for PLWH.
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Affiliation(s)
- Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Yann Collins Fosso Ngangue
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Carmen Falvino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Miriam Lichtner
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
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Crispino P, Marocco R, Di Trento D, Guarisco G, Kertusha B, Carraro A, Corazza S, Pane C, Di Troia L, del Borgo C, Lichtner M. Use of Monoclonal Antibodies in Pregnant Women Infected by COVID-19: A Case Series. Microorganisms 2023; 11:1953. [PMID: 37630512 PMCID: PMC10459383 DOI: 10.3390/microorganisms11081953] [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: 07/07/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Monoclonal antibodies are designed to target specific proteins of COVID-19 and can be used as a treatment for people with mild to moderate infection and at a high risk of severe disease. Casirivimab/imdevimab, sotrovimab, and Bamlanivimab/etesevimab have been authorized for emergency use in the treatment of COVID-19. However, during pregnancy, these drugs have not been extensively studied. METHODS A total of 22 pregnant women with mild to moderate infection were treated with three different monoclonal antibodies, and efficacy and safety were evaluated in the first period and until six months of follow-up. RESULTS No infusion/allergic reactions occurred. No fatal or adverse events were observed in the pregnant women or fetus. The time of negativization with sotrovimab was shorter in comparison to Imdevimav/casirivimab (p = 0.0187) and Bamlanivimab/etesevimab (p < 0.00001). The time of negativization with sotrovimab was earlier in comparison to Imdevimav/casirivimab (t-value: 2.92; p = 0.0052) in vaccinated patients and similar in comparison to Imdevimav/casirivimab (t-value: 1.48; p = 0.08). In unvaccinated patients, sotrovimab was faster to achieve negativization in comparison to Bamlanivimab/etesevimab (t-value: 10.75; p < 0.0005). CONCLUSIONS Pregnant COVID-19 patients receiving sotrovimab obtained better clinical outcomes. Pregnancy or neonatal complications were not observed after monoclonal treatment, confirming the safety and tolerability of these drugs in pregnant women.
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Affiliation(s)
- Pietro Crispino
- Medicine, Santa Maria Goretti Hospital, Via Scaravelli Snc, 04100 Latina, Italy
| | - Raffaella Marocco
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Daniela Di Trento
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Gloria Guarisco
- Unit of Diabetology, Santa Maria Goretti Hospital, 04100 Latina, Italy;
| | - Blerta Kertusha
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Anna Carraro
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Sara Corazza
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Cristina Pane
- Unit of Gynecology, Santa Maria Goretti Hospital, 04100 Latina, Italy; (C.P.); (L.D.T.)
| | - Luciano Di Troia
- Unit of Gynecology, Santa Maria Goretti Hospital, 04100 Latina, Italy; (C.P.); (L.D.T.)
| | - Cosimo del Borgo
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
| | - Miriam Lichtner
- Unit of Infectious Disease, Sapienza University of Rome, 04100 Latina, Italy; (R.M.); (D.D.T.); (B.K.); (A.C.); (S.C.); (C.d.B.)
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5
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Del Borgo C, Garattini S, Bortignon C, Carraro A, Di Trento D, Gasperin A, Grimaldi A, De Maria SG, Corazza S, Tieghi T, Belvisi V, Kertusha B, De Masi M, D'Onofrio O, Bagaglini G, Bonanni G, Zuccalà P, Fabietti P, Tortellini E, Guardiani M, Spagnoli A, Marocco R, Alunni Fegatelli D, Lichtner M. Effectiveness, Tolerability and Prescribing Choice of Antiviral Molecules Molnupiravir, Remdesivir and Nirmatrelvir/r: A Real-World Comparison in the First Ten Months of Use. Viruses 2023; 15:v15041025. [PMID: 37113006 PMCID: PMC10145588 DOI: 10.3390/v15041025] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
In 2022, three antiviral drugs-molnupiravir, remdesivir and nirmatrelvir/ritonavir-were introduced for treatment of mild-to-moderate COVID-19 in high-risk patients. The aim of this study is the evaluation of their effectiveness and tolerability in a real-life setting. A single-center observational study was set up, with the involvement of 1118 patients, with complete follow-up data, treated between the 5th of January and the 3rd of October 2022 at Santa Maria Goretti's hospital in Latina, Central Italy. A univariable and a multivariable analysis were performed on clinical and demographic data and composite outcome, the persistence of symptoms at 30 days and time to negativization, respectively. The three antivirals showed a similar effectiveness in containing the progression of the infection to severe COVID-19 and a good tolerability in the absence of serious adverse effects. Persistence of symptoms after 30 days was more common in females than males and less common in patients treated with molnupiravir and nirmatrelvir/r. The availability of different antiviral molecules is a strong tool and, if correctly prescribed, they can have a significant role in changing the natural history of infection for frail persons, in which vaccination could be not sufficient for the prevention of severe COVID-19.
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Affiliation(s)
- Cosmo Del Borgo
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Silvia Garattini
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Carolina Bortignon
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Carraro
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Daniela Di Trento
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Gasperin
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandra Grimaldi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Sara Giovanna De Maria
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Sara Corazza
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Tiziana Tieghi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Valeria Belvisi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Blerta Kertusha
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Margherita De Masi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Ombretta D'Onofrio
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Gabriele Bagaglini
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Gabriella Bonanni
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Paola Zuccalà
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Paolo Fabietti
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
| | - Raffaella Marocco
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
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Nijhawan P, Carraro A, Vita S, Del Borgo C, Tortellini E, Guardiani M, Zingaropoli MA, Mengoni F, Petrozza V, Di Troia L, Marcucci I, Kertusha B, Scerpa MC, Turriziani O, Vullo V, Ciardi MR, Mastroianni CM, Marocco R, Lichtner M. Systemic, Mucosal Immune Activation and Psycho-Sexual Health in ART-Suppressed Women Living with HIV: Evaluating Biomarkers and Environmental Stimuli. Viruses 2023; 15:v15040960. [PMID: 37112940 PMCID: PMC10144999 DOI: 10.3390/v15040960] [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: 01/20/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Gender medicine is now an approach that can no longer be neglected and must be considered in scientific research. We investigated the systemic and mucosal immune response in a population of women living with HIV (WLWH) who were receiving successful ART and the sexual and psychological repercussions of HIV infection on the women's health. As control group, healthy women (HW) matched for age and sex distribution, without any therapy, were included. In summary, our study highlighted the persistence of immune-inflammatory activation in our population, despite virological suppression and a normal CD4 cell count. We found a hyperactivation of the systemic monocyte and an increase in inflammatory cytokine concentrations at the systemic level. The analysis carried out showed a significantly higher risk of HPV coinfection in WLWH compared to HW. Furthermore, our data revealed that WLWH have a profile compatible with sexual dysfunction and generalized anxiety disorders. Our study underlines that patients living with HIV should be evaluated by multidisciplinary teams. These findings also support the idea that more and different immunological markers, in addition to those already used in clinical practice, are needed. Further studies should be carried out to clarify which of these could represent future therapy targets.
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Affiliation(s)
- Parni Nijhawan
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Serena Vita
- INMI IRCCS Lazzaro Spallanzani, via Portuense, 00149 Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Vincenzo Petrozza
- UOC of Pathology, Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome Polo Pontino, I.C.O.T, 04100 Latina, Italy
| | - Luciana Di Troia
- Department of Andrology and Pathophysiology of Reproduction, Santa Maria (SM) Goretti Hospital, 04100 Latina, Italy
| | - Immacolata Marcucci
- Department of Andrology and Pathophysiology of Reproduction, Santa Maria (SM) Goretti Hospital, 04100 Latina, Italy
| | - Blerta Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Maria Cristina Scerpa
- Hematology Unit, Santa Maria (SM) Goretti Hospital, AUSL Latina, 04100 Latina, Italy
| | - Ombretta Turriziani
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Raffaella Marocco
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
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Marocco R, Del Borgo C, Tortellini E, Garattini S, Carraro A, Di Trento D, Gasperin A, Grimaldi A, Tieghi T, Belvisi V, Kertusha B, Guardiani M, Zuccalà P, Alunni Fegatelli D, Spagnoli A, Lichtner M. Use of Remdesivir in Patients with SARS-CoV-2 Pneumonia in a Real-Life Setting during the Second and Third COVID-19 Epidemic Waves. Viruses 2023; 15:v15040947. [PMID: 37112927 PMCID: PMC10143300 DOI: 10.3390/v15040947] [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: 03/25/2023] [Revised: 04/08/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
In this retrospective comparative study, we evaluated the effectiveness of remdesivir (RDSV) in patients with SARS-CoV-2 pneumonia. Individuals hospitalized between March 2020 and August 2022 at S.M. Goretti Hospital, Latina, with a positive test for SARS-CoV-2 and, concomitantly, pneumonia, were included. The overall survival was the primary endpoint. The composite secondary endpoint included death or progression in severe ARDS at 40 days. The study population was stratified according to treatment into two groups: the RDSV group (patients treated with RDSV-based regimens) and the no-RDSV group (patients treated with any other, not RDSV-based, regimens). Factors associated with death and progression to severe ARDS or death were assessed by multivariable analysis. A total of 1153 patients (632 belonging to the RDSV group and 521 to the no-RDSV group) were studied. The groups were comparable in terms of sex, PaO2/FiO2 at admission, and duration of symptoms before hospitalization. Further, 54 patients (8.5%) in the RDSV group and 113 (21.7%) in the no-RDSV group (p < 0.001) died. RDSV was associated with a significantly reduced hazard ratio (HR) of death (HR, 0.69 [95% CI, 0.49-0.97]; p = 0.03), compared to the no-RDSV group, as well as a significantly reduced OR of progression in severe ARDS or death (OR, 0.70 [95% CI 0.49-0.98]; p = 0.04). An overall significantly higher survival rate was observed in the RDSV group (p < 0.001, by log-rank test). These findings reinforce the survival benefit of RDSV and support its routine clinical use for the treatment of COVID-19 patients.
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Affiliation(s)
- Raffaella Marocco
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Silvia Garattini
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Carraro
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Daniela Di Trento
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Andrea Gasperin
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Alessandra Grimaldi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Tiziana Tieghi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Valeria Belvisi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Blerta Kertusha
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Paola Zuccalà
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Danilo Alunni Fegatelli
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Alessandra Spagnoli
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00189 Rome, Italy
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Del Giudice E, Mondì F, Bazzanella GR, Marcellino A, Martucci V, Pontrelli G, Sanseviero M, Pavone P, Bloise S, Martellucci S, Carraro A, Ventriglia F, Lichtner M, Lubrano R. Post-Infectious Acute Cerebellar Ataxia Treatment, a Case Report and Review of Literature. Children 2023; 10:children10040668. [PMID: 37189917 DOI: 10.3390/children10040668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
Background: infectious mononucleosis is very common during childhood and neurological manifestations are extremely rare. However, when they occur, an appropriate treatment must be undertaken to reduce morbidity and mortality as well as to ensure appropriate management. Methods: we describe the clinical and neurological records of a female patient with post-EBV acute cerebellar ataxia, whose symptoms rapidly resolved with intravenous immunoglobulin therapy. Afterwards, we compared our results with published data. Results: we reported the case of an adolescent female with a 5-day history of sudden asthenia, vomiting, dizziness, and dehydration, with a positive monospot test and hypertransaminasemia. In the following days, she developed acute ataxia, drowsiness, vertigo, and nystagmus with a positive EBV IgM titer, confirming acute infectious mononucleosis. The patient was clinically diagnosed with EBV-associated acute cerebellitis. A brain MRI showed no acute changes and a CT scan showed hepatosplenomegaly. She started therapy with acyclovir and dexamethasone. After a few days, because of her condition’s deterioration, she received intravenous immunoglobulin and demonstrated a good clinical response. Conclusions: although there are no consensus guidelines for the treatment of post-infectious acute cerebellar ataxia, early intervention with intravenous immunoglobulin might prevent adverse outcomes, especially in cases that do not respond to high-dose steroid therapy.
