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Trunfio M, Sacchi A, Vai D, Pittaluga F, Croce M, Cavallo R, Imperiale D, Bonora S, Di Perri G, Letendre SL, Calcagno A. Intrathecal production of anti-Epstein-Barr virus viral capsid antigen IgG is associated with neurocognition and tau proteins in people with HIV. AIDS 2024; 38:477-486. [PMID: 37939156 DOI: 10.1097/qad.0000000000003775] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE HIV and Epstein-Barr virus (EBV) co-infection has been linked to increased immune activation and larger HIV reservoir. We assessed whether anti-EBV humoral responses are associated with increased cerebrospinal fluid (CSF) inflammation and with neurocognitive impairment (NCI) in people with HIV (PWH). DESIGN Cross-sectional analysis in 123 EBV-seropositive PWH either on antiretroviral therapy ( n = 70) or not. METHODS Serum and CSF anti-EBV viral capsid antigen immunoglobulin G (anti-EVI) and CSF EBV DNA were measured by commercial immunoassay and RT-PCR. Seventy-eight participants without neurological confounding factors underwent neurocognitive assessment (Global Deficit Score, GDS). CSF total tau and 181-phosphorylated-tau (ptau) were measured by immunoassays together with biomarkers of blood-brain barrier (BBB) integrity, immune activation, astrocytosis, and intrathecal synthesis. Logistic and linear regressions and moderation analysis were used to investigate the relationships between CSF anti-EVI, GDS, and biomarkers. RESULTS Twenty-one (17.1%) and 22 participants (17.9%) had detectable CSF anti-EVI (10.5-416.0 U/ml) and CSF EBV DNA (25-971 copies/ml). After adjusting for BBB integrity, age, and clinical factors, the presence of CSF anti-EVI was only associated with serum levels of anti-EVI, and not with CSF EBV DNA. CSF anti-EVI, tau and ptau showed reciprocal interactions affecting their associations with GDS. After adjusting for demographics and clinical parameters, higher CSF anti-EVI levels were associated with worse GDS (aβ 0.45, P < 0.001), and CSF levels of tau and ptau had a moderation effect on the strength of this association (models' P < 0.001). CONCLUSION Humoral immune responses against EBV within the central nervous system may contribute to NCI in PWH through mechanisms that involve neuronal injury.
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Affiliation(s)
- Mattia Trunfio
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, UCSD, La Jolla, CA, USA
| | - Alessandra Sacchi
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino
| | - Daniela Vai
- Neurology unit, Maria Vittoria Hospital, Turin, Italy
| | - Fabrizia Pittaluga
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino
| | - Michele Croce
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino
| | | | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Scott Lee Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California, UCSD, La Jolla, CA, USA
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
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Salvi M, Molinari F, Ciccarelli M, Testi R, Taraglio S, Imperiale D. Quantitative analysis of prion disease using an AI-powered digital pathology framework. Sci Rep 2023; 13:17759. [PMID: 37853094 PMCID: PMC10584956 DOI: 10.1038/s41598-023-44782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023] Open
Abstract
Prion disease is a fatal neurodegenerative disorder characterized by accumulation of an abnormal prion protein (PrPSc) in the central nervous system. To identify PrPSc aggregates for diagnostic purposes, pathologists use immunohistochemical staining of prion protein antibodies on tissue samples. With digital pathology, artificial intelligence can now analyze stained slides. In this study, we developed an automated pipeline for the identification of PrPSc aggregates in tissue samples from the cerebellar and occipital cortex. To the best of our knowledge, this is the first framework to evaluate PrPSc deposition in digital images. We used two strategies: a deep learning segmentation approach using a vision transformer, and a machine learning classification approach with traditional classifiers. Our method was developed and tested on 64 whole slide images from 41 patients definitively diagnosed with prion disease. The results of our study demonstrated that our proposed framework can accurately classify WSIs from a blind test set. Moreover, it can quantify PrPSc distribution and localization throughout the brain. This could potentially be extended to evaluate protein expression in other neurodegenerative diseases like Alzheimer's and Parkinson's. Overall, our pipeline highlights the potential of AI-assisted pathology to provide valuable insights, leading to improved diagnostic accuracy and efficiency.
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Affiliation(s)
- Massimo Salvi
- Biolab, PoliTo(BIO)Med Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy.
| | - Filippo Molinari
- Biolab, PoliTo(BIO)Med Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Mario Ciccarelli
- Biolab, PoliTo(BIO)Med Lab, Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Roberto Testi
- SC Medicina Legale, ASL Città di Torino, Turin, Italy
| | | | - Daniele Imperiale
- SC Neurologia Ospedale Maria Vittoria & Centro Diagnosi Osservazione Malattie Prioniche, ASL Città di Torino, Turin, Italy
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Roveta F, Marcinnò A, Grassini A, Ferrandes F, Cermelli A, Boschi S, Gallone S, Atzori C, Imperiale D, Dentelli P, Pasini B, Brusco A, Rubino E, Rainero I. A Novel PSEN1 Variant Leading to Posterior Cortical Atrophy: A Case Report. J Alzheimers Dis Rep 2023; 7:469-473. [PMID: 37313494 PMCID: PMC10259045 DOI: 10.3233/adr230023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/21/2023] [Indexed: 06/15/2023] Open
Abstract
We describe a 52-year-old patient with a progressive visuospatial disorder and apraxia. Neuropsychological assessment, neuroradiological findings, and Alzheimer's disease (AD) core biomarker assay on cerebrospinal fluid led to a diagnosis of posterior cortical atrophy due to AD. We performed a next generation sequencing dementia-gene panel and found the c.1301 C>T p.(Ala434Val) variant in the Presenilin1 (PSEN1) gene. The missense change affects the PAL (Pro433-Ala434-Leu435) motif critical for catalytic activity of the macromolecular γ-secretase complex. Evolutionary and integrated bioinformatic tools predicted a deleterious effect of the variant supporting its role in the AD pathogenesis.
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Affiliation(s)
- Fausto Roveta
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
| | - Andrea Marcinnò
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
| | - Alberto Grassini
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
| | - Fabio Ferrandes
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
| | - Aurora Cermelli
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
| | - Silvia Boschi
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
| | - Salvatore Gallone
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza University Hospital, Torino, Italy
| | | | | | - Patrizia Dentelli
- Medical Genetics Unit, Cittàdella Salute e della Scienza University Hospital, Torino, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Barbara Pasini
- Medical Genetics Unit, Cittàdella Salute e della Scienza University Hospital, Torino, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alfredo Brusco
- Medical Genetics Unit, Cittàdella Salute e della Scienza University Hospital, Torino, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Elisa Rubino
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Innocenzo Rainero
- Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino, Torino, Italy
- Department of Neuroscience and Mental Health, Città della Salute e della Scienza University Hospital, Torino, Italy
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Manca A, Chiara F, Mula J, Palermiti A, Maiese D, Zeaiter S, De Nicolò A, Imperiale D, De Filippis G, Vischia F, De Cori D, Cusato J, D’Avolio A. A new UHPLC-MS/MS method for cannabinoids determination in human plasma: A clinical tool for therapeutic drug monitoring. Biomed Pharmacother 2022; 156:113899. [DOI: 10.1016/j.biopha.2022.113899] [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] [Received: 09/02/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/28/2022] Open
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Trunfio M, Di Girolamo L, Ponzetta L, Russo M, Burdino E, Imperiale D, Atzori C, Di Perri G, Calcagno A. Seropositivity and reactivations of HSV-1, but not of HSV-2 nor VZV, associate with altered blood–brain barrier, beta amyloid, and tau proteins in people living with HIV. J Neurovirol 2022; 29:100-105. [PMID: 36352195 DOI: 10.1007/s13365-022-01105-z] [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] [Received: 07/31/2022] [Revised: 09/20/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
Among 128 adult people living with HIV and no neurological conditions confounding the cerebrospinal fluid results, the presence of HSV-1 chronic infection (detected either by serology or PCR), but not of HSV-2 and VZV, independently associated with higher odds of blood-brain barrier impairment, abnormally increased cerebrospinal fluid levels of tau and phosphorylated-181 tau, and decreased concentrations of fragments 1-42 of beta amyloid compared to the seronegative counterpart. These associations were even stronger for seropositive participants with a positive history of at least one symptomatic reactivation of HSV-1.
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Bacigalupo I, Lombardo FL, Bargagli AM, Cascini S, Agabiti N, Davoli M, Scalmana S, Palma AD, Greco A, Rinaldi M, Giordana R, Imperiale D, Secreto P, Golini N, Gnavi R, Lovaldi F, Biagini CA, Gualdani E, Francesconi P, Magliocchetti N, Fiandra TD, Vanacore N. Identification of dementia and MCI cases in health information systems: An Italian validation study. Alzheimers Dement (N Y) 2022; 8:e12327. [PMID: 36320346 PMCID: PMC9617569 DOI: 10.1002/trc2.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
Introduction The identification of dementia cases through routinely collected health data represents an easily accessible and inexpensive method to estimate the prevalence of dementia. In Italy, a project aimed at the validation of an algorithm was conducted. Methods The project included cases (patients with dementia or mild cognitive impairment [MCI]) recruited in centers for cognitive disorders and dementias and controls recruited in outpatient units of geriatrics and neurology. The algorithm based on pharmaceutical prescriptions, hospital discharge records, residential long‐term care records, and information on exemption from health‐care co‐payment, was applied to the validation population. Results The main analysis was conducted on 1110 cases and 1114 controls. The sensitivity, specificity, and positive and negative predictive values in discerning cases of dementia were 74.5%, 96.0%, 94.9%, and 79.1%, respectively, whereas in detecting cases of MCI these values were 29.7%, 97.5%, 92.2%, and 58.1%, respectively. The variables associated with misclassification of cases were also identified. Discussion This study provided a validated algorithm, based on administrative data, which can be used to identify cases with dementia and, with lower sensitivity, also early onset dementia but not cases with MCI.
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Affiliation(s)
- Ilaria Bacigalupo
- National Center for Disease Prevention and Health PromotionItalian NationalInstitute of HealthRomeItaly
| | - Flavia L. Lombardo
- National Center for Disease Prevention and Health PromotionItalian NationalInstitute of HealthRomeItaly
| | | | - Silvia Cascini
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | - Nera Agabiti
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | - Marina Davoli
- Department of EpidemiologyLazio Regional Health ServiceRomeItaly
| | | | | | | | | | | | | | - Piero Secreto
- Geriatric unitLocal Health Authority TO3Piemonte RegionTurinItaly
| | - Natalia Golini
- Epidemiology UnitLocal Health Authority TO3Piemonte RegionGrugliascoItaly
| | - Roberto Gnavi
- Epidemiology UnitLocal Health Authority TO3Piemonte RegionGrugliascoItaly
| | | | | | - Elisa Gualdani
- Epidemiology UnitToscana Regional Health AgencyFlorenceItaly
| | | | | | - Teresa Di Fiandra
- General Directorate for Health PreventionMinistry of HealthRomeItaly
| | - Nicola Vanacore
- National Center for Disease Prevention and Health PromotionItalian NationalInstitute of HealthRomeItaly
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Bosso T, Vischia F, Keller R, Vai D, Imperiale D, Vercelli A. A case report and literature review of cognitive malingering and psychopathology. Front Psychiatry 2022; 13:981475. [PMID: 36311526 PMCID: PMC9613951 DOI: 10.3389/fpsyt.2022.981475] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Malingering of cognitive difficulties constitutes a major issue in psychiatric forensic settings. Here, we present a selective literature review related to the topic of cognitive malingering, psychopathology and their possible connections. Furthermore, we report a single case study of a 60-year-old man with a long and ongoing judicial history who exhibits a suspicious multi-domain neurocognitive disorder with significant reduction of autonomy in daily living, alongside a longtime history of depressive symptoms. Building on this, we suggest the importance of evaluating malingering conditions through both psychiatric and neuropsychological assessment tools. More specifically, the use of Performance Validity Tests (PVTs)-commonly but not quite correctly considered as tests of "malingering"-alongside the collection of clinical history and the use of routine psychometric testing, seems to be crucial in order to detect discrepancies between self-reported patient's symptoms, embedded validity indicators and psychometric results.
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Affiliation(s)
- Tea Bosso
- Department of Psychology, University of Turin, Turin, Italy
| | - Flavio Vischia
- Cognitive Disorders Diagnosis and Treatment Centre, North-West Unit Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Roberto Keller
- Mental Health Department North-West Unit, Local Health Unit, ASL Città di Torino, Turin, Italy
| | - Daniela Vai
- Cognitive Disorders Diagnosis and Treatment Centre, North-West Unit Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Daniele Imperiale
- Cognitive Disorders Diagnosis and Treatment Centre, North-West Unit Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Vercelli
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Cistaro A, Quartuccio N, Cassalia L, Vai D, Guerra UP, Atzori C, Rainero I, Imperiale D. Brain 18 F-Florbetapir PET/CT Findings in an Early-onset Alzheimer Disease Patient Carrying Presenilin-1 G378E Mutation. Alzheimer Dis Assoc Disord 2022; 36:347-349. [PMID: 34132671 DOI: 10.1097/wad.0000000000000461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
Positron emission tomography (PET) with 18 F-Fluorodeoxyglucose ( 18 F-FDG) plays an outstanding role in the diagnostic work-up of dementia. Amyloid PET imaging is a complementary imaging technique for the early detection of Alzheimer disease (AD). β-amyloid precursor protein ( APP ), Presenilin-1 ( PSEN1 ) and Presenilin-2 ( PSEN2 ) are the 3 main causative genes responsible for autosomal dominant early-onset Alzheimer disease (EOAD). This is the first report of 18 F-Florbetapir amyloid imaging findings in a 35-year-old male patient with EOAD carrying the G378E mutation in PSEN1 gene. Brain computed tomography (CT) and magnetic resonance imaging scans showed remarkable cerebral atrophy with dilatation of the cerebrospinal fluid spaces; furthermore, a 18 F-Florbetapir PET/CT scan demonstrated also widespread remarkable accumulation of the amyloid tracer in the cerebral cortex, with reduction of the normal contrast between white and gray matter and flattening of the external cortical margins. Furthermore, PET/CT showed intense 18 F-florbetapir uptake in the striatum and in the thalamus bilaterally. Our case supports the usefulness of amyloid PET imaging in the diagnostic work-up of EOAD.
