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Barbanti P, Aurilia C, Egeo G, Proietti S, D'Onofrio F, Torelli P, Aguggia M, Bertuzzo D, Finocchi C, Trimboli M, Cevoli S, Fiorentini G, Orlando B, Zucco M, Di Clemente L, Cetta I, Colombo B, di Poggio MLB, Favoni V, Grazzi L, Salerno A, Carnevale A, Robotti M, Frediani F, Altamura C, Filippi M, Vernieri F, Bonassi S. Correction to: Ultra-late response (> 24 weeks) to anti-CGRP monoclonal antibodies in migraine: a multicenter, prospective, observational study. J Neurol 2024; 271:2444-2445. [PMID: 38564057 PMCID: PMC11055716 DOI: 10.1007/s00415-024-12287-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
- San Raffaele University, Rome, Italy.
| | - Cinzia Aurilia
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
| | - Gabriella Egeo
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Rome, Italy
| | - Florindo D'Onofrio
- Headache Center Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Paola Torelli
- Unit of Neurology, Department of Medicine and Surgery, Headache Center, University of Parma, Parma, Italy
| | | | | | - Cinzia Finocchi
- Divisione di Neurologia, Ospedale San Paolo, ASL 2 Savonese, Savona, Italy
| | | | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Fiorentini
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Bianca Orlando
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Maurizio Zucco
- Headache Center, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Ilaria Cetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Valentina Favoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Licia Grazzi
- Neuroalgology Unit, Headache Center Fondazione, IRCCS Istituto Neurologico"Carlo Besta", Milan, Italy
| | - Antonio Salerno
- Headache Center San Giovanni Addolorata Hospital, Rome, Italy
| | | | | | | | - Claudia Altamura
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Stefano Bonassi
- San Raffaele University, Rome, Italy
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Rome, Italy
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Barbanti P, Aurilia C, Egeo G, Proietti S, D'Onofrio F, Torelli P, Aguggia M, Bertuzzo D, Finocchi C, Trimboli M, Cevoli S, Fiorentini G, Orlando B, Zucco M, Di Clemente L, Cetta I, Colombo B, di Poggio MLB, Favoni V, Grazzi L, Salerno A, Carnevale A, Robotti M, Frediani F, Altamura C, Filippi M, Vernieri F, Bonassi S. Ultra-late response (> 24 weeks) to anti-CGRP monoclonal antibodies in migraine: a multicenter, prospective, observational study. J Neurol 2024; 271:2434-2443. [PMID: 38231271 PMCID: PMC11055785 DOI: 10.1007/s00415-023-12103-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Nearly 60% of migraine patients treated with monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway experience a ≥ 50% reduction in monthly migraine days (MMD) at 12 weeks compared to baseline (responders). However, approximately half of the patients not responding to anti-CGRP mAbs ≤ 12 weeks do respond ≤ 24 weeks (late responders). We assessed frequency and characteristics of patients responding to anti-CGRP mAbs only > 24 weeks (ultra-late responders). METHODS In this multicenter (n = 16), prospective, observational, real-life study, we enrolled all consecutive adults affected by high-frequency episodic migraine (HFEM: ≥ 8 days/month) or chronic migraine (CM), with ≥ 3 prior therapeutic failures, treated with any anti-CGRP mAbs for ≥ 48 weeks. We defined responders patients with a ≥ 50% response rate ≤ 12 weeks, late responders those with a ≥ 50% response rate ≤ 24 weeks, and ultra-late responders those achieving a ≥ 50% response only > 24 weeks. RESULTS A total of 572 migraine patients completed ≥ 48 weeks of anti-CGRP mAbs treatment. Responders accounted for 60.5% (346/572), late responders for 15% (86/572), and ultra-late responders for 15.7% (90/572). Among ultra-late responders, 7.3% (42/572) maintained the ≥ 50% response rate across all subsequent time intervals (weeks 28, 32, 36, 40, 44, and 48) and were considered persistent ultra-late responders, while 8.4% (48/572) missed the ≥ 50% response rate at ≥ 1 subsequent time interval and were classified as fluctuating ultra-late responders. Fifty patients (8.7%) did not respond at any time interval ≤ 48 weeks. Ultra-late responders differed from responders for higher BMI (p = 0.033), longer duration of medication overuse (p < 0.001), lower NRS (p = 0.017) and HIT-6 scores (p = 0.002), higher frequency of dopaminergic symptoms (p = 0.002), less common unilateral pain-either alone (p = 0.010) or in combination with UAS (p = 0.023), allodynia (p = 0.043), or UAS and allodynia (p = 0.012)-a higher number of comorbidities (p = 0.012), psychiatric comorbidities (p = 0.010) and a higher proportion of patients with ≥ 1 comorbidity (p = 0.020). CONCLUSION Two-thirds of patients not responding to anti-CGRP mAbs ≤ 24 weeks do respond later, while non-responders ≤ 48 weeks are quite rare (8.7%). These findings suggest to rethink the duration of migraine prophylaxis and the definition of resistant and refractory migraine, currently based on the response after 2-3 months of treatment.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
- San Raffaele University, Rome, Italy.