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9
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Paoli D, Pallotti F, Anzuini A, Bianchini S, Caponecchia L, Carraro A, Ciardi MR, Faja F, Fiori C, Gianfrilli D, Lenzi A, Lichtner M, Marcucci I, Mastroianni CM, Nigro G, Pasculli P, Pozza C, Rizzo F, Salacone P, Sebastianelli A, Lombardo F. Male reproductive health after 3 months from SARS-CoV-2 infection: a multicentric study. J Endocrinol Invest 2023; 46:89-101. [PMID: 35943723 PMCID: PMC9362397 DOI: 10.1007/s40618-022-01887-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE While SARS-CoV-2 infection appears not to be clinically evident in the testes, indirect inflammatory effects and fever may impair testicular function. To date, few long-term data of semen parameters impairment after recovery and comprehensive andrological evaluation of recovered patients has been published. The purpose of this study was to investigate whether SARS-CoV-2 infection affect male reproductive health. METHODS Eighty patients were recruited three months after COVID-19 recovery. They performed physical examination, testicular ultrasound, semen analysis, sperm DNA integrity evaluation (TUNEL), anti-sperm antibodies (ASA) testing, sex hormone profile evaluation (Total testosterone, LH, FSH). In addition, all patients were administered International Index of Erectile Function questionnaire (IIEF-15). Sperm parameters were compared with two age-matched healthy pre-COVID-19 control groups of normozoospermic (CTR1) and primary infertile (CTR2) subjects. RESULTS Median values of semen parameters from recovered SARS-CoV-2 subjects were within WHO 2010 fifth percentile. Mean percentage of sperm DNA fragmentation (%SDF) was 14.1 ± 7.0%. Gelatin Agglutination Test (GAT) was positive in 3.9% of blood serum samples, but no positive semen plasma sample was found. Only five subjects (6.2%) had total testosterone levels below the laboratory reference range. Mean bilateral testicular volume was 31.5 ± 9.6 ml. Erectile dysfunction was detected in 30% of subjects. CONCLUSION Our data remark that COVID-19 does not seem to cause direct damage to the testicular function, while indirect damage appears to be transient. It is possible to counsel infertile couples to postpone the research of parenthood or ART procedures around three months after recovery from the infection.
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Affiliation(s)
- D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A Anzuini
- Hormone Laboratory, Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - S Bianchini
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - L Caponecchia
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - A Carraro
- Infectious Diseases Unit, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - M R Ciardi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - F Faja
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - C Fiori
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Lichtner
- Infectious Diseases Unit, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - I Marcucci
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - C M Mastroianni
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - G Nigro
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - P Pasculli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - C Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Rizzo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - P Salacone
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - A Sebastianelli
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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10
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Zingaropoli MA, Parente A, Kertusha B, Campagna R, Tieghi T, Garattini S, Marocco R, Carraro A, Tortellini E, Guardiani M, Dominelli F, Turriziani O, Ciardi MR, Mastroianni CM, Del Borgo C, Lichtner M. Longitudinal Virological and Immunological Profile in a Case of Human Monkeypox Infection. Open Forum Infect Dis 2022; 9:ofac569. [PMID: 36474633 PMCID: PMC9716865 DOI: 10.1093/ofid/ofac569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/16/2022] [Accepted: 10/29/2022] [Indexed: 10/03/2023] Open
Abstract
In a male with severe proctitis, monkeypox virus DNA was detected in skin lesions, blood, the nasopharynx, and the rectum, underlying generalized viral spreading. Rectal involvement was still found when skin lesions disappeared. At this early stage, an increase of cytotoxic and activated T cells was observed, while a reduction in CD56dimCD57+ NK cells compared with recovery time point was observed.
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Affiliation(s)
| | - Alberico Parente
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Blerta Kertusha
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Roberta Campagna
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Tiziana Tieghi
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Silvia Garattini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Cosmo Del Borgo
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Miriam Lichtner
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, University of Rome, Rome, Italy
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11
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Zuccalà P, Latronico T, Marocco R, Savinelli S, Vita S, Mengoni F, Tieghi T, Borgo C, Kertusha B, Carraro A, D’Ettorre G, Vullo V, Mastroianni CM, Liuzzi GM, Lichtner M. Longitudinal Assessment of Multiple Immunological and Inflammatory Parameters during Successful DAA Therapy in HCV Monoinfected and HIV/HCV Coinfected Subjects. Int J Mol Sci 2022; 23:ijms231911936. [PMID: 36233234 PMCID: PMC9570033 DOI: 10.3390/ijms231911936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/24/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
In the direct-acting antiviral (DAA) era, it is important to understand the immunological changes after HCV eradication in HCV monoinfected (mHCV) and in HIV/HCV coinfected (HIV/HCV) patients. In this study, we analyzed sub-populations of monocytes, dendritic cells (DCs), T-lymphocytes and inflammatory biomarkers following initiation of DAA in 15 mHCV and 16 HIV/HCV patients on effective antiretroviral therapy at baseline and after sustained virological response at 12 weeks (SVR12). Fifteen age- and sex-matched healthy donors (HD) were enrolled as a control group. Activated CD4+ and CD8+ T-lymphocytes, mDCs, pDCs, MDC8 and classical, non-classical and intermediate monocytes were detected using flow cytometry. IP-10, sCD163 and .sCD14 were assessed by ELISA while matrix metalloproteinase-2 (MMP-2) was measured by zymography. At baseline, increased levels of IP-10, sCD163 and MMP-2 were found in both HIV/HCV and mHCV patients compared to HD, whereas sCD14 increased only in HIV/HCV patients. After therapy, IP-10, sCD163 and sCD14 decreased, whereas MMP-2 persistently elevated. At baseline, activated CD8+ T-cells were high in HIV/HCV and mHCV patients compared to HD, with a decrease at SVR12 only in HIV/HCV patients. Activated CD4+ T-cells were higher in HIV/HCV patients without modification after DAAs therapy. These results suggest complex interactions between both viruses and the immune system, which are only partially reversed by DAA treatment.
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Affiliation(s)
- Paola Zuccalà
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Tiziana Latronico
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, 70126 Bari, Italy
- Correspondence: ; Tel.: +39-080-5443376
| | - Raffaella Marocco
- Infectious Diseases Unit, Sapienza University of Rome, Polo Pontino, S. M. Goretti Hospital, 04100 Latina, Italy
| | - Stefano Savinelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Department of Infectious Diseases, St. Vincent’s University Hospital, D04 YN26 Dublin, Ireland
| | - Serena Vita
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Tiziana Tieghi
- Infectious Diseases Unit, Sapienza University of Rome, Polo Pontino, S. M. Goretti Hospital, 04100 Latina, Italy
| | - Cosmo Borgo
- Infectious Diseases Unit, Sapienza University of Rome, Polo Pontino, S. M. Goretti Hospital, 04100 Latina, Italy
| | - Blerta Kertusha
- Infectious Diseases Unit, Sapienza University of Rome, Polo Pontino, S. M. Goretti Hospital, 04100 Latina, Italy
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Gabriella D’Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Grazia Maria Liuzzi
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, 70126 Bari, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, 00185 Rome, Italy
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12
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Marocco R, Carraro A, Zingaropoli MA, Nijhawan P, Tortellini E, Guardiani M, Mengoni F, Zuccalà P, Belvisi V, Kertusha B, Parente A, Del Borgo C, Vullo V, Ciardi M, Mastroianni CM, Lichtner M. Role of Tocilizumab in Down Regulating sCD163 Plasmatic Levels in a Cohort of COVID-19 Patients. Front Immunol 2022; 13:871592. [PMID: 35444637 PMCID: PMC9013773 DOI: 10.3389/fimmu.2022.871592] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background CD163, a haptoglobin-hemoglobin scavenger receptor mostly expressed by monocytes and macrophages, is involved in the regulation of inflammatory processes. Following proteolytic cleavage after pro-inflammatory stimulation, CD163 is shed from the cell surface and its soluble form in plasma, sCD163, is a biomarker of monocyte/macrophage lineage activation. The assessment of sCD163 plasmatic levels in an early stage of the disease could have clinical utility in predicting the severity of COVID-19 pneumonia. The use of tocilizumab (monoclonal antibody anti-IL-6 receptor) in COVID-19 patients reduces lethality rate at 30 days. The aim of the study was to investigate the effect of tocilizumab on sCD163 plasmatic levels in a cohort of COVID-19 patients. Methods In COVID-19 patients, on hospital admission (T0), after 7 days from hospitalization (T7) and after 45 days from discharge (T45) sCD163 plasmatic levels were evaluated, along with other laboratory parameters. COVID-19 patients were stratified into tocilizumab (TCZ) and non-tocilizumab (non-TCZ) groups. TCZ group was further divided into responder (R) and non-responder (NR) groups. Patients who died or required mechanical ventilation were defined as NR. As control group, healthy donors (HD) were enrolled. Results Seventy COVID-19 patients and 47 HD were enrolled. At T0, sCD163 plasmatic levels were higher in COVID-19 patients compared to HD (p<0.0001) and the longitudinal evaluation showed a reduction in sCD163 plasmatic levels at T7 compared to T0 (p=0.0211). At T0, both TCZ and non-TCZ groups showed higher sCD163 plasmatic levels compared to HD (p<0.0001 and p=0.0147, respectively). At T7, the longitudinal evaluation showed a significant reduction in sCD163 plasmatic levels (p=0.0030) only in the TCZ group, reaching levels comparable to those of HD. Conversely, not statistically significance in non-TCZ group was observed and, at T7, a statistically significance was found comparing non-TCZ group to HD (p=0.0019). At T0, R and NR groups showed not statistically significance in sCD163 plasmatic levels and both groups showed higher levels compared to HD (p=0.0001 and p=0.0340, respectively). The longitudinal evaluation showed significant reductions in both groups (R: p=0.0356; NR: p=0.0273) independently of the outcome. After 45 days of follow-up sCD163 plasmatic levels remain stable. Conclusion sCD163 plasmatic levels are increased in COVID-19 pneumonia and is efficiently down-regulated by tocilizumab treatment regardless of the clinical outcome.
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Affiliation(s)
- Raffaella Marocco
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Anna Carraro
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- *Correspondence: Maria Antonella Zingaropoli,
| | - Parni Nijhawan
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paola Zuccalà
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Valeria Belvisi
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Blerta Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alberico Parente
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Miriam Lichtner
- Infectious Diseases Unit, Santa Maria (SM) Goretti Hospital, Sapienza University of Rome, Latina, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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13
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Guarisco G, Fasolo M, Capoccia D, Morsello G, Carraro A, Zuccalà P, Marocco R, Del Borgo C, Pelle G, Iannarelli A, Orlando E, Spagnoli A, Carbone I, Lichtner M, Iacobellis G, Leonetti F. Blood glucose and epicardial adipose tissue at the hospital admission as possible predictors for COVID-19 severity. Endocrine 2022; 75:10-18. [PMID: 34729688 PMCID: PMC8563297 DOI: 10.1007/s12020-021-02925-5] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/20/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE To study the possible association of CT-derived quantitative epicardial adipose tissue (EAT) and glycemia at the admission, with severe outcomes in patients with COVID-19. METHODS Two hundred and twenty-nine patients consecutively hospitalized for COVID-19 from March 1st to June 30th 2020 were studied. Non contrast chest CT scans, to confirm diagnosis of pneumonia, were performed. EAT volume (cm3) and attenuation (Hounsfield units) were measured using a CT post-processing software. The primary outcome was acute respiratory distress syndrome (ARDS) or in-hospital death. RESULTS The primary outcome occurred in 56.8% patients. Fasting blood glucose was significantly higher in the group ARDS/death than in the group with better prognosis [114 (98-144) vs. 101 (91-118) mg/dl, p = 0.001]. EAT volume was higher in patients with vs without the primary outcome [103 (69.25; 129.75) vs. 78.95 (50.7; 100.25) cm3, p < 0.001] and it was positively correlated with glycemia, PCR, fibrinogen, P/F ratio. In the multivariable logistic regression analysis, age and EAT volume were independently associated with ARDS/death. Glycemia and EAT attenuation would appear to be factors involved in ARDS/death with a trend of statistical significance. CONCLUSIONS Our findings suggest that both blood glucose and EAT, easily measurable and modifiable targets, could be important predisposing factors for severe Covid-19 complications.
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Affiliation(s)
- G Guarisco
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy.
| | - M Fasolo
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - D Capoccia
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - G Morsello
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - A Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - P Zuccalà
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - R Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - C Del Borgo
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - G Pelle
- Department of Diagnostic and Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy
| | - A Iannarelli
- Department of Diagnostic and Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy
| | - E Orlando
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, I.C.O.T. Hospital, Latina, Italy
| | - A Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - I Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, I.C.O.T. Hospital, Latina, Italy
| | - M Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - G Iacobellis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami, Miami, FL, USA
| | - F Leonetti
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
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14
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Russo G, Solimini A, Zuccalà P, Zingaropoli MA, Carraro A, Pasculli P, Perri V, Marocco R, Kertusha B, Del Borgo C, Del Giudice E, Fondaco L, Tieghi T, D’Agostino C, Oliva A, Vullo V, Ciardi MR, Mastroianni CM, Lichtner M. Real-life use of tocilizumab with or without corticosteroid in hospitalized patients with moderate-to-severe COVID-19 pneumonia: A retrospective cohort study. PLoS One 2021; 16:e0257376. [PMID: 34506608 PMCID: PMC8432821 DOI: 10.1371/journal.pone.0257376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the effectiveness of Tocilizumab (with or without corticosteroids) in a real-life context among moderate-to-severe COVID-19 patients hospitalized at the Infectious Diseases ward of two hospitals in Lazio region, Italy, during the first wave of SARS-CoV-2 pandemic. Method We conducted a retrospective cohort study among moderate-to-severe COVID-19 pneumonia to assess the influence of tocilizumab (with or without corticosteroids) on: 1) primary composite outcome: risk for death/invasive mechanical ventilation/ICU-transfer at 14 days from hospital admission; 2) secondary outcome: COVID-related death only. Both outcomes were also assessed at 28 days and restricted to baseline more severe cases. We also evaluated the safety of tocilizumab. Results Overall, 412 patients were recruited, being affected by mild (6.8%), moderate (66.3%) or severe (26.9%) COVID-19 at baseline. The median participant’ age was 63 years, 56.5% were men, the sum of comorbidities was 1.34 (±1.44), and the median time from symptom onset to hospital admission was 7 [3–10] days. Patients were subdivided in 4 treatment groups: standard of care (SoC) only (n = 172), SoC plus corticosteroid (n = 65), SoC plus tocilizumab (n = 50), SoC plus tocilizumab and corticosteroid (n = 125). Twenty-six (6.3%) patients underwent intubation, and 37 (9%) COVID-related deaths were recorded. After adjusting for several factors, multivariate analysis showed that tocilizumab (with or without corticosteroids) was associated to improved primary and secondary outcomes at 14 days, and at 28-days only when tocilizumab administered without corticosteroid. Among more severe cases the protective effect of tocilizumab (± corticosteroids) was observed at both time-points. No safety concerns were recorded. Conclusion Although contrasting results from randomized clinical trials to date, in our experience tocilizumab was a safe and efficacious therapeutic option for patients with moderate-to-severe COVID-19 pneumonia. Its efficacy was improved by the concomitant administration of corticosteroids in patients affected by severe-COVID-19 pneumonia at baseline.