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Affiliation(s)
- Angelina Cistaro
- Nuclear Medicine Department, Ospedali Galliera, Genoa
- AIMN Neuroimaging Study Group, Milan
| | - Natale Quartuccio
- AIMN Neuroimaging Study Group, Milan
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo
| | - Laura Cassalia
- Department of Radiology, Institute of Radiology, "Magna Grecia" University, Catanzaro
| | - Daniela Vai
- Neurology Unit and Human TSE Regional Center, "Amedeo di Savoia" & "Maria Vittoria" Hospital, Turin
| | | | - Cristiana Atzori
- Neurology Unit and Human TSE Regional Center, "Amedeo di Savoia" & "Maria Vittoria" Hospital, Turin
| | - Innocenzo Rainero
- Neurology I, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Daniele Imperiale
- Neurology Unit and Human TSE Regional Center, "Amedeo di Savoia" & "Maria Vittoria" Hospital, Turin
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Trunfio M, De Francesco D, Vai D, Medina C, Milesi M, Domini S, Alcantarini C, Imperiale D, Bonora S, Di Perri G, Calcagno A. Screening Accuracy of Mini Addenbrooke's Cognitive Examination Test for HIV-Associated Neurocognitive Disorders in People Ageing with HIV. AIDS Behav 2022; 26:2203-2211. [PMID: 34982319 DOI: 10.1007/s10461-021-03563-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
Aging and increased cardiovascular risk are major drivers for HIV-associated neurocognitive disorders (HAND), for which accurate screenings are lacking. Mini-Addenbrooke's Cognitive Examination (MACE) reliably detects vascular and neurodegenerative cognitive decline among HIV-negative patients. We evaluated MACE diagnostic accuracy in detecting HAND in people living with HIV (PLWH) and we compared it with the International HIV Dementia Scale (IHDS). A single-centre double-blind study of diagnostic accuracy on adult outpatient PLWH without neurocognitive confounding was performed. MACE and IHDS were administered in 5 and 10 min by clinicians, followed by the reference standard battery (14 tests) by neuropsychologists. HAND diagnosis was based on the modified version of Frascati's criteria by Gisslén to reduce false positives. Exploratory cut-offs were evaluated for MACE. Diagnostic accuracy and clinical utility parameters were assessed. 231 patients were enrolled. 75.7% men with a median age, education, and length of infection of 54 (48-59), 10 (8-13) and 16 (5-25) years. HAND prevalence was 48.5% (38.9% asymptomatic impairment). Compared to IHDS, MACE sensitivity (89.3% vs 70.5%), specificity (94.1% vs 63.0%), correct classification rate (86.5% vs 66.7%), J index (0.83 vs 0.34), AUROC (0.97 vs 0.79), agreement with the gold standard (k 0.84 vs 0.33) and effect size in distinguishing HAND vs non-HAND (d 2.11 vs 1.15) were higher. Among PLWH aged 65 years and above (n = 37) MACE performance was consistently better than IHDS. The quick and easy-to-perform MACE could possess an accurate and useful screening performance for HAND in otherwise neurocognitively healthy cohorts of PLWH.
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Affiliation(s)
- Mattia Trunfio
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy.
| | - Davide De Francesco
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Daniela Vai
- Neurology Unit, Maria Vittoria Hospital, ASL Città Di Torino, Torino, Italy
| | - Caterina Medina
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Maurizio Milesi
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Simone Domini
- Neurology Unit, Maria Vittoria Hospital, ASL Città Di Torino, Torino, Italy
| | - Chiara Alcantarini
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Daniele Imperiale
- Neurology Unit, Maria Vittoria Hospital, ASL Città Di Torino, Torino, Italy
| | - Stefano Bonora
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
| | - Andrea Calcagno
- Department of Medical Sciences, University of Torino at Infectious Diseases Unit, Amedeo Di Savoia Hospital, Torino, Italy
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Trunfio M, Atzori C, Pasquero M, Di Stefano A, Vai D, Nigra M, Imperiale D, Bonora S, Di Perri G, Calcagno A. Patterns of Cerebrospinal Fluid Alzheimer’s Dementia Biomarkers in People Living with HIV: Cross-Sectional Study on Associated Factors According to Viral Control, Neurological Confounders and Neurocognition. Viruses 2022; 14:v14040753. [PMID: 35458483 PMCID: PMC9031633 DOI: 10.3390/v14040753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/11/2022] Open
Abstract
People living with HIV (PLWH) age with an excess burden of comorbidities that may increase the incidence of age-related complications. There is controversy surrounding the hypothesis that HIV can accelerate neurodegeneration and Alzheimer’s dementia (AD). We performed a retrospective study to analyze the distribution of cerebrospinal fluid (CSF) AD biomarkers (beta amyloid 1–42 fragment, tau, and phosphorylated tau) in adult PLWH (on cART with undetectable viremia, n = 136, with detectable viremia, n = 121, and with central nervous system CNS disorders regardless of viremia, n = 72) who underwent a lumbar puncture between 2008 to 2018; HIV-negative controls with AD were included (n = 84). Five subjects (1.5%) presented CSF biomarkers that were compatible with AD: one was diagnosed with AD, whereas the others showed HIV encephalitis, multiple sclerosis, cryptococcal meningitis, and neurotoxoplasmosis. Regardless of confounders, 79.6% of study participants presented normal CSF AD biomarkers. Isolated abnormalities in CSF beta amyloid 1–42 (7.9%) and tau (10.9%) were associated with age, biomarkers of intrathecal injury, and inflammation, although no HIV-specific feature was associated with abnormal CSF patterns. CSF levels of AD biomarkers very poorly overlapped between HIV-positive clinical categories and AD controls. Despite the correlations with neurocognitive performance, the inter-relationship between amyloid and tau proteins in PLWH seem to differ from that observed in AD subjects; the main driver of the isolated increase in tau seems represented by non-specific CNS inflammation, whereas the mechanisms underlying isolated amyloid consumption remain unclear.
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Affiliation(s)
- Mattia Trunfio
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
- Correspondence: ; Tel.: +39-0114393884
| | | | - Marta Pasquero
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Alessandro Di Stefano
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Daniela Vai
- Neurology Unit, Maria Vittoria Hospital, 10144 Torino, Italy
| | - Marco Nigra
- Laboratory Medicine, Maria Vittoria Hospital, 10144 Torino, Italy
| | | | - Stefano Bonora
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Giovanni Di Perri
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
| | - Andrea Calcagno
- Infectious Disease Unit, Department of Medical Sciences, University of Turin at Amedeo di Savoia Hospital, 10149 Torino, Italy
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Watson N, Hermann P, Ladogana A, Denouel A, Baiardi S, Colaizzo E, Giaccone G, Glatzel M, Green AJE, Haïk S, Imperiale D, MacKenzie J, Moda F, Smith C, Summers D, Tiple D, Vaianella L, Zanusso G, Pocchiari M, Zerr I, Parchi P, Brandel JP, Pal S. Validation of Revised International Creutzfeldt-Jakob Disease Surveillance Network Diagnostic Criteria for Sporadic Creutzfeldt-Jakob Disease. JAMA Netw Open 2022; 5:e2146319. [PMID: 35099544 PMCID: PMC8804913 DOI: 10.1001/jamanetworkopen.2021.46319] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Sporadic Creutzfeldt-Jakob disease (sCJD) is a rapidly lethal disease. Rapid, accurate diagnosis is imperative for epidemiological surveillance and public health activities to exclude treatable differentials and facilitate supportive care. In 2017, the International CJD Surveillance Network diagnostic criteria were revised to incorporate cortical ribboning on magnetic resonance imaging and the real-time quaking-induced conversion (RT-QuIC) assay, developments that require multicenter evaluation. OBJECTIVE To evaluate the accuracy of revised diagnostic criteria through the retrospective diagnosis of autopsy-confirmed cases (referred to as in-life diagnosis). DESIGN, SETTING, AND PARTICIPANTS This diagnostic study used a 3-year clinicopathological series using all cases of autopsy-confirmed sCJD and a noncase group with alternative neuropathological diagnoses from national surveillance centers in the United Kingdom, France, Germany, and Italy. Data were collected from January 2017 to December 2019 and analyzed from January 2020 to November 2021. MAIN OUTCOMES AND MEASURES Sensitivity and specificity of revised diagnostic criteria and diagnostic investigations. Secondary analyses assessing sCJD subgroups by genotype, pathological classification, disease duration, and age. RESULTS A total of 501 sCJD cases and 146 noncases were included. Noncase diagnoses included neurodegenerative diseases, autoimmune encephalitis, and cerebral insults such as anoxia. Participants in the sCJD cases cohort were younger (mean [SD] age, 68.8 [9.8] years vs 72.8 [10.9] years; P < .001) and had longer median (IQR) disease duration (118 [74.8-222.3] days vs 85 [51.5-205.5] days; P = .002); sex ratios were equivalent (253 [50.5%] male cases vs 74 [50.7%] male noncases). Sensitivity of revised criteria in in-life diagnosis (450 of 488 [92.2%] diagnoses; 95% CI, 89.5%-94.4%) was increased compared with prior criteria (378 of 488 [77.5%] diagnoses; 95% CI, 73.5%-81.1%; P < .001), while specificity (101 of 125 [80.8%] diagnoses; 95% CI, 72.8%-87.3%) was unchanged (102 of 125 [81.6%] diagnoses; 95% CI, 73.7%-88.0%; P > .99). Among 223 cases and 52 noncases with the full panel of investigations performed, sensitivity of revised criteria (97.8%; 95% CI, 94.9%-99.3%) was increased compared with prior criteria (76.2%; 95% CI, 70.1%-81.7%; P < .001) while specificity was unchanged (67.3%; 95% CI, 52.9%-79.7% vs 69.2%; 95% CI, 54.9%-81.3%; P > .99). In 455 cases and 111 noncases, cortical ribboning was 67.9% sensitive (95% CI, 63.4%-72.2%) and 86.5% specific (95% CI, 78.7%-92.2%). In 274 cases and 77 noncases, RT-QuIC was 91.6% sensitive (95% CI, 87.7%-94.6%) and 100% specific (95% CI, 96.2%-100%). Investigation sensitivity varied with genetic and pathological features, disease duration, and age. CONCLUSIONS AND RELEVANCE This diagnostic study demonstrated significantly improved sensitivity of revised sCJD diagnostic criteria with unaltered specificity. The revision has enhanced diagnostic accuracy for clinical care and surveillance.
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Affiliation(s)
- Neil Watson
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Hermann
- National Reference Centre for TSE, Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Anna Ladogana
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Angeline Denouel
- Cellule Nationale de référence des MCJ, Groupe Hospitalier Pitié-Salpêtrière, Paris Cedex 13, France
| | - Simone Baiardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Elisa Colaizzo
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Giorgio Giaccone
- Neurology 5/Neuropathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alison J. E. Green
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stéphane Haïk
- Cellule Nationale de référence des MCJ, Groupe Hospitalier Pitié-Salpêtrière, Paris Cedex 13, France
| | | | - Janet MacKenzie
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Fabio Moda
- Neurology 5/Neuropathology Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Colin Smith
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - David Summers
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Dorina Tiple
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Luana Vaianella
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Maurizio Pocchiari
- Registry of Creutzfeldt-Jakob Disease, Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Inga Zerr
- National Reference Centre for TSE, Department of Neurology, University Medical Centre Göttingen, Göttingen, Germany
| | - Piero Parchi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuropatologia delle Malattie Neurodegenerative, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Jean-Philippe Brandel
- Cellule Nationale de référence des MCJ, Groupe Hospitalier Pitié-Salpêtrière, Paris Cedex 13, France
| | - Suvankar Pal
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Calcagno A, Celani L, Trunfio M, Orofino G, Imperiale D, Atzori C, Arena V, d'Ettorre G, Guaraldi G, Gisslen M, Di Perri G. Alzheimer Dementia in People Living With HIV. Neurol Clin Pract 2021; 11:e627-e633. [PMID: 34840876 DOI: 10.1212/cpj.0000000000001060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
Objective Given the aging of people living with HIV (PLWH) and the high prevalence of HIV-associated neurocognitive disorders, we aimed at describing the clinical, instrumental, and CSF features of PLWH diagnosed with Alzheimer dementia (AD). Methods The databases of 3 large Italian outpatient clinics taking care of more than 9,000 PLWH were searched for the diagnosis of AD. After obtaining patients' or their next of kin's consent for publication, anonymous data were collected in an excel spreadsheet and described. Routinely collected CSF biomarkers and radiologic imaging results were recorded whether available. Results Four patients were included in this case series who were diagnosed with AD aged between 60 and 74 years. All participants were on highly active antiretroviral therapy and showed nondetectable serum HIV RNA. Memory impairment was the most prominent cognitive feature. The diagnosis was obtained considering the exclusion of other potential causes, MRI and fluorodeoxyglucose-PET features, and, in (in 2/4), CSF AD biomarkers levels. In 1 patient, longitudinal CSF tau/p-tau increased, and beta-amyloid1-42 decreased over time despite antiretroviral therapy containing nucleotide reverse transcriptase inhibitors. Conclusions In older PLWH cognitive symptoms may represent the onset of AD: a multidisciplinary team may be needed for reaching a likely in vivo diagnosis.