| | - Cinzia Aurilia
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy.
| | - Gabriella Egeo
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Roma, Rome, Italy
| | - Florindo D'Onofrio
- Headache Center Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Paola Torelli
- Unit of Neurology, Department of Medicine and Surgery, Headache Center, University of Parma, Parma, Italy
| | | | | | - Cinzia Finocchi
- Divisione di Neurologia, Ospedale San Paolo, ASL 2 Savonese, Savona, Italy
| | | | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Fiorentini
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Bianca Orlando
- Headache and Pain Unit, IRCCS San Raffaele Roma, Via Della Pisana 235, 00163, Rome, Italy
| | - Maurizio Zucco
- Headache Center, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Ilaria Cetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Valentina Favoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Licia Grazzi
- Neuroalgology Unit, Headache Center Fondazione, IRCCS Istituto Neurologico"Carlo Besta", Milan, Italy
| | - Antonio Salerno
- Headache Center San Giovanni Addolorata Hospital, Rome, Italy
| | | | | | | | - Claudia Altamura
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Stefano Bonassi
- San Raffaele University, Rome, Italy
- Headache Center Neurology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
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Parisi M, Dogliotti I, Clerico M, Bertuzzo D, Benevolo G, Orsucci L, Schiavetti I, Cavallo R, Cavallo F, Ragaini S, Di Liberto A, Ferrante M, Bondielli G, Artusi CA, Drandi D, Lopiano L, Ferrero B, Ferrero S. Efficacy of rituximab in anti-myelin-associated glycoprotein demyelinating polyneuropathy: Clinical, hematological and neurophysiological correlations during 2 years of follow-up. Eur J Neurol 2022; 29:3611-3622. [PMID: 36083713 PMCID: PMC9825860 DOI: 10.1111/ene.15553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE We evaluated the clinical and neurophysiological efficacy of rituximab (RTX) in a neurophysiologically homogeneous group of patients with monoclonal gammopathy and immunoglobulin M (IgM) anti-myelin-associated glycoprotein antibody (anti-MAG) demyelinating polyneuropathy. METHODS Twenty three anti-MAG-positive polyneuropathic patients were prospectively evaluated before and for 2 years after treatment with RTX 375 mg/m2 . The Inflammatory Neuropathy Cause and Treatment (INCAT) disability scale (INCAT-ds), modified INCAT sensory score (mISS), Medical Research Council sum score, Patients' Global Impression of Change scale were used, IgM levels were assessed and extensive electrophysiological examinations were performed before (T0) and 1 year (T1) and 2 years (T2) after RTX treatment. RESULTS At T1 and T2 there was a significant reduction from T0 both in mISS and in INCAT-ds, with a p value < 0.001 in the inferential Friedman's test overall analysis. Ulnar nerve Terminal Latency Index and distal motor latency significantly changed from T0 to T1 and in the overall analysis (p = 0.001 and p = 0.002), and ulnar nerve sensory nerve action potential (SNAP) amplitude was significantly increased at T2 from T1, with a p value < 0.001 in the overall analysis. Analysis of the receiver-operating characteristic curves showed that a 41.8% increase in SNAP amplitude in the ulnar nerve at T2 from T0 was a fair predictor of a mISS reduction of ≥2 points (area under the curve 0.85; p = 0.005; sensitivity: 90.9%, specificity: 83.3%). CONCLUSIONS This study suggests that RTX is effective in patients with clinically active demyelinating anti-MAG neuropathy over 2 years of follow-up, and that some neurophysiological variables might be useful for monitoring this efficacy.