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Affiliation(s)
- Gianluca Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Angelo Solimini
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Paola Zuccalà
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Carraro
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Valentina Perri
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Raffaella Marocco
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Blerta Kertusha
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Emanuela Del Giudice
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Laura Fondaco
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Tiziana Tieghi
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
| | - Claudia D’Agostino
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Policlinico Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
- Infectious Diseases Unit, S. Maria Goretti Hospital/Sapienza University of Rome, Latina, Italy
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15
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Perrone S, Cenfra N, Viola F, Carraro A, Marocco R, Lichtner M, Cimino G. Unexpected cause of pancytopenia in a teenager with Noonan syndrome. eJHaem 2021; 2:642-643. [PMID: 35844717 PMCID: PMC9176038 DOI: 10.1002/jha2.225] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Salvatore Perrone
- HematologyPolo Universitario PontinoS.M. Goretti HospitalLatinaItaly
| | - Natalia Cenfra
- HematologyPolo Universitario PontinoS.M. Goretti HospitalLatinaItaly
| | - Federica Viola
- Department of Medical Oncology“Sapienza University of Rome”Medical and Surgical Sciences and BiotechnologyRomeItaly
| | - Anna Carraro
- Department of Public Health and Infectious Diseases“Sapienza University”S.M. Goretti HospitalLatinaItaly
| | - Raffaella Marocco
- Department of Public Health and Infectious Diseases“Sapienza University”S.M. Goretti HospitalLatinaItaly
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases“Sapienza University”S.M. Goretti HospitalLatinaItaly
| | - Giuseppe Cimino
- HematologyPolo Universitario PontinoS.M. Goretti HospitalLatinaItaly
- Department of Medical Oncology“Sapienza University of Rome”Medical and Surgical Sciences and BiotechnologyRomeItaly
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16
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Violi F, Cangemi R, Romiti GF, Ceccarelli G, Oliva A, Alessandri F, Pirro M, Pignatelli P, Lichtner M, Carraro A, Cipollone F, D'ardes D, Pugliese F, Mastroianni CM. Is Albumin Predictor of Mortality in COVID-19? Antioxid Redox Signal 2021; 35:139-142. [PMID: 32524832 DOI: 10.1089/ars.2020.8142] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [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] [Indexed: 01/27/2023]
Abstract
Coronavirus 2019 (COVID-19) is a pandemic associated with a high risk of mortality. Human serum albumin (HSA) is an acute phase reactant with antioxidant property; however, its behavior and impact on survival in COVID-19 patients have never been studied so far. Among 319 COVID-19 patients followed up for a median of 19 days, 64 died. Compared with survivors, nonsurvivors had more prevalence of intensive care unit (ICU) admission, chronic obstructive pulmonary disease (COPD), heart failure, elevated levels of D-dimer, high-sensitivity C reactive protein (hs-CRP) and troponins, and lower values of albumin. At the Cox regression analysis, albumin (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.23-0.63, p < 0.001) and age (HR: 1.03, 95% CI: 1.01-1.06, p = 0.001) were independently associated with mortality, irrespective of adjustment for gender, ICU admission, heart failure, COPD, and hs-CRP levels. Our observation leads to the hypothesis that HSA analysis may be used to identify patients at higher risk of death in COVID-19 patients.
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Affiliation(s)
- Francesco Violi
- I Clinica Medica, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Departments of Sapienza University of Rome, Rome, Italy
| | - Roberto Cangemi
- Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Giancarlo Ceccarelli
- Public Health and Infectious Diseases, and Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- Public Health and Infectious Diseases, and Sapienza University of Rome, Rome, Italy
| | | | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Departments of Sapienza University of Rome, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, SM Goretti Hospital of Latina, Latina, Italy
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, SM Goretti Hospital of Latina, Latina, Italy
| | - Francesco Cipollone
- Clinica Medica, Department of Medicine and Aging, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Damiano D'ardes
- Clinica Medica, Department of Medicine and Aging, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesco Pugliese
- General Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy
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17
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Zingaropoli MA, Nijhawan P, Carraro A, Pasculli P, Zuccalà P, Perri V, Marocco R, Kertusha B, Siccardi G, Del Borgo C, Curtolo A, Ajassa C, Iannetta M, Ciardi MR, Mastroianni CM, Lichtner M. Increased sCD163 and sCD14 Plasmatic Levels and Depletion of Peripheral Blood Pro-Inflammatory Monocytes, Myeloid and Plasmacytoid Dendritic Cells in Patients With Severe COVID-19 Pneumonia. Front Immunol 2021; 12:627548. [PMID: 33777012 PMCID: PMC7993197 DOI: 10.3389/fimmu.2021.627548] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [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: 11/09/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background Emerging evidence argues that monocytes, circulating innate immune cells, are principal players in COVID-19 pneumonia. The study aimed to investigate the role of soluble (s)CD163 and sCD14 plasmatic levels in predicting disease severity and characterize peripheral blood monocytes and dendritic cells (DCs), in patients with COVID-19 pneumonia (COVID-19 subjects). Methods On admission, in COVID-19 subjects sCD163 and sCD14 plasmatic levels, and peripheral blood monocyte and DC subsets were compared to healthy donors (HDs). According to clinical outcome, COVID-19 subjects were divided into ARDS and non-ARDS groups. Results Compared to HDs, COVID-19 subjects showed higher sCD163 (p<0.0001) and sCD14 (p<0.0001) plasmatic levels. We observed higher sCD163 plasmatic levels in the ARDS group compared to the non-ARDS one (p=0.002). The cut-off for sCD163 plasmatic level greater than 2032 ng/ml was predictive of disease severity (AUC: 0.6786, p=0.0022; sensitivity 56.7% [CI: 44.1–68.4] specificity 73.8% [CI: 58.9–84.7]). Positive correlation between plasmatic levels of sCD163, LDH and IL-6 and between plasmatic levels of sCD14, D-dimer and ferritin were found. Compared to HDs, COVID-19 subjects showed lower percentages of non-classical (p=0.0012) and intermediate monocytes (p=0.0447), slanDCs (p<0.0001), myeloid DCs (mDCs, p<0.0001), and plasmacytoid DCs (pDCs, p=0.0014). Compared to the non-ARDS group, the ARDS group showed lower percentages of non-classical monocytes (p=0.0006), mDCs (p=0.0346), and pDCs (p=0.0492). Conclusions The increase in sCD163 and sCD14 plasmatic levels, observed on hospital admission in COVID-19 subjects, especially in those who developed ARDS, and the correlations of these monocyte/macrophage activation markers with typical inflammatory markers of COVID-19 pneumonia, underline their potential use to assess the risk of progression of the disease. In an early stage of the disease, the assessment of sCD163 plasmatic levels could have clinical utility in predicting the severity of COVID-19 pneumonia.
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Affiliation(s)
| | - Parni Nijhawan
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paola Zuccalà
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Valentina Perri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Blerta Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guido Siccardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Ambrogio Curtolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Marco Iannetta
- Department of System Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
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18
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Nijhawan P, Nijhawan P, Carraro A, Marocco R, Vita S, Kertusha B, Mascia C, Lichtner M, Mastroianni C, Zingaropoli MA, Masci G, Ianiri P, Vito M, Fondaco L, Del Borgo C, Mirella D. 1203. Systemic, Mucosal Immune Activation And Psycho-sexual Health in HIV-Infected And Uninfected Women: Evaluation of Biomarkers And Environmental Stimuli. Open Forum Infect Dis 2020. [PMCID: PMC7777619 DOI: 10.1093/ofid/ofaa439.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background HIV infection in women in disproportionate ratios as compared to men has been a grave concern over the years. It is in proportion to reproductive and hormonal differences making women more vulnerable. It elicits an Immune response which can be monitored by analysing various factors such as mucosal immunity, sexual behaviour, biomarkers in the plasma, serum and vaginal lavage and vaginal infections. Aim Evaluating and comparing the systemic and mucosal immuno-inflammatory status, the female sexual function (FSF) and generalized anxiety in HIV+ women on successful HAART with healthy women (HW). Methods We enrolled 53 subjects (23 HIV+ women on successful HAART and 30 Healthy women (HW)) with no statistical differences in age. The figure (named: methodology) below explains the methods applied: Cytometry and Kit ELISA were used to estimate lymphocytes and all cytokines. Women were also tested for co-morbidities such as diabetes, blood pressure, HCV, cervical cancer etc. Statistical analysis was performed using PRISM 8.0. Methodology ![]()
Results Higher CD4 and CD8 cell count was observed in HW compared to HIV+ women (p=0.02,p=0.004).Plasma levels of sCD 163, CXCL-10, IL-1, IL-6 and IL-8 were significantly higher in HIV women as compared to HW(p< 0.001), while IL-6 and IL8 were lower in the VL of HIV women. An ASCUS in HW was found for PAP Test. CXCL-10 was correlated to estradiol levels (r=0.8, p=0.02). 57% reported FSD and 43% had a FSFI score≤10. A significant difference between the two groups in the FSFI score (p=0.007) was found, particularly in sexual desire, arousal and pain. A positive correlation between level of testosterone and FSFI score was found only in HIV+ women (p=0.02; r= 0.74). 17% of women presented an anxiety disorder. Z-index was associated with orgasm domains (p=0.01; r=-0.4) and CD4+ T cells (p=0.02; r=-0.45). Conclusion Higher plasma levels of the cytokines despite successful antiretroviral therapy were observed. At the mucosal level evaluating the balance within pro anti-inflammatory cytokines and micro-biome will be interesting to study. FSD is detected in more than half of HIV infected women and seems to be related to testosterone levels. The comparison with uninfected women underlying a persistent gap in quality of life of young HIV women should be bridged. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | | | - Serena Vita
- Sapienza University of Rome, Rome, Lazio, Italy
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19
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Rosenbaum S, Morell R, Abdel-Baki A, Ahmadpanah M, Anilkumar TV, Baie L, Bauman A, Bender S, Boyan Han J, Brand S, Bratland-Sanda S, Bueno-Antequera J, Camaz Deslandes A, Carneiro L, Carraro A, Castañeda CP, Castro Monteiro F, Chapman J, Chau JY, Chen LJ, Chvatalova B, Chwastiak L, Corretti G, Dillon M, Douglas C, Egger ST, Gaughran F, Gerber M, Gobbi E, Gould K, Hatzinger M, Holsboer-Trachsler E, Hoodbhoy Z, Imboden C, Indu PS, Iqbal R, Jesus-Moraleida FR, Kondo S, Ku PW, Lederman O, Lee EHM, Malchow B, Matthews E, Mazur P, Meneghelli A, Mian A, Morseth B, Munguia-Izquierdo D, Nyboe L, O’Donoghue B, Perram A, Richards J, Romain AJ, Romaniuk M, Sadeghi Bahmani D, Sarno M, Schuch F, Schweinfurth N, Stubbs B, Uwakwe R, Van Damme T, Van Der Stouwe E, Vancampfort D, Vetter S, Waterreus A, Ward PB. Assessing physical activity in people with mental illness: 23-country reliability and validity of the simple physical activity questionnaire (SIMPAQ). BMC Psychiatry 2020; 20:108. [PMID: 32143714 PMCID: PMC7060599 DOI: 10.1186/s12888-020-2473-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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: 07/15/2019] [Accepted: 01/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness. METHODS The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments. RESULTS Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ. CONCLUSIONS The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals.
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Affiliation(s)
- S. Rosenbaum
- grid.1005.40000 0004 4902 0432School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - R. Morell
- grid.1005.40000 0004 4902 0432School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - A. Abdel-Baki
- grid.410559.c0000 0001 0743 2111Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Canada
| | - M. Ahmadpanah
- grid.411950.80000 0004 0611 9280Behavioral Disorders and Substances Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - T. V. Anilkumar
- grid.413226.00000 0004 1799 9930Department of Psychiatry, Government Medical College, Trivandrum, India
| | - L. Baie
- grid.16149.3b0000 0004 0551 4246Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - A. Bauman
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Sydney, Australia
| | - S. Bender
- LWL-Klinik Marsberg, Hospital for Psychiatry, Psychotherapy and Psychosomatics, Marsberg, Germany
| | - J. Boyan Han
- grid.253561.60000 0001 0806 2909California State University, Los Angeles, USA
| | - S. Brand
- grid.6612.30000 0004 1937 0642University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland ,grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino, Urbino, Italy ,grid.477714.60000 0004 0587 919XThe Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, Australia
| | - S. Bratland-Sanda
- Department of Sport, Physical Education and Outdoor Studies, University of South-Eastern Norway, Bø, Notodden, Norway
| | - J. Bueno-Antequera
- grid.15449.3d0000 0001 2200 2355Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain
| | - A. Camaz Deslandes
- grid.8536.80000 0001 2294 473XPsychiatry Institute, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - L. Carneiro
- Research Centre in Sports Sciences, Health Sciences and Human Development, CIDESD, GERON Research Community, Vila Real, Portugal
| | - A. Carraro
- grid.34988.3e0000 0001 1482 2038Faculty of Education, Free University of Bolzano, Bolzano, Italy
| | - C. P. Castañeda
- Early Intervention Program, JHorwitz Psychiatric Institute, Santiago, Chile
| | - F. Castro Monteiro
- grid.8532.c0000 0001 2200 7498Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - J. Chapman
- grid.1049.c0000 0001 2294 1395QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - J. Y. Chau
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Sydney, Australia ,grid.1004.50000 0001 2158 5405Department of Health Systems and Populations, Macquarie University, Sydney, Australia
| | - L. J. Chen
- grid.445057.7Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - B. Chvatalova
- grid.447902.cNational Institute of Mental Health, Klecany, Czech Republic
| | - L. Chwastiak
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - G. Corretti
- Department of Mental Health, North-West Tuscany, Italy
| | - M. Dillon
- HSE Louth Meath Mental Health Services, Louth, Ireland
| | - C. Douglas
- South Coast Private Hospital, Wollongong, Australia
| | - S. T. Egger
- grid.10863.3c0000 0001 2164 6351Department of Psychiatry, Faculty of Medicine, University of Oviedo, Oviedo, Spain ,grid.7400.30000 0004 1937 0650Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - F. Gaughran
- grid.451052.70000 0004 0581 2008South London and Maudesley NHS Foundation Trust, London, UK
| | - M. Gerber
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino, Urbino, Italy
| | - E. Gobbi
- grid.6612.30000 0004 1937 0642Department of Sport, Exercise and Health, Division of Sport and Psychosocial Health, University of Basel, Basel, Switzerland
| | - K. Gould
- grid.460013.0St John of God Hospital, North Richmond, Australia
| | - M. Hatzinger
- Psychiatric Services Solothurn, Solothurn, Switzerland
| | - E. Holsboer-Trachsler
- grid.6612.30000 0004 1937 0642Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
| | - Z. Hoodbhoy
- grid.7147.50000 0001 0633 6224Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - C. Imboden
- Psychiatric Services Solothurn, Solothurn, Switzerland ,Private Clinic Wyss, Muenchenbuchsee, Switzerland
| | - P. S. Indu
- grid.413226.00000 0004 1799 9930Department of Community Medicine, Government Medical College, Trivandrum, India
| | - R. Iqbal
- grid.7147.50000 0001 0633 6224Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - F. R. Jesus-Moraleida
- grid.8395.70000 0001 2160 0329Department of Physical Therapy, Universidade Federal do Ceará, Fortaleza, Brazil
| | - S. Kondo
- grid.412708.80000 0004 1764 7572Department of Neuropsychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - P. W. Ku
- grid.412038.c0000 0000 9193 1222Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan
| | - O. Lederman
- grid.477714.60000 0004 0587 919XKeeping the Body In Mind, South Eastern Sydney Local Health District, Sydney, Australia
| | - E. H. M. Lee
- grid.194645.b0000000121742757Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - B. Malchow
- grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - E. Matthews
- grid.24349.380000000106807997School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - P. Mazur
- LWL-Klinik Marsberg, Hospital for Psychiatry, Psychotherapy and Psychosomatics, Marsberg, Germany
| | - A. Meneghelli
- Association of early intervention in mental disorders-Cambiare la Rotta-Onlus, Milano, Italy
| | - A. Mian
- grid.7147.50000 0001 0633 6224Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | - B. Morseth
- grid.10919.300000000122595234School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - D. Munguia-Izquierdo
- grid.15449.3d0000 0001 2200 2355Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain
| | - L. Nyboe
- grid.154185.c0000 0004 0512 597XDepartment of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - B. O’Donoghue
- grid.488501.0Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - A. Perram
- grid.267827.e0000 0001 2292 3111Faculty of Health, Victoria University Wellington, Wellington, New Zealand
| | - J. Richards
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Sydney, Australia ,Gallipoli Medical Research Institute, Brisbane, Australia
| | - A. J. Romain
- grid.410559.c0000 0001 0743 2111Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Canada
| | - M. Romaniuk
- grid.412112.50000 0001 2012 5829Kermanshah University of Medical Sciences, Sleep Disorders and Substance Abuse Prevention Research Center, Kermanshah, Iran
| | - D. Sadeghi Bahmani
- grid.6612.30000 0004 1937 0642University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland ,grid.477714.60000 0004 0587 919XThe Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, Australia
| | - M. Sarno
- Association of early intervention in mental disorders-Cambiare la Rotta-Onlus, Milano, Italy
| | - F. Schuch
- grid.411239.c0000 0001 2284 6531Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - N. Schweinfurth
- grid.6612.30000 0004 1937 0642University of Basel, Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
| | - B. Stubbs
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, King’s College London, London, England
| | - R. Uwakwe
- grid.412207.20000 0001 0117 5863Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - T. Van Damme
- grid.5596.f0000 0001 0668 7884Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - E. Van Der Stouwe
- grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, Netherlands
| | - D. Vancampfort
- grid.5596.f0000 0001 0668 7884Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - S. Vetter
- grid.7400.30000 0004 1937 0650Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - A. Waterreus
- grid.1012.20000 0004 1936 7910Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, Australia
| | - P. B. Ward
- grid.1005.40000 0004 4902 0432School of Psychiatry, UNSW Sydney, Sydney, Australia ,grid.429098.eSchizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, Australia
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Tolomeo AM, Carraro A, Bakiu R, Toppo S, Garofalo F, Pellegrino D, Gerdol M, Ferro D, Place SP, Santovito G. Molecular characterization of novel mitochondrial peroxiredoxins from the Antarctic emerald rockcod and their gene expression in response to environmental warming. Comp Biochem Physiol C Toxicol Pharmacol 2019; 225:108580. [PMID: 31374295 DOI: 10.1016/j.cbpc.2019.108580] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/25/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023]
Abstract
In the present study we describe the molecular characterization of the two paralogous mitochondrial peroxiredoxins from Trematomus bernacchii, a teleost that plays a pivotal role in the Antarctic food chain. The two putative amino acid sequences were compared with orthologs from other fish, highlighting a high percentage of identity and similarity with the respective variant, in particular for the residues that are essential for the characteristic peroxidase activity of these enzymes. The temporal expression of Prdx3 and Prdx5 mRNAs in response to short-term thermal stress showed a general upregulation of prdx3, suggesting that this isoform is the most affected by temperature increase. These data, together with the peculiar differences between the molecular structures of the two mitochondrial Prdxs in T. bernacchii as well as in the tropical species Stegastes partitus, suggest an adaptation that allowed these poikilothermic aquatic vertebrates to colonize very different environments, characterized by different temperature ranges.
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Affiliation(s)
- A M Tolomeo
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - A Carraro
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - R Bakiu
- Department of Aquaculture and Fisheries, Agricultural University of Tirana, Tirana, Albania
| | - S Toppo
- Department of Molecular Medicine, University of Padova, Italy
| | - F Garofalo
- Departmentof of Biology, Ecology and Earth Sciences (B.E.S.T.), University of Calabria, Arcavacata di Rende, Italy
| | - D Pellegrino
- Departmentof of Biology, Ecology and Earth Sciences (B.E.S.T.), University of Calabria, Arcavacata di Rende, Italy
| | - M Gerdol
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - D Ferro
- Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - S P Place
- Department of Biology, Sonoma State University, Rohnert Park, CA, USA
| | - G Santovito
- Department of Biology, University of Padova, Padova, Italy.
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21
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Tognetti L, Rubegni P, Vitiello G, Bormioli S, Carraro A, Cinotti E, Fimiani M, Maggi E. Persistent unilateral ulcer of the ear as the first manifestation of relapsing polychondritis. Clin Exp Dermatol 2018; 43:823-824. [PMID: 29770469 DOI: 10.1111/ced.13615] [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] [Accepted: 01/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- L Tognetti
- Division of Dermatology, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - P Rubegni
- Division of Dermatology, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - G Vitiello
- Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
| | - S Bormioli
- Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
| | - A Carraro
- Division of Dermatology, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - E Cinotti
- Division of Dermatology, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - M Fimiani
- Division of Dermatology, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - E Maggi
- Experimental and Clinical Medicine Department, University of Florence, Florence, Italy
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22
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Cima L, Riva G, D'Errico A, Casartelli-Liviero M, Capelli P, Tomezzoli A, Montin U, Carraro A, Scarpa A, Ghimenton C, Colombari R, Brunelli M, Eccher A. Fast Chromotrope Aniline Blue Special Stain Is a Useful Tool to Assess Fibrosis on Liver Biopsy During Transplantation. Transplant Proc 2017; 49:667-670. [PMID: 28457367 DOI: 10.1016/j.transproceed.2017.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Assessment of potential liver allograft donors with frozen sections has clinical relevant consequences for the transplant recipient. Several clinical risk factors have been identified that increase the risk of transplantation failure and it is critical for the pathologist to become familiar with the histologic criteria for donor liver suitability. In this setting an accurate and reliable assessment of fibrosis is crucial. We sought to report the value of the rapid chromotrope aniline blue stain (CAB) in a transplantation clinical work-flow for scoring liver fibrosis. MATERIALS AND METHODS Twenty consecutive intraoperative donor liver biopsy specimens were evaluated by a pathologist at the Transplant Pathology Board Room, AOUI Verona, during 24-hour on-call service. The stage of fibrosis was evaluated according to Ishak score ranging from 0 to 6 (absent to cirrhosis) using hematoxylin and eosin stain (H&E) plus rapid CAB special stain. After a 3-week washout period, only the slides stained with H&E were re-assessed for fibrosis stage by the same pathologist blinded to donor patient data. RESULTS Combination H&E-CAB staging fibrosis score was higher in 20%, lower in 10%, and the same in 70% of biopsy specimens as determined using only H&E stain alone. Rapid CAB stain takes 20 minutes longer than H&E stain alone. CONCLUSIONS CAB staining may be performed on frozen tissue from liver biopsy during a transplantation process without a significant delay in diagnosis. Combination H&E-CAB staining improves sensibility of interpretation of fibrosis.
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Affiliation(s)
- L Cima
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - G Riva
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - A D'Errico
- Department of Specialized, Experimental and Diagnostic Medicine, S. Orsola-Malpighi University Hospital of Bologna, Bologna, Italy
| | - M Casartelli-Liviero
- Department of Surgical Science, Neurosurgery and Intensive Care Unit, University and Hospital Trust of Verona, Verona, Italy
| | - P Capelli
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - A Tomezzoli
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - U Montin
- Department of Surgical Science, Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy
| | - A Carraro
- Department of Surgical Science, Liver Transplant Unit, University and Hospital Trust of Verona, Verona, Italy
| | - A Scarpa
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - C Ghimenton
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - R Colombari
- Anatomic Pathology, Fra Castoro Hospital of San Bonifacio, Verona, Italy
| | - M Brunelli
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - A Eccher
- Department of Diagnostics and Public Health, Anatomic Pathology, University and Hospital Trust of Verona, Verona, Italy.
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Guillaud M, Keyes M, Ye Q, Carraro A, Harrison A, Hayes M, Nichol A, Leung S. Large-scale DNA organization is a prognostic marker of breast cancer survival. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Carraro A, Fabbri P, Giaretta A, Peruzzo L, Tateo F, Tellini F. Effects of redox conditions on the control of arsenic mobility in shallow alluvial aquifers on the Venetian Plain (Italy). Sci Total Environ 2015; 532:581-594. [PMID: 26115337 DOI: 10.1016/j.scitotenv.2015.06.003] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 06/04/2023]
Abstract
The Venetian Plain is known for the occurrence of areas with high concentrations of arsenic in groundwater (greater than 400 μg/L). The study area represents the typical residential, industrial and agricultural features of most Western countries and is devoid of hydrothermal, volcanic or anthropogenic sources of arsenic. The aim of the study is to model the arsenic mobilization and the water-rock interaction by a complete hydrogeochemical investigation (analyses of filtered and unfiltered groundwater sediment mineralogy and geochemistry). The groundwater arsenic contamination and redox conditions are highly variable. Groundwaters with oxidizing and strongly reducing potentials have much lower arsenic concentrations than do mildly reducing waters. The grain size of the aquifer sediments includes gravels, sands and silty-clays. A continuous range of organic material concentrations is observed (from zero to 40%). The amount of sedimentary organic matter is highly correlated with the arsenic content of the sediments (up to 300 mg/kg), whereas no relationships are detectable between arsenic and other chemical parameters. The occurrence of arsenic minerals was observed as a peculiar feature under the scanning electron microscope. Arsenic and sulfur are the sole constituents of small tufts or thin crystals concentrated in small masses. These arsenic minerals were clearly observed in the peat sediments, in agreement with the geochemical modeling that requires very reducing conditions for their precipitation from the groundwater. The modeling suggests that, under oxidizing conditions, arsenic is adsorbed; moreover, a continuous decrease in the redox potential causes increasing desorption of arsenic. If the reducing conditions become more intense, the formation of As-S minerals would explain the lower concentration of arsenic measured in the strongly reducing groundwater. Even if As-sulfides are rare under low-temperature conditions, the anomalous abundance of reductants (organic matter) can locally stabilize As-S minerals, which can scavenge large quantities of groundwater arsenic.
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Affiliation(s)
- A Carraro
- Institute of Geosciences and Earth Resources, National Research Council (CNR) of Italy, Padova, Italy c/o Department of Geosciences, University of Padova, 35131 Padova, Italy
| | - P Fabbri
- Institute of Geosciences and Earth Resources, National Research Council (CNR) of Italy, Padova, Italy c/o Department of Geosciences, University of Padova, 35131 Padova, Italy; Department of Geosciences, University of Padova, 35131 Padova, Italy
| | - A Giaretta
- Institute of Geosciences and Earth Resources, National Research Council (CNR) of Italy, Padova, Italy c/o Department of Geosciences, University of Padova, 35131 Padova, Italy
| | - L Peruzzo
- Institute of Geosciences and Earth Resources, National Research Council (CNR) of Italy, Padova, Italy c/o Department of Geosciences, University of Padova, 35131 Padova, Italy
| | - F Tateo
- Institute of Geosciences and Earth Resources, National Research Council (CNR) of Italy, Padova, Italy c/o Department of Geosciences, University of Padova, 35131 Padova, Italy
| | - F Tellini
- Institute of Geosciences and Earth Resources, National Research Council (CNR) of Italy, Padova, Italy c/o Department of Geosciences, University of Padova, 35131 Padova, Italy
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Tolomeo AM, Carraro A, Bakiu R, Toppo S, Place SP, Ferro D, Santovito G. Peroxiredoxin 6 from the Antarctic emerald rockcod: molecular characterization of its response to warming. J Comp Physiol B 2015; 186:59-71. [PMID: 26433650 DOI: 10.1007/s00360-015-0935-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 07/15/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 12/22/2022]
Abstract
In the present study, we describe the purification and molecular characterization of two peroxiredoxins (Prdxs), referred to as Prdx6A and Prdx6B, from Trematomus bernacchii, a teleost widely distributed in many areas of Antarctica, that plays a pivotal role in the Antarctic food chain. The two putative amino acid sequences were compared with Prdx6 orthologs from other fish, highlighting a high percentage of identity and similarity with the respective variant, in particular for the residues that are essential for the characteristic peroxidase and phospholipase activities of these enzymes. Phylogenetic analyses suggest the appearance of the two prdx6 genes through a duplication event before the speciation that led to the differentiation of fish families and that the evolution of the two gene variants seems to proceed together with the evolution of fish orders and families. The temporal expression of Prdx6 mRNA in response to short-term thermal stress showed a general upregulation of prdx6b and inhibition of prdx6a, suggesting that the latter is the variant most affected by temperature increase. The variations of mRNA accumulation are more conspicuous in heart than the liver, probably related to behavioral changes of the specimens in response to elevated temperature. These data, together with the peculiar differences between the molecular structures of the two Prdx6s in T. bernacchii as well as in the tropical species Stegastes partitus, suggest an adaptation that allowed these poikilothermic aquatic vertebrates to colonize very different environments, characterized by different temperature ranges.
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Affiliation(s)
- A M Tolomeo
- Department of Biology, University of Padova, via U. Bassi 58/B, 35100, Padua, Italy
| | - A Carraro
- Department of Biology, University of Padova, via U. Bassi 58/B, 35100, Padua, Italy
| | - R Bakiu
- Department of Aquaculture and Fisheries, Agricultural University of Tirana, Tirana, Albania
| | - S Toppo
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - S P Place
- Department of Biology, Sonoma State University, Rohnert Park, CA, USA
| | - D Ferro
- Institute for Evolution and Biodiversity, Westfälische Wilhelms-Universität, Münster, Germany
| | - G Santovito
- Department of Biology, University of Padova, via U. Bassi 58/B, 35100, Padua, Italy.
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Zanus G, Carraro A, Vitale A, Gringeri E, D'Amico F, Valmasoni M, D'Amico FE, Brolese A, Boccagni P, Neri D, Srsen N, Burra P, Feltracco P, Bonsignore P, Scopelliti M, Cillo U. Alcohol abuse and de novo tumors in liver transplantation. Transplant Proc 2014; 41:1310-2. [PMID: 19460548 DOI: 10.1016/j.transproceed.2009.03.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 12/14/2022]
Abstract
INTRODUCTION Organ transplant recipients show an increased incidence of cancer ranging from 4% to 16% owing to several causes: immunosuppression, viral infection, individual predisposition, and so on. MATERIALS AND METHODS We retrospectively reviewed the records of 43/683 (6.3%) recipients of 734 liver transplants performed from November 1991 to November 2008 who experienced a de novo neoplasm. CONCLUSION Alcohol abuse significantly increased the rate of all de novo neoplasms and particularly pharyngogastroesophageal cancers among population of liver transplant recipients. Minimization of immunosuppressive therapy is necessary to reduce the risk of a de novo neoplasm. Strict posttransplant follow-up is required to identify early gastroenteric tumors.
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Affiliation(s)
- G Zanus
- Hepatobiliary and Liver Transplant Unit, Department of General Surgery and Organ Transplant, University of Padua, Padua, Italy.
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27
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Gringeri E, Bonsignore P, Bassi D, D'Amico F, Mescoli C, Polacco M, Buggio M, Luisetto R, Boetto R, Noaro G, Ferrigno A, Boncompagni E, Freitas I, Vairetti M, Carraro A, Neri D, Cillo U. Subnormothermic Machine Perfusion for Non–Heart-Beating Donor Liver Grafts Preservation in a Swine Model: A New Strategy to Increase the Donor Pool? Transplant Proc 2012; 44:2026-8. [DOI: 10.1016/j.transproceed.2012.06.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Rinonapoli G, Carraro A, Delcogliano A. The clinical diagnosis of meniscal tear is not easy. Reliability of two clinical meniscal tests and magnetic resonance imaging. Int J Immunopathol Pharmacol 2011; 24:39-44. [PMID: 21669136 DOI: 10.1177/03946320110241s208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM to clarify the reliability of two clinical meniscal tests, McMurray's and Apley's and the MRI imaging, in order to establish how to reduce unjustified arthroscopies. METHODS 102 patients were selected out of 160. All patients were submitted to a triple clinical examination (by a young surgeon and two skilled surgeons), MRI and an arthroscopic procedure. The investigated clinical tests were McMurray's and Apley's test. The positivity or negativity of the tests and MRI were compared to arthroscopic findings. Arthroscopy is considered the gold standard for the diagnosis of meniscal lesions. We measured the length of the meniscal lesions in order to correlate it to the clinical findings. RESULTS From the clinical examination, we got the following data: McMurray's test: sensitivity 79.7%, specificity 78.5%, accuracy 79.4%, positive likelihood ratio 3.7, negative likelihood ratio 0.2. Apley's test: sensitivity 83.7%, specificity 71.4%, accuracy 80.3%, positive likelihood ratio 2.9, negative likelihood ratio 0.2. The composite assessment is strictly dependent on how the discordance of the two tests is evaluated. The assessment of the clinical tests was done even in relation to medial or lateral meniscal lesion. No statistical difference was found about the length of the meniscal tear. MRI gave the following results: sensitivity 78.3%, specificity 85.7%, accuracy 80.3%. CONCLUSIONS If we use, as diagnostic means, McMurray's and Apley's clinical tests and MRI as imaging procedure, we have an accuracy of about 80%. It is important to keep in mind that it is not possible to have the absolute certainty of make a correct diagnosis in case of meniscal lesions. Patients, too, have to be informed about the risk of a negative arthroscopy.
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Affiliation(s)
- G Rinonapoli
- Orthopaedic Dept., University of Perugia, Italy.
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29
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Zanus G, Boetto R, Gringeri E, Vitale A, D'Amico F, Carraro A, Bassi D, Bonsignore P, Noaro G, Mescoli C, Rugge M, Angeli P, Senzolo M, Burra P, Feltracco P, Cillo U. Microwave thermal ablation for hepatocarcinoma: six liver transplantation cases. Transplant Proc 2011; 43:1091-4. [PMID: 21620060 DOI: 10.1016/j.transproceed.2011.02.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Surgical resection for malignant hepatic tumors, especially hepatocarcinoma (HCC), has been demonstrated to increase overall survival; however, the majority of patients are not suitable for resection. Radiofrequency ablation (RFA) is the most widely used modality for radical treatment of small HCC (<3 cm). It improves 5-year survival compared with standard chemotherapy and chemical ablation, allowing down-staging of unresectable hepatic masses. Microwave ablation (MWA) has been extensively applied in Asia and was recently introduced in the United States of America and Europe with excellent results, especially with regard to large unresectable HCC. Our single-center experience between May 2009 and October 2010 included application of MWA to 154 patients of median age ± standard deviation of 63.5 ± 8.5 years, 6 males, and 1 female, of mean Model for End-Stage Liver Disease (MELD) score (10.1 ± 3.8). The HCC included, hepatitis C virus (HCV)-related (n=70; 45.5%); alcool (ETOH)-related (n=42; 27%), hepatitis B virus (HBV)-related (n=16; 10.5%); and cryptogenic cases (n=26; 17%). The cases were performed for radical treatment down-staging for multifocal pathology or bridging liver transplantation to orthotopic (OLT) in selected patients with single nodules. A computed tomography (CT) scan was performed at 1 month after the surgical procedure to evalue responses to treatment. Among 6 selected patients who underwent OLT; 5 (83.3%) showed disease-free survival at one-year follow-up. The radical treatment achieved no intraoperative evidence of tumor spread or of pathological signs of active HCC among the explanted liver specimens. In conclusion, a MWA seemed to be a safe novel approach to treat HCC and could serve as a "bridge" to OLT and down-staging for patients with HCC.
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Affiliation(s)
- G Zanus
- General Surgery and Organ Transplantation, Hepatobiliary Surgery and Liver Transplant Unit, Azienda Università di Padova, Padova, Italy.
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30
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Vitale A, Volk ML, Gambato M, Zanus G, D'Amico F, Carraro A, Pauletto A, Bonsignore P, Scopelliti M, Polacco M, Russo F, Senzolo M, Burra P, Romano A, Angeli P, Cillo U. Estimation of the harm to the waiting list as a crucial factor in the selection of patients with hepatocellular carcinoma for liver transplantation. Transplant Proc 2010; 42:1194-6. [PMID: 20534259 DOI: 10.1016/j.transproceed.2010.03.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Long-term survival rates after orthotopic liver transplantation (OLT) for patients with hepatocellular carcinoma (HCC) of any size and number may now be predicted using the Metroticket calculator. The aim of this study was to evaluate the minimum post-OLT survival threshold that would justify the selection of a patient with HCC for OLT. METHODS We used a Markov model, recently developed at the University of Michigan, which assumes that a patient with HCC should undergo OLT if his or her transplant benefit is greater than the cumulative harm to the rest of the waiting list (WL). In the base case, we considered a patient with a low survival perspective without OLT (5-year survival rate, 10%). The data sources to construct and validate the model were as follows: the Organ Procurement and Transplantation Network report, and our prospective database. RESULTS Our center was generally characterized by lower WL mortalities, although there were lower transplant probabilities for both HCC and non-HCC patients than the average US center. The proportion of HCC patients on the WL was higher in Padua (25%) than in the United States (10%). The calculated harm to the WL was 434 quality-adjusted days of life in Padua, and 957 in the United States (P < .01). The OLT benefit outweighed the harm to the WL when the 5-year post-OLT survival rate was higher than 30% in Padua, and 61% in the United States. CONCLUSIONS In a decision model including the concepts of transplantation benefit and harm to the WL, the minimum 5-year post-OLT survival threshold justifying the selection of a patient with HCC for OLT in Padua was 30%.
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Affiliation(s)
- A Vitale
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda - Università di Padova, Padova, Italy
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Polacco M, Vitale A, Valmasoni M, D'Amico F, Gringeri E, Brolese A, Zanus G, Neri D, Carraro A, Pauletto A, Romanelli E, Lo Bello S, Cillo U. Liver resection associated with mini porto-caval shunt as salvage treatment in patients with progression of hepatocellular carcinoma before liver transplantation: a case report. Transplant Proc 2010; 42:1378-80. [PMID: 20534307 DOI: 10.1016/j.transproceed.2010.03.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tumor progression before orthotopic liver transplantation (OLT) is the main cause of dropouts from waiting lists among patients with hepatocellular carcinoma (HCC). Performing a porto-caval shunt (PCS) before parenchymal liver transection has the potential to allow an extended hepatectomy in patients with decompensated liver cirrhosis, reducing portal hyperflow and therefore the sinusoidal shear-stress on the remnant liver. We report the case of a 59-year-old man affected by hepatitis C virus (HCV)-related decompensated liver cirrhosis (Child Pugh score presentation, C-10; Model for End Stage Liver Disease score, 18) and HCC (2 lesions of 2 and 2.8 cm). The patient began the evaluation to join the OLT waiting list, but, in the 3 months required to complete the evaluation, he developed tumor progression: 3 HCC lesions, the largest 1 with a diameter of about 4.4 cm. These findings excluded transplantation criteria and the patient was referred to our center. After appropriate preoperative studies, the patient underwent a major liver resection (trisegmentectomy) after side-to-side PCS by interposition of an iliac vein graft from a cadaveric donor. The patient overcame the worsened severity of cirrhosis. After 6 months of follow-up, he developed 2 other HCC nodules. He was then included on the waiting list at our center, undergoing OLT from a cadaveric donor at 8 months after salvage treatment. At 36 months after OLT, he is alive and free from HCC recurrence. Associating a partial side-to-side PCS with hepatic resection may represent a potential salvage therapy for patients with decompensated cirrhosis and HCC progression beyond listing criteria for OLT.
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Affiliation(s)
- M Polacco
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Dipartimento assistenziale di Chirurgia Generale e Trapianti d'Organo, Università degli Studi di Padova, Padova, Italy.
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Vitale A, Saracino E, D'Amico F, Grigoletto F, Burra P, Angeli P, Boccagni P, Brolese A, Zanus G, Neri D, Gringeri E, D'Amico F, Valmasoni M, Carraro A, Gambato M, Feltracco P, Romano A, Buggio M, D'Amico D, Cillo U. Prospective Validation of a New Priority Allocation Model for Liver Transplant Candidates: An Interim Analysis. Transplant Proc 2009; 41:1092-5. [DOI: 10.1016/j.transproceed.2009.03.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Vitale A, Saracino E, Boccagni P, Brolese A, D'Amico F, Gringeri E, Neri D, Srsen N, Valmasoni M, Zanus G, Carraro A, Violi P, Pauletto A, Bassi D, Polacco M, Burra P, Farinati F, Feltracco P, Romano A, D'Amico D, Cillo U. Validation of the BCLC Prognostic System in Surgical Hepatocellular Cancer Patients. Transplant Proc 2009; 41:1260-3. [DOI: 10.1016/j.transproceed.2009.03.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nosadini R, Carboni A, Manconi A, Angius F, Caria S, Cherchi S, Satta A, Faedda R, Obinu D, Nieddu M, Carraro A, Tonolo GC. WITHDRAWN: The decline of glomerular function is not always associated with the development of micro- and macroalbuminuria in hypertensive patients with type 2 diabetes. Diabetologia 2008. [PMID: 18607559 DOI: 10.1007/s00125-008-1079-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 05/21/2008] [Indexed: 11/25/2022]
Affiliation(s)
- R Nosadini
- Department of Endocrinology and Metabolic Diseases, Internal Medicine Department, University of Sassari, Viale San Pietro 8, 07100, Sassari, Italy,
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Vitale A, Gringeri E, Valmasoni M, D'Amico F, Carraro A, Pauletto A, D'Amico FJ, Polacco M, D'Amico DF, Cillo U. Long-term results of liver transplantation for hepatocellular carcinoma: an update of the University of Padova experience. Transplant Proc 2007; 39:1892-4. [PMID: 17692645 DOI: 10.1016/j.transproceed.2007.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 01/08/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) competes with benign liver disease as indication for liver transplantation (OLT). The aim of this study was to determine long-term results of OLT for HCC. METHODS We retrospectively analyzed the prognostic role of HCC diagnosis at pathological exam in adult OLT. In the HCC group, we evaluated the prognostic role of the time of diagnosis (incidental versus nonincidental) and of pathological tumor TNM staging. The primary endpoint was 1-, 3-, and 10-year patient survivals. RESULTS From 1991 to 2006, among 550 adults who underwent first OLT, HCC was found in 120 patients at pathological exam. In 26 cases (22%), the diagnosis of HCC was incidental. There were 59 cases (49%) of pathological T1 to T2 tumor (one nodule < 5 cm, or two to three nodules < 3 cm, without metastases and/or vascular invasion), and 61 cases (51%) of pathologic T3-T4a tumor. HCC diagnosis did not show a significant prognostic impact by Cox survival analysis. After a median follow-up of 31 months, 1-, 5-, and 10-year survivals were 91%, 81%, and 73% in the HCC group, and 84%, 76%, and 67% in the non-HCC group. Time of HCC diagnosis (incidental versus nonincidental) and pathological TNM staging (T1 to T2 vs T3 to T4a) did not result significant survival predictors upon Cox analysis. CONCLUSION In our experience, the long-term results of OLT for HCC overlapped those of OLT for benign disease, although 51% of tumors were T3 to T4a at pathological exam.
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Affiliation(s)
- A Vitale
- Unità di Chirurgia Oncologica, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy.
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Gringeri E, Vitale A, Brolese A, Zanus G, Boccagni P, Neri D, Valmasoni M, D'Amico F, Ciarleglio FA, Carraro A, Pauletto A, Violi P, Bassi D, D'Amico F, D'Amico DF, Cillo U. Hepatitis C virus-related cirrhosis as a significant mortality factor in intention-to-treat analysis in liver transplantation. Transplant Proc 2007; 39:1901-3. [PMID: 17692648 DOI: 10.1016/j.transproceed.2007.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/30/2022]
Abstract
INTRODUCTION Liver transplantation represents the gold standard for the treatment of chronic liver disease. The whole transplantation process was assessed using an intention-to-treat analysis and considering patients from the time of their inclusion on the list and throughout lengthy follow-up. MATERIALS AND METHODS From January 1, 1999 to June 1, 2004, 373 adults joined the waiting list for liver transplantation at our institution. The main variables analyzed were: age, gender, etiology, Model for End-stage Liver Disease score, Child-Pugh class, United Network for Organ Sharing (UNOS) status. Global survival was evaluated using intention-to-treat analysis from the time of patient inclusion in the list to the end of their late follow-up. RESULTS The median waiting time was 20 months (range 0.1 to 70.2). By univariate analysis, the variables significantly influencing survival when patients joined the waiting list were: encephalopathy; ascites, poor nutritional status, Child-Pugh class C, UNOS 2, hepatitis C virus (HCV) and bilirubin > 2 mg/dL. By multivariate analysis, only HCV-related cirrhosis emerged as having an independent prognostic value. By intention-to-treat analysis, the 5-year survival rate was 67% and 79% for HCV-positive and HCV-negative patients, respectively (P = .0003). CONCLUSIONS HCV-related cirrhosis is an independent prognostic factor for survival according to an intention-to-treat analysis. Different inclusion criteria or treatments while on the waiting list and after transplantation need to be considered in the future for HCV-positive patients.
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Affiliation(s)
- E Gringeri
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Dipartimento assistenziale di Chirugia Generale e Trapianti d'Organo, Università, Azienda Ospedaliera di Padova, Padova, Italy.
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Zanus G, Carraro A, Vitale A, Boccagni P, Brolese A, Neri D, Srsen N, Gringeri E, Valmasoni M, D'Amico F, Ciarleglio FA, Violi P, Bonsignore P, Pauletto A, Bassi D, D'Amico F, Burra P, Masier A, Rigotti P, Furian L, Polacco M, D'Amico DF, Cillo U. Combined liver and kidney transplantation: analysis of Padova experience. Transplant Proc 2007; 39:1933-5. [PMID: 17692657 DOI: 10.1016/j.transproceed.2007.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/29/2022]
Abstract
BACKGROUND/AIM The main indications for combined liver and kidney transplantation (CLKT) are as follows: (1) cirrhosis with renal damage dependent or not upon liver disease, (2) renal failure with dialysis and concomitant liver end-stage disease, (3) congenital diseases, and (4) enzymatic liver deficiency with concomitant renal failure. The aim of this study was to evaluate our results with CLKT both in adult and pediatric patients. METHODS From September 1995 to September 2006, 15 CLKT (2.8%) among 541 liver transplantations included 4 pediatric patients (27%). The main indications for CLKT were hepatitis C virus (HCV) and polycystic diseases in adult patients, and primary hyperoxaluria in pediatric patients. RESULTS The double transplantation was performed from the same donor in all cases. All adult patients received whole liver grafts, whereas 3 split transplants and 1 whole liver graft were transplanted in the pediatric patients. Median liver and kidney cold ischemia times were 468 and 675 minutes, respectively. After a median follow-up of 36 months (range, 1-125), the overall survival rate was 80%. Five-year patient and graft survival rates were 100% for adult CLKT, whereas they were 50% for pediatric patients. We observed only 2 cases (18%) of delayed renal function, requiring temporary hemodialysis with progressive graft improvement. There was only 1 case of kidney retransplantation due to early graft nonfunction in a pediatric patient. CONCLUSION Although CLKT is related to major surgical risks, results after transplantation are satisfactory with an evident immunological advantage.
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Affiliation(s)
- G Zanus
- Department of Surgical and Gastroenterological Science, University of Padova, Padova, Italy.
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38
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Carraro A, Gringeri E, Calabrese F, Violi P, Brolese A, Zanus G, Boccagni P, Valente ML, Bassi D, D'Amico F, D'Amico DF, Cillo U. A new experimental model of isolated perfused pig liver to support acute hepatic failure. Transplant Proc 2007; 39:2028-30. [PMID: 17692683 DOI: 10.1016/j.transproceed.2007.05.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 02/07/2023]
Abstract
Liver transplantation still represents the only effective treatment for patients with liver failure, but many patients die while awaiting transplantation, even though many attempts have been made to increase the organ procurement rates and to partially support hepatic function in recent years. Our aim was to design an "open" ex vivo perfused liver model to simplify liver support using an isolated porcine liver perfused with arterial and portal blood from the recipient pig, while monitoring the metabolic capacity of the supporting graft. It was possible to perfuse the isolated liver for 6 hours as a bridging procedure with satisfactory hemodynamic homeostasis controlled by software biofeedbacks.
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Affiliation(s)
- A Carraro
- 1st Surgical Clinic, Hepatobiliary and Transplant Unit, University of Padova, Padova, Italy.
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39
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Vitale A, D'Amico F, Brolese A, Zanus G, Boccagni P, Neri D, Gringeri E, Valmasoni M, Ciarleglio FA, Carraro A, Pauletto A, Bonsignore P, Bassi D, Polacco M, D'Amico DF, Cillo U. Prognostic Impact of Model for End-Stage Liver Disease Score in Patients Undergoing Liver Transplantation With Suboptimal Livers. Transplant Proc 2007; 39:1907-9. [PMID: 17692650 DOI: 10.1016/j.transproceed.2007.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 10/23/2022]
Abstract
BACKGROUND/AIMS The aim of this retrospective study is to analyze the prognostic impact of Model for End-Stage Liver Disease (MELD) score in patients undergoing liver transplantation (OLT) with suboptimal livers. METHODS Between January 2002 and January 2006, 160 adult patients with liver cirrhosis received a whole liver for primary OLT at our institution including 81 with a suboptimal liver (SOL group) versus 79 with an optimal liver (group OL). The definition of suboptimal liver was: one major criterion (age >60 years, steatosis >20%) or at least two minor criteria: sodium >155 mEq/L, Intensive Care Unit stay >7 days, dopamine >10 microg/kg/min, abnormal liver tests, and relevant hemodynamic instability. RESULTS Baseline recipients characteristics were comparable in the two study groups. The SOL group had a significantly greater number of early graft deaths (<30 days) than the OL group, while the 3-year Kaplan-Meier patient survivals were similar. Using logistic regression, MELD score was significantly related to patient death only in the SOL group (P = .01), and the receiver operator characteristics curve method identified 17 as the best MELD cutoff with the 3-year survival of 93% versus 85% for MELD < or =7 versus >17, respectively (P > 05). In comparison, it was 94% and 72% in the SOL group (P < .05). Similarly, MELD >17 was significantly associated with early graft death rates only in the SOL group. CONCLUSION This study advised surgeons to not use suboptimal livers for patients with advanced MELD scores, thus supporting a donor-recipient matching policy.
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Affiliation(s)
- A Vitale
- Unità di Chirurgia Oncologica, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy.
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40
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Brolese A, Vitale A, Zanus G, Boccagni P, Neri D, Gringeri E, D'Amico F, Valmasoni M, Ciarleglio FA, Carraro A, Zancan L, Guariso G, D'Antiga L, D'Amico DF, Cillo U. Pediatric Liver Transplantation: The University of Padua Experience. Transplant Proc 2007; 39:1939-41. [PMID: 17692659 DOI: 10.1016/j.transproceed.2007.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to analyze experience on pediatric liver transplantation (LT) between June 1993 and September 2006, including split liver transplantation (SLT), living donor liver transplantation (LDLT), and auxiliary partial orthotopic liver transplantation (APOLT). Furthermore, hepatocyte transplantation (HT) had a role in one patient with metabolic disease. METHODS From November 1990 to September 2006, 657 LTs were performed including 63 pediatric LTs (9.6%) in 57 patients (32 boys and 25 girls). Six were retransplantations (9.5%). Thirty-two patients (57%) were younger than 5 years. The types of graft included the following: 26 whole organs (41%), 32 in situ split organs (51%), 4 reduced-size organs (6%), and 1 graft from a living donor (2%). Two patients received an APOLT, 4 patients received a combined kidney-liver transplantation (CKLT), and 1 patient received HT. Of the 63 pediatric LTs, 16 were behaved to be highly urgent (25%). RESULTS Overall 1-, 3-, 5-, and 10-year patient survival rates were 82%, 82%, 78%, and 78%, respectively. Overall 1-, 3-, 5-, and 10-year graft survival rates were 76%, 76%, 72%, and 72%, respectively. In patients younger than 1 year, the 5-year survival rate was 100%. Perioperative mortality was 8.8%. Vascular complications occurred in 4 patients (6.3%). Six children required retransplantation due to primary nonfunction (PNF) in 4 cases (7%) and vascular thrombosis in 2 cases (3.5%). CONCLUSIONS Cholestatic liver disease and age younger than 1 year were the best prognostic factors for excellent survival.
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Affiliation(s)
- A Brolese
- Hepato-Biliary and Liver Transplantation Unit, University of Padua, Padua, Italy.
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Cillo U, Vitale A, Grigoletto F, Gringeri E, D'Amico F, Valmasoni M, Brolese A, Zanus G, Srsen N, Carraro A, Burra P, Farinati F, Angeli P, D'Amico DF. Intention-to-treat analysis of liver transplantation in selected, aggressively treated HCC patients exceeding the Milan criteria. Am J Transplant 2007; 7:972-81. [PMID: 17391137 DOI: 10.1111/j.1600-6143.2006.01719.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This prospective study analyzed the dropout probability and intention-to-treat survival rates of patients with hepatocellular carcinoma (HCC) selected and treated according to our policy before liver transplantation (LT), with particular attention to those exceeding the Milan criteria. Exclusion criteria for LT were macroscopic vascular invasion, metastases, and poorly differentiated disease at percutaneous biopsy. A specific multi-modal adjuvant algorithm was used to treat HCC before LT. A total of 100 HCC patients were listed for LT: 40 exceeded the Milan criteria in terms of nodule size and number (MILAN OUT) either at listing or in list, while 60 patients continued to meet the criteria (MILAN IN). The Milan criteria did not prove to be a significant predictor of dropout probability or survival rates using Cox's analysis. Cumulative dropout probability at 6 and 12 months was 0% and 4% for MILAN OUT, and 6% and 11% for MILAN IN. The intention-to-treat survival rates at 1 and 3 years were 95% and 85% in MILAN OUT, and 84% and 69% in MILAN IN. None of the 68 transplanted patients had recurrent HCC after a median 16-month follow-up (0-69 months). In conclusion, LT may be effective for selected, aggressively-treated HCC patients exceeding the Milan criteria.
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Affiliation(s)
- U Cillo
- Unità di Chirurgia Epatobiliare e Trapianto Epatico, Dipartimento di Chirurgia Generale e Trapianti d'Organo, Azienda Ospedaliera di Padova, Italy
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Tonolo G, Velussi M, Brocco E, Abaterusso C, Carraro A, Morgia G, Satta A, Faedda R, Abhyankar A, Luthman H, Nosadini R. Simvastatin maintains steady patterns of GFR and improves AER and expression of slit diaphragm proteins in type II diabetes. Kidney Int 2006; 70:177-86. [PMID: 16710349 DOI: 10.1038/sj.ki.5001515] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 11/08/2022]
Abstract
The factors determining the course of glomerular filtration rate (GFR) and albumin excretion rate (AER) and the expression of mRNA of slit diaphragm (SD) and podocyte proteins in microalbuminuric, hypertensive type II diabetic patients are not fully understood. GFR, AER, and SD protein mRNA were studied in 86 microalbuminuric, hypertensive, type II diabetics at baseline and after 4-year random double-blind treatment either with 40 mg simvastatin (Group 1) or with 30 g cholestyramine (Group 2) per day. Both groups had at baseline a GFR decay per year in the previous 2-4 years of 3 ml/min/1.73 m(2). Both Groups 1 and 2 showed a significant decrease of low-density lipoprotein cholesterol levels after simvastatin and cholestyramine treatment (P<0.01). No change from base line values was observed as for hs-C-reactive protein and interleukin-6. A significant decrease of 8-hydroxydeoxyguanosine urinary excretion was observed after simvastatin treatment. GFR did not change from baseline with simvstatin, whereas a decrease was observed with cholestyramine treatment (simvastatin vs cholestyramine: -0.21 vs -2.75 ml/min/1.73 m(2), P<0.01). AER decreased in Group 1 (P<0.01), but not in Group 2 patients. Real-time polymerase chain reaction measurement of mRNA SD proteins (CD2AP, FAT, Actn 4, NPHS1, and NPHS2) significantly increased in kidney biopsy specimens after simvastatin, but not cholestyramine treatment. Simvastatin, but not cholestyramine, 4-year treatment maintains steady patterns of GFR, and improves AER and expression of SD proteins in type II diabetes, despite similar hypocholesterolemic effects in circulation.
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Affiliation(s)
- G Tonolo
- U.O. Diabetologia, Asl, Olbia, Italy
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43
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Galioto A, Angeli P, Guarda S, Burra P, Zanus G, Fasolato S, Fagiuoli S, Sticca A, Semplicini A, Sartori M, Carraro A, Boccagni P, Cillo U, Gatta A. Comparison Between Nifedipine and Carvedilol in the Treatment of de novo Arterial Hypertension After Liver Transplantation: Preliminary Results of a Controlled Clinical Trial. Transplant Proc 2005; 37:1245-7. [PMID: 15848684 DOI: 10.1016/j.transproceed.2005.01.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 01/16/2023]
Abstract
There is no controlled clinical trial on the treatment of de novo arterial hypertension after liver transplantation (LT) a common complication using calcineurin inhibitors (CNI) for immunosuppressive therapy. The aim of this study was to compare the efficacy and safety of nifedipine, a calcium channel blocker, and carvedilol, an alpha1- and beta-blocker. The study included 50 patients who developed arterial hypertension after LT. The data on the first 30 patients who have completed 12-month follow-up are reported herein. Eighteen patients received nifedipine, and 12 patients received carvedilol. Patients were evaluated monthly at the outpatient clinic for 1 year. If patients developed severe adverse effects to nifedipine, they were switched to carvedilol and vice versa (therapy failure). The two groups were similar for clinical features, indications for LT, immunosuppressive therapy, and baseline blood pressures. A failure of treatment was observed in 9 of 18 patients treated with nifedipine (50.0%) and one of 12 patients treated with carvedilol (8%, P < .025). Nifedipine was effective in 4 of 18 patients, carvedilol, in 4 of 12 patients (22.21% vs 33.3%, P = NS). Two of the nine nonresponders to nifedipine responded to carvedilol. The efficacy of monotherapy was observed in 11 of 40 randomized patients (27.5%). Carvedilol monotherapy is as effective as nifedipine but far better tolerated.
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Affiliation(s)
- A Galioto
- Department of Clinical and Experimental Medicine, University of Padua, Padova, Italy.
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Bassanello M, Vitale A, Ciarleglio FA, Brolese A, Zanus G, D'Amico F, Carraro A, Cappuzzo G, Bridda A, Senzolo M, Burra P, Pevere S, D'Amico D, Cillo U. Adjuvant chemotherapy for transplanted hepatocellular carcinoma patients: impact on survival or HCV recurrence timing. Transplant Proc 2004; 35:2991-4. [PMID: 14697958 DOI: 10.1016/j.transproceed.2003.10.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 02/07/2023]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide. In the Western world the current epidemic of cirrhosis due to the hepatitis C virus (HCV) is increasing the number of new cases. Liver transplantation (OLTx) represents a radical treatment for HCC and the underlying cirrhosis. Whether adjuvant chemotherapy is indicated in the postoperative period to prevent recurrence is controversial. MATERIAL AND PATIENTS Forty-eight HCC patients underwent liver transplantation during 11 years, including 21 who were chemo-treated (CT) patients. Thirty-one patients (65%) had post-necrotic virus-C cirrhosis (PNC-C). Twenty-one cases (44%) were p-TNM stages III-IV, and 15 cases (31%) incidental HCC detected in the explanted liver. Seven HCV patients (15%) received chemotherapy (before 1998). RESULTS One-, 3-, and 5-year overall survival rates were 100%, 85%, 79% (CT group), and 89%, 71%, 71% (no CT group), respectively. The HCV recurrence-free survival rates at 3, 6, and 12 months were 29%, 14%, 0% for the CT group, versus 76%, 38%, 25% for the no CT group (P =.005). CONCLUSIONS Discontinuation of HCV-HCC patients by chemotherapeutic adjuvant protocols after transplantation appears rational due to the early hepatitis C recurrence confirmed in our series. Moreover, few studies have demonstrated that CT prolongs survival of HCC transplanted patients. New pharmacological approaches are necessary to solve these questions.
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Affiliation(s)
- M Bassanello
- Clinica Chirurgica 1 and Liver Transplantation Unit, Department of Surgical and Gastroenterological Sciences, Padua University, P.G. Cevese University Hospital, Via Giustiniani 2, Padua 35128, Italy.
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45
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Cillo U, Ciarleglio FA, Bassanello M, Brolese A, Vitale A, Boccagni P, Zanus G, Zancan L, D'Antiga L, Dall'igna P, Montin U, Gringeri E, Carraro A, Cappuzzo G, Violi P, Baldessin M, Bridda A, D'Amico DF, Perilongo G. Liver transplantation for the management of hepatoblastoma. Transplant Proc 2003; 35:2983-5. [PMID: 14697956 DOI: 10.1016/j.transproceed.2003.10.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Hepatoblastoma (HEP) is the most frequent liver malignancy occurring in childhood. Surgical resection currently represents the gold standard for treatment. In patients with initially unresectable tumors, chemotherapy may induce remarkable reductions in size. In nonresponder patients, liver transplantation (OLTx) may offer a chance of cure. MATERIALS AND METHODS From 1990 to 2003, a total of 400 OLTx (31 pediatric transplants) have been performed at Padua University. Seven patients (4 males and 3 females) underwent OLTx for hepatoblastoma. All patients presented with bilobar liver involvement and had received chemotherapy according to the SIOPEL-1. In all patients preoperative staging was negative for extrahepatic involvement. RESULTS The mean age of the pts was 8.2 years (range 6.4 months to 34 years). Mean follow-up after OLTx was 41.4 months (median 36, range 3 to 108 months). Actuarial patient survival rates after OLTx for hepatoblastoma are 83.3%, 83.3%, and 56% at 1, 3, and 5 years, respectively. Five of seven subjects with HEP are alive after transplant at 3, 12, 36, 65, and 108 months. Two patients died owing to recurrent disease after 6 and 60 months, respectively, from transplantation. Another subject, primarily treated with surgical resection, shows HEP recurrence at 40 months after OLTx. The remaining 4 patients are alive and well at a mean follow-up of 28 months (median 24, range 3 to 65 months). CONCLUSIONS Liver transplantation may represent a valid therapeutic option for patients with unresectable HEP, but it is contraindicated in cases of recurrence following previous resection surgery. Neo-adjuvant chemotherapy is of paramount importance to obtain good long-term results.
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Affiliation(s)
- U Cillo
- Clinica Chirurgica 1 and Liver Transplantation Unit, P.G. Cevese Department of Surgical and Gastroenterological Sciences, Padua University, Via Giustiniani 2, Padua 35128, Italy
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Poulin N, Frost A, Carraro A, Mommers E, Guillaud M, Van Diest PJ, Grizzle W, Beenken S. Risk biomarker assessment for breast cancer progression: replication precision of nuclear morphometry. Anal Cell Pathol 2003; 25:129-38. [PMID: 12775917 PMCID: PMC4618986 DOI: 10.1155/2003/262918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nuclear morphometry is a method for quantitative measurement of histopathologic changes in the appearance of stained cell nuclei. Numerous studies have indicated that these assessments may provide clinically relevant information related to the degree of progression and malignant potential of breast neoplasia. Nuclear features are derived from computerized analysis of digitized microscope images, and a quantitative Feulgen stain for DNA was used. Features analyzed included: (1) DNA content; (2) nuclear size and shape; and (3) texture features, describing spatial features of chromatin distribution. In this study replicated measurements are described on a series of 54 breast carcinoma specimens of differing pathologic grades. Duplicate measurements were performed using two serial sections, which were processed and analyzed separately. The value of a single feature measurement, the nuclear area profile, was shown to be the strongest indicator of progression. A quantitative nuclear grade was derived and shown to be strongly correlated with not only the pathologic nuclear grade, but also with tubule formation, mitotic grade, and with the overall histopathologic grade. Analysis of replication precision showed that the standard methods of the histopathology laboratory, if practiced in a uniform manner, are sufficient to ensure reproducibility of these assessments. We argue that nuclear morphometry provides a standardized and reproducible framework for quantitative pathologic assessments.
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Affiliation(s)
- N Poulin
- Cancer Imaging, BC Cancer Research Center, Vancouver, Canada.
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Brocco E, Velussi M, Cernigoi AM, Abaterusso C, Bruseghin M, Carraro A, Sambataro M, Piarulli F, Sfriso A, Nosadini R. Evidence of a threshold value of glycated hemoglobin to improve the course of renal function in type 2 diabetes with typical diabetic glomerulopathy. J Nephrol 2001; 14:461-71. [PMID: 11783602] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We recently observed that the course of glomerular filtration rate (GFR) rapidly declines in a subgroup of Type 2 diabetic patients (D) with abnormalities of albumin excretion rate (AER) and typical diabetic nephropathy, despite tight blood pressure control. The aim of this study was to evaluate whether amelioration of blood glucose control, using insulin, improves the course of GFR. GFR decay was measured by spline modeling analysis of the plasma clearance rate of 51CR-EDTA, assessed every 6 months. We identified two groups of D using morphometric analysis of renal biopsy, who had values of glomerular basement membrane (GBM) and fractional mesangial volume (Vv mes/glom) respectively below (Group A: 38) or above (Group B: 50) the mean+2SD of values found in 27 kidney donors (GBM: 389 nm; Vv mes/glom: 0.25), as previously described in detail. Median AER was similar at base line in the 2 groups (109 microg/min, 29-1950, in Group A, 113 microg/min, 37-1845, in Group B; n.s.). Conventional metabolic therapy (sulphonylureas and/or biguanides) was used both in Group A and B during a 3 year follow-up period (Period 1). Group B was further divided in two subgroups with body mass index below (Group B, a) and above (Group B, b) the value of 30 kg/m2. Mean +/- SD HbA1c was 8.2 +/- 1.6% in Group A, 8.3 +/- 1.7% in Group B (a) (n.s.) and 9.1 +/- 1.7% in Group B (b) (n.s.). Tight blood pressure control was achieved and maintained using angiotensin converting enzyme inhibitors and/or beta blockers and/or calcium antagonists and/or thiazides. The mean arterial blood pressure (MAP) was 92 +/- 3 mmHg in Group A and 91 +/- 4 mmHg in Group B (n.s.). GFR decay was significantly greater in Group B than in Group A (Group A vs B: +1.21 +/- 0.71 vs -5.86 +/- 1.61 ml/min/1.73 m2/year). Median AER significantly rose in Group B (177 microg/min, p<0.05 vs base line) but not in Group A (134 microg/min, n.s.) during the third year of follow-up. Groups A and B were then followed over 4.1 years (range 3.1-4.4) (Period 2) maintaining the above described antihypertensive regimen, resulting in MAP values similar to those described during Period 1. Group A patients were treated with the same conventional glycemic control during Period 2. Group B (a) was conversely treated with intensive insulin therapy to achieve a HbA1c value below 7.5% (3 daily injections of regular and 1 or 2 daily injections of intermediate acting insulin associated with metformin 500 mg twice daily in 64% of the patients). Group B (b) patients were only treated by metformin (850 mg thrice daily) to achieve a HbA1c value below 7.5%. HbA1c decreased below the 7.5% target value in Group B (a) (7.0 +/- 1.6%, p<0.01 vs Period 1), but not in Group B (b) (8.0 +/- 1.6%, p<0.05 vs Period 1) and in Group A (8.3 +/- 1.7%, n.s. vs Period 1). The GFR decay of Group B, a during Period 2 was lower than that during Period 1 (Period 1 vs Period 2: -5.9 +/- 1.8 vs -1.8 +/- 0.7 ml/min/1.73 m2/year, p<0.01). GFR decay during Period 2 was similar to that observed during Period 1 in Group A (Period 1 vs Period 2: +1.21 +/- 0.71 vs +0.7 +/- 0.6 ml/min/1.73 ml/year, n.s.) and in Group B (b) (Period 1 vs Period 2: -4.4 +/- 0.71 vs -4.2 +/- 0.6 ml/min/1.73 m2/year, n.s.). Median AER did not significantly change in the fourth year of Period 2 , either in Group A or B (Group A vs B: 141 vs 152 microg/min, n.s.). In conclusion, our findings seem to suggest that amelioration of blood glucose control is attained both by insulin and metformin intensive treatment, but only insulin decreases and maintains HbA1c levels below 7.5%. These pattens of HbA1c appear to be a threshold value in order to significantly blunt GFR decay in a subgroup of Type 2 diabetic patients with typical diabetic glomerular lesions, who are less responsive to tight blood pressure control alone. Conversely, the cohort of patients with less severe diabetic glomerulopathy steadily show constant GFR patterns, despite similar abnormalities of albumin excretion rate, and HbA1c average values above 7.5%.
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Affiliation(s)
- E Brocco
- Department of Medical and Surgical Sciences and Center for the Study of Ageing of the National Research Council, University of Padua, Italy
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Nosadini R, Velussi M, Brocco E, Bruseghin M, Abaterusso C, Saller A, Dalla Vestra M, Carraro A, Bortoloso E, Sambataro M, Barzon I, Frigato F, Muollo B, Chiesura-Corona M, Pacini G, Baggio B, Piarulli F, Sfriso A, Fioretto P. Course of renal function in type 2 diabetic patients with abnormalities of albumin excretion rate. Diabetes 2000; 49:476-84. [PMID: 10868971 DOI: 10.2337/diabetes.49.3.476] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Heterogeneity in renal structure has been described in type 2 diabetic patients with both microalbuminuria and proteinuria; in fact, only a subset of type 2 diabetic patients have the typical diabetic glomerulopathy. However, it is currently unknown whether abnormalities in albumin excretion rate (AER) have a different renal prognostic value depending on the underlying renal structure. Aims of this study were: 1) to study the course of renal function in type 2 diabetic patients with altered AER; 2) to evaluate the relationship between the course of glomerular filtration rate (GFR) and renal structure; and 3) to evaluate the relationship between the course of GFR and baseline AER levels, metabolic control, and blood pressure levels during a follow-up period of 4 years. A total of 108 type 2 diabetic patients, 74 with microalbuminuria (MA) and 34 with proteinuria (P), were recruited into a prospective study that encompassed: 1) a baseline kidney biopsy with morphometric measurements of glomerular parameters; 2) intensified antihypertensive treatment for an average 4-year period (blood pressure target <140/90 mmHg); and 3) determinations of GFR at baseline and every 6 months. Mean (+/- SD) GFR significantly decreased from baseline in both MA (-1.3+/-9.4 [95% CI -3.51 to +0.86], P < 0.05) and P (-3.0+/-13.0 ml x min(-1) x 1.73 m(-2) per year [-7.71 to +1.61], P < 0.01). However, the changes in GFR were quite heterogeneous. Thus, on the basis of percent GFR change per year from baseline (delta%GFR), both MA and P patients were defined as progressors or nonprogressors when they were below or above the median, respectively. Baseline parameters of glomerular structure had a strong influence on the course of GFR. Indeed, the odds ratios of being progressors significantly increased across the quartiles of baseline glomerular basement membrane (GBM) width and mesangial fractional volume [Vv(mes/glom)], being 2.71 and 2.85 higher, respectively, in the fourth quartile than in the first quartile (P < 0.01 for both). Conversely, nonprogressors outnumbered progressors in the first quartile of GBM width (odds ratio: 2.14, P < 0.05) and in the first quartile of Vv(mes/glom) (odds ratio: 2.28, P < 0.01). Baseline albumin excretion rate (AER) did not influence delta%GFR; in fact, the number of progressors did not increase across quartiles of baseline AER among either MA or P. Similarly, mean blood pressure levels during follow-up (and intensified antihypertensive therapy) did not affect the course of GFR: the number of progressors and nonprogressors did not change across quartiles of mean blood pressure. In contrast, HbA1c during follow-up had an impact on delta%GFR: the odds ratio for being a progressor increased across quartiles of HbA1c, particularly for the highest quartile (HbA1c >9.0%). In conclusion, the course of renal function is heterogeneous in type 2 diabetic patients with microalbuminuria or proteinuria. In fact, a subset of patients has a rapid decline in GFR over a 4-year follow-up period; these patients have more advanced diabetic glomerulopathy and worse metabolic control than the remaining patients, whose GFR remains stable. These two cohorts are otherwise undistinguishable as regards the degree of AER at baseline and tight blood pressure control. Kidney biopsy has an important prognostic role in these patients. Thus, tight blood pressure control, when not associated with satisfactory glycemic control, is unable to prevent rapid GFR decline in type 2 diabetic patients with typical diabetic glomerulopathy.
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Affiliation(s)
- R Nosadini
- Department of Endocrinology and Metabolic Diseases, University of Sassari, Italy
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Abstract
The importance of work focused on body experience in the therapy of Eating Disorders is widely acknowledged. Even so, few researches have been devoted to this aspect. This paper describes the employment of adapted physical activity as part of a residential cure programme for 96 eating disorder patients. The chief aims of this programme relate to individual identity, relations with others, the body, and getting patients to build themselves a correct image of physical activity. The wide variety of working tools includes both individual and group activities: movement exercise, adapted sports, dancing, expressive activities, relaxation. The following are used to evaluate results: individual and group talks, specific observation scales, and video recordings of some meetings. As shown by other authors, the observations indicate that controlled physical activities can be usefully integrated into an eating disorders cure project.
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Affiliation(s)
- A Carraro
- Casa di Cura Parco dei Tigli, Villa di Teolo, PD, Italy
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50
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Fioretto P, Stehouwer CD, Mauer M, Chiesura-Corona M, Brocco E, Carraro A, Bortoloso E, van Hinsbergh VW, Crepaldi G, Nosadini R. Heterogeneous nature of microalbuminuria in NIDDM: studies of endothelial function and renal structure. Diabetologia 1998; 41:233-6. [PMID: 9498659 DOI: 10.1007/s001250050895] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Microalbuminuria (MA) is associated with microangiopathy (renal and retinal lesions) in insulin-dependent diabetic (IDDM) patients. In contrast MA does not reflect microvascular damage in a substantial number of non-insulin-dependent diabetic (NIDDM) patients. MA predicts cardiovascular disease in NIDDM patients with increased von Willebrand factor (vWF) plasma levels which are hypothesized to reflect endothelial dysfunction. However, it is not known whether MA is consequent to generalised endothelial dysfunction or to renal injury. Thus, this study evaluated vWF plasma levels in relation to renal and retinal structural abnormalities in NIDDM patients with MA. Kidney biopsies, fundoscopy and measures of vWF plasma levels were performed in 32 NIDDM patients with MA. These patients were allocated to two renal structural categories: A) Without renal structural abnormalities (C I, n = 10): normal or near-normal renal structure, and B) With renal structural abnormalities (n = 22), further divided into: C II (n = 12) with typical diabetic nephropathology, predominantly glomerulopathy, and C III (n = 10) with atypical patterns of renal injury (more advanced tubulo-interstitial and arteriolar than glomerular changes). vWF plasma levels were significantly higher in category B (C II: 195+/-49% and C III: 161+/-46%) than in category A (C I: 119+/-42%), (chi-square, p < 0.05). Diabetic retinopathy was also related to vWF plasma levels (ANOVA, p < 0.05). These data suggest that there are two types of MA in NIDDM: one associated with increased vWF levels, established renal injury and frequently retinopathy, and the other characterized by normal vWF levels, normal renal structure and absent or mild diabetic retinopathy. We propose that vWF plasma levels in NIDDM patients with MA may help to identify patients with important renal structural changes, increased retinopathy risk and, perhaps, generalised endothelial dysfunction. Whether vWF plasma levels predict end-stage renal disease and cardiovascular events deserves longitudinal studies.
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Affiliation(s)
- P Fioretto
- Department of Internal Medicine and Center for the Study of Aging, National Research Council, University of Padova, Italy
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