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Affiliation(s)
- Andrea Calcagno
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Luigi Celani
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Mattia Trunfio
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Giancarlo Orofino
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Daniele Imperiale
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Cristiana Atzori
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Vincenzo Arena
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Gabriella d'Ettorre
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Giovanni Guaraldi
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Magnus Gisslen
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Giovanni Di Perri
- Unit of Infectious Diseases (C. Andrea, MT, GDP), Department of Medical Sciences, University of Torino, Italy; Department of Public Health and Infectious Diseases (LC, GE), Sapienza University of Rome, Italy; "Divisione A" Unit of Infectious Diseases (GO), Ospedale Amedeo di Savoia, ASL Città di Torino, Italy; Unit of Neurology (DI, C. Atzori), Ospedale Maria Vittoria, ASL Città di Torino, Italy; AFFIDEA Irmet PET/CT Center (VA), Torino, Italy; Department of Surgical (GG), Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy; Department of Infectious Diseases (MG), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden; and Region Västra Götaland (MG), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
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Keller R, Costa T, Imperiale D, Bianco A, Rondini E, Hassiotis A, Bertelli MO. Stereotypies in the Autism Spectrum Disorder: Can We Rely on an Ethological Model? Brain Sci 2021; 11:762. [PMID: 34201177 PMCID: PMC8230333 DOI: 10.3390/brainsci11060762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stereotypic behaviour can be defined as a clear behavioural pattern where a specific function or target cannot be identified, although it delays on time. Nonetheless, repetitive and stereotypical behaviours play a key role in both animal and human behaviour. Similar behaviours are observed across species, in typical human developmental phases, and in some neuropsychiatric conditions, such as Autism Spectrum Disorder (ASD) and Intellectual Disability. This evidence led to the spread of animal models of repetitive behaviours to better understand the neurobiological mechanisms underlying these dysfunctional behaviours and to gain better insight into their role and origin within ASD and other disorders. This, in turn, could lead to new treatments of those disorders in humans. METHOD This paper maps the literature on repetitive behaviours in animal models of ASD, in order to improve understanding of stereotypies in persons with ASD in terms of characterization, pathophysiology, genomic and anatomical factors. RESULTS Literature mapping confirmed that phylogenic approach and animal models may help to improve understanding and differentiation of stereotypies in ASD. Some repetitive behaviours appear to be interconnected and mediated by common genomic and anatomical factors across species, mainly by alterations of basal ganglia circuitry. A new distinction between stereotypies and autotypies should be considered. CONCLUSIONS Phylogenic approach and studies on animal models may support clinical issues related to stereotypies in persons with ASD and provide new insights in classification, pathogenesis, and management.
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Affiliation(s)
- Roberto Keller
- Adult Autism Centre, Mental Health Department, ASL Città di Torino, 10138 Turin, Italy; (R.K.); (T.C.)
| | - Tatiana Costa
- Adult Autism Centre, Mental Health Department, ASL Città di Torino, 10138 Turin, Italy; (R.K.); (T.C.)
| | - Daniele Imperiale
- Neurology Unit, Maria Vittoria Hospital, ASL Città di Torino, 10144 Turin, Italy;
| | - Annamaria Bianco
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, 50142 Florence, Italy; (A.B.); (E.R.)
| | - Elisa Rondini
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, 50142 Florence, Italy; (A.B.); (E.R.)
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London W1T 7NF, UK;
| | - Marco O. Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, 50142 Florence, Italy; (A.B.); (E.R.)
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Caligaris G, Trunfio M, Ghisetti V, Cusato J, Nigra M, Atzori C, Imperiale D, Bonora S, Di Perri G, Calcagno A. Blood-Brain Barrier Impairment in Patients Living with HIV: Predictors and Associated Biomarkers. Diagnostics (Basel) 2021; 11:867. [PMID: 34065785 PMCID: PMC8151579 DOI: 10.3390/diagnostics11050867] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/18/2022] Open
Abstract
Despite the substantial changes resulting from the introduction of combination antiretroviral therapy (cART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains substantial. Blood-brain barrier impairment (BBBi) is a frequent feature in people living with HIV (PLWH) and it may persist despite effective antiretroviral treatment. A cross-sectional study was performed in PLWH who underwent lumbar puncture for clinical reasons or research protocols and several cerebrospinal fluid biomarkers were studied. BBBi was defined as cerebrospinal fluid-to-serum albumin ratio (CSAR) >6.5 (<40 years) or >8 (>40 years). We included 464 participants: 147 cART-naïve and 317 on cART. Male sex was prevalent in both groups (72.1% and 72.2% respectively); median age was 44 (38-52) years in naïve and 49 (43-57) years in treated subjects. BBBi was observed in 35.4% naïve and in 22.7% treated participants; the use of integrase inhibitors was associated with a lower prevalence (18.3 vs. 30.9%, p = 0.050). At multivariate binary logistic regression (including age and sex) nadir CD4 cell count (p = 0.034), presence of central nervous system (CNS) opportunistic infections (p = 0.024) and cerebrospinal fluid (CSF) HIV RNA (p = 0.002) in naïve participants and male sex (p = 0.021), a history of CNS opportunistic infections (p = 0.001) and CSF HIV RNA (p = 0.034) in treated patients were independently associated with BBBi. CSF cells and neopterin were significantly higher in participants with BBBi. BBBi was prevalent in naïve and treated PLWH and it was associated with CSF HIV RNA and neopterin. Systemic control of viral replication seems to be essential for BBB integrity while sex and treatment influence need further studies.
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Affiliation(s)
- Giulia Caligaris
- Department of Medical Sciences, Faculty of Medicine and Surgery, University of Torino, 10126 Torino, Italy; (M.T.); (J.C.); (D.I.); (S.B.); (G.D.P.); (A.C.)
| | - Mattia Trunfio
- Department of Medical Sciences, Faculty of Medicine and Surgery, University of Torino, 10126 Torino, Italy; (M.T.); (J.C.); (D.I.); (S.B.); (G.D.P.); (A.C.)
| | - Valeria Ghisetti
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, 10149 Torino, Italy;
| | - Jessica Cusato
- Department of Medical Sciences, Faculty of Medicine and Surgery, University of Torino, 10126 Torino, Italy; (M.T.); (J.C.); (D.I.); (S.B.); (G.D.P.); (A.C.)
| | - Marco Nigra
- Diagnostic Laboratory Unit, San Giovanni Bosco Hospital, 10154 Torino, Italy;
| | - Cristiana Atzori
- Unit of Neurology, Maria Vittoria Hospital, ASL Città di Torino, 10144 Torino, Italy;
| | - Daniele Imperiale
- Department of Medical Sciences, Faculty of Medicine and Surgery, University of Torino, 10126 Torino, Italy; (M.T.); (J.C.); (D.I.); (S.B.); (G.D.P.); (A.C.)
| | - Stefano Bonora
- Department of Medical Sciences, Faculty of Medicine and Surgery, University of Torino, 10126 Torino, Italy; (M.T.); (J.C.); (D.I.); (S.B.); (G.D.P.); (A.C.)
| | - Giovanni Di Perri
- Department of Medical Sciences, Faculty of Medicine and Surgery, University of Torino, 10126 Torino, Italy; (M.T.); (J.C.); (D.I.); (S.B.); (G.D.P.); (A.C.)
| | - Andrea Calcagno
- Department of Medical Sciences, Faculty of Medicine and Surgery, University of Torino, 10126 Torino, Italy; (M.T.); (J.C.); (D.I.); (S.B.); (G.D.P.); (A.C.)
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Melis F, Guido M, Amellone C, Suppo M, Bonanno M, Bovio C, Pessia A, Savio K, Lucciola MT, Ebrille E, Guastamacchia G, Cassano D, Filippi P, Milano E, Giammaria M, Imperiale D. Prevalence and predictors of atrial fibrillation in patients with embolic stroke of undetermined source: a real-life single-center retrospective study. Neurol Sci 2021; 42:3707-3714. [PMID: 33443664 DOI: 10.1007/s10072-020-04963-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Up to one-third of ischemic strokes remained cryptogenic despite extensive investigations. Atrial fibrillation may be detected in a significant proportion of patients with embolic stroke of undetermined source, particularly after the introduction of implantable loop recorder in clinical practice. METHODS We retrospectively included all the consecutive patients with embolic stroke of undetermined source referred to our units in the period November 2013 to December 2018 and in which an implantable loop recorder was positioned within 6 months from stroke event. Prevalence and predictors of atrial fibrillation were investigated. RESULTS One hundred thirty-eight patients with embolic stroke of undetermined source fulfilling inclusion criteria were identified. The crude prevalence of atrial fibrillation at the end of observation period was of 45.7%. Incidence rates at 6, 12, 18, 24, and 36 months resulted, respectively, 31.8% (95% CI, 30.4-46.7), 38.0% (95% CI, 30.4-46.9), 42.6% (95% CI, 34.5-51.6), 46.6% (95% CI, 38.2-55.8), and 50.4% (95% CI, 41.6-59.9). On multivariate analysis, only excessive supraventricular electric activity and left atrial enlargement resulted to be significant predictors of atrial fibrillation (p = 0.037 and p < 0.0001, respectively). CONCLUSIONS Atrial fibrillation may be detected in a relevant proportion (up to 50%) of patients with embolic stroke of undetermined source if a careful and extensive diagnostic work-up is employed. Excessive supraventricular electric activity and left atrial enlargement are significant predictors of the occurrence of atrial fibrillation in these patients.
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Affiliation(s)
- Fabio Melis
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Marilena Guido
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | | | - Marco Suppo
- SC Cardiologia 1 - Ospedale Maria Vittoria, Torino, Italy
| | - Maria Bonanno
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Consuelo Bovio
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Andrea Pessia
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Katia Savio
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | | | - Elisa Ebrille
- SC Cardiologia 1 - Ospedale Maria Vittoria, Torino, Italy
| | - Giulia Guastamacchia
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Daniela Cassano
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Paola Filippi
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | - Eva Milano
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy
| | | | - Daniele Imperiale
- SC Neurologia 1 - Ospedale Maria Vittoria, Via Cibrario 72, 10144, Torino, Italy.
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Mella A, Mingozzi S, Gallo E, Lavacca A, Rossetti M, Clari R, Randone O, Maffei S, Salomone M, Imperiale D, Biancone L. Case series of six kidney transplanted patients with COVID-19 pneumonia treated with tocilizumab. Transpl Infect Dis 2020; 22:e13348. [PMID: 32500936 PMCID: PMC7300504 DOI: 10.1111/tid.13348] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
Few reports described the outcome of kidney transplanted patients (KTs) affected by COVID‐19 treated with interleukin‐6 receptor inhibitor tocilizumab (TCZ). We report our case series of 6 KTs with COVID‐19 pneumonia who received TCZ: All were of male gender, with a mean age of 55.5 ± 8.4 years, a median time from transplantation of 3611 days (1465‐5757); 5/6 had cardiovascular comorbidities, 1/6 had diabetes, and 3/6 have one or more previous KTs. Four out of six patients died, at an average time of 9.75 ± 2.4 days after tocilizumab administration, 3/6 due to a coexistent septic shock. Two patients improved after TCZ and were discharged at 20 and 21 days, respectively; in both patient, a significant increase of total lymphocyte count was observed. In conclusion, KTs, where the role of peculiar factors such as chronic immunosuppression is still undetermined, represent a high‐risk group with significant COVID‐19‐associated mortality. The evaluation of the TCZ effect in COVID‐19 pneumonia requires controlled studies (ideally RCTs) in this specific population.
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Affiliation(s)
- Alberto Mella
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Silvia Mingozzi
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ester Gallo
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Antonio Lavacca
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maura Rossetti
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberta Clari
- Department of Nephrology and Dialysis, Ospedale Maggiore di Chieri, Chieri, Italy
| | - Olga Randone
- Department of Nephrology and Dialysis, Cardinal Massaia Hospital, Asti, Italy
| | - Stefano Maffei
- Department of Nephrology and Dialysis, Cardinal Massaia Hospital, Asti, Italy
| | - Mario Salomone
- Department of Nephrology and Dialysis, Ospedale Maggiore di Chieri, Chieri, Italy
| | | | - Luigi Biancone
- Renal Transplant Center "A. Vercellone", Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza" Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
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Sciascia S, Aprà F, Baffa A, Baldovino S, Boaro D, Boero R, Bonora S, Calcagno A, Cecchi I, Cinnirella G, Converso M, Cozzi M, Crosasso P, De Iaco F, Di Perri G, Eandi M, Fenoglio R, Giusti M, Imperiale D, Imperiale G, Livigni S, Manno E, Massara C, Milone V, Natale G, Navarra M, Oddone V, Osella S, Piccioni P, Radin M, Roccatello D, Rossi D. Pilot prospective open, single-arm multicentre study on off-label use of tocilizumab in patients with severe COVID-19. Clin Exp Rheumatol 2020; 38:529-532. [PMID: 32359035] [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: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES No agent has yet been proven to be effective for the treatment of patients with severe COVID-19. METHODS We conducted a pilot prospective open, single-arm multicentre study on off-label use of tocilizumab (TCZ) involving 63 hospitalised adult patients (56 males, age 62.6±12.5) with severe COVID-19. Clinical and laboratory parameters were prospectively collected at baseline, day 1, 2, 7 and 14. No moderate-to-severe adverse events attributable to TCZ were recorded. RESULTS We observed a significant improvement in the levels of ferritin, C-reactive protein, D-dimer. The ratio of the partial pressure of oxygen (Pa02) to the fraction of inspired oxygen (Fi02) improved (mean±SD Pa02/Fi02 at admission: 152±53; at day 7: 283.73±115.9, at day 14: 302.2±126, p<0.05). The overall mortality was 11%; D-dimer level at baseline, but not IL-6 levels were predictors of mortality. TCZ administration within 6 days from admission in the hospital was associated with an increased likelihood of survival (HR 2.2 95%CI 1.3-6.7, p<0.05). CONCLUSIONS In hospitalised adult patients with severe COVID-19, TCZ could be a safe option. An improvement in respiratory and laboratory parameters was observed. Future controlled trials in patients with severe illness are urgently needed to confirm the definite benefit with IL-6 target therapy.
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Affiliation(s)
- Savino Sciascia
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | - Alessandra Baffa
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | - Simone Baldovino
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | | | - Irene Cecchi
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | - Martina Cozzi
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | | | - Roberta Fenoglio
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | | | | | - Carlo Massara
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | | | - Valentina Oddone
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | | | | | - Massimo Radin
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
| | - Dario Roccatello
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy.
| | - Daniela Rossi
- CMID, Centre of Research of Immunopathology and Rare Diseases, Coordinating Centre of the Network for Rare Diseases of Piemonte and Valle d'Aosta, ASL Città di Torino, Department of Clinical and Biological Sciences, University of Torino, and ASL Città di Torino, Italy
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18
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Lupia T, Milia MG, Atzori C, Gianella S, Audagnotto S, Imperiale D, Mighetto L, Pirriatore V, Gregori G, Lipani F, Ghisetti V, Bonora S, Di Perri G, Calcagno A. Presence of Epstein-Barr virus DNA in cerebrospinal fluid is associated with greater HIV RNA and inflammation. AIDS 2020; 34:373-380. [PMID: 31764071 PMCID: PMC7773520 DOI: 10.1097/qad.0000000000002442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The current study aimed to investigate whether cerebrospinal fluid (CSF) Epstein-Barr virus (EBV) or cytomegalovirus (CMV) DNA was associated with viral, inflammatory and neuronal damage biomarkers in people living with HIV (PLWH). DESIGN A cross-sectional diagnostic study on CSF fluid samples in patients undergoing lumbar punctures for clinical reasons, to better understand the role of EBV and CMV in the CNS on HIV RNA replication, blood-brain-barrier (BBB) damage and biomarkers of neuronal damage/inflammation. METHODS EBV, CMV DNA and HIV RNA were measured on CSF, through real time (RT)-PCR, from PLWHs undergoing lumbar punctures for clinical reasons (excluding oncho-haematological comorbidities). Immune-enzymatic assays evaluated blood-brain barrier inflammation and damage. Patients were stratified according to plasma HIV RNA levels in viremic (≥50 copies/ml) and aviremic (<50 copies/ml). RESULTS We included 297 participants. Among 167 viremic patients CSF EBV and CMV DNA were detectable in 42 (25.1%) and 10 (6.3%) participants; among 130 aviremic individuals CSF EBV and CMV DNA were detectable in 12 (9.2%) and 0 (0%) participants, respectively. In viremic group detectable CSF EBV DNA was associated with CSF pleocytosis (P < 0.001), higher CSF HIV RNA (P < 0.001) and neopterin levels (P = 0.002). In aviremic participants detectable EBV DNA was associated with pleocytosis (P = 0.056), higher neopterin (P = 0.027) and immune globulins (P = 0.016) in the CSF; CSF escape was more common in those with detectable EBV DNA (50 vs. 21.2%, P = 0.036). CONCLUSION EBV DNA was frequently detected in the CSF of viremic and fewer aviremic patients on antiretroviral treatment. In PLWH without clinical evidence of encephalitis CSF EBV DNA was associated with higher biomarkers levels of neuronal damage/inflammation. The role of EBV reactivation in HIV-associated central nervous system disorders warrants further studies.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino
| | - Maria Grazia Milia
- Laboratory of Virology and Molecular Biology, Ospedale Amedeo di Savoia, ASL ‘Città di Torino’
| | - Cristiana Atzori
- Unit of Neurology, Ospedale Maria Vittoria, ASL ‘Città di Torino’, Torino, Italy
| | - Sara Gianella
- University of California San Diego, La Jolla, California, USA
| | - Sabrina Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino
| | - Daniele Imperiale
- Unit of Neurology, Ospedale Maria Vittoria, ASL ‘Città di Torino’, Torino, Italy
| | - Lorenzo Mighetto
- Laboratory of Immunology, Ospedale Maria Vittoria, ASL ‘Città di Torino’, Torino, Italy
| | - Veronica Pirriatore
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino
| | - Gabriella Gregori
- Laboratory of Virology and Molecular Biology, Ospedale Amedeo di Savoia, ASL ‘Città di Torino’
| | - Filippo Lipani
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino
| | - Valeria Ghisetti
- Laboratory of Virology and Molecular Biology, Ospedale Amedeo di Savoia, ASL ‘Città di Torino’
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino
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19
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Trunfio M, Manini C, Trentalange A, Boghi A, Audagnotto S, Imperiale D, Taraglio S, Bonora S, Di Perri G, Calcagno A. The "milky way" galaxy of HIV-related central nervous system immune reaction syndromes. J Neurovirol 2019; 25:887-892. [PMID: 31214917 DOI: 10.1007/s13365-019-00769-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022]
Abstract
The landscape of central nervous system HIV infection is rapidly changing, leading to the recognition of a new constellation of overlapping syndromes and to a better insight for the elder ones. Among these, progressive multifocal leukoencephalopathy (PML) still poses several diagnostic and therapeutic challenges; nevertheless, recent developments in understanding PML in patients with multiple sclerosis may have benefitted HIV-positive patients suffering from PML too. We describe a peculiar case of PML-immune reconstitution inflammatory syndrome (IRIS) presenting a punctate pattern with "milky way" appearance on magnetic resonance imaging. Despite the fact that brain imaging and histopathology remain the mainstays for extricating through the expanding galaxy of HIV-related central nervous system dysimmune syndromes and although punctate pattern has been already well acknowledged as a suggestive finding of PML among patients on natalizumab, this radiological presentation is still poorly recognised in AIDS-related PML cases, leading to possible life-threatening diagnostic delays. This is also the first report about intravenous immunoglobulin treatment in AIDS-related PML-IRIS; the favourable clinical and radiological outcome of our case and the preliminary administrations of intravenous immunoglobulins in natalizumab-associated PML-IRIS from literature support probable benefits also among HIV-positive patients.
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Affiliation(s)
- Mattia Trunfio
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy.
| | - Claudia Manini
- Unit of Pathology, San Giovanni Bosco Hospital, Piazza Donatore di Sangue 3, 10154, Torino, Italy
| | - Alice Trentalange
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy
| | - Andrea Boghi
- Unit of Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore di Sangue 3, 10154, Torino, Italy
| | - Sabrina Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy
| | - Daniele Imperiale
- Unit of Neurology, Maria Vittoria Hospital, Via Luigi Cibrario 72, 10144, Torino, Italy
| | - Stefano Taraglio
- Unit of Pathology, San Giovanni Bosco Hospital, Piazza Donatore di Sangue 3, 10154, Torino, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy
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20
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Piaceri I, Imperiale D, Ghidoni E, Atzori C, Bagnoli S, Ferrari C, Ungari S, Ambrogio L, Sorbi S, Nacmias B. Novel GRN Mutations in Alzheimer's Disease and Frontotemporal Lobar Degeneration. J Alzheimers Dis 2019; 62:1683-1689. [PMID: 29614680 DOI: 10.3233/jad-170989] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND During the twentieth century, frontotemporal dementia (FTD) was often misdiagnosed, confused with Alzheimer's disease or psychiatric disorders, jeopardizing care and research. OBJECTIVE To analyze the FTD genes in the DNA samples of patients belonging to families clinically classified as probable Alzheimer's disease (FAD) in the early 1990s and not carrying mutation in the three main genes linked to FAD (Presenilin 1, Presenilin 2, and Amyloid precursor protein). METHODS The genetic screening was performed on 63 probands diagnosed as FAD before the early 2000s. RESULTS Four patients out of the 63 studied (4/63, 6.3%) resulted as carrying four different GRN genetic variations: p.T272SfsX10, p.R110X, p.C149LfsX10, and p.W304C. The first two mutations (p.T272SfsX10, p.R110X) are the most frequent ones in Italy in FTD patients; the latter two (p.C149LfsX10 and p.W304C) are not described in the scientific literature. CONCLUSION Our data suggest that it can be important to re-examine FAD patients diagnosed when the FTD spectrum was not well recognized and the causative FTD genes had not yet been identified. Moreover, we propose initially analyzing genes associated with the first form of suspected dementia and, if the results are negative, studying genes implicated in the other form of dementia.
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Affiliation(s)
- Irene Piaceri
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Daniele Imperiale
- Neurology Unit and Human TSE Regional Center, ASL TO2 Maria Vittoria Hospital, Turin, Italy
| | | | - Cristiana Atzori
- Neurology Unit and Human TSE Regional Center, ASL TO2 Maria Vittoria Hospital, Turin, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | | | - Silvana Ungari
- ASO Neurologia, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Luca Ambrogio
- ASO Neurologia, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy.,IRCCS Don Gnocchi, Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
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21
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Bertero L, Joseph SB, Trunfio M, Allice T, Catera S, Imperiale D, Cassoni P, Kincer LP, Pirriatore V, Ghisetti V, Amasio E, Zanusso G, Bonora S, Di Perri G, Calcagno A. HIV-1 detection in the olfactory mucosa of HIV-1-infected participants. AIDS 2019; 33:665-674. [PMID: 30608272 DOI: 10.1097/qad.0000000000002102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE HIV infection chronically affects the central nervous system (CNS). Olfactory mucosa is a unique site in the respiratory tract that is directly connected to the CNS; thus we wanted to evaluate olfactory mucosa as a surrogate of CNS sampling. DESIGN We conducted a preliminary study examining HIV populations and susceptible cells in the olfactory mucosa. METHODS Olfactory mucosa was sampled by minimally invasive brushing. Cerebrospinal fluid (CSF) analyses were performed as per routine clinical procedures. Olfactory marker protein, CD4+, CD8+, and trans-activator of transcription (TAT) expressions were assessed by immunohistochemistry. Plasma, CSF, and olfactory mucosa HIV-RNA were quantified using the Cobas AmpliPrep/Cobas TaqMan assay, whereas HIV proviral DNA was evaluated on peripheral blood mononuclear cell and olfactory mucosa. HIV-1 env deep sequencing was performed for phylogenetic analysis. RESULTS Among ART-naive participants, 88.2% (15/17), and among ART-treated participants, 21.4% (6/28) had detectable HIV-RNA in samples from their olfactory mucosa; CSF escape was more common in patients with olfactory mucosa escape (50 vs. 7.9%; P = 0.010). Olfactory mucosa samples contained few cells positive for CD4, CD8, or HIV-DNA, and no HIV TAT-positive cells, indicating that this approach efficiently samples virions in the olfactory mucosa, but not HIV-infected cells. Yet, using a deep sequencing approach to phylogenetically compare partial HIV env genes in five untreated participants, we identified distinct viral lineages in the OM. CONCLUSIONS The results of this study suggest that nasal brushing is a well tolerated and useful technique for sampling the olfactory mucosa. HIV-RNA was detected in most naïve and in some treated patients, warranting larger longitudinal studies.
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22
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Di Fede G, Catania M, Atzori C, Moda F, Pasquali C, Indaco A, Grisoli M, Zuffi M, Guaita MC, Testi R, Taraglio S, Sessa M, Gusmaroli G, Spinelli M, Salzano G, Legname G, Tarletti R, Godi L, Pocchiari M, Tagliavini F, Imperiale D, Giaccone G. Clinical and neuropathological phenotype associated with the novel V189I mutation in the prion protein gene. Acta Neuropathol Commun 2019; 7:1. [PMID: 30606247 PMCID: PMC6317215 DOI: 10.1186/s40478-018-0656-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022] Open
Abstract
Prion diseases are neurodegenerative disorders which are caused by an accumulation of the abnormal, misfolded prion protein known as scrapie prion protein (PrPSc). These disorders are unique as they occur as sporadic, genetic and acquired forms. Sporadic Creutzfeldt-Jakob Disease (CJD) is the most common human prion disease, accounting for approximately 85–90% of cases, whereas autosomal dominant genetic forms, due to mutations in the prion protein gene (PRNP), account for 10–15% of cases. Genetic forms show a striking variability in their clinical and neuropathological picture and can sometimes mimic other neurodegenerative diseases. We report a novel PRNP mutation (V189I) in four CJD patients from three unrelated pedigrees. In three patients, the clinical features were typical for CJD and the diagnosis was pathologically confirmed, while the fourth patient presented with a complex phenotype including rapidly progressive dementia, behavioral abnormalities, ataxia and extrapyramidal features, and the diagnosis was probable CJD by current criteria, on the basis of PrPSc detection in CSF by Real Time Quaking-Induced Conversion assay. In all the three patients with autopsy findings, the neuropathological analysis revealed diffuse synaptic type deposition of proteinase K-resistant prion protein (PrPres), and type 1 PrPres was identified in the brain by western blot analysis. So, the histopathological and biochemical profile associated with the V189I mutation was indistinguishable from the MM1/MV1 subtype of sporadic CJD. Our findings support a pathogenic role for the V189I PRNP variant, confirm the heterogeneity of the clinical phenotypes associated to PRNP mutations and highlight the importance of PrPSc detection assays as diagnostic tools to unveil prion diseases presenting with atypical phenotypes.
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23
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Abu-Rumeileh S, Redaelli V, Baiardi S, Mackenzie G, Windl O, Ritchie DL, Didato G, Hernandez-Vara J, Rossi M, Capellari S, Imperiale D, Rizzone MG, Belotti A, Sorbi S, Rozemuller AJM, Cortelli P, Gelpi E, Will RG, Zerr I, Giaccone G, Parchi P. Sporadic Fatal Insomnia in Europe: Phenotypic Features and Diagnostic Challenges. Ann Neurol 2018; 84:347-360. [PMID: 30048013 DOI: 10.1002/ana.25300] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/28/2018] [Accepted: 07/22/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Comprehensively describe the phenotypic spectrum of sporadic fatal insomnia (sFI) to facilitate diagnosis and management of this rare and peculiar prion disorder. METHODS A survey among major prion disease reference centers in Europe identified 13 patients diagnosed with sFI in the past 20 years. We undertook a detailed analysis of clinical and histopathological features and the results of diagnostic investigations. RESULTS Mean age at onset was 43 years, and mean disease duration 30 months. Early clinical findings included psychiatric, sleep, and oculomotor disturbances, followed by cognitive decline and postural instability. In all tested patients, video-polysomnography demonstrated a severe reduction of total sleep time and/or a disorganized sleep. Cerebrospinal fluid (CSF) levels of proteins 14-3-3 and t-tau were unrevealing, the concentration of neurofilament light protein (NfL) was more consistently increased, and the real-time quaking-induced conversion assay (RT-QuIC) revealed a positive prion seeding activity in 60% of cases. Electroencephalography and magnetic resonance imaging showed nonspecific findings, whereas fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated a profound bilateral thalamic hypometabolism in 71% of cases. Molecular analyses revealed PrPSc type 2 and methionine homozygosity at PRNP codon 129 in all cases. INTERPRETATION sFI is a disease of young or middle-aged adults, which is difficult to reconcile with the hypothesis of a spontaneous etiology related to stochastic, age-related PrP misfolding. The combination of psychiatric and/or sleep-related symptoms with oculomotor abnormalities represents an early peculiar clinical feature of sFI to be valued in the differential diagnosis. Video-polysomnography, FDG-PET, and especially CSF prion RT-QuIC and NfL constitute the most promising supportive diagnostic tests in vivo. Ann Neurol 2018;84:347-360.
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Affiliation(s)
- Samir Abu-Rumeileh
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Veronica Redaelli
- Neurology and Neuropathology Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Graeme Mackenzie
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - Otto Windl
- Center for Neuropathology and Prion Research, Ludwig Maximilian University, Munich, Germany
| | - Diane L Ritchie
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - Giuseppe Didato
- Clinical and Experimental Epileptology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | | | - Marcello Rossi
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | | | | | | | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy.,IRCCS Don Gnocchi, Florence, Italy
| | | | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobanc, - Hospital Clínic - Institut d'Investigacions Biomédiques, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Robert G Will
- National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland, United Kingdom
| | - Inga Zerr
- Department of Neurology, University Medical School, Göttingen, Germany
| | - Giorgio Giaccone
- Neurology and Neuropathology Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Piero Parchi
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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Scabini S, Trunfio M, Pirriatore V, Imperiale D, Audagnotto S, Bertucci R, Ghisetti V, Cinnirella G, Cistaro A, Perna M, Calcagno A, Di Perri G. Antiviral activity of maraviroc plus mirtazapine in a low-risk HIV-negative patient with progressive multifocal leukoencephalopathy. Infez Med 2018; 26:160-163. [PMID: 29932090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A case of progressive multifocal leukoencephalopathy (PML) is described in an HIV-negative patient with mixed connective-tissue disease (MCTD) on a minimally immunosuppressive treatment with hydroxychloroquine. The patient presented with right-sided weakness, episodes of disorientation and loss of short-term memory and of vision in her right eye. PML was diagnosed by JCV DNA on cerebrospinal fluid and radiological criteria. She was treated with off-label maraviroc and mirtazapine but died two months after hospital admission, despite a surprising decrease in the viral load of cerebrospinal fluid three weeks after starting therapy. Prompt diagnosis and antiviral treatment of PML even in low-risk patients are warranted. Future studies are required to define the therapeutic role of maraviroc (MVC) and mirtazapine in this setting.
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Affiliation(s)
- Silvia Scabini
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - Mattia Trunfio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - Veronica Pirriatore
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - Daniele Imperiale
- Department of Neurology, Maria Vittoria Hospital, ASLTO2, Torino, Italy
| | - Sabrina Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - Roberto Bertucci
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Molecular Biology, Amedeo di Savoia Hospital, ASLTO2, Torino, Italy
| | | | - Angelina Cistaro
- Positron Emission Tomography Centre IRMET, Affidea, Torino, Italy, Neuroimaging Steering Committee of AIMN, Italy
| | - Mariaelena Perna
- Department of Radiology, Giovanni Bosco Hospital, ASLTO2, Torino, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Italy
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25
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Trunfio M, Vai D, Montrucchio C, Alcantarini C, Livelli A, Tettoni MC, Orofino G, Audagnotto S, Imperiale D, Bonora S, Di Perri G, Calcagno A. Diagnostic accuracy of new and old cognitive screening tools for HIV-associated neurocognitive disorders. HIV Med 2018; 19:455-464. [PMID: 29761877 DOI: 10.1111/hiv.12622] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Considering the similarities between HIV-associated neurocognitive disorders (HAND) and neurodegenerative dementias and the frequency of executive dysfunctions among HIV-positive patients, we evaluated the accuracy of the Frontal Assessment Battery and Clock-Drawing Test together with the Three Questions Test and International HIV Dementia Scale to screen for HAND. METHODS A cross-sectional monocentric study was conducted from 2010 to 2017. The index tests were represented by the four screening tools; the reference standard was represented by a comprehensive neurocognitive battery used to investigate 10 cognitive domains. Patients were screened by a trained infectious diseases physician and those showing International HIV Dementia Scale scores ≤ 10 and/or complaining of neurocognitive symptoms were then evaluated by a trained neuropsychologist. RESULTS A total of 650 patients were screened and 281 received the full neurocognitive evaluation. HAND was diagnosed in 140 individuals. The sensitivity, specificity, correct classification rate and area under the receiver operating characteristic curve (AUROC) were, respectively, as follows: Frontal Assessment Battery, 40.7%, 95.1%, 68.3% and 0.81; International HIV Dementia Scale, 74.4%, 56.8%, 65.4% and 0.73; Clock-Drawing Test, 30.9%, 73.4%, 53.8% and 0.56; and Three Questions Test, 37.3%, 54.1% and 45.7%. Raising the Frontal Assessment Battery's cut-off to ≤ 16 improved its sensitivity, specificity and correct classification rate to 78.0%, 63.9% and 70.8%, respectively. CONCLUSIONS We observed poor screening performances of the Three Questions and Clock-Drawing Tests. While the International HIV Dementia Scale showed a poor specificity, the Frontal Assessment Battery showed the highest correct classification rate and a promising performance at different exploratory cut-offs.
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Affiliation(s)
- M Trunfio
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - D Vai
- Unit of Neurology, Maria Vittoria Hospital, Torino, Italy
| | - C Montrucchio
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - C Alcantarini
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - A Livelli
- Unit of Infectious Diseases, Divisione A, Amedeo di Savoia Hospital, Torino, Italy
| | - M C Tettoni
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - G Orofino
- Unit of Infectious Diseases, Divisione A, Amedeo di Savoia Hospital, Torino, Italy
| | - S Audagnotto
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - D Imperiale
- Unit of Neurology, Maria Vittoria Hospital, Torino, Italy
| | - S Bonora
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - G Di Perri
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - A Calcagno
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
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26
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Mornese Pinna S, Scarvaglieri E, Milia MG, Imperiale D, Ghisetti V, Audagnotto S, Prochet A, Lipani F, Bonora S, Di Perri G, Calcagno A. Detectable cerebrospinal fluid JCV DNA in late-presenting HIV-positive patients: beyond progressive multifocal leukoencephalopathy? J Neurovirol 2017; 23:763-767. [PMID: 28681343 DOI: 10.1007/s13365-017-0549-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/08/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
In the absence of effective prophylaxis and treatment, therapeutic options in HIV-positive patients with progressive multifocal leukoencephalopathy (PML) are limited to antiretroviral therapy: nevertheless, outcome is poor. We conducted a retrospective study (2009-2015) describing the outcome of 25 HIV-positive patients with detectable cerebrospinal fluid JC virus DNA: 14 had a probable PML while the others had evidence of other inflammatory central nervous system (CNS) affecting disorders. In the former group, 6-month mortality was 45.5% vs 21.4 in the latter one: survival was higher than previously described but no predictor of poor outcome was identified. Two patients treated with 5HT2-inhibitors survived. The contributing role of JCV replication in other CNS-affecting disorders needs to be assessed as well as the benefits of 5HT2-inhibitors in HIV-positive patients with proven PML.
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Affiliation(s)
- S Mornese Pinna
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, C.so Svizzera 164, 10149, Turin, Italy.
| | - E Scarvaglieri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, C.so Svizzera 164, 10149, Turin, Italy
| | - M G Milia
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Turin, Italy
| | - D Imperiale
- Unit of Neurology, Ospedale Maria Vittoria, ASL TO2, Turin, Italy
| | - V Ghisetti
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Turin, Italy
| | - S Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, C.so Svizzera 164, 10149, Turin, Italy
| | - A Prochet
- Unit of Radiology, Ospedale San Giovanni Bosco, ASL TO2, Turin, Italy
| | - F Lipani
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, C.so Svizzera 164, 10149, Turin, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, C.so Svizzera 164, 10149, Turin, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, C.so Svizzera 164, 10149, Turin, Italy
| | - A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, C.so Svizzera 164, 10149, Turin, Italy
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27
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Bongianni M, Orrù C, Groveman BR, Sacchetto L, Fiorini M, Tonoli G, Triva G, Capaldi S, Testi S, Ferrari S, Cagnin A, Ladogana A, Poleggi A, Colaizzo E, Tiple D, Vaianella L, Castriciano S, Marchioni D, Hughson AG, Imperiale D, Cattaruzza T, Fabrizi GM, Pocchiari M, Monaco S, Caughey B, Zanusso G. Diagnosis of Human Prion Disease Using Real-Time Quaking-Induced Conversion Testing of Olfactory Mucosa and Cerebrospinal Fluid Samples. JAMA Neurol 2017; 74:155-162. [PMID: 27942718 DOI: 10.1001/jamaneurol.2016.4614] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Early and accurate in vivo diagnosis of Creutzfeldt-Jakob disease (CJD) is necessary for quickly distinguishing treatable from untreatable rapidly progressive dementias and for future therapeutic trials. This early diagnosis is becoming possible using the real-time quaking-induced conversion (RT-QuIC) seeding assay, which detects minute amounts of the disease-specific pathologic prion protein in cerebrospinal fluid (CSF) or olfactory mucosa (OM) samples. Objective To develop an algorithm for accurate and early diagnosis of CJD by using the RT-QuIC assay on CSF samples, OM samples, or both. Design, Setting, and Participants In this case-control study, samples of CSF and OM were collected from 86 patients with a clinical diagnosis of probable (n = 51), possible (n = 24), or suspected (n = 11) CJD and 104 negative control samples (54 CSF and 50 OM). The CSF and OM samples were analyzed using conventional RT-QuIC. The CSF samples underwent further testing using improved RT-QuIC conditions. In addition, the diagnostic performance of a novel, easy-to-use, gentle flocked swab for sampling of OM was evaluated. Data were collected from January 1 to June 30, 2015. Main Outcome and Measures Correlations between RT-QuIC results and the final diagnosis of recruited patients. Results Among the 86 patients (37 men [43%] and 49 women [57%]; mean [SD] age, 65.7 [11.5] years) included for analysis, all 61 patients with sporadic CJD had positive RT-QuIC findings using OM or CSF samples or both for an overall RT-QuIC diagnostic sensitivity of 100% (95% CI, 93%-100%). All patients with a final diagnosis of non-prion disease (71 CSF and 67 OM samples) had negative RT-QuIC findings for 100% specificity (95% CI, 94%-100%). Of 8 symptomatic patients with various mutations causing CJD or Gerstmann-Sträussler-Scheinker syndrome, 6 had positive and 2 had negative RT-QuIC findings for a sensitivity of 75% (95% CI, 36%-96%). Conclusions and Relevance A proposed diagnostic algorithm for sporadic CJD combines CSF and OM RT-QuIC testing to provide virtually 100% diagnostic sensitivity and specificity in the clinical phase of the disease.
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Affiliation(s)
- Matilde Bongianni
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Christina Orrù
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Bradley R Groveman
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Michele Fiorini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Giovanni Tonoli
- Struttura Complessa di Otorinolaringoiatria, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | - Stefano Capaldi
- Biocrystallography Laboratory, Department of Biotechnology, University of Verona, Italy
| | - Silvia Testi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Sergio Ferrari
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Annachiara Cagnin
- Department of Neuroscience, University of Padova, Padova, Italy8Istituto di Ricovero e Cura a Carattere Scientifico San Camillo Hospital, Venice, Italy
| | - Anna Ladogana
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Anna Poleggi
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Colaizzo
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Dorina Tiple
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Luana Vaianella
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | | | - Daniele Marchioni
- Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Andrew G Hughson
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | | | | | - Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Maurizio Pocchiari
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, Verona, Italy
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28
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Motta I, Allice T, Romito A, Ferrara M, Ecclesia S, Imperiale D, Ghisetti V, Di Perri G, Bonora S, Calcagno A. Cerebrospinal fluid viral load and neopterin in HIV-positive patients with undetectable viraemia. Antivir Ther 2017; 22:539-543. [PMID: 28198350 DOI: 10.3851/imp3140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) HIV RNA is commonly used as a marker of compartmental antiviral activity in HIV-positive patients. Undetectable CSF HIV RNA levels have been associated with low CSF neopterin levels and better neurocognitive performances. The aim of this study was to analyse the prevalence and predictors of non-detectable CSF HIV RNA using a commercial assay. METHODS In adult HIV-positive HAART-treated patients with confirmed plasma HIV RNA <50 copies/ml, CSF HIV RNA (with Roche Amplicor Assay) and neopterin were measured. RESULTS 112 adult patients were included. Plasma and CSF HIV RNA were non-detectable (target not detected [TND]) in 29 (25.9%) and 36 (32.1%) patients, respectively. CSF TND was observed more frequently in patients with plasma TND (P=0.005, OR=3.87). CSF neopterin levels were associated with age (rho =0.333, P=0.002) and current (rho= -0.272, P=0.015) and nadir (rho =-0.240, P=0.038) CD4+ T-lymphocytes; the lowest CSF neopterin concentration was observed in patients with CSF TND versus other viral load strata (0.62 mg/dl versus 0.78 mg/dl; P=0.048). CONCLUSIONS Efficaciously treated HIV-positive patients with detectable plasma HIV RNA might imperfectly control CSF viral replication. Prospective studies addressing the management and neurocognitive consequences of CSF low-level viraemia are warranted.
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Affiliation(s)
- Ilaria Motta
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Tiziano Allice
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - Alessandra Romito
- Laboratory of Immunology, Ospedale Maria Vittoria, ASL TO2, Torino, Italy
| | - Micol Ferrara
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Sara Ecclesia
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Valeria Ghisetti
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
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29
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Cistaro A, Cassalia L, Ferrara C, Atzori C, Vai D, Quartuccio N, Fania P, Vaudano GP, Imperiale D. Brain 18F-FDG PET/CT findings in a case of genetic Creutzfeldt-Jakob disease due to V203I heterozygous mutation in the PRNP gene. J Neurol 2017; 264:170-173. [PMID: 27844164 DOI: 10.1007/s00415-016-8327-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 02/07/2023]
Affiliation(s)
- A Cistaro
- Positron Emission Tomography Centre IRMET, S.p.A., Affidea, V. O. Vigliani 89, 10136, Turin, Italy.
| | - L Cassalia
- Nuclear Medicine Unit, Department of Biomedical Sciences and of Mophologic and Functional Images, University of Messina, Messina, Italy
| | - C Ferrara
- Nuclear Medicine Unit Department, P.O. Umberto I, Siracusa, Italy
| | - C Atzori
- Neurology Unit and Human TSE Regional Center, ASL TO2 Maria Vittoria Hospital, Turin, Italy
| | - D Vai
- Neurology Unit and Human TSE Regional Center, ASL TO2 Maria Vittoria Hospital, Turin, Italy
| | - N Quartuccio
- Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK
| | - P Fania
- Positron Emission Tomography Centre IRMET, S.p.A., Affidea, V. O. Vigliani 89, 10136, Turin, Italy
| | - G P Vaudano
- Neuroradiology Unit, ASL TO2 San Giovanni Bosco Hospital, Turin, Italy
| | - D Imperiale
- Neurology Unit and Human TSE Regional Center, ASL TO2 Maria Vittoria Hospital, Turin, Italy
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30
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Groveman BR, Orrú CD, Hughson AG, Bongianni M, Fiorini M, Imperiale D, Ladogana A, Pocchiari M, Zanusso G, Caughey B. Extended and direct evaluation of RT-QuIC assays for Creutzfeldt-Jakob disease diagnosis. Ann Clin Transl Neurol 2016; 4:139-144. [PMID: 28168213 PMCID: PMC5288466 DOI: 10.1002/acn3.378] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 09/23/2016] [Revised: 11/04/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022] Open
Abstract
Real-Time Quaking-Induced Conversion (RT-QuIC) testing of human cerebrospinal fluid (CSF) is highly sensitive and specific in discriminating sporadic CJD patients from those without prion disease. Here, using CSF samples from 113 CJD and 64 non-prion disease patients, we provide the first direct and concurrent comparison of our improved RT-QuIC assay to our previous assay, which is similar to those commonly used internationally for CJD diagnosis. This extended comparison demonstrated a ~21% increase in diagnostic sensitivity, a 2-day reduction in average detection time, and 100% specificity.
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Affiliation(s)
- Bradley R Groveman
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Christina D Orrú
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Andrew G Hughson
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
| | - Matilde Bongianni
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Fiorini
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Anna Ladogana
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Maurizio Pocchiari
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Gianluigi Zanusso
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Byron Caughey
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana
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31
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Calcagno A, Romito A, Atzori C, Ghisetti V, Cardellino C, Audagnotto S, Scarvaglieri E, Lipani F, Imperiale D, Di Perri G, Bonora S. Blood Brain Barrier Impairment in HIV-Positive Naïve and Effectively Treated Patients: Immune Activation Versus Astrocytosis. J Neuroimmune Pharmacol 2016; 12:187-193. [PMID: 27826896 DOI: 10.1007/s11481-016-9717-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/28/2016] [Indexed: 11/26/2022]
Abstract
Blood brain barrier (BBB) damage is a common feature in central nervous system infections by HIV and it may persist despite effective antiretroviral therapy. Astrocyte involvement has not been studied in this setting. Patients were enrolled in an ongoing prospective study and subjects with central nervous system-affecting disorders were excluded. Patients were divided into two groups: treated subjects with cerebrospinal fluid (CSF) HIV RNA <50 copies/mL (CSF-controllers) and in late-presenters CD4+ T lymphocytes <100/uL. CSF biomarkers of neuronal or astrocyte damage were measured and compared to CSF serum-to-albumin ratio. 134 patients were included; 67 subjects in each group (50 %) with similar demographic characteristics (with the exception of older age in CSF controllers). CD4 (cells/uL), plasma and CSF HIV RNA (Log10 copies/mL) were 43 (20-96), 5.6 (5.2-6) and 3.9 (3.2-4.7) in LPs and 439 (245-615), <1.69 (9 patients <2.6) and <1.69 in CSFc. BBB impairment was observed in 17 late-presenters (25.4 %) and in 9 CSF-controllers (13.4 %). CSF biomarkers were similar but for higher CSF neopterin values in late-presenters (2.3 vs. 0.6 ng/mL, p < 0.001). CSARs were associated with CSF neopterin (rho = 0.31, p = 0.03) and HIV RNA (rho = 0.24, p = 0.05) in late-presenters and with CSF tau (rho = 0.51, p < 0.001), p-tau (rho = 0.47, p < 0.001) and S100beta (rho = 0.33, p = 0.009) in CSF-controllers. In HAART-treated subjects with suppressed CSF HIV RNA, BBB altered permeability was associated with markers of neuronal damage and astrocytosis. Additional treatment targeting astrocytosis and/or viral protein production might be needed in order to reduce HIV effects in the central nervous system.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy.
| | - A Romito
- Laboratory of Immunology, Ospedale Maria Vittoria, ASL TO2, Torino, Italy
| | - C Atzori
- Unit of Neurology, Ospedale Maria Vittoria, ASL TO2, Torino, Italy
| | - V Ghisetti
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - C Cardellino
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - S Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - E Scarvaglieri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - F Lipani
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - D Imperiale
- Unit of Neurology, Ospedale Maria Vittoria, ASL TO2, Torino, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
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Trentalange A, Calcagno A, Ghisetti V, Atzori C, Busolli P, Bonora S, Imperiale D. Clearance of cerebrospinal fluid JCV DNA with mirtazapine in a patient with progressive multifocal leukoencephalopathy and sarcoidosis. Antivir Ther 2016; 21:633-635. [PMID: 26857363 DOI: 10.3851/imp3032] [Citation(s) in RCA: 7] [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] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a severe encephalic demyelinating disease associated with JC virus (JCV) reactivation that occurs mostly in patients with immune disorders. Patients affected by sarcoidosis are at risk for developing PML both for leukocyte dysfunction and for receiving immunosuppressive medications: delayed diagnosis and high-dose corticosteroids are associated with a reduced survival. Although no specific treatment for PML exists, several therapeutic possibilities have been assessed with uncertain benefits (5HT2a receptor inhibitors are active in vitro against JCV): the cornerstone of sarcoidosis-associated PML is immunosuppressants withdrawal.We report the case of a female patient affected by systemic sarcoidosis for 30 years receiving low-dose corticosteroids (5 mg every other day). Due to memory impairment an MRI was performed showing three T2 hyperintense lesions involving white matter. Cerebrospinal fluid JCV PCR (845 copies/ml), neuropathological examination and immunohistochemistry (SV40 protein and JCV DNA positivity) on brain biopsy confirmed PML. Mirtazapine 15 mg was started while prednisone treatment was continued. 3 and 6 months later cognitive performances improved and brain MRIs were stable while cerebrospinal fluid JCV DNA was undetectable (6 months later). In conclusion the diagnosis of PML in patients with sarcoidosis is challenging given the overlapping presentation; the use of 5HT2a receptor antagonists deserves further studying in patients needing immunosuppressant drugs to control their dysimmune disease.
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Affiliation(s)
- Alice Trentalange
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Molecular Biology, Amedeo di Savoia Hospital, ASL TO2, Torino, Italy
| | - Cristiana Atzori
- Department of Neurology, Maria Vittoria Hospital, ASL TO2, Torino, Italy
| | - Paolo Busolli
- Department of Radiology, San Giovanni Bosco Hospital, ASL TO2, Torino, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Daniele Imperiale
- Department of Neurology, Maria Vittoria Hospital, ASL TO2, Torino, Italy
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Calcagno A, Atzori C, Romito A, Vai D, Audagnotto S, Stella ML, Montrucchio C, Imperiale D, Di Perri G, Bonora S. Blood brain barrier impairment is associated with cerebrospinal fluid markers of neuronal damage in HIV-positive patients. J Neurovirol 2015; 22:88-92. [PMID: 26246357 DOI: 10.1007/s13365-015-0371-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/22/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
Blood brain barrier impairment occurs early in the course of infection by HIV and it may persist in a subset of patients despite effective antiretroviral treatment. We tested the hypothesis that HIV-positive patients with dysfunctional blood brain barrier may have altered biomarkers of neuronal damage. In adult HIV-positive highly active antiretroviral treatment (HAART)-treated patients (without central nervous system infections and undergoing lumbar punctures for clinical reasons) cerebrospinal fluid albumin to serum ratios (CSAR), total tau, phosphorylated tau, 1-42 beta amyloid, and neopterin were measured. In 101 adult patients, cerebrospinal fluid-to-serum albumin ratios were 4.8 (3.7-6.1) with 12 patients (11.9%) presenting age-defined impaired blood brain barrier. A significant correlation was observed between CSAR and total tau (p = 0.005), phosphorylated tau (p = 0.008), and 1-42 beta amyloid (p = 0.040). Patients with impaired blood brain barrier showed significantly higher total tau (201.6 vs. 87.3 pg/mL, p = 0.010), phosphorylated tau (35.3 vs. 32.1 ng/mL, p = 0.035), and 1-42 beta amyloid (1134 vs. 830 pg/mL, p = 0.045). Despite effective antiretroviral treatment, blood brain barrier impairment persists in some HIV-positive patients: it is associated with markers of neuronal damage and it was not associated with CSF neopterin concentrations.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10149, Torino, Italy.
| | - C Atzori
- Unit of neurology, Ospedale Maria Vittoria, ASLTO2, Torino, Italy
| | - A Romito
- Laboratory of Immunology, Ospedale Maria Vittoria, ASLTO2, Torino, Italy
| | - D Vai
- Unit of neurology, Ospedale Maria Vittoria, ASLTO2, Torino, Italy
| | - S Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10149, Torino, Italy
| | - M L Stella
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10149, Torino, Italy
| | - C Montrucchio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10149, Torino, Italy
| | - D Imperiale
- Unit of neurology, Ospedale Maria Vittoria, ASLTO2, Torino, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10149, Torino, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10149, Torino, Italy
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Giorgio E, Robyr D, Spielmann M, Ferrero E, Di Gregorio E, Imperiale D, Vaula G, Stamoulis G, Santoni F, Atzori C, Gasparini L, Ferrera D, Canale C, Guipponi M, Pennacchio LA, Antonarakis SE, Brussino A, Brusco A. A large genomic deletion leads to enhancer adoption by the lamin B1 gene: a second path to autosomal dominant adult-onset demyelinating leukodystrophy (ADLD). Hum Mol Genet 2015; 24:3143-54. [PMID: 25701871 PMCID: PMC4424952 DOI: 10.1093/hmg/ddv065] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/13/2015] [Indexed: 01/23/2023] Open
Abstract
Chromosomal rearrangements with duplication of the lamin B1 (LMNB1) gene underlie autosomal dominant adult-onset demyelinating leukodystrophy (ADLD), a rare neurological disorder in which overexpression of LMNB1 causes progressive central nervous system demyelination. However, we previously reported an ADLD family (ADLD-1-TO) without evidence of duplication or other mutation in LMNB1 despite linkage to the LMNB1 locus and lamin B1 overexpression. By custom array-CGH, we further investigated this family and report here that patients carry a large (∼660 kb) heterozygous deletion that begins 66 kb upstream of the LMNB1 promoter. Lamin B1 overexpression was confirmed in further ADLD-1-TO tissues and in a postmortem brain sample, where lamin B1 was increased in the frontal lobe. Through parallel studies, we investigated both loss of genetic material and chromosomal rearrangement as possible causes of LMNB1 overexpression, and found that ADLD-1-TO plausibly results from an enhancer adoption mechanism. The deletion eliminates a genome topological domain boundary, allowing normally forbidden interactions between at least three forebrain-directed enhancers and the LMNB1 promoter, in line with the observed mainly cerebral localization of lamin B1 overexpression and myelin degeneration. This second route to LMNB1 overexpression and ADLD is a new example of the relevance of regulatory landscape modifications in determining Mendelian phenotypes.
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Affiliation(s)
- Elisa Giorgio
- Department of Medical Sciences, University of Torino, via Santena, 19, Torino 10126, Italy
| | - Daniel Robyr
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva 1211, Switzerland
| | - Malte Spielmann
- Max Planck Institute for Molecular Genetics, Ihnestr. 63-73, Berlin 14195, Germany
| | - Enza Ferrero
- Department of Medical Sciences, University of Torino, via Santena, 19, Torino 10126, Italy
| | - Eleonora Di Gregorio
- Department of Medical Sciences, University of Torino, via Santena, 19, Torino 10126, Italy Medical Genetics Unit and
| | - Daniele Imperiale
- Centro Regionale Malattie Da Prioni - Domp (ASLTO2), Torino 10144, Italy
| | - Giovanna Vaula
- Department of Neurology, Città della Salute e della Scienza University Hospital, Torino 10126, Italy
| | - Georgios Stamoulis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva 1211, Switzerland
| | - Federico Santoni
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva 1211, Switzerland
| | - Cristiana Atzori
- Centro Regionale Malattie Da Prioni - Domp (ASLTO2), Torino 10144, Italy
| | | | | | - Claudio Canale
- Department of Nanophysics, Istituto Italiano di Tecnologia, Genoa 16163, Italy and
| | - Michel Guipponi
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva 1211, Switzerland
| | - Len A Pennacchio
- Genomics Division, Lawrence Berkeley National Laboratory, MS 84-171, Berkeley, CA 9472, USA
| | - Stylianos E Antonarakis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva 1211, Switzerland
| | - Alessandro Brussino
- Department of Medical Sciences, University of Torino, via Santena, 19, Torino 10126, Italy
| | - Alfredo Brusco
- Department of Medical Sciences, University of Torino, via Santena, 19, Torino 10126, Italy Medical Genetics Unit and
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Leone MA, Raymkulova O, Lochner P, Bolamperti L, Rivadossi G, Stecco A, Zaccala G, Maggio M, Liboni W, Guido M, Coppo L, Imperiale D. Chronic cerebrospinal venous insufficiency is not associated with chronic venous disorders: A case-control study. Phlebology 2014; 30:736-8. [PMID: 25081746 DOI: 10.1177/0268355514544782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and the presence of a Chronic Venous Disorder (CVD). METHOD We included 55 subjects with CCSVI aged >18 years, and 186 controls without CCSVI. Each subject was evaluated with color Doppler sonography in accordance with Zamboni's five criteria, examined by two neurologists and interviewed with an ad-hoc designed form. The neurologists and the sonographers were mutually blinded. CVD were classified according to CEAP. RESULTS Mean age was 42 years (SD = 9) in cases and 43 years (10) in controls (p = ns). The odds ratios in subjects CCSVI were 0.6 (0.2-2.2) for CEAP 1, 0.9 (0.2-4.5) for CEAP 2, and 1.0 (0.6-1.9) for family history of varicose veins. The prevalence of CVD and, family history of varicose veins, was similar between cases and controls for each Zamboni criterion. CONCLUSIONS We found no association of CCSVI with the presence of CVD or family history of varicose veins.
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Affiliation(s)
- Maurizio A Leone
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy Interdisciplinary Research Center of Autoimmune Diseases, IRCAD, Novara, Italy
| | - Olga Raymkulova
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy
| | | | - Laura Bolamperti
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy
| | | | - Alessandro Stecco
- Istituto di Radiologia Diagnostica e Interventistica, AOU "Maggiore della Carità", Novara, Italy
| | - Giuseppe Zaccala
- Department of Medicine, AOU "Maggiore della Carità", Novara, Italy
| | | | | | | | - Lorenzo Coppo
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy
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Calcagno A, Alberione MC, Romito A, Imperiale D, Ghisetti V, Audagnotto S, Lipani F, Raviolo S, Di Perri G, Bonora S. Prevalence and predictors of blood-brain barrier damage in the HAART era. J Neurovirol 2014; 20:521-5. [PMID: 24973194 DOI: 10.1007/s13365-014-0266-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/08/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022]
Abstract
Blood-brain barrier damage (BBBD) is prevalent in HIV-positive patients and may enhance cell trafficking to the central nervous system. A retrospective analysis in adult HIV-positive patients with no central nervous system disease was conducted in order to estimate the prevalence and risk factors of BBBD (according to cerebrospinal fluid to plasma albumin ratios). One hundred fifty-eight HIV-positive adult patients were included. BBBD impairment and intrathecal IgG synthesis were respectively observed in 45 (28.5 %) and 100 patients (63.3 %). Low CD4 nadir and high CSF HIV RNA were independently associated with both abnormalities. BBBD is common in HIV-positive patients, and its main determinants are advanced immune depression and compartmental viral replication.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy,
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Haïk S, Marcon G, Mallet A, Tettamanti M, Welaratne A, Giaccone G, Azimi S, Pietrini V, Fabreguettes JR, Imperiale D, Cesaro P, Buffa C, Aucan C, Lucca U, Peckeu L, Suardi S, Tranchant C, Zerr I, Houillier C, Redaelli V, Vespignani H, Campanella A, Sellal F, Krasnianski A, Seilhean D, Heinemann U, Sedel F, Canovi M, Gobbi M, Di Fede G, Laplanche JL, Pocchiari M, Salmona M, Forloni G, Brandel JP, Tagliavini F. Doxycycline in Creutzfeldt-Jakob disease: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet Neurol 2014; 13:150-8. [DOI: 10.1016/s1474-4422(13)70307-7] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Imperiale D, Labate C, Testi R, Romito A, Taraglio S. Clinical and neuropathological findings in Hashimoto's encephalopathy: a case report. Neurol Sci 2013; 35:327-9. [PMID: 24062213 DOI: 10.1007/s10072-013-1554-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Daniele Imperiale
- Centro Regionale Diagnosi ed Osservazione Malattie Prioniche DOMP, ASL To2, Via Cibrario 72, 10144, Turin, Italy,
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Imperiale D, Melis F, Giaccone C, Guido M, Milano E, Buffa C, Appendino L. Chronic cerebrospinal venous insufficiency in multiple sclerosis: A sonographer-blinded case-control study. Clin Neurol Neurosurg 2013; 115:1394-8. [PMID: 23384545 DOI: 10.1016/j.clineuro.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 01/21/2023]
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Bianchi FT, Camera P, Ala U, Imperiale D, Migheli A, Boda E, Tempia F, Berto G, Bosio Y, Oddo S, LaFerla FM, Taraglio S, Dotti CG, Di Cunto F. The collagen chaperone HSP47 is a new interactor of APP that affects the levels of extracellular beta-amyloid peptides. PLoS One 2011; 6:e22370. [PMID: 21829458 PMCID: PMC3145648 DOI: 10.1371/journal.pone.0022370] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 06/27/2011] [Indexed: 01/08/2023] Open
Abstract
Alzheimer disease (AD) is a neurodegenerative disorder characterized by progressive decline of cognitive function that represents one of the most dramatic medical challenges for the aging population. Aβ peptides, generated by processing of the Amyloid Precursor Protein (APP), are thought to play a central role in the pathogenesis of AD. However, the network of physical and functional interactions that may affect their production and deposition is still poorly understood. The use of a bioinformatic approach based on human/mouse conserved coexpression allowed us to identify a group of genes that display an expression profile strongly correlated with APP. Among the most prominent candidates, we investigated whether the collagen chaperone HSP47 could be functionally correlated with APP. We found that HSP47 accumulates in amyloid deposits of two different mouse models and of some AD patients, is capable to physically interact with APP and can be relocalized by APP overexpression. Notably, we found that it is possible to reduce the levels of secreted Aβ peptides by reducing the expression of HSP47 or by interfering with its activity via chemical inhibitors. Our data unveil HSP47 as a new functional interactor of APP and imply it as a potential target for preventing the formation and/or growth amyloid plaques.
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Affiliation(s)
- Federico T. Bianchi
- Department of Genetics, Biology and Biochemistry, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Paola Camera
- Department of Genetics, Biology and Biochemistry, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Ugo Ala
- Department of Genetics, Biology and Biochemistry, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | | | | | - Enrica Boda
- Department of Neurosciences, University of Torino, Torino, Italy
| | - Filippo Tempia
- Department of Neurosciences, University of Torino, Torino, Italy
| | - Gaia Berto
- Department of Genetics, Biology and Biochemistry, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Ylenia Bosio
- Department of Genetics, Biology and Biochemistry, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Salvatore Oddo
- Department of Physiology, University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Frank M. LaFerla
- Department of Neurobiology and Behavior, Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, United States of America
| | | | - Carlos G. Dotti
- VIB Department of Molecular and Developmental Genetics and Katholieke Universiteit Leuven, Department of Human Genetics, Leuven, Belgium
| | - Ferdinando Di Cunto
- Department of Genetics, Biology and Biochemistry, Molecular Biotechnology Center, University of Torino, Torino, Italy
- * E-mail:
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Leto K, Bartolini A, Di Gregorio A, Imperiale D, De Luca A, Parmigiani E, Filipkowski RK, Kaczmarek L, Rossi F. Modulation of cell-cycle dynamics is required to regulate the number of cerebellar GABAergic interneurons and their rhythm of maturation. Development 2011; 138:3463-72. [PMID: 21771816 DOI: 10.1242/dev.064378] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The progenitors of cerebellar GABAergic interneurons proliferate up to postnatal development in the prospective white matter, where they give rise to different neuronal subtypes, in defined quantities and according to precise spatiotemporal sequences. To investigate the mechanisms that regulate the specification of distinct interneuron phenotypes, we examined mice lacking the G1 phase-active cyclin D2. It has been reported that these mice show severe reduction of stellate cells, the last generated interneuron subtype. We found that loss of cyclin D2 actually impairs the whole process of interneuron genesis. In the mutant cerebella, progenitors of the prospective white matter show reduced proliferation rates and enhanced tendency to leave the cycle, whereas young postmitotic interneurons undergo severe delay of their maturation and migration. As a consequence, the progenitor pool is precociously exhausted and the number of interneurons is significantly reduced, although molecular layer interneurons are more affected than those of granular layer or deep nuclei. The characteristic inside-out sequence of interneuron placement in the cortical layers is also reversed, so that later born cells occupy deeper positions than earlier generated ones. Transplantation experiments show that the abnormalities of cyclin D2(-/-) interneurons are largely caused by cell-autonomous mechanisms. Therefore, cyclin D2 is not required for the specification of particular interneuron subtypes. Loss of this protein, however, disrupts regulatory mechanisms of cell cycle dynamics that are required to determine the numbers of interneurons of different types and impairs their rhythm of maturation and integration in the cerebellar circuitry.
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Affiliation(s)
- Ketty Leto
- Neuroscience Institute of Turin (NIT), Department of Neuroscience, University of Turin, I-10125 Turin, Italy
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Quaglio E, Restelli E, Garofoli A, Dossena S, De Luigi A, Tagliavacca L, Imperiale D, Migheli A, Salmona M, Sitia R, Forloni G, Chiesa R. Expression of mutant or cytosolic PrP in transgenic mice and cells is not associated with endoplasmic reticulum stress or proteasome dysfunction. PLoS One 2011; 6:e19339. [PMID: 21559407 PMCID: PMC3084828 DOI: 10.1371/journal.pone.0019339] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 03/27/2011] [Indexed: 12/20/2022] Open
Abstract
The cellular pathways activated by mutant prion protein (PrP) in genetic prion diseases, ultimately leading to neuronal dysfunction and degeneration, are not known. Several mutant PrPs misfold in the early secretory pathway and reside longer in the endoplasmic reticulum (ER) possibly stimulating ER stress-related pathogenic mechanisms. To investigate whether mutant PrP induced maladaptive responses, we checked key elements of the unfolded protein response (UPR) in transgenic mice, primary neurons and transfected cells expressing two different mutant PrPs. Because ER stress favors the formation of untranslocated PrP that might aggregate in the cytosol and impair proteasome function, we also measured the activity of the ubiquitin proteasome system (UPS). Molecular, biochemical and immunohistochemical analyses found no increase in the expression of UPR-regulated genes, such as Grp78/Bip, CHOP/GADD153, or ER stress-dependent splicing of the mRNA encoding the X-box-binding protein 1. No alterations in UPS activity were detected in mutant mouse brains and primary neurons using the UbG76V-GFP reporter and a new fluorogenic peptide for monitoring proteasomal proteolytic activity in vivo. Finally, there was no loss of proteasome function in neurons in which endogenous PrP was forced to accumulate in the cytosol by inhibiting cotranslational translocation. These results indicate that neither ER stress, nor perturbation of proteasome activity plays a major pathogenic role in prion diseases.
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Affiliation(s)
- Elena Quaglio
- Dulbecco Telethon Institute, Milan, Italy
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Elena Restelli
- Dulbecco Telethon Institute, Milan, Italy
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Anna Garofoli
- Dulbecco Telethon Institute, Milan, Italy
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Sara Dossena
- Dulbecco Telethon Institute, Milan, Italy
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Ada De Luigi
- Department of Biochemistry and Molecular Pharmacology, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Luigina Tagliavacca
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Imperiale
- Neurology Unit, Human Prion Diseases Center D.O.M.P., Maria Vittoria Hospital, Torino, Italy
| | - Antonio Migheli
- Neurology Unit, Human Prion Diseases Center D.O.M.P., Maria Vittoria Hospital, Torino, Italy
| | - Mario Salmona
- Department of Biochemistry and Molecular Pharmacology, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Roberto Sitia
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy
| | - Gianluigi Forloni
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Roberto Chiesa
- Dulbecco Telethon Institute, Milan, Italy
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
- * E-mail:
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Cagnoli C, Brussino A, Sbaiz L, Di Gregorio E, Atzori C, Caroppo P, Orsi L, Migone N, Buffa C, Imperiale D, Brusco A. A previously undiagnosed case of Gerstmann-Sträussler-Scheinker disease revealed by PRNP gene analysis in patients with adult-onset ataxia. Mov Disord 2008; 23:1468-71. [PMID: 18566986 DOI: 10.1002/mds.21953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Ataxia is a frequently reported symptom in prion diseases (PD) and it is characteristic of Gerstmann-Sträussler-Scheinker syndrome (GSS), a genetic PD mainly related to the P102L mutation in the PRNP gene. Our aim was to screen for the P102L and other six known PRNP gene mutations (P105L, A117V, Y145X, E200K, D202N, and V210I) a group of 206 consecutive patients diagnosed with adult-onset cerebellar ataxia of unknown origin. The patients, negative for the most common acquired and genetic forms, were analyzed using a combination of restriction endonuclease digestion and pyrosequencing; eight, affected by ataxia and cognitive dysfunction, were also sequenced for the PRNP gene. One patient resulted to be heterozygous for the P102L mutation. Retrospectively, the clinical picture was consistent with a "classical" GSS phenotype. In conclusion, the screening for the P102L mutation, or even the sequencing of the PRNP gene should be taken in consideration in patients with late-onset ataxia (>50 years).
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Affiliation(s)
- Claudia Cagnoli
- Department of Genetics, Biology and Biochemistry, University of Torino, Medical Genetics Unit, Az. Osp. San Giovanni Battista, Torino, Italy
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Imperiale D, Taraglio S, Atzori C, Testi R, Buffa C, Migheli A. Multifocal necrotizing leukoencephalopathy mimicking sporadic Creutzfeldt-Jakob disease. Eur Neurol 2008; 59:327-9. [PMID: 18408376 DOI: 10.1159/000121425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 08/05/2007] [Indexed: 11/19/2022]
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Imperiale D, Cassano D, Pomari F, Cecchi E, Cerrato P, Buffa C. Ischaemic stroke, factor V Leiden heterozygosity and left atrial thrombosis in sinus rhythm: a case report. Neurol Sci 2007; 28:111-3. [PMID: 17464477 DOI: 10.1007/s10072-007-0798-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Accepted: 03/30/2007] [Indexed: 10/23/2022]
Abstract
We describe a 63-year-old man in sinus rhythm (SR) with an ischaemic stroke involving basal ganglia region on the right side. The patient was known to be heterozygous for factor V Leiden (FVL) mutation. On diagnostic work-up, no arterial sources of embolism were found. Transoesophageal echocardiography evidenced a left atrial (LA) thrombosis without relevant cardiopathies. LA thrombosis is generally associated to atrial fibrillation, atrial enlargement, mitral valve stenosis and left ventricular dysfunction, whereas mitral regurgitation is considered protective. To our knowledge, this is the first report of cardioembolic stroke related to a LA thrombosis in a patient in SR without risk factors for thrombus formation except for FVL heterozygosity.
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Affiliation(s)
- D Imperiale
- Neurology Unit, Human Prion Diseases Center D.O.M.P., Maria Vittoria Hospital, Via Cibrario 72, I-10144 Torino, Italy.
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Imperiale D, Guastamacchia G, Duca S, Appendino L, Marietti G, Romito A, Atzori C, Buffa C. Regression of white matter MRI abnormalities in nonvasculitic autoimmune inflammatory meningoencephalitis following intravenous immunoglobulin. Eur Neurol 2007; 57:244-5. [PMID: 17389804 DOI: 10.1159/000101291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 11/19/2006] [Indexed: 11/19/2022]
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Wrabetz L, D'Antonio M, Pennuto M, Dati G, Tinelli E, Fratta P, Previtali S, Imperiale D, Zielasek J, Toyka K, Avila RL, Kirschner DA, Messing A, Feltri ML, Quattrini A. Different intracellular pathomechanisms produce diverse Myelin Protein Zero neuropathies in transgenic mice. J Neurosci 2006; 26:2358-68. [PMID: 16495463 PMCID: PMC6674823 DOI: 10.1523/jneurosci.3819-05.2006] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Missense mutations in 22 genes account for one-quarter of Charcot-Marie-Tooth (CMT) hereditary neuropathies. Myelin Protein Zero (MPZ, P0) mutations produce phenotypes ranging from adult demyelinating (CMT1B) to early onset [Déjérine-Sottas syndrome (DSS) or congenital hypomyelination] to predominantly axonal neuropathy, suggesting gain of function mechanisms. To test this directly, we produced mice in which either the MpzS63C (DSS) or MpzS63del (CMT1B) transgene was inserted randomly, so that the endogenous Mpz alleles could compensate for any loss of mutant P0 function. We show that either mutant allele produces demyelinating neuropathy that mimics the corresponding human disease. However, P0S63C creates a packing defect in the myelin sheath, whereas P0S63del does not arrive to the myelin sheath and is instead retained in the endoplasmic reticulum, where it elicits an unfolded protein response (UPR). This is the first evidence for UPR in association with neuropathy and provides a model to determine whether and how mutant proteins can provoke demyelination from outside of myelin.
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Cerrato P, Priano L, Imperiale D, Bosco G, Destefanis E, Villar AM, Ribezzo M, Trevi GP, Bergamasco B, Orzan F. Recurrent cerebrovascular ischaemic events in patients with interatrial septal abnormalities: a follow-up study. Neurol Sci 2006; 26:411-8. [PMID: 16601933 DOI: 10.1007/s10072-006-0524-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 12/30/2005] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the risk of recurrent ischaemic cerebrovascular events (stroke or transient ischaemic attack (TIA)) in patients with patent foramen ovale (PFO) or atrial septal aneurysm (ASA) treated with different therapeutic regimens. We enrolled 86 patients aged 18-60 years with an unexplained ischaemic stroke or TIA referred to our inpatient department in the period May 1994-December 1999. Follow-up lasted until April 2003. Patients were excluded if the stroke or TIA was related to large-artery atherosclerosis, small artery occlusion, major cardiac sources of embolism or other uncommon causes. During a follow-up (mean+/-SD) of 64.1+/-28.8 months (range 8.1-105.6) a recurrent ischaemic cerebrovascular event occurred in 11/86 patients (12.8%) (5 TIA and 6 strokes). Eight events (4 TIA, 4 strokes) occurred in the 59 patients with PFO alone, three (1 TIA, 2 strokes) in the 21 with PFO plus ASA and none in the 6 patients with ASA alone. In the overall population the cumulative risk of recurrent stroke/TIA was 1.2% at 2 years, 5.5% at 4 years, 7.6% at 6 years and 23.6% at 8 years, and was similar in patients with PFO alone vs. patients with PFO plus ASA (9.0% vs. 6.1% at 6 years, 26.0% vs. 23.1% at 8 years; p>0.05). Nine cerebral ischaemic events (4 TIA, 5 strokes) occurred in the 48 patients treated with antiplatelet drugs (7 in patients with PFO, 2 in patients with PFO plus ASA), and two (1 TIA, 1 stroke) in the 17 patients treated with oral anticoagulants (1 with PFO, 1 with PFO plus ASA). No events occurred in patients submitted to transcatheteral closure.
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Affiliation(s)
- P Cerrato
- First Division of Neurology, University of Turin, Italy.
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Cerrato P, Baima C, Grasso M, Lentini A, Bosco G, Cassader M, Gambino R, Cavallo Perin P, Pagano G, Fornengo P, Imperiale D, Bergamasco B, Bruno G. Apolipoprotein E Polymorphism and Stroke Subtypes in an Italian Cohort. Cerebrovasc Dis 2005; 20:264-9. [PMID: 16123547 DOI: 10.1159/000087709] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 06/07/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies have indicated that apolipoprotein E (ApoE)-epsilon4 is a risk factor for ischemic cerebrovascular diseases (ICVD), but the existence of this association is still controversial. The aims of this study were: (1) to compare ApoE genotype and allele frequencies in Italian cases with ICVD and in healthy control subjects and (2) to compare ApoE allele frequencies among ischemic stroke subtypes. METHODS A hospital-based cohort of 302 Italian subjects with ICVD and 228 healthy subjects have been recruited to investigate the role of ApoE polymorphisms as risk factors for ICVD. TOAST criteria were employed to stratify ICVD cases by subtypes. RESULTS No significant differences in ApoE genotype and allele frequencies were found between cases and control subjects. The frequency of ApoE-epsilon4 was lower in cases than in control subjects (6% vs. 10.1%), although not significantly. No differences in ApoE genotype and allele frequencies were evident among ICVD subtypes. However, out of 36 ApoE-epsilon4 alleles 23 (3.7%) were found in subjects with ICVD related to primary degenerative arterial disease related to large vessel disease and small vessel disease, and 13 (2.1%) in remaining subjects. Using logistic regression analysis we assessed whether ApoE-epsilon4 allele was independently associated with risk of ICVD related to a primary degenerative arterial disease compared to other ICVD subtypes. While classical risk factors were significantly associated with higher risk for ICVD due to large vessel disease and small vessel disease than other ICVD subtypes, the role of ApoE-epsilon4 allele was not significant (OR 1.25, 95% CI 0.57-2.74). CONCLUSION Our study shows similar ApoE-epsilon4 genotype and allele frequencies in patients with ICVD and in control subjects. No differences were found among different ICVD subtypes either.
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Affiliation(s)
- P Cerrato
- Department of Neuroscience, University of Turin, Turin, Italy.
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Cerrato P, Baima C, Bergui M, Grasso M, Lentini A, Azzaro C, Bosco G, Imperiale D, Migone N, Allavena A, Bergamasco B. Juvenile Vertebrobasilar Ischaemic Stroke in a Patient with Camurati-Engelmann Disease. Cerebrovasc Dis 2005; 20:283-4. [PMID: 16127272 DOI: 10.1159/000087712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2004] [Indexed: 11/19/2022] Open
Affiliation(s)
- Paolo Cerrato
- Department of Neurology, University of Turin, Turin, Italy
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