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Affiliation(s)
- Mattia Parisi
- Department of NeurosciencesUniversity of TurinTurinItaly
| | - Irene Dogliotti
- Stem Cell Transplant UnitUniversity Hospital A.O.U. “Città della Salute e della Scienza di Torino”TurinItaly
| | - Michele Clerico
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | | | - Giulia Benevolo
- SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Lorella Orsucci
- Division of Hematology 2A.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Irene Schiavetti
- Section of Biostatistics, Department of Health SciencesUniversity of GenoaGenoaItaly
| | - Roberto Cavallo
- Department of NeurologyOspedale San Giovanni BoscoTurinItaly
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Simone Ragaini
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | | | - Martina Ferrante
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | - Giulia Bondielli
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | | | - Daniela Drandi
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | | | - Bruno Ferrero
- Department of NeurosciencesUniversity of TurinTurinItaly
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
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Vernieri F, Altamura C, Brunelli N, Costa CM, Aurilia C, Egeo G, Fofi L, Favoni V, Lovati C, Bertuzzo D, d'Onofrio F, Doretti A, Di Fiore P, Finocchi C, Schiano Di Cola F, Ranieri A, Colombo B, Bono F, Albanese M, Cevoli S, Barbanti P. Rapid response to galcanezumab and predictive factors in chronic migraine patients: A 3-month observational, longitudinal, cohort, multicenter, Italian real-life study. Eur J Neurol 2022; 29:1198-1208. [PMID: 34826192 DOI: 10.1111/ene.15197] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE A rapid response to preventive therapy is of pivotal importance in severely disabled patients with chronic migraine (CM) and diverse preventive treatment failures. This prospective, observational, multicenter real-life study aimed at investigating the effectiveness of galcanezumab in the first 3 months of treatment of CM patients at 14 Italian headache centers. METHODS All consecutive adult patients with CM diagnosis with the clinical indication for galcanezumab were considered. We collected patients' baseline characteristics, monthly headache days, monthly painkiller intake, migraine clinical characteristics, and disability scale scores during a 1-month run-in period (baseline) and the first 3 months of therapy. Possible predictive factors of treatment were considered. RESULTS A total of 156 patients (82.4% female, aged 47.3 ± 12.3 years) were enrolled. The 65 (41.7%) patients with a consecutive ≥50% response rate (RR) in the 3 months of therapy presented a lower body mass index (p = 0.004) and more frequently presented unilateral migraine pain (p = 0.002) and good response to triptans (p = 0.003). Persistent conversion from CM to episodic migraine was observed in 55.8% (87/156) of patients. They more frequently presented a good response to triptans (p = 0.003) and unilateral pain (p = 0.046). At baseline, 131 of 156 (83.9%) patients presented medication overuse (MO). Of these, 61.8% (81/131) no longer displayed MO consistently during the 3 months. These patients were more frequently responders to triptans (p = 0.002) and less frequently suffered from gastrointestinal comorbidity (p = 0.007). CONCLUSIONS Unilateral pain, good response to triptans, and normal weight may be associated with a persistent positive response in the first 3 months of therapy with galcanezumab in CM patients.
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Affiliation(s)
- Fabrizio Vernieri
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Claudia Altamura
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | - Nicoletta Brunelli
- Headache and Neurosonology Unit, Campus Bio-Medico University Hospital, Rome, Italy
| | | | - Cinzia Aurilia
- Headache and Pain Unit, San Raffaele Pisana, Scientific Institute for Research and Health Care, Rome, Italy
| | - Gabriella Egeo
- Headache and Pain Unit, San Raffaele Pisana, Scientific Institute for Research and Health Care, Rome, Italy
| | - Luisa Fofi
- Headache and Pain Unit, San Raffaele Pisana, Scientific Institute for Research and Health Care, Rome, Italy
| | - Valentina Favoni
- Bologna Institute of Neurological Sciences, Scientific Institute for Research and Health Care, Bologna, Italy
| | - Carlo Lovati
- Neurology Unit, Headache Center, L. Sacco University Hospital, Milan, Italy
| | | | | | - Alberto Doretti
- Department of Neurology, Stroke Unit and Laboratory of Neuroscience, Italian Auxological Institute, Scientific Institute for Research and Health Care, Milan, Italy
| | - Paola Di Fiore
- Headache Center, Neurology and Stroke Unit, S. Carlo Borromeo Hospital, Milan, Italy
| | - Cinzia Finocchi
- San Martino Polyclinic Hospital, Scientific Institute for Research and Health Care, Genoa, Italy
| | - Francesca Schiano Di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angelo Ranieri
- Headache Center, Neurology and Stroke Unit, A. Cardarelli Hospital, Naples, Italy
| | - Bruno Colombo
- San Raffaele Hospital, Scientific Institute for Research and Health Care, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bono
- Center for Headache and Intracranial Pressure Disorders, Neurology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Maria Albanese
- Headache Center, Neurology Unit, Tor Vergata University Hospital, Rome, Italy.,Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Sabina Cevoli
- Bologna Institute of Neurological Sciences, Scientific Institute for Research and Health Care, Bologna, Italy
| | - Piero Barbanti
- Headache and Pain Unit, San Raffaele Pisana, Scientific Institute for Research and Health Care, Rome, Italy.,San Raffaele University, Rome, Italy
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5
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Aurilia C, Cevoli S, Egeo G, Fofi L, Messina R, Salerno A, Torelli P, Albanese M, Carnevale A, Bono F, D'Amico D, Filippi M, Altamura C, Vernieri F, Colombo B, Frediani F, Mercuri B, D'Onofrio F, Grazzi L, Aguggia M, Favoni V, Finocchi C, Di Fiore P, Costa CM, Brunelli N, Fallacara A, Bertuzzo D, Zucco M, Di Clemente L, Trimboli M, Pascarella A, Manzo L, Barbanti P. Long term (48-weeks) effectiveness, safety and tolerability of erenumab in the prevention of high-frequency episodic and chronic migraine in real-world: The early 2 study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Agostini A, Merli M, Avallone G, Burzi L, Mastorino L, Parisi M, Bertuzzo D, Ferrero B, Cerrato M, Badellino S, Molinaro L, Lopiano L, Ribero S, Quaglino P. Lambert-Eaton Myasthenic Syndrome and Paraneoplastic Cerebellar Degeneration Associated with Merkel Cell Carcinoma with Unknown Primary: A Case Report. Acta Derm Venereol 2021; 101:adv00452. [PMID: 33846760 PMCID: PMC9367044 DOI: 10.2340/00015555-3798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea Agostini
- Department of Medical Sciences and Human Oncology, Section of Dermatology, University of Turin, Via Cherasco 23, IT-12124 Torino, Italy. E-mail:
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7
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Vernieri F, Altamura C, Aurilia C, Brunelli N, Egeo G, Fofi L, Costa CM, Fallacara A, Favoni V, Pierangeli G, Aguggia M, Bertuzzo D, Albanese M, Di Fiore P, Frediani F, Cevoli S, Barbanti P. Effectiveness, safety, and tolerability of galcanezumab in a real-life setting in patients with migraine in Italy (the GARLIT study). Neurol Sci 2020; 41:487-488. [DOI: 10.1007/s10072-020-04669-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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8
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Lo Schirico M, Ferrante M, Dogliotti I, Zamò A, Ferrero B, Bertuzzo D, Benevolo G, Omedè P, Cavallo F, Ladetto M, Boccadoro M, Drandi D, Ferrero S. Droplet Digital PCR Assay for MYD88 L265P : Clinical Applications in Waldenström Macroglobulinemia. Hemasphere 2020; 4:e324. [PMID: 32072140 PMCID: PMC7000466 DOI: 10.1097/hs9.0000000000000324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mariella Lo Schirico
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Martina Ferrante
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy
| | - Irene Dogliotti
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Alberto Zamò
- Department of Oncology, Pathology Division, University of Torino, Italy
| | - Bruno Ferrero
- Rita Levi Montalcini' Department of Neuroscience, Neurology Division, University of Torino, Torino, Italy
| | - Davide Bertuzzo
- Rita Levi Montalcini' Department of Neuroscience, Neurology Division, University of Torino, Torino, Italy
| | - Giulia Benevolo
- Division of Hematology 2, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Paola Omedè
- Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Marco Ladetto
- Division of Hematology, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Mario Boccadoro
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
| | - Daniela Drandi
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino",Torino, Italy
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9
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Chiò A, Mora G, Moglia C, Manera U, Canosa A, Cammarosano S, Ilardi A, Bertuzzo D, Bersano E, Cugnasco P, Grassano M, Pisano F, Mazzini L, Calvo A. Secular Trends of Amyotrophic Lateral Sclerosis: The Piemonte and Valle d'Aosta Register. JAMA Neurol 2017; 74:1097-1104. [PMID: 28692730 DOI: 10.1001/jamaneurol.2017.1387] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance This study reports the long-term epidemiologic trends of amyotrophic lateral sclerosis (ALS) based on a prospective register. Objective To examine the 20-year epidemiologic trends of ALS in the Piemonte and Valle d'Aosta regions of Italy. Design, Setting, and Participants The Piemonte and Valle d'Aosta Register for ALS (PARALS) is an epidemiologic prospective register that covers 2 Italian regions (population of 4 476 931 inhabitants according to the 2011 census) from January 1, 1995, through December 31, 2014. Case ascertainment is based on multiple sources (neurologic departments, hospital discharge archives, and mortality records). Incidence rates are age and sex standardized for the Italian population of the 2011 census. Age-period-cohort (APC) analysis was performed using a Poisson regression model. Main Outcomes and Measures The primary study outcomes were long-term incidence and prevalence rates of ALS using a prospective design and their determinants. Results During the study period, a total of 2702 patients (mean [SD] age at onset, 65.7 [11.1] years; 1246 [46.1%] female and 1456 [53.9%] male) received a diagnosis of ALS between 1995 and 2014, corresponding to a crude annual incidence rate of 3.03 per 100 000 population (95% CI, 2.85-3.23) and an adjusted incidence rate of 2.78 per 100 000 population (95% CI, 2.57-2.96). The age-adjusted incidence rate increased in the 2 decades of the study (1995-2004: 2.66; 95% CI, 2.50-2.83; 2005-2014: 2.89; 95% CI, 2.71-3.07; P = .04), mostly in women. The adjusted rate ratio of men to women decreased from 1.27:1 (1995-2004) to 1.17:1 (2005-2014). The analysis of deviance for the APC regression models indicated that the drift variable is relevant in explaining the variation of ALS incidence rates over time in the overall population (change in deviance, 4.6553; P = .03) and in women (change in deviance, 3.8821; P = .05) but not in men (change in deviance, 0.77215; P = .38). A total of 479 patients with ALS were alive and had not undergone tracheostomy at the prevalence day (December 31, 2014), corresponding to a crude prevalence rate of 10.54 per 100 000 population (95% CI, 9.64-11.52). Conclusions and Relevance During the 1995 to 2014 period, the crude and adjusted incidences of ALS increased in Piemonte and Valle d'Aosta, mostly in women. The APC model revealed that the increase of ALS incidence is attributable to a birth cohort effect in women, with a peak in the 1930 cohort. The different increase of ALS incidence in men and women points to an effect of exogenous factors with a differential effect on the 2 sexes, acting on a genetic background.
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Affiliation(s)
- Adriano Chiò
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy.,The Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.,The Neuroscience Institute of Torino, Torino, Italy
| | - Gabriele Mora
- ALS Center, "Salvatore Maugeri" Clinical-Scientific Institutes, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Cristina Moglia
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy.,The Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Umberto Manera
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Antonio Canosa
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Stefania Cammarosano
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Antonio Ilardi
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Davide Bertuzzo
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Enrica Bersano
- ALS Center, the Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Paolo Cugnasco
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Maurizio Grassano
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy
| | - Fabrizio Pisano
- Department of Neurological Rehabilitation, "Salvatore Maugeri" Clinical-Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Veruno, Italy
| | - Letizia Mazzini
- ALS Center, the Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Andrea Calvo
- ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Torino, Torino, Italy.,The Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.,The Neuroscience Institute of Torino, Torino, Italy
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Moglia C, Calvo A, Canosa A, Bertuzzo D, Cugnasco P, Solero L, Grassano M, Bersano E, Cammarosano S, Manera U, Pisano F, Mazzini L, Dalla Vecchia LA, Mora G, Chiò A. Influence of arterial hypertension, type 2 diabetes and cardiovascular risk factors on ALS outcome: a population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:590-597. [PMID: 28616937 DOI: 10.1080/21678421.2017.1336560] [Citation(s) in RCA: 16] [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] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the prognostic influence of pre-morbid type 2 diabetes mellitus, arterial hypertension and cardiovascular (CV) risk profile on ALS phenotype and outcome in a population-based cohort of Italian patients. METHODS A total of 650 ALS patients from the Piemonte/Valle d'Aosta Register for ALS, incident in the 2007-2011 period, were recruited. Information about premorbid presence of type 2 diabetes mellitus, arterial hypertension was collected at the time of diagnosis. Patients' CV risk profile was calculated according to the Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice (JBS2). RESULTS At the univariate analysis, the presence of pre-morbid arterial hypertension was associated with a higher age at onset of ALS and a shorter survival, and patients with a high CV risk profile had a worse prognosis than those with a low CV risk profile. The Cox multivariable analysis did not confirm such findings. Type 2 diabetes mellitus did not modify either the phenotype or the prognosis of ALS patients. CONCLUSIONS This study performed on a large population-based cohort of ALS patients has demonstrated that arterial hypertension, type 2 diabetes and CV risk factors, calculated using the Framingham equation, do not influence ALS phenotype and prognosis.
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Affiliation(s)
- Cristina Moglia
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy.,b Azienda Ospedaliero Universitaria Città della Salute e della Scienza , Turin , Italy
| | - Andrea Calvo
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy.,b Azienda Ospedaliero Universitaria Città della Salute e della Scienza , Turin , Italy
| | - Antonio Canosa
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy
| | - Davide Bertuzzo
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy
| | - Paolo Cugnasco
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy
| | - Luca Solero
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy
| | - Maurizio Grassano
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy
| | - Enrica Bersano
- c ALS Center, Department of Neurology , Azienda Ospedaliero Universitaria Maggiore della Carità , Novara , Italy.,d Eastern Piedmont University , Novara , Italy
| | - Stefania Cammarosano
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy
| | - Umberto Manera
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy
| | | | - Fabrizio Pisano
- e Salvatore Maugeri Foundation , IRCSS, Scientific Institute of Veruno , Veruno , Italy
| | - Letizia Mazzini
- c ALS Center, Department of Neurology , Azienda Ospedaliero Universitaria Maggiore della Carità , Novara , Italy
| | - Laura A Dalla Vecchia
- f Salvatore Maugeri Foundation , IRCSS, Scientific Institute of Milano , Milano , Italy , and
| | - Gabriele Mora
- f Salvatore Maugeri Foundation , IRCSS, Scientific Institute of Milano , Milano , Italy , and
| | - Adriano Chiò
- a ALS Center, 'Rita Levi Montalcini' Department of Neuroscience , University of Turin , Turin , Italy.,b Azienda Ospedaliero Universitaria Città della Salute e della Scienza , Turin , Italy.,g Institute of Cognitive Sciences and Technologies , Consiglio Nazionale delle Ricerche , Rome , Italy
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Calvo A, Moglia C, Canosa A, Cammarosano S, Ilardi A, Bertuzzo D, Traynor BJ, Brunetti M, Barberis M, Mora G, Casale F, Chiò A. Common polymorphisms of chemokine (C-X3-C motif) receptor 1 gene modify amyotrophic lateral sclerosis outcome: A population-based study. Muscle Nerve 2017; 57:212-216. [PMID: 28342179 DOI: 10.1002/mus.25653] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 10/08/2016] [Revised: 03/05/2017] [Accepted: 03/20/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In the brain, the chemokine (C-X3-C motif) receptor 1 (1CX3CR1) gene is expressed only by microglia, where it acts as a key mediator of the neuron-microglia interactions. We assessed whether the 2 common polymorphisms of the CX3CR1 gene (V249I and T280M) modify amyotrophic lateral sclerosis (ALS) phenotype. METHODS The study included 755 ALS patients diagnosed in Piemonte between 2007 and 2012 and 369 age-matched and sex-matched controls, all genotyped with the same chips. RESULTS Neither of the variants was associated with an increased risk of ALS. Patients with the V249I V/V genotype had a 6-month-shorter survival than those with I/I or V/I genotypes (dominant model, P = 0.018). The T280M genotype showed a significant difference among the 3 genotypes (additive model, P = 0.036). Cox multivariable analysis confirmed these findings. DISCUSSION We found that common variants of the CX3CR1 gene influence ALS survival. Our data provide further evidence for the role of neuroinflammation in ALS. Muscle Nerve 57: 212-216, 2018.
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Affiliation(s)
- Andrea Calvo
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Cristina Moglia
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Antonio Canosa
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy
| | - Stefania Cammarosano
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy
| | - Antonio Ilardi
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy
| | - Davide Bertuzzo
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy
| | - Bryan J Traynor
- Neuromuscular Diseases Research Section, Laboratory of Neurogenetics, National Institute on Aging, Bethesda, Maryland, USA
| | - Maura Brunetti
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy
| | - Marco Barberis
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy
| | - Gabriele Mora
- Salvatore Maugeri Foundation, IRCSS, Scientific Institute of Milano, Milano, Italy
| | - Federico Casale
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, Neurology II, ALS Center, University of Torino, Via Cherasco 15, I-10126, Torino, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy.,Institute of Cognitive Sciences and Technologies, National Council of Researches, Rome, Italy
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12
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Calvo A, Canosa A, Bertuzzo D, Cugnasco P, Solero L, Clerico M, De Mercanti S, Bersano E, Cammarosano S, Ilardi A, Manera U, Moglia C, Marinou K, Bottacchi E, Pisano F, Mora G, Mazzini L, Chiò A. Influence of cigarette smoking on ALS outcome: a population-based study. J Neurol Neurosurg Psychiatry 2016; 87:1229-1233. [PMID: 27656044 DOI: 10.1136/jnnp-2016-313793] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/02/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the prognostic influence of premorbid smoking habits and vascular risk profile on amyotrophic lateral sclerosis (ALS) phenotype and outcome in a population-based cohort of Italian patients. METHODS A total of 650 patients with ALS from the Piemonte/Valle d'Aosta Register for ALS, incident in the 2007-2011 period, were recruited. Information about premorbid cigarette smoking habits and chronic obstructive pulmonary disease (COPD) were collected at the time of diagnosis. RESULTS Current smokers had a significantly shorter median survival (1.9 years, IQR 1.2-3.4) compared with former (2.3 years, IQR 1.5-4.2) and never smokers (2.7 years, IQR 1.8-4.6) (p=0.001). Also COPD adversely influenced patients' prognosis. Both smoking habits and CODP were retained in Cox multivariable model. CONCLUSIONS This study has demonstrated in a large population-based cohort of patients with ALS that cigarette smoking is an independent negative prognostic factor for survival, with a dose-response gradient. Its effect is not related to the presence of COPD or to respiratory status at time of diagnosis. The understanding of the mechanisms, either genetic or epigenetic, through which exogenous factors influence disease phenotype is of major importance towards a more focused approach to cure ALS.
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Affiliation(s)
- Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Davide Bertuzzo
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Paolo Cugnasco
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Luca Solero
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Marinella Clerico
- Department of Biological and Clinical Science, University of Turin, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Stefania De Mercanti
- Department of Biological and Clinical Science, University of Turin, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Enrica Bersano
- Department of Neurology, ALS Center, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy Eastern Piedmont University, Novara, Italy
| | - Stefania Cammarosano
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Antonio Ilardi
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Umberto Manera
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy
| | - Kalliopi Marinou
- Salvatore Maugeri Foundation, IRCSS, Scientific Institute of Milano, Milano, Italy
| | - Edo Bottacchi
- Department of Neurology, Azienda Ospedaliera Regionale di Aosta, Azienda USL Valle d'Aosta, Aosta, Italy
| | - Fabrizio Pisano
- Salvatore Maugeri Foundation, IRCSS, Scientific Institute of Veruno (NO), Veruno, Italy
| | - Gabriele Mora
- Salvatore Maugeri Foundation, IRCSS, Scientific Institute of Milano, Milano, Italy
| | - Letizia Mazzini
- Department of Neurology, ALS Center, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, ALS Center, University of Turin, Turin, Italy Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy Neuroscience Institute of Torino (NIT), Turin, Italy
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Marrali G, Casale F, Salamone P, Fuda G, Caorsi C, Amoroso A, Brunetti M, Restagno G, Barberis M, Bertuzzo D, Canosa A, Moglia C, Calvo A, Chiò A. NADPH oxidase (NOX2) activity is a modifier of survival in ALS. J Neurol 2014; 261:2178-83. [PMID: 25178511 DOI: 10.1007/s00415-014-7470-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/08/2014] [Accepted: 08/10/2014] [Indexed: 12/11/2022]
Abstract
NADPH-oxidases (NOX) catalyze the formation of reactive oxygen species (ROS), which play a role in the development of neurological diseases, particularly those generated by the phagocytic isoform NOX2. Increased ROS has been observed in the amyotrophic lateral sclerosis (ALS) SOD1 transgenic mouse, and in this preclinical model the inactivation of NOX2 decreases ROS production and extends survival. Our aim was to evaluate NOX2 activity measuring neutrophil oxidative burst in a cohort of 83 ALS patients, and age- and gender-matched healthy controls. Oxidative burst was measured directly in fresh blood using Phagoburst™ assay by flow cytometry. Mean fluorescence intensity (MFI), emitted in response to different stimuli, leads to produce ROS and corresponds to the percentage of oxidizing cells and their enzymatic activity (GeoMean). No difference was found between the MFI values in cases and controls. NOX2 activity was independent from gender and age, and in patients was not related to disease duration, site of onset (bulbar vs. spinal), or ALSFRS-R score. However, patients with a NOX2 activity lower than the median value showed a 1-year increase of survival from onset (p = 0.011). The effect of NOX2 was independent from other known prognostic factors. These findings are in keeping with the observations in the mouse model of ALS, and demonstrate the strong role of NOX2 in modifying progression in ALS patients. A proper modulation of NOX2 activity might hold therapeutic potential for ALS.
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Affiliation(s)
- Giuseppe Marrali
- "Rita Levi Montalcini" Department of Neuroscience, ALS Centre, University of Torino, Via Cherasco 15, 10126, Turin, Italy,
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Chiò A, Calvo A, Bovio G, Canosa A, Bertuzzo D, Galmozzi F, Cugnasco P, Clerico M, De Mercanti S, Bersano E, Cammarosano S, Ilardi A, Manera U, Moglia C, Sideri R, Marinou K, Bottacchi E, Pisano F, Cantello R, Mazzini L, Mora G. Amyotrophic Lateral Sclerosis Outcome Measures and the Role of Albumin and Creatinine. JAMA Neurol 2014; 71:1134-42. [DOI: 10.1001/jamaneurol.2014.1129] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adriano Chiò
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy2Città della Salute e della Scienza, Azienda Ospedaliero Universitaria, Turin, Italy3Neuroscience Institute of Torino, Turin, Italy
| | - Andrea Calvo
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy2Città della Salute e della Scienza, Azienda Ospedaliero Universitaria, Turin, Italy
| | - Giacomo Bovio
- Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Scientific Institute of Pavia, Pavia, Italy
| | - Antonio Canosa
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Davide Bertuzzo
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesco Galmozzi
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Paolo Cugnasco
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Marinella Clerico
- Department of Biological and Clinical Science, Azienda Ospedaliero Universitaria San Luigi Gonzaga, University of Turin, Orbassano, Italy
| | - Stefania De Mercanti
- Department of Biological and Clinical Science, Azienda Ospedaliero Universitaria San Luigi Gonzaga, University of Turin, Orbassano, Italy
| | - Enrica Bersano
- Amyotrophic Lateral Sclerosis Center, Department of Neurology, Azienda Ospedaliero Universitaria Maggiore di Novara, Novara, Italy
| | - Stefania Cammarosano
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Antonio Ