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D'Angelo S, Malavolta N, Scambi C, Salvarani C, Caso F, Tirri E, Ramonda R, Quarta L, Erre GL, Riva M, Buono R, Furini F, Grembiale RD, Lomater C, Cantini F, Maio T, Chimenti MS, Scrivo R, Salaffi F, Caporali RF, Volpe P, Gualberti G, Marando F, Marchesoni A. Quality of life and therapeutic management of axial spondyloarthritis patients in Italy: a 12-month prospective observational study. Clin Exp Rheumatol 2021; 39:961-969. [PMID: 33427620 DOI: 10.55563/clinexprheumatol/dz0xrd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the health-related quality of life (HRQoL), disease activity, treatment adherence, and work ability in the real-world setting in patients with axial spondyloarthritis (axSpA). METHODS QUASAR was a prospective 12-month, observational study involving 23 rheumatology centres across Italy, including adult patients with axSpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. Patients were followed at baseline, 3, 6, and 12 months for disease activity and health-related QoL (HRQoL), treatment adherence and work ability. Regression analysis was used to assess the association between treatment and outcome variables. RESULTS 413 (80.7%) out of axSpA 512 patients were diagnosed with ankylosing spondylitis (AS) and 99 (19.3%) with non-radiographic axSpA (nr-axSpA). Nr-axSpA and AS patients had similar baseline disease activity and HRQoL. Biologic disease-modifying anti-rheumatic drugs (bDMARDs) were the most frequent medication (n=426, 83.2%). Over the 1-year follow-up, disease activity measures (joint pain and swelling, CRP, global assessment, BASDAI, ASDAS), HRQoL and work ability significantly improved, while few differences emerged between nr-axSpA and AS patients. Treatment satisfaction and adherence questionnaires improved over the 12 months. Patients treated with bDMARDs showed improved outcomes for disease activity measures and HRQoL variables, greater benefit observed in patients with AS. CONCLUSIONS We found clinical and HRQoL improvement over 1 year in a large, real-world population of nr-axSpA and AS patients treated with bDMARDs or conventional synthetic DMARDs.
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Affiliation(s)
- Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Italy.
| | | | - Cinzia Scambi
- UOSD Reumatologia, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Italy
| | - Francesco Caso
- Reumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Enrico Tirri
- UOSD Reumatologia, Ospedale San Giovanni Bosco, Napoli, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy
| | | | - Gian Luca Erre
- Università degli Studi di Sassari e Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Marta Riva
- Struttura Semplice di Reumatologia, AO San Gerardo, Monza, Italy
| | | | - Federica Furini
- UO Reumatologia, AOU Arcispedale Sant'Anna di Ferrara, Italy
| | | | | | | | - Tiziana Maio
- SC Reumatologia, PO Cairo Montenotte, Ospedale San Paolo, Savona, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, University of Roma Tor Vergata, Rome, Italy
| | - Rossana Scrivo
- UOC di Reumatologia, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Italy
| | - Fausto Salaffi
- UO Reumatologia, AUSL 5 Jesi, Ospedale C.Urbani, Jesi, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto F Caporali
- UO Reumatologia, IRCCS Policlinico San Matteo di Pavia, and Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Paola Volpe
- UO Reumatologia, Presidio Ospedaliero di Pescara, Italy
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Scambi C, Ugolini S, Tonello M, Bortolami O, De Franceschi L, Castagna A, Lotti V, Corbella M, Raffaelli R, Caramaschi P, Mattia E, Biasi D, Ruffatti A. Complement activation in the plasma and placentas of women with different subsets of antiphospholipid syndrome. Am J Reprod Immunol 2019; 82:e13185. [DOI: 10.1111/aji.13185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/13/2019] [Accepted: 08/21/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cinzia Scambi
- Department of Medicine Rheumatology Unit University Hospital of Verona Verona Italy
| | - Sara Ugolini
- Department of Medicine Section of Internal Medicine University Hospital of Verona Verona Italy
| | - Marta Tonello
- Department of Medicine Rheumatology Unit University Hospital of Padua Padua Italy
| | - Oscar Bortolami
- Department of Diagnostics and Public Health University Hospital of Verona Verona Italy
| | | | | | - Virginia Lotti
- Department of Medicine Rheumatology Unit University Hospital of Verona Verona Italy
| | - Michela Corbella
- Department of Medicine University Hospital of Verona Verona Italy
| | - Ricciarda Raffaelli
- Department of Surgical Sciences Dentistry, Gynecology and Pediatrics University Hospital of Verona Verona Italy
| | - Paola Caramaschi
- Department of Medicine University Hospital of Verona Verona Italy
| | - Elena Mattia
- Department of Medicine Rheumatology Unit University Hospital of Padua Padua Italy
| | - Domenico Biasi
- Department of Medicine Rheumatology Unit University Hospital of Verona Verona Italy
| | - Amelia Ruffatti
- Department of Medicine Rheumatology Unit University Hospital of Padua Padua Italy
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D'Angelo S, Gilio M, D'Attino RM, Gualberti G, Merolla R, di Luzio Paparatti U, Malavolta N, Corvaglia S, Marchetta A, Scambi C, Romeo N, Pettiti G, Salvarani C, Catanoso MG, Scarpa R, Costa L, Ramonda R, Frallonardo P, Muratore M, Quarta L, Passiu G, Erre GL, Lubrano D, Tirri E, Govoni M, Furini F, Russo R, Buono R, Pozzi MR, Riva M, Grembiale RD, Bruno C, Gibertini P, Marchesoni A. Observational study on the QUality of life of Italian Axial SpondyloARthritis patients (QUASAR): baseline data. Clin Exp Rheumatol 2019; 37:748-755. [PMID: 30943145] [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] [Received: 07/23/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To describe the baseline characteristics of the patients enrolled in the QUality of life in patients with Axial SpondyloARthritis (QUASAR) study in terms of quality of life (QoL), disease activity, therapy adherence, and work ability in a real-world setting. METHODS QUASAR is an Italian multicentre, prospective 12-month observational study, including consecutive adult patients classified as axial spondyloarthritis (axSpA) according to the Assessment of SpondyloArthritis international Society criteria for axSpA. RESULTS Of 512 patients enrolled in 23 rheumatology centres, 80.7% had ankylosing spondylitis (AS) and 19.3% had non-radiographic axSpA (nr-axSpA). Mean ages were 34.1±13.3 years at axSpA symptoms onset and 39.5±13.0 years at diagnosis. Of the patients, 51.4% presented with ≥1 extra articular manifestation (EAM); the most common were psoriasis (17.8%) and uveitis (16.4%). Patients with nr-axSpA and AS had similar EAM rates, disease activity, and QoL. Biologic disease-modifying anti-rheumatic drugs (bDMARDs; 83.2%) were the most commonly received medication, followed by conventional synthetic DMARDs (22.9%) and non-steroidal anti-inflammatory drugs (NSAIDs; 16.6%). At baseline, higher treatment satisfaction was reported with bDMARDs which, together with NSAIDs, were associated with the best overall scores for disease activity, function, and QoL in the overall population and AS subgroup. CONCLUSIONS QUASAR is the first Italian prospective study that comprehensively evaluated a large axSpA patient sample in a real-world setting. This interim analysis at baseline confirmed that i) patients with AS and nr-axSpA have similar QoL and disease burden, ii) nearly all axSpA patients receive treatment, and iii) bDMARDs and NSAIDs, overall, yield better disease activity and QoL.
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Affiliation(s)
- Salvatore D'Angelo
- Rheumatology Institute of Lucania (IRel) and the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy.
| | - Michele Gilio
- Rheumatology Inst.of Lucania (IRel) & Rheumatology Dept.of Lucania, San Carlo Hosp. of Potenza and Madonna delle Grazie Hosp. of Matera, Potenza & Matera, and PhD Scholarship in Life Sciences, Dept.Health Sciences, Univ.Catanzaro 'Magna Graecia', Italy
| | | | | | | | | | - Nazzarena Malavolta
- Programma Dipartimentale 'Gestione delle Malattie Reumatiche e del Connettivo e Malattie Metaboliche dell'Osso', Dipartimento Cardio-Toraco Vascolare AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Stefania Corvaglia
- Programma Dipartimentale 'Gestione delle Malattie Reumatiche e del Connettivo e Malattie Metaboliche dell'Osso', Dipartimento Cardio-Toraco Vascolare AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Antonio Marchetta
- U.O.S. di Reumatologia, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Cinzia Scambi
- U.O.S. di Reumatologia, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Nicoletta Romeo
- S.S.D. Reumatologia A.S.O. Santa Croce e Carle, Cuneo, Italy
| | - Giorgio Pettiti
- S.S.D. Reumatologia A.S.O. Santa Croce e Carle, Cuneo, Italy
| | - Carlo Salvarani
- U.O.C. di Reumatologia USL-IRCCS Reggio Emilia, and University of Modena and Reggio Emilia, Italy
| | | | - Raffaele Scarpa
- U.O.C. di Reumatologia, Università Federico II Napoli, Italy
| | - Luisa Costa
- U.O.C. di Reumatologia, Università Federico II Napoli, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Paola Frallonardo
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | | | - Laura Quarta
- U.O. Reumatologia-P.O. "Vito Fazzi", Lecce, Italy
| | - Giuseppe Passiu
- Rheumatology Unit, Department of Clinical and Experimental Medicine, A.O.U. and University of Sassari, Italy
| | - Gian Luca Erre
- Rheumatology Unit, Department of Clinical and Experimental Medicine, A.O.U. and University of Sassari, Italy
| | - Daniele Lubrano
- U.O.S.D. di Reumatologia, Ospedale S. Giovanni Bosco, Napoli, Italy
| | - Enrico Tirri
- U.O.S.D. di Reumatologia, Ospedale S. Giovanni Bosco, Napoli, Italy
| | - Marcello Govoni
- U.O.C. Reumatologia, Azienda Ospedaliero-Universitaria S. Anna, Ferrara (loc. Cona), Dip. Scienze Mediche Università di Ferrara, Italy
| | - Federica Furini
- U.O.C. Reumatologia, Azienda Ospedaliero-Universitaria S. Anna, Ferrara (loc. Cona), Dip. Scienze Mediche Università di Ferrara, Italy
| | - Romualdo Russo
- U.O.S. di Reumatologia A.O.R.N. Cardarelli, Napoli, Italy
| | - Rosario Buono
- U.O.S. di Reumatologia A.O.R.N. Cardarelli, Napoli, Italy
| | - Maria Rosa Pozzi
- Dipartimento di Medicina, Ospedale S. Gerardo - ASST Monza, Italy
| | - Marta Riva
- Dipartimento di Medicina, Ospedale S. Gerardo - ASST Monza, Italy
| | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Dipartimento Scienze della Salute, Policlinico Universitario Mater Domini, Catanzaro, Italy
| | - Caterina Bruno
- Rheumatology Research Unit, Dipartimento Scienze della Salute, Policlinico Universitario Mater Domini, Catanzaro, Italy
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Lombardi E, Matte A, Risitano AM, Ricklin D, Lambris JD, De Zanet D, Jokiranta ST, Martinelli N, Scambi C, Salvagno G, Bisoffi Z, Colato C, Siciliano A, Bortolami O, Mazzuccato M, Zorzi F, De Marco L, De Franceschi L. Factor H interferes with the adhesion of sickle red cells to vascular endothelium: a novel disease-modulating molecule. Haematologica 2019; 104:919-928. [PMID: 30630982 PMCID: PMC6518911 DOI: 10.3324/haematol.2018.198622] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Received: 05/27/2018] [Accepted: 01/08/2019] [Indexed: 12/27/2022] Open
Abstract
Sickle cell disease is an autosomal recessive genetic red cell disorder with a worldwide distribution. Growing evidence suggests a possible involvement of complement activation in the severity of clinical complications of sickle cell disease. In this study we found activation of the alternative complement pathway with microvascular deposition of C5b-9 on skin biopsies from patients with sickle cell disease. There was also deposition of C3b on sickle red cell membranes, which is promoted locally by the exposure of phosphatidylserine. In addition, we showed for the first time a peculiar “stop-and-go” motion of sickle cell red blood cells on tumor factor-α–activated vascular endothelial surfaces. Using the C3b/iC3b binding plasma protein factor Has an inhibitor of C3b cell-cell interactions, we found that factor H and its domains 19-20 prevent the adhesion of sickle red cells to the endothelium, normalizing speed transition times of red cells. We documented that factor H acts by preventing the adhesion of sickle red cells to P-selectin and/or the Mac-1 receptor (CD11b/CD18), supporting the activation of the alternative pathway of complement as an additional mechanism in the pathogenesis of acute sickle cell related vaso-occlusive crises. Our data provide a rationale for further investigation of the potential contribution of factor H and other modulators of the alternative complement pathway with potential implications for the treatment of sickle cell disease.
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Affiliation(s)
| | | | - Antonio M Risitano
- Hematology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Daniel Ricklin
- Molecular Pharmacy Group, Department of Pharmaceutical Sciences, University of Basel, Switzerland
| | - John D Lambris
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; USA
| | - Denise De Zanet
- Department of Translational Research, National Cancer Center, Aviano, Italy.,Polytechnic Department of Engineering and Architecture, University of Udine, Italy
| | - Sakari T Jokiranta
- Research Programs Unit, Immunobiology, University of Helsinki and United Medix Laboratories, Helsinki, Finland
| | | | - Cinzia Scambi
- Department of Medicine, University of Verona-AOUI Verona; Italy
| | - Gianluca Salvagno
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Zeno Bisoffi
- Centre of Tropical Diseases, Sacro Cuore-Don Calabria Hospital Negrar, Verona, Italy.,Department of Diagnostics and Public Health, University of Verona-AOUI Verona, Italy
| | - Chiara Colato
- Department of Diagnostics and Public Health, University of Verona-AOUI Verona, Italy
| | | | - Oscar Bortolami
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic & Public Health, University of Verona
| | - Mario Mazzuccato
- Department of Translational Research, National Cancer Center, Aviano, Italy
| | - Francesco Zorzi
- Department of Medicine, University of Verona-AOUI Verona; Italy
| | - Luigi De Marco
- Department of Translational Research, National Cancer Center, Aviano, Italy.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
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5
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Scambi C, Ugolini S, Jokiranta TS, De Franceschi L, Bortolami O, La Verde V, Guarini P, Caramaschi P, Ravagnani V, Martignoni G, Colato C, Pedron S, Benedetti F, Sorio M, Poli F, Biasi D. The local complement activation on vascular bed of patients with systemic sclerosis: a hypothesis-generating study. PLoS One 2015; 10:e0114856. [PMID: 25658605 PMCID: PMC4319765 DOI: 10.1371/journal.pone.0114856] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/13/2014] [Indexed: 11/26/2022] Open
Abstract
Objective The role of complement system in the pathogenesis of systemic sclerosis (SSc) has been debated during the last decade but an evident implication in this disease has never been found. We carried out an explorative study on SSc patients to evaluate the expression of soluble and local C5b-9 complement complex and its relation with a complement regulator, the Membrane Cofactor Protein (MCP, CD46) on skin vascular bed as target distinctive of SSc disease. We also analyzed two polymorphic variants in the complement activation gene cluster involving the MCP region. Methods C5b-9 plasma levels of SSc patients and healthy subjects were analyzed by ELISA assay. Archival skin biopsies of SSc patients and controls were subjected to immunofluorescence analysis to detect C5b-9 and MCP on vascular endothelial cells. The expression of MCP was validated by immunoblot analysis with specific antibody. Polymorphic variants in the MCP gene promoter were tested by a quantitative PCR technique-based allelic discrimination method. Results Even though circulating levels of C5b-9 did not differ between SSc and controls, C5b-9 deposition was detected in skin biopsies of SSc patients but not in healthy subjects. MCP was significantly lower in skin vessels of SSc patients than in healthy controls and was associated with the over-expression of two polymorphic variants in the MCP gene promoter, which has been related to more aggressive phenotypes in other immune-mediated diseases. Conclusions Our results firsty document the local complement activation with an abnormal expression of MCP in skin vessels of SSc patients, suggesting that a subset of SSc patients might be exposed to more severe organ complications and clinical evolution due to abnormal local complement activation.
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Affiliation(s)
- Cinzia Scambi
- Department of Medicine, University of Verona, Verona, Italy
- * E-mail:
| | - Sara Ugolini
- Department of Medicine, University of Verona, Verona, Italy
| | - T. Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | | | - Oscar Bortolami
- Research Support Unit and Biostatistics, Verona University Hospital, Verona, Italy
| | | | | | | | | | - Guido Martignoni
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Chiara Colato
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Serena Pedron
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | | | - Marco Sorio
- Department of Medicine, University of Verona, Verona, Italy
| | - Fabio Poli
- Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Biasi
- Department of Medicine, University of Verona, Verona, Italy
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Caramaschi P, Tonolli E, Biasi D, Caimmi C, Pieropan S, Dal Forno I, Scambi C, Adami S. Antinuclear autoantibody profile in systemic sclerosis patients who are negative for anticentromere and anti-topoisomerase I specificities. Joint Bone Spine 2014; 82:209-10. [PMID: 25543274 DOI: 10.1016/j.jbspin.2014.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Paola Caramaschi
- Rheumatology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
| | - Elisabetta Tonolli
- Microbiology and Virology, Diagnostic and Pathology Department, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Domenico Biasi
- Rheumatology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Cristian Caimmi
- Rheumatology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Sara Pieropan
- Rheumatology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Ilaria Dal Forno
- Rheumatology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Cinzia Scambi
- Rheumatology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Silvano Adami
- Rheumatology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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Scambi C, Biasi D, Ugolini S, Tonello M, Bortolami O, Mattia E, Ruffatti A. AB0125 The crosstalk between the complement system and the coagulation cascade in the antiphospholipid syndrome. preliminary data from basic research. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2448] [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: 11/04/2022]
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De Franceschi L, Bosello S, Scambi C, Biasi D, De Santis M, Caramaschi P, Peluso G, La Verde V, Bambara LM, Ferraccioli G. Proteome analysis of biological fluids from autoimmune-rheumatological disorders. Proteomics Clin Appl 2011; 5:78-89. [PMID: 21246742 DOI: 10.1002/prca.201000069] [Citation(s) in RCA: 14] [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] [Received: 07/07/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 11/10/2022]
Abstract
Autoimmune-rheumatological diseases are worldwide distributed disorders and represent a complex array of illnesses characterized by autoreactivity (reactivity against self-antigens) of T-B lymphocytes and by the synthesis of autoantibodies crucial for diagnosis (biomarkers). Yet, the effects of the autoimmune chronic inflammation on the infiltrated tissues and organs generally lead to profound tissue and organ damage with loss of function (i.e., lung, kidney, joints, exocrine glands). Although progresses have been made on the knowledge of these disorders, much still remains to be investigated on their pathogenesis and identification of new biomarkers useful in clinical practice. The rationale of using proteomics in autoimmune-rheumatological diseases has been the unmet need to collect, from biological fluids that are easily obtainable, a summary of the final biochemical events that represent the effects of the interplay between immune cells, mesenchymal cells and endothelial cells. Proteomic analysis of these fluids shows encouraging results and in this review, we addressed four major autoimmune-rheumatological diseases investigated through proteomic techniques and provide evidence-based data on the highlights obtained in systemic sclerosis, primary and secondary Sjogren's syndrome, systemic lupus erythematosus and rheumatoid arthritis.
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Affiliation(s)
- Lucia De Franceschi
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
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Scambi C, La Verde V, De Franceschi L, Barausse G, Poli F, Benedetti F, Sorio M, Deriu F, Roncada P, Bortolami O, Turrini F, Caramaschi P, Stranieri C, Bambara LM, Biasi D. Comparative proteomic analysis of serum from patients with systemic sclerosis and sclerodermatous GVHD. Evidence of defective function of factor H. PLoS One 2010; 5:e12162. [PMID: 20730046 PMCID: PMC2921355 DOI: 10.1371/journal.pone.0012162] [Citation(s) in RCA: 14] [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: 12/18/2009] [Accepted: 06/13/2010] [Indexed: 01/07/2023] Open
Abstract
Background Systemic sclerosis (SSc) is an autoimmune disease characterized by immunological and vascular abnormalities. Until now, the cause of SSc remains unclear. Sclerodermatous graft-versus-host disease (ScGVHD) is one of the most severe complications following bone marrow transplantation (BMT) for haematological disorders. Since the first cases, the similarity of ScGVHD to SSc has been reported. However, both diseases could have different etiopathogeneses. The objective of this study was to identify new serum biomarkers involved in SSc and ScGVHD. Methodology Serum was obtained from patients with SSc and ScGVHD, patients without ScGVHD who received BMT for haematological disorders and healthy controls. Bi-dimensional electrophoresis (2D) was carried out to generate maps of serum proteins from patients and controls. The 2D maps underwent image analysis and differently expressed proteins were identified. Immuno-blot analysis and ELISA assay were used to validate the proteomic data. Hemolytic assay with sheep erythrocytes was performed to evaluate the capacity of Factor H (FH) to control complement activation on the cellular surface. FH binding to endothelial cells (ECs) was also analysed in order to assess possible dysfunctions of this protein. Principal Findings Fourteen differentially expressed proteins were identified. We detected pneumococcal antibody cross-reacting with double stranded DNA in serum of all bone marrow transplanted patients with ScGVHD. We documented higher levels of FH in serum of SSc and ScGVHD patients compared healthy controls and increased sheep erythrocytes lysis after incubation with serum of diffuse SSc patients. In addition, we observed that FH binding to ECs was reduced when we used serum from these patients. Conclusions The comparative proteomic analysis of serum from SSc and ScGVHD patients highlighted proteins involved in either promoting or maintaining an inflammatory state. We also found a defective function of Factor H, possibly associated with ECs damage.
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Affiliation(s)
- Cinzia Scambi
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy.
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10
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Barausse G, Caramaschi P, Scambi C, Benedetti F, Sorio M, Tinelli M, Tinazzi I, Benini L, Bambara LM, Biasi D. Clinical, serologic and instrumental data of ten patients affected by sclerodermatous chronic graft versus host disease: similarities and differences in respect to systemic sclerosis. Int J Immunopathol Pharmacol 2010; 23:373-7. [PMID: 20378027 DOI: 10.1177/039463201002300139] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic graft versus host disease (cGVHD), the most common late complication of allogeneic haematopoietic stem cell transplantation (HSCT), may present with sclerodermatous lesions resembling in some cases the cutaneous involvement of systemic sclerosis (SSc). Certain pathogenetic findings connect the two diseases. In this report we describe ten subjects affected by cGVHD who underwent the examinations routinely carried out to stage SSc patients. Demographic, clinical, serologic and instrumental data were recorded. These patients showed differences in appearance, extent and progression of the sclerodermatous lesions with greater involvement of the trunk and proximal part of the limbs than the extremities. In seven subjects ANA test was positive; scleroderma-associated autoantibodies were not detected in any of the cases. Moreover, typical organ involvement of SSc was not found. Only one patient developed Raynauds phenomenon after HSCT and only one patient demonstrated a nailfold videocapillaroscopic scleroderma pattern. Except for cutaneous involvement of cGVHD, that may resemble SSc, the clinical features of the two diseases are quite different, suggesting that the fibrotic process characterizing cGVHD and SSc has different etiologies and different initial pathobiologic events.
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Affiliation(s)
- G Barausse
- Dipartimento di Medicina Clinica e Sperimentale, Università di Verona, Italy
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11
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Scambi C, De Franceschi L, Guarini P, Poli F, Siciliano A, Pattini P, Biondani A, La Verde V, Bortolami O, Turrini F, Carta F, D'Orazio C, Assael BM, Faccini G, Bambara LM. Preliminary evidence for cell membrane amelioration in children with cystic fibrosis by 5-MTHF and vitamin B12 supplementation: a single arm trial. PLoS One 2009; 4:e4782. [PMID: 19277125 PMCID: PMC2652076 DOI: 10.1371/journal.pone.0004782] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 01/20/2009] [Indexed: 11/19/2022] Open
Abstract
Background Cystic fibrosis (CF) is one of the most common fatal autosomal recessive disorders in the Caucasian population caused by mutations of gene for the cystic fibrosis transmembrane conductance regulator (CFTR). New experimental therapeutic strategies for CF propose a diet supplementation to affect the plasma membrane fluidity and to modulate amplified inflammatory response. The objective of this study was to evaluate the efficacy of 5-methyltetrahydrofolate (5-MTHF) and vitamin B12 supplementation for ameliorating cell plasma membrane features in pediatric patients with cystic fibrosis. Methodology and Principal Findings A single arm trial was conducted from April 2004 to March 2006 in an Italian CF care centre. 31 children with CF aged from 3 to 8 years old were enrolled. Exclusion criteria were diabetes, chronic infections of the airways and regular antibiotics intake. Children with CF were supplemented for 24 weeks with 5-methyltetrahydrofolate (5-MTHF, 7.5 mg /day) and vitamin B12 (0.5 mg/day). Red blood cells (RBCs) were used to investigate plasma membrane, since RBCs share lipid, protein composition and organization with other cell types. We evaluated RBCs membrane lipid composition, membrane protein oxidative damage, cation content, cation transport pathways, plasma and RBCs folate levels and plasma homocysteine levels at baseline and after 24 weeks of 5-MTHF and vitamin B12 supplementation. In CF children, 5-MTHF and vitamin B12 supplementation (i) increased plasma and RBC folate levels; (ii) decreased plasma homocysteine levels; (iii) modified RBC membrane phospholipid fatty acid composition; (iv) increased RBC K+ content; (v) reduced RBC membrane oxidative damage and HSP70 membrane association. Conclusion and Significance 5-MTHF and vitamin B12 supplementation might ameliorate RBC membrane features of children with CF. Trial Registration ClinicalTrials.gov NCT00730509
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Affiliation(s)
- Cinzia Scambi
- Department of Clinical and Experimental Medicine, Section of Rheumatology & Internal Medicine, University of Verona, Verona, Italy.
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12
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Scambi C, Guarini P, De Franceschi L, Bambara LM. Can 5-methyltetrahydrofolate modify the phospholipid fatty acid pattern in cystic fibrosis pediatric patients? J Cyst Fibros 2006; 5:197-9. [DOI: 10.1016/j.jcf.2006.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 12/06/2005] [Accepted: 01/20/2006] [Indexed: 10/24/2022]
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13
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Caramaschi P, Martinelli N, Biasi D, Carletto A, Faccini G, Volpe A, Ferrari M, Scambi C, Bambara LM. Homocysteine plasma concentration is related to severity of lung impairment in scleroderma. J Rheumatol 2003; 30:298-304. [PMID: 12563684] [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: 02/28/2023]
Abstract
OBJECTIVE To investigate the correlation between plasma concentration of total homocysteine and pulmonary involvement in patients with limited or diffuse scleroderma (systemic sclerosis, SSc). METHODS Seventy-one patients with scleroderma were divided into 3 groups based on pulmonary involvement: Group A comprised patients without lung involvement (9 cases); Group B patients with lung involvement of mild and moderate stages (44 cases); and Group C patients with lung involvement of severe stage and endstage (18 cases). At the time of evaluation of lung involvement all patients underwent determination of plasma homocysteine concentration. Homocysteine concentration was also measured in 30 healthy controls homogeneous for sex and age. RESULTS In patients with scleroderma the homocysteine concentration was significantly higher than in controls (11.1 and 6.9 micromol/l, respectively; p < 0.001). We found a significant association between plasma homocysteine concentration and severity of lung involvement that was not modified by correction for age, time from the diagnosis, type of scleroderma pattern, and serum creatinine and folate levels. Homocysteine concentration progressively increases in scleroderma patients with more severe pulmonary involvement. Subjects with high homocysteine concentration (i.e., > or = 75th percentile of homocysteine concentration in patients with scleroderma without lung involvement) were mostly present in the group with the greatest lung involvement. CONCLUSION High level of homocysteinemia is associated with an increased risk of pulmonary disease in patients with scleroderma. We hypothesize that hyperhomocysteinemia may worsen injury of the endothelium, a key lesion in scleroderma disease, favoring the development of lung involvement. Our data support the hypothesis that homocysteine could be involved in the pathogenetic process of scleroderma pulmonary involvement.
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Affiliation(s)
- Paola Caramaschi
- Dipartmento di Medicina Clinica e Sperimentale, Policlinico GB Rossi, Verona, Italy.
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14
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Caramaschi P, Canestrini S, Biasi D, Carletto A, Scambi C, Scarperi A, Bambara LM. [Infliximab in aggressive and refractory rheumatoid arthritis. A pilot study]. Recenti Prog Med 2002; 93:19-24. [PMID: 11850995] [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: 02/23/2023]
Abstract
UNLABELLED Rheumatoid arthritis is a chronic inflammatory disease with a progressive course, that frequently provokes permanent incapacity if not adequately treated. Rheumatoid arthritis may be not responsive to the common second line drugs. This study was aimed to treat 15 patients affected by severe refractory rheumatoid arthritis with infliximab. PATIENTS AND METHODS Fifteen patients with refractory rheumatoid arthritis were treated with infliximab--monoclonal antibody direct to TNF alpha--in association with methotrexate or azathioprine. Infliximab was administered at the dosage of 3 mg/Kg at the weeks 0, 2 and 6 and then every 8 weeks. RESULTS About half patients ameliorated in agreement with both ACR 20 criteria and DAS28 evaluation. The clinical improvement was accompanied by a reduction of the steroid daily dosage. No relevant side effects were observed. CONCLUSION Infliximab is effective in a significant number of patients with severe rheumatoid arthritis, with a good tolerability.
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Affiliation(s)
- Paola Caramaschi
- Cattedra di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università, Verona
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15
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Biasi D, Carletto A, Caramaschi P, Maleknia T, Scambi C, Melchiori S, Bambara LM. [The articular damage of hemochromatosis. A little known aspect]. Recenti Prog Med 1999; 90:226-30. [PMID: 10354739] [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: 02/12/2023]
Abstract
Genetic haemochromatosis is a HLA-linked disease characterized by a high and inappropriate gastrointestinal iron absorption; the excess iron is stored in parenchymal cells, provoking the failure of the involved organs. The common target organs of genetic haemochromatosis are liver, heart, pancreas, pituitary, joints and skin. The disease is inherited in an autosomal recessive manner with predilection for male sex and penetration conditioned by age, sex and food habits. The first clinical manifestation of genetic haemochromatosis, whose onset is typically between ages 40 and 60, is represented by arthropathy in 45% of the cases; the articular features are unfortunately often misdiagnosed and it is known that the diagnosis delay heavily compromises the outcome; vice-versa the early identification of the disease, and the consequent suitable treatment give back a normal life expectancy to these patients. The articular features of genetic haemochromatosis are of two types: 1) progressive degenerative arthropathy, characterized by pain without inflammatory signs, morning stiffness and functional impairment involving hands, wrists, shoulders, hips, knees and feet; 2) chondrocalcinosis with its typical proteiform clinical manifestations. The aim of this report is to underline that the patients with premature osteoarthritis or unexplained chondrocalcinosis must be screened for genetic haemochromatosis in order to formulate the correct diagnosis before the development of severe internal organ involvement.
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Affiliation(s)
- D Biasi
- Istituto di Patologia Speciale Medica, Università, Verona
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16
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Biasi D, Carletto A, Caramaschi P, Bellavite P, Maleknia T, Scambi C, Favalli N, Bambara LM. Neutrophil functions and IL-8 in psoriatic arthritis and in cutaneous psoriasis. Inflammation 1998; 22:533-43. [PMID: 9793799 DOI: 10.1023/a:1022354212121] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [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: 11/12/2022]
Abstract
The aim of this study is to determine some functions of neutrophil in patients affected by psoriatic arthritis and to compare them to those of patients affected by cutaneous psoriasis and to normal controls. We used a model of experimental cutaneous inflammation allowing to separate a cluster of purified and viable PMN cells. Then we analyzed, within the three groups, the IL-8 concentration in serum and in the supernatant obtained from the inflammatory site to gather data on the possible pathogenic role played by this cytokine in psoriatic arthritis. We studied neutrophil functions in patients with cutaneous psoriasis and psoriatic arthritis, in acute phase, in comparison with healthy control subjects. We investigated in vivo neutrophil migration by Senn's skin window technique and measured adhesion assay and superoxide production in circulating and migrating neutrophils after different stimuli. We also measured IL-8 concentration in serum and in the supernatant obtained from the inflammatory site, artificially created through the skin window scrape. Neutrophil migration in vivo was significantly higher in both groups of patients than in controls. In the presence of fMLP, blood cells showed a burst of superoxide release, which was significantly more pronounced in patients when compared to healthy controls. Neutrophils from skin window scrape showed a much higher response to fMLP as compared to blood cells of all subject groups, but no differences were observed between patients and controls. No correlation was found between the three groups in adhesion ability under basal condition or in response to different stimuli by circulating and migrating neutrophils. Our results also show a great increase of IL-8 in the exudate from patients compared to controls. Our study shows that there is no difference in neutrophil functions between patients with psoriatic arthritis and cutaneous psoriasis; moreover we suggest that the source of high IL-8 levels are neutrophils rather than the keratinocytes.
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Affiliation(s)
- D Biasi
- Institute of Medical Pathology, University of Verona, Ospedale Policlinico, Italy
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