1
|
Nordengen K, Cappelletti C, Bahrami S, Frei O, Pihlstrøm L, Henriksen SP, Geut H, Rozemuller AJM, van de Berg WDJ, Andreassen OA, Toft M. Pleiotropy with sex-specific traits reveals genetic aspects of sex differences in Parkinson's disease. Brain 2024; 147:858-870. [PMID: 37671566 PMCID: PMC10907091 DOI: 10.1093/brain/awad297] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
Parkinson's disease is an age-related neurodegenerative disorder with a higher incidence in males than females. The causes for this sex difference are unknown. Genome-wide association studies (GWAS) have identified 90 Parkinson's disease risk loci, but the genetic studies have not found sex-specific differences in allele frequency on autosomal chromosomes or sex chromosomes. Genetic variants, however, could exert sex-specific effects on gene function and regulation of gene expression. To identify genetic loci that might have sex-specific effects, we studied pleiotropy between Parkinson's disease and sex-specific traits. Summary statistics from GWASs were acquired from large-scale consortia for Parkinson's disease (n cases = 13 708; n controls = 95 282), age at menarche (n = 368 888 females) and age at menopause (n = 69 360 females). We applied the conditional/conjunctional false discovery rate (FDR) method to identify shared loci between Parkinson's disease and these sex-specific traits. Next, we investigated sex-specific gene expression differences in the superior frontal cortex of both neuropathologically healthy individuals and Parkinson's disease patients (n cases = 61; n controls = 23). To provide biological insights to the genetic pleiotropy, we performed sex-specific expression quantitative trait locus (eQTL) analysis and sex-specific age-related differential expression analysis for genes mapped to Parkinson's disease risk loci. Through conditional/conjunctional FDR analysis we found 11 loci shared between Parkinson's disease and the sex-specific traits age at menarche and age at menopause. Gene-set and pathway analysis of the genes mapped to these loci highlighted the importance of the immune response in determining an increased disease incidence in the male population. Moreover, we highlighted a total of nine genes whose expression or age-related expression in the human brain is influenced by genetic variants in a sex-specific manner. With these analyses we demonstrated that the lack of clear sex-specific differences in allele frequencies for Parkinson's disease loci does not exclude a genetic contribution to differences in disease incidence. Moreover, further studies are needed to elucidate the role that the candidate genes identified here could have in determining a higher incidence of Parkinson's disease in the male population.
Collapse
Affiliation(s)
- Kaja Nordengen
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
| | - Chiara Cappelletti
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
- Department of Mechanical, Electronics and Chemical Engineering, Faculty of Technology, Art and Design, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway
- Department of Research, Innovation and Education, Oslo University Hospital, 0424 Oslo, Norway
| | - Shahram Bahrami
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, 0450 Oslo, Norway
| | - Oleksandr Frei
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, 0450 Oslo, Norway
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Hanneke Geut
- Section of Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 Amsterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 Amsterdam, The Netherlands
| | - Wilma D J van de Berg
- Section of Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam Neuroscience, 1081 Amsterdam, The Netherlands
| | - Ole A Andreassen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, 0450 Oslo, Norway
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
| |
Collapse
|
2
|
Incocciati A, Kubeš J, Piacentini R, Cappelletti C, Botta S, Bertuccini L, Šimůnek T, Boffi A, Macone A, Bonamore A. Hydrophobicity-enhanced ferritin nanoparticles for efficient encapsulation and targeted delivery of hydrophobic drugs to tumor cells. Protein Sci 2023; 32:e4819. [PMID: 37883077 PMCID: PMC10661074 DOI: 10.1002/pro.4819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023]
Abstract
Ferritin, a naturally occurring iron storage protein, has gained significant attention as a drug delivery platform due to its inherent biocompatibility and capacity to encapsulate therapeutic agents. In this study, we successfully genetically engineered human H ferritin by incorporating 4 or 6 tryptophan residues per subunit, strategically oriented towards the inner cavity of the nanoparticle. This modification aimed to enhance the encapsulation of hydrophobic drugs into the ferritin cage. Comprehensive characterization of the mutants revealed that only the variant carrying four tryptophan substitutions per subunit retained the ability to disassemble and reassemble properly. As a proof of concept, we evaluated the loading capacity of this mutant with ellipticine, a natural hydrophobic indole alkaloid with multimodal anticancer activity. Our data demonstrated that this specific mutant exhibited significantly higher efficiency in loading ellipticine compared to human H ferritin. Furthermore, to evaluate the versatility of this hydrophobicity-enhanced ferritin nanoparticle as a drug carrier, we conducted a comparative study by also encapsulating doxorubicin, a commonly used anticancer drug. Subsequently, we tested both ellipticine and doxorubicin-loaded nanoparticles on a promyelocytic leukemia cell line, demonstrating efficient uptake by these cells and resulting in the expected cytotoxic effect.
Collapse
Affiliation(s)
- Alessio Incocciati
- Department of Biochemical Sciences “A. Rossi Fanelli”Sapienza University of RomeRomeItaly
| | - Jan Kubeš
- Department of Biochemical Sciences, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Roberta Piacentini
- Department of Biochemical Sciences “A. Rossi Fanelli”Sapienza University of RomeRomeItaly
- Center of Life Nano‐ and Neuro‐ScienceItalian Institute of TechnologyRomeItaly
| | - Chiara Cappelletti
- Department of Biochemical Sciences “A. Rossi Fanelli”Sapienza University of RomeRomeItaly
| | - Sofia Botta
- Department of Biochemical Sciences “A. Rossi Fanelli”Sapienza University of RomeRomeItaly
| | | | - Tomáš Šimůnek
- Department of Biochemical Sciences, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Alberto Boffi
- Department of Biochemical Sciences “A. Rossi Fanelli”Sapienza University of RomeRomeItaly
| | - Alberto Macone
- Department of Biochemical Sciences “A. Rossi Fanelli”Sapienza University of RomeRomeItaly
| | - Alessandra Bonamore
- Department of Biochemical Sciences “A. Rossi Fanelli”Sapienza University of RomeRomeItaly
| |
Collapse
|
3
|
Andersen MS, Leikfoss IS, Brorson IS, Cappelletti C, Bettencourt C, Toft M, Pihlstrøm L. Epigenome-wide association study of peripheral immune cell populations in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:149. [PMID: 37903812 PMCID: PMC10616224 DOI: 10.1038/s41531-023-00594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
Understanding the contribution of immune mechanisms to Parkinson's disease pathogenesis is an important challenge, potentially of major therapeutic implications. To further elucidate the involvement of peripheral immune cells, we studied epigenome-wide DNA methylation in isolated populations of CD14+ monocytes, CD19+ B cells, CD4+ T cells, and CD8+ T cells from Parkinson's disease patients and healthy control participants. We included 25 patients with a maximum five years of disease duration and 25 controls, and isolated four immune cell populations from each fresh blood sample. Epigenome-wide DNA methylation profiles were generated from 186 samples using the Illumina MethylationEpic array and association with disease status was tested using linear regression models. We identified six differentially methylated CpGs in CD14+ monocytes and one in CD8 + T cells. Four differentially methylated regions were identified in monocytes, including a region upstream of RAB32, a gene that has been linked to LRRK2. Methylation upstream of RAB32 correlated negatively with mRNA expression, and RAB32 expression was upregulated in Parkinson's disease both in our samples and in summary statistics from a previous study. Our epigenome-wide association study of early Parkinson's disease provides evidence for methylation changes across different peripheral immune cell types, highlighting monocytes and the RAB32 locus. The findings were predominantly cell-type-specific, demonstrating the value of isolating purified cell populations for genomic studies.
Collapse
Affiliation(s)
- Maren Stolp Andersen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | - Conceicao Bettencourt
- Department of Neurodegenerative Disease and Queen Square Brain Bank for Neurological Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
| |
Collapse
|
4
|
Cappelletti C, Henriksen SP, Geut H, Rozemuller AJM, van de Berg WDJ, Pihlstrøm L, Toft M. Transcriptomic profiling of Parkinson's disease brains reveals disease stage specific gene expression changes. Acta Neuropathol 2023; 146:227-244. [PMID: 37347276 PMCID: PMC10329075 DOI: 10.1007/s00401-023-02597-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/02/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
Parkinson´s disease (PD) is a progressive neurodegenerative disorder characterized by both motor and non-motor symptoms. Aggravation of symptoms is mirrored by accumulation of protein aggregates mainly composed by alpha-synuclein in different brain regions, called Lewy bodies (LB). Previous studies have identified several molecular mechanisms as autophagy and inflammation playing a role in PD pathogenesis. Increased insights into mechanisms involved in early disease stages and driving the progression of the LB pathology are required for the development of disease-modifying strategies. Here, we aimed to elucidate disease stage-specific transcriptomic changes in brain tissue of well-characterized PD and control donors. We collected frontal cortex samples from 84 donors and sequenced both the coding and non-coding RNAs. We categorized our samples into groups based on their degree of LB pathology aiming to recapitulate a central aspect of disease progression. Using an analytical pipeline that corrected for sex, age at death, RNA quality, cell composition and unknown sources of variation, we found major disease stage-specific transcriptomic changes. Gene expression changes were most pronounced in donors at the disease stage when microscopic LB changes first occur in the sampled brain region. Additionally, we identified disease stage-specific enrichment of brain specific pathways and immune mechanisms. On the contrary, we showed that mitochondrial mechanisms are enriched throughout the disease course. Our data-driven approach also suggests a role for several poorly characterized lncRNAs in disease development and progression of PD. Finally, by combining genetic and epigenetic information, we highlighted two genes (MAP4K4 and PHYHIP) as candidate genes for future functional studies. Together our results indicate that transcriptomic dysregulation and associated functional changes are highly disease stage-specific, which has major implications for the study of neurodegenerative disorders.
Collapse
Affiliation(s)
- Chiara Cappelletti
- Department of Mechanical, Electronics and Chemical Engineering, Faculty of Technology, Art and Design, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Department of Research, Innovation and Education, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Hanneke Geut
- Amsterdam UMC, Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, Netherlands
- Netherlands Brain Bank, Netherlands Institute of Neurosciences, Amsterdam, Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam UMC, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, Netherlands
| | - Wilma D J van de Berg
- Amsterdam UMC, Section Clinical Neuroanatomy and Biobanking, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, Netherlands
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|
5
|
Cappelletti C, Eriksson A, Brorson IS, Leikfoss IS, Kråbøl O, Høgestøl EA, Vitelli V, Mjaavatten O, Harbo HF, Berven F, Bos SD, Berge T. Quantitative proteomics reveals protein dysregulation during T cell activation in multiple sclerosis patients compared to healthy controls. Clin Proteomics 2022; 19:23. [PMID: 35790914 PMCID: PMC9254507 DOI: 10.1186/s12014-022-09361-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 06/22/2022] [Indexed: 12/20/2022] Open
Abstract
Background Multiple sclerosis (MS) is an autoimmune, neurodegenerative disorder with a strong genetic component that acts in a complex interaction with environmental factors for disease development. CD4+ T cells are pivotal players in MS pathogenesis, where peripherally activated T cells migrate to the central nervous system leading to demyelination and axonal degeneration. Through a proteomic approach, we aim at identifying dysregulated pathways in activated T cells from MS patients as compared to healthy controls. Methods CD4+ T cells were purified from peripheral blood from MS patients and healthy controls by magnetic separation. Cells were left unstimulated or stimulated in vitro through the TCR and costimulatory CD28 receptor for 24 h prior to sampling. Electrospray liquid chromatography-tandem mass spectrometry was used to measure protein abundances. Results Upon T cell activation the abundance of 1801 proteins was changed. Among these proteins, we observed an enrichment of proteins expressed by MS-susceptibility genes. When comparing protein abundances in T cell samples from healthy controls and MS patients, 18 and 33 proteins were differentially expressed in unstimulated and stimulated CD4+ T cells, respectively. Moreover, 353 and 304 proteins were identified as proteins exclusively induced upon T cell activation in healthy controls and MS patients, respectively and dysregulation of the Nur77 pathway was observed only in samples from MS patients. Conclusions Our study highlights the importance of CD4+ T cell activation for MS, as proteins that change in abundance upon T cell activation are enriched for proteins encoded by MS susceptibility genes. The results provide evidence for proteomic disturbances in T cell activation in MS, and pinpoint to dysregulation of the Nur77 pathway, a biological pathway known to limit aberrant effector T cell responses.
Collapse
|
6
|
Iqbal Z, Koht J, Pihlstrøm L, Henriksen SP, Cappelletti C, Russel MB, Norberto de Souza O, Skogseid IM, Toft M. Missense mutations in DYT-TOR1A dystonia. Neurol Genet 2019; 5:e343. [PMID: 31321303 PMCID: PMC6563516 DOI: 10.1212/nxg.0000000000000343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/09/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Zafar Iqbal
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Jeanette Koht
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Lasse Pihlstrøm
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Sandra P Henriksen
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Chiara Cappelletti
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Michael Bjørn Russel
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Osmar Norberto de Souza
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Inger Marie Skogseid
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Mathias Toft
- Department of Neurology (Z.I., L.P., S.P.H., C.C,. I.M.S,. M.T), Oslo University Hospital; Institute of Clinical Medicine (J.K., M.T), University of Oslo; Department of Neurology (J.K), Drammen Hospital, Vestre Viken Hospital Trust; Head and Neck Research Group, Research Center (M.B.R), Akershus University Hospital; Campus Akershus University Hospital (M.B.R), University of Oslo, Norway; and Faculty of Informatics, Laboratory for Bioinformatics, Modelling & Simulation of Biosystems (O.N.D.S), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| |
Collapse
|
7
|
Pihlstrøm L, Blauwendraat C, Cappelletti C, Berge-Seidl V, Langmyhr M, Henriksen SP, van de Berg WDJ, Gibbs JR, Cookson MR, Singleton AB, Nalls MA, Toft M. A comprehensive analysis of SNCA-related genetic risk in sporadic parkinson disease. Ann Neurol 2018; 84:117-129. [PMID: 30146727 DOI: 10.1002/ana.25274] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/13/2018] [Accepted: 06/15/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The goal of this study was to refine our understanding of disease risk attributable to common genetic variation in SNCA, a major locus in Parkinson disease, with potential implications for clinical trials targeting α-synuclein. We aimed to dissect the multiple independent association signals, stratify individuals by SNCA-specific risk profiles, and explore expression quantitative trait loci. METHODS We analyzed participant-level data from 12,503 patients and 12,502 controls, optimizing a risk model and assessing SNCA-specific risk scores and haplotypes as predictors of individual risk. We also explored hypotheses about functional mechanisms and correlated risk variants to gene expression in human brain and protein levels in cerebrospinal fluid. RESULTS We report and replicate a novel, third independent association signal at genome-wide significance level downstream of SNCA (rs2870004, p = 3.0*10-8 , odds ratio [OR] = 0.88, 95% confidence interval [CI] = 0.84-0.92). SNCA risk score stratification showed a 2-fold difference in disease susceptibility between top and bottom quintiles (OR = 1.99, 95% CI = 1.78-2.23). Contrary to previous reports, we provide evidence supporting top variant rs356182 as functional in itself and associated with a specific SNCA 5' untranslated region transcript isoform in frontal cortex. INTERPRETATION The SNCA locus harbors a minimum of 3 independent association signals for Parkinson disease. We demonstrate a fine-grained stratification of α-synuclein-related genetic burden in individual patients of potential future clinical relevance. Further efforts to pinpoint the functional mechanisms are warranted, including studies of the likely causal top variant rs356182 and its role in regulating levels of specific SNCA mRNA transcript variants. Ann Neurol 2018;83:117-129.
Collapse
Affiliation(s)
- Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Cornelis Blauwendraat
- Neurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.,Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | | | | | | | | | - Wilma D J van de Berg
- Department of Anatomy and Neurosciences, Clinical Neuroanatomy Section, Amsterdam Neuroscience, VU Medical Center, Amsterdam, the Netherlands
| | - J Raphael Gibbs
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | - Mark R Cookson
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | | | | | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD.,Data Tecnica International, Glen Echo, MD
| | - Mathias Toft
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
8
|
Imperatori L, Lippe P, Trapuzzano C, Laid G, Cappelletti C, Tamburrano T, Mattioli R. 5075 POSTER Non-pegylated Liposomal Doxorubicin (Myocet e) Plus Docetaxel (Taxotere e) (MYTAX), as First-line Chemotherapy (CHT), in Metastatic Breast Cancer (MBC): Results of a Phase II Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71517-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
9
|
Cappelletti C, Baggi F, Zolezzi F, Biancolini D, Beretta O, Severa M, Coccia EM, Confalonieri P, Morandi L, Mora M, Mantegazza R, Bernasconi P. Type I interferon and Toll-like receptor expression characterizes inflammatory myopathies. Neurology 2011; 76:2079-88. [DOI: 10.1212/wnl.0b013e31821f440a] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
10
|
Franchi GM, Cappelletti C, Villa VV, Bosi E, Manzoni MF. Role of high dose octreotide LAR for the treatment of GEP-NETs. CMI 2009. [DOI: 10.7175/cmi.v3i1.555] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Neuroendocrine Tumours (NETs) are a heterogeneous group of rare neoplasms that account for 0,5% of all malignancies. The increased incidence observed in the last few decades may be accounted for by increased awareness, improved diagnostic tools and a revision in the definition. The main primary sites are the gastro-entero-pancreatic (GEP) tract (62-67%), and the lung (22-27%). In patients with GEP-NETs, the strongest predictor of 5-years survival is the staging. An adequate clinical management of GEP-NETs should be multidisciplinary and should aim at assuring a good quality of life. Somatostatin (sst) analogues are widely used in these tumours, which often express sst receptors, since they are demonstrated to reduce clinical symptoms and tumour growth. Herein we explore the usefulness of doubling octreotide LAR dose in selected patients after escaping from symptoms control and/or tumour stabilization in course of treatment with standard dose.
Collapse
|
11
|
Piani C, Franchi GM, Cappelletti C, Scavini M, Albarello L, Zerbi A, Giorgio Arcidiacono P, Bosi E, Manzoni MF. Cytological Ki-67 in pancreatic endocrine tumours: an opportunity for pre-operative grading. Endocr Relat Cancer 2008; 15:175-81. [PMID: 18310285 DOI: 10.1677/erc-07-0126] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [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: 12/13/2022]
Abstract
The cytological Ki-67 expression measured on cytological samples collected by endoscopic ultrasonography-guided fine needle aspiration cytology (EUS-FNAC) may provide pre-operative indications for pancreatic endocrine tumours (PETs) management. The aim of our study was to assess reliability of Ki-67 expression measured on cytological samples obtained by EUS-FNAC in patients with PETs. Eighteen patients with PETs underwent EUS-FNAC before surgery. Ki-67 expression was measured on FNACs and on histological sections. Using a cut-off of 2%, percent agreement of Ki-67 expression on cytological and histological samples was 89% (k-statistic: 0.78, 95% confidence intervals (95% CI): 0.5, 1.0). Using cut-off values of 2 and 10%, percent agreement was 78% (k-statistic: 0.65, 95% CI: 0.3, 0.9). Ki-67 expression measured on cytological samples obtained by EUS-FNAC before surgery showed good agreement with that measured on histological samples.
Collapse
Affiliation(s)
- Cecilia Piani
- General Medicine, Diabetes and Endocrinology Unit, San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Via Olgettina 60, Milano, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Manzoni MF, Franchi GM, Sartorio SM, Di Rosa E, Cappelletti C, Piani C, Cattaneo C, Ferrari M, Bosi E, Carrera P. A novel MEN1 gene mutation. ACTA ACUST UNITED AC 2008; 180:165-7. [DOI: 10.1016/j.cancergencyto.2007.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 10/22/2007] [Indexed: 10/22/2022]
|
13
|
Mattioli R, Massacesi C, Recchia F, Marcucci F, Cappelletti C, Imperatori L, Pilone A, Rocchi M, Cesta A, Laici G, Bonsignori M, Lippe P. High activity and reduced neurotoxicity of bi-fractionated oxaliplatin plus 5-fluorouracil/leucovorin for elderly patients with advanced colorectal cancer. Ann Oncol 2005; 16:1147-51. [PMID: 15849224 DOI: 10.1093/annonc/mdi222] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [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: 11/15/2022] Open
Abstract
BACKGROUND The proportion of elderly within the general population is increasing and the incidence of colorectal cancer increases with age. Oxaliplatin and 5-fluorouracil (FU) combination is active in this disease. PATIENTS AND METHODS This multicenter phase II study was designed to investigate feasibility, efficacy, activity of daily living (ADL) and instrumental activity of daily living (IADL) in elderly patients with metastatic colorectal cancer treated, as first-line chemotherapy, with a bi-fractionated oxaliplatin/5-FU based regimen. Treatment was oxaliplatin 45 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 and 22 h continuous infusion of 5-FU 600 mg/m2, all given intravenously on days 1 and 2, every 2 weeks. RESULTS Seventy-eight patients were enrolled; median age was 75 years (range 70-85). Among 77 evaluable patients, we observed seven complete responses and 32 partial responses, for an overall response rate of 51% (95% confidence interval 40% to 62%). A stabilization of disease was observed in 25% of patients while 19 patients progressed. Canadian NCI grade 3/4 toxicities were: neutropenia in 32% of patients (febrile in two), diarrhea in 10%, mucositis in 4%, and fatigue in 4%. Sensory neuropathy was mild and occurred as grade 3 in 6% of patients. ADL and IADL scores did not change significantly during treatment. CONCLUSIONS The bi-fractionated delivery of oxaliplatin plus 5-FU/leucovorin demonstrated high antitumor activity in elderly patients with advanced colorectal cancer. Splitting oxaliplatin administration might reduce incidence of severe neuropathy, although this has to be confirmed by further studies.
Collapse
Affiliation(s)
- R Mattioli
- S. Croce Hospital, Medical Oncology Unit, Fano
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Massacesi C, Lippe P, Recchia F, Marcucci F, Rocchi M, Cesta A, Pilone A, Cappelletti C, Bonsignori M, Mattioli R. Bi-fractionated oxaliplatin (L-OHP) plus 5-fluorouracil (5FU)/leucovorin (LV) for elderly patients (pts) with advanced colorectal cancer (CRC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Massacesi
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - P. Lippe
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - F. Recchia
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - F. Marcucci
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - M. Rocchi
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - A. Cesta
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - A. Pilone
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - C. Cappelletti
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - M. Bonsignori
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| | - R. Mattioli
- Medcl Oncology/Radiotherapy, Ospedali Riuniti, Ancona, Italy; Medcl Oncology, Fano, Italy; Medcl Oncology, Avezzano, Italy; Biomathematics Institute, Urbino University, Italy
| |
Collapse
|
15
|
Lippe P, Mazzanti P, Recchia F, Massacesi C, Cappelletti C, Imperatori L, Laici G, Bonsignori M, Mattioli R. Gemcitabine-oxaliplatin combination (GEM-OHP) in metastatic non-small cell lung cancer (NSCLC): Final results of a phase II study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. Lippe
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - P. Mazzanti
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - F. Recchia
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - C. Massacesi
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - C. Cappelletti
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - L. Imperatori
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - G. Laici
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - M. Bonsignori
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| | - R. Mattioli
- S. Croce Hosp, Fano, Italy; Torrette Hosp, Ancona, Italy; Civilian Hosp, Avezzano, Italy
| |
Collapse
|
16
|
Bartoletti A, Fabiani P, Gianni R, Cappelletti C, Santoro GM, Fortini A, Adriani P, Baccetti F, Buffini G, Lavacchi A, Ticali PF, Viganò S. [After the 2001 European Society of Cardiology Guidelines: is it possible to reduce the number of patients with syncope to be hospitalized?]. Minerva Med 2004; 95:451-60. [PMID: 15467520] [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: 04/30/2023]
Abstract
AIM The aim of this paper was to evaluate how many patients with syncope should be hospitalized according to the 2001 European Society of Cardiology (ESC) Guidelines on the management of syncope. METHODS Starting from August 2002 we prompted a Syncope Unit (SU), as a multi-disciplinary functional structure including the Emergency Department. One of the main objectives of the SU was the implementation of the 2001 ESC Guidelines on Syncope and of the relevant criteria for hospitalization. All the clinical data concerning the patients presenting with syncope were prospectively collected and stored in a dedicated database. RESULTS Between September 1, 2002 and April 30, 2003, 402 patients were observed for a syncope. Out of these, 19 had a cardiogenic syncope, 3 focal neurologic disorders, 25 a severe trauma, 4 severe orthostatic hypotension and 5 carotid syncope. Therefore, 56 patients out of 402 were found to have indication to therapeutical hospitalization. Among the remaining 346 patients, 83 patients were found to have a structural heart disease and/or an abnormal ECG, 1 had syncope during exercise, 3 presented a familial history of sudden death. Thirty-three were found to have severe comorbidities and further 14 had occasional indication to hospitalization. Thus, 190 out of the 402 patients with syncope (47.3%) presented at least 1 criterion for hospitalization according to the ESC Guidelines. CONCLUSION The implementation of the ESC Guidelines on Syncope is technically feasible. Nevertheless, even when the Guidelines are strictly observed, a high percentage of patients with syncope has still to be hospitalized. Our data suggest that new criteria should be established for a safe Emergency Department discharge of the patients with syncope, particularly of those with structural heart disease or abnormal ECG.
Collapse
Affiliation(s)
- A Bartoletti
- Unità Operativa di Cardiologia, Nuovo Ospedale San Giovanni di Dio, Firenze, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Mattioli R, Lippe P, Massacesi C, Cappelletti C, Nacciarriti D, Bisonni R, Graziano F, Menichetti ET, Imperatori L, Testa E, Laici G, Balletra A, Silva RR. Long-survival in responding patients with metastatic breast cancer treated with doxorubicin-docetaxel combination. A multicentre phase II trial. Anticancer Res 2004; 24:3257-61. [PMID: 15510620] [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: 05/01/2023]
Abstract
BACKGROUND The doxorubicin-docetaxel combination is active in breast cancer; the aim of the present study was to evaluate the complete response rate and safety profile of the doxorubicin and docetaxel regimen as first-line chemotherapy in metastatic breast cancer patients. PATIENTS AND METHODS Forty-three patients entered the study. Treatment plan was: doxorubicin (50 mg/m2, i.v. bolus) followed 1 hour later by docetaxel (75 mg/m2 i.v. infusion over 1 hour), q 3 weeks, for up to six courses. The patients achieving a response or a stabilisation of disease after 6 courses were allowed to intensify the treatment with docetaxel (100 mg/m2, q 3 weeks) for up to 2 courses. G-CSF (or GM-CSF) was administered if clinically indicated. RESULTS Patients' median age was 57years (range 32-75) and 72% of them had visceral disease. A total of 217 doxorubicin-docetaxel courses were delivered, with 70% of patients receiving all the 6 planned cycles. Among the 40 patients assessable for response (WHO criteria), 7 (16%) achieved a complete remission and 22 (51%) a partial remission, for an overall response rate (intent-to-treat) of 67% (95% C.I. =53% to 81%). In 19 patients, the treatment was intensified with two more single-agent docetaxel cycles, without ameliorating the response. Twenty-seven patients with oestrogen receptor-positive received hormonal therapy as 'maintenance' after completing chemotherapy treatment. NCIC G3-G4 neutropenia was recorded in 58% of patients, with G/GM-CSF used in 23 (53%) patients and 91 (38%) cycles. No patients experienced severe cardiac or neurological toxicity. No toxic death occurred. With a median follow-up of 41 months among alive patients, we observed in responder patients an overall median time to progression and survival of 18 and 33 months respectively, with ten long-survivors still alive. CONCLUSION This study confirmed the combination doxorubicin-docetaxel as a very active regimen for metastatic breast cancer. Remarkably long survival times were observed not only in complete responders, but also in those patients who responded partially. This might be equally attributed to first-line treatment and sequential maintenance hormonal therapy.
Collapse
|
18
|
Massacesi C, Terrazzino S, Marcucci F, Rocchi MBL, Cappelletti C, Giustini L, Lombardo M, Rinaldi L, Mattioli R, Bonsignori M. Role of UGT1A1, MTHFR AND TS gene polymorphisms in the prediction of irinotecan (CPT11) and raltitrexed (TOM) gastrointestinal toxicity in pre-treated patients (pts) with metastatic colorectal cancer (CRC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Massacesi
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - S. Terrazzino
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - F. Marcucci
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - M. B. L. Rocchi
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - C. Cappelletti
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - L. Giustini
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - M. Lombardo
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - L. Rinaldi
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - R. Mattioli
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| | - M. Bonsignori
- Oncology & Radiotherapy Department, Ancona, Italy; Research & Innovation, Padova, Italy; Medical Oncology, Ancona, Italy; Urbino University, Bio-Mathematics & Statistic Department, Urbino, Italy; Medical Oncology, Fano, Italy; Medical Oncology, Fermo, Italy; Medical Oncology, Pescara, Italy
| |
Collapse
|
19
|
Affiliation(s)
- Stefania Iametti
- Dipartimento di Scienze Molecolari Agroalimentari
- Corresponding author. Phone: +39-02-5031-6819. Fax: +39-02-5031-6801. E-mail:
| | | | | | - Laura Scafuri
- Associazione Italiana Celiachia, Via Lombardia 11, 23888 Rovagnate, Italy
| | - Francesco Bonomi
- Dipartimento di Scienze Molecolari Agroalimentari
- Centro Studi Celiachia, Università degli Studi di Milano, Via Celoria 2, 20133 Milano, Italy
| |
Collapse
|
20
|
Prisco D, Fedi S, Brunelli T, Chiarugi L, Lombardi A, Gianni R, Santoro E, Cappelletti C, Pepe G, Gensini GF, Abbate R. The influence of smoking on von Willebrand factor is already manifest in healthy adolescent females: the Floren-teen (Florence Teenager) Study. Int J Clin Lab Res 2000; 29:150-4. [PMID: 10784376 DOI: 10.1007/s005990050082] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The early onset of atherosclerosis and the involvement of physiological biochemical, and environmental factors in its pathogenesis is well documented. Few data are available on the role of risk factors related to hemostasis in the pathogenesis of atherosclerosis in the young and, in particular, little information is available on adolescent populations. In the Study of Preventive Medicine and Education Program (Floren-teen Study), von Willebrand factor, a risk factor for cardiovascular disorder, was studied, together with classical cardiovascular risk factors, in apparently healthy students from two high schools in Florence. Familial and personal history, physical examination, and cardiovascular risk factors were evaluated in 144 students (aged 17-19 years). Blood was withdrawn to assess von Willebrand factor (ELISA) and lipid parameters. Levels of von Willebrand factor were significantly higher (P<0.044) in smokers than in nonsmokers and were correlated with the number of cigarettes per day in the whole group (P=0.01) and in females (P=0.006). In females a positive correlation was observed between von Willebrand factor and high-density lipoprotein cholesterol (P=0.0365). There was no significant correlation between von Willebrand factor and blood pressure or between von Willebrand factor and physical activity. In conclusion, this study shows an association between levels of von Willebrand factor and smoking habits and is the first show that even a brief period of smoking affects levels of von Willebrand factor in healthy adolescent females independently of other risk factors. These results stress the relevance of extending prevention programs to reduce smoking in high school students.
Collapse
Affiliation(s)
- D Prisco
- Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Fortini A, Corti G, Cappelletti C. [Chlamydia pneumoniae and atherosclerosis]. Ann Ital Med Int 1999; 14:253-63. [PMID: 10638018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
There is widespread consensus that atherosclerosis is an inflammatory disease. Between possible pathogenetic mechanisms, infective hypothesis has received increasing attention. Researches have recently focused their attention on the role of Chlamydia pneumoniae, a gram-negative intracellular organism, as infection by this bacterium has been demonstrated frequently associated with atherosclerosis. This review attempts to analyze and critically evaluate available data of the literature about the association between Chlamydia pneumoniae and atherosclerosis in order to provide updated elements of judgement concerning a possible future revolutionary scenario: the consideration of atherosclerosis as an infective disease, susceptible to prevention and treatment by means of antimicrobial therapy. More than twenty sero-epidemiological studies have found a two-fold or greater risk of cardiovascular events in subjects with serological evidence of Chlamydia pneumoniae infection. The organism has been identified in over 50% of atherosclerotic plaques examined by various histopathological techniques, while it has been only rarely found in normal artery tissues; moreover, viable Chlamydia pneumoniae has recently been isolated from coronary and carotid atherosclerotic plaques. Several experimental studies have shown that the biological properties of Chlamydia pneumoniae can explain its potential role in initiating and/or modulating plaque formation. The most relevant issue, i.e. the possibility of preventing or slowing progression of the disease with antimicrobial treatment, is still unsolved: only data from experimental studies on animals and four small intervention trials on humans are available, and their encouraging results require confirmation in larger prospective studies. In conclusion, while the association between Chlamydia pneumoniae and atherosclerosis seems to be established, it is still uncertain whether or not the organism plays a causal role in atherosclerosis and its complications. It is hoped that the results of wide scale clinical intervention trials with antibiotics for the secondary prevention of atherosclerotic diseases now in progress will clarify this problem.
Collapse
Affiliation(s)
- A Fortini
- Nuovo Ospedale San Giovanni di Dio di Firenze
| | | | | |
Collapse
|
22
|
Spolveri S, Baruffi MC, Cappelletti C, Semerano F, Rossi S, Pracucci G, Inzitari D. Vascular risk factors linked to multiple lacunar infarcts. Cerebrovasc Dis 1998; 8:152-7. [PMID: 9619698 DOI: 10.1159/000015841] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [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: 11/19/2022] Open
Abstract
BACKGROUND The pathogenesis of lacunar infarcts is still incompletely established. Data from the literature suggest that vascular risk factors differ among patients with multiple (MLI) and single lacunar infarcts (SLI). We reexamined this hypothesis using stricter inclusion criteria and a less selected study population. METHODS We evaluated 136 patients consecutively admitted for first-ever minor stroke to a general hospital with the characteristics of a community hospital. Vascular risk factors were studied by univariate and multivariate statistical analyses among the following subgroups of patients, classified according to CT findings: (a) with lacunar infarct; (b) with nonlacunar infarct (NLI); (c) with SLI; (d) with MLI; (e) with single, either lacunar or nonlacunar, infarct. RESULTS No significant difference was observed between patients with lacunar infarcts and patients with NLI. Compared to patients with SLI or NLI, patients with MLI had significantly more often a family history of hypertension, cardiomegaly on the chest radiograph and CT leukoaraiosis as well as a higher systolic and diastolic blood pressure on admission. Logistic regression analysis selected CT leukoaraiosis, Rx cardiomegaly and admission diastolic blood pressure as independent, significant predictors of MLI. CONCLUSION In patients with first-ever minor stroke, the risk factor profile differs according to the evidence of SLI or MLI on the CT scan. In terms of risk factors, patients with SLI seem more similar to those with NLI than those with MLI. Based on the predicting effect of variables linked with type and severity of arterial hypertension, the CT appearance of MLI might express a more univocal and specific cerebrovascular pathology (hypertensive arteriolosclerosis).
Collapse
Affiliation(s)
- S Spolveri
- Department of Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | | | | | | | | | | | | |
Collapse
|
23
|
Prisco D, Fedi S, Brunelli T, Cellai AP, Hagi MI, Gianni R, Santoro E, Cappelletti C, Pepe G, Gensini GF, Abbate R. Fibrinogen and factor VIIag in healthy adolescents: the Floren-teen (Florence teenager) Study. Thromb Haemost 1996; 75:778-81. [PMID: 8725723] [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: 02/01/2023]
Abstract
At least five studies based on more than twenty thousand healthy subjects indicated that fibrinogen is an independent risk factor for cardiovascular events; less clear-cut is the relation between factor VII and risk for arterial thrombotic disorders, which was demonstrated in two of the three studies investigating this association. However, no study has investigated the behaviour of fibrinogen and factor VII in an adolescent population. In a study of Preventive Medicine and Education Program, fibrinogen (clotting method) and factor VIIag (ELISA), in addition to other metabolic parameters, life-style and familial history, were investigated in 451 students (313 females and 138 males, age 15-17 years) from two high schools of Florence. Fibrinogen levels were significantly higher in women than in men, whereas factor VIIag levels did not significantly differ. Both fibrinogen and factor VIIag significantly correlated with total cholesterol (p < 0.05) while only fibrinogen correlated with body mass index (p < 0.01). Factor VIIag was significantly correlated with systolic blood pressure (p < 0.001). This study provides information on coagulation risk factors in a population of adolescents which may be of importance in planning coronary heart disease prevention programs.
Collapse
Affiliation(s)
- D Prisco
- Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Fortini A, Nenci G, Laureano R, Cappelletti C. [Hypertension, hyperpotassemia and normal glomerular filtration (Gordon's syndrome): a case report]. G Ital Cardiol 1996; 26:51-6. [PMID: 8682260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe a case of a 26 year old patient affected by a rare syndrome characterized by hyperkalemia, arterial hypertension and normal glomerular filtration rate (Gordon's syndrome), probably due to a renal tubular defect in the reabsorption of sodium or chloride. The patient, who had hyperkalemia since the age of 4 years, was referred to our Centre because of hypertension not well controlled with antihypertensive treatment. After drug therapy wash-out, we confirmed the existence of hypertension (180/100 mm Hg; ambulatory BP monitoring: 24-h mean BP = 151/91 mm Hg; 7 am-11 pm = 157/95; 11 pm-7 am: 133/82) and blood and urine tests showed hyperkalemia (6.6 mEq/L), hyperchloremia (115 mEq/L), mild metabolic acidosis (pH = 7.35, HCO3 = 19 mEq/L), low levels of plasma renin activity ( < 0.2 ng/ml/h), slight increase of plasma (1.08 nM/L) and daily urine aldosterone (129 nM) and normal serum creatinine (1.1 mg/dl) and glomerular filtration rate (91 ml/min). These data allowed to exclude the presence of renal failure and hyporeninemic hypoaldosteronism, which are the most common diseases with hypertension and hyperkalemia, and suggested the diagnosis of Gordon's syndrome. After 1 month of treatment with chlorthalidone (12.5 mg o.i.d) we observed the normalization of BP (130/80 mm Hg; ambulatory BP monitoring: 24-h BP: 132/76 mm), serum potassium (5,1 mEq/L) and the other blood and urine tests. These results were confirmed 6 months later and at present the patient has good clinical conditions.
Collapse
Affiliation(s)
- A Fortini
- Centro per lo Studio Della Ipertensione Arteriosa, i Medicina Interna, Nuovo Ospedale San Giovanni di dio, Firenze
| | | | | | | |
Collapse
|
25
|
Fortini A, Laureano R, Nenci G, Cappelletti C. [The use of ambulatory pressure monitoring for evaluating antihypertensive treatment in clinical practice]. Minerva Med 1995; 86:527-35. [PMID: 8684679] [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: 02/01/2023]
Abstract
OBJECTIVE To describe the clinical experience of our Centre in the assessment of antihypertensive therapy with 24-hour ambulatory blood pressure monitoring (ABPM). DESIGN AND PATIENTS We retrospectively studied all the 241 out-patients on antihypertensive therapy submitted to ABPM (SpaceLabs 90207, USA) between March 1992 and March 1993 for clinical purposes. We evaluated: 1) the clinical indications for the test; 2) the modifications of drug treatment suggested by the ABPM results; 3) the referring physicians' acceptance of these suggestions; 4) the changes of office BP measured before and 3-6 months after ABPM. RESULTS 1) The indications for ABPM were: resistant or poorly controlled hypertension (n = 170-71%); suspected "white coat effect" (n = 51-21%); assessment of symptoms (n = 20-8%). 2) The analysis of ABPM suggested to modify drug treatment in 51% of the patients; a "white-coat effect" was found in 18% of the patients. 3) The ABPM suggestions about treatment were accepted by the referring physicians in 89% of the patients. 4) Office BP decreased from 163 +/- 18/99 +/- 9 mm Hg (before ABPM) to 151 +/- 13/91 +/- 7 (3-6 months after ABPM), (p < 0.001). CONCLUSIONS The use of ABPM in our Centre, which is based on specific clinical indications, provided indications to modify the drug treatment in a high percentage of patients.
Collapse
Affiliation(s)
- A Fortini
- Centro per lo studio dell'Ipertensione Arteriosa, Medicina Interna I, Ospedale Nuovo San Giovanni di Dio, Firenze
| | | | | | | |
Collapse
|
26
|
Fortini A, Cappelletti C, Cecchi L, Laureano R. Fosinopril in the treatment of hypertension: effects on 24h ambulatory blood pressure and on blood pressure response to exercise. J Hum Hypertens 1994; 8:469-74. [PMID: 8089833] [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: 01/28/2023]
Abstract
This study evaluated the effects of medium-term once daily administration of fosinopril (20 mg) on BP profile and on BP response to exercise in patients with mild to moderate hypertension. Twenty patients (14 males and 6 females; 25-57 years of age), after a six week drug wash-out phase, underwent 24h ambulatory BP monitoring (ABPM) (Spacelabs 90207) and, the day after, maximal bicycle exercise testing. Patients then received a once daily treatment with fosinopril and ABPM and exercise testing were repeated 45-60 days later. Fosinopril decreased average 24h SBP and DBP (-13.5 mmHg and -9.7 mmHg, respectively, P < 0.002); a significant BP reduction was observed both in day and in nighttime, without alteration in diurnal BP profile. The antihypertensive effect was still evident 24h after dosing. Trough to peak ratio was 0.58 +/- 0.16. Fosinopril induced a reduction of SBP and DBP during exercise testing (-20 and -11 mmHg at baseline; -17 and -8 mmHg at peak exercise; -24 and -14 mmHg at the sixth minute of recovery; P < 0.002), with a slight prolongation of exercise time (+46 seconds, P = 0.041). These results indicate that fosinopril at a once daily dose of 20 mg provides a sustained 24h BP reduction associated with BP reduction during physical exercise. These effects have been obtained without altering diurnal BP profile, without excessive hypotension at the time of maximal antihypertensive effect and with a slight improvement of exercise tolerance.
Collapse
Affiliation(s)
- A Fortini
- Centro per lo Studio dell'Ipertensione Arteriosa, Medicina Interna I, Ospedale Nuovo San Giovanni di Dio, Firenze, Italy
| | | | | | | |
Collapse
|
27
|
Gianni R, Benucci M, Santoro E, Nenci G, Baruffi MC, Cappelletti C. [Hypersensitivity vasculitis after thrombolytic therapy with APSAC (anisoylated plasminogen streptokinase activator complex). Presentation of a clinical case and review of the literature]. Ann Ital Med Int 1994; 9:105-6. [PMID: 7917762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe a rare case of hypersensitivity vasculitis associated with APSAC administration in a 54-year-old man. Fifteen days after receiving thrombolytic therapy (APSAC 30 U) for acute myocardial infarction, the patient was admitted to our department for myalgia, livedo reticularis and erythema of the legs with an ulcerative necrotic lesion of the fifth toe of the right foot. The presence of circulating immune complexes at high titer supported the diagnosis of hypersensitivity vasculitis.
Collapse
Affiliation(s)
- R Gianni
- I Divisione di Medicina Interna, Nuovo Ospedale S. Giovanni di Dio, U.S.L. 10/C, Firenze
| | | | | | | | | | | |
Collapse
|
28
|
Cecchi L, Gianni R, Santoro E, Leopardi A, Taccetti G, Baruffi MC, Cappelletti C. [Thrombosis of the superior sagittal sinus and ulcerative colitis. A case report]. Ann Ital Med Int 1992; 7:176-8. [PMID: 1457258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a rare case of superior sagittal sinus thrombosis in a young man (26 years) with undiagnosed ulcerative colitis. The patient was hospitalized with headache and paresis of the right arm and leg. he had had rectal bleeding and diarrhea for the previous 4 weeks. Despite the fact that heparin therapy is still considered controversial, we successfully treated our patient with low doses of sub-cutaneous heparin. He did not suffer any side-effect.
Collapse
Affiliation(s)
- L Cecchi
- I Divisione di Medicina Interna, Nuovo Ospedale S. Giovanni di Dio, Firenze
| | | | | | | | | | | | | |
Collapse
|
29
|
Cappelletti C, Cecchi L, Leopardi A, Innocenti M, Tinacci L. [Thrombocytopenic purpura during treatment with pantethine]. Recenti Prog Med 1987; 78:242. [PMID: 3628948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
30
|
Zoppi M, Moretti R, Maresca M, Cappelletti C, Leoncini F. [Classification of cervicobrachialgias. Etiopathogenetic and nosographic problems]. Policlinico Med 1972; 79:9-30. [PMID: 4537150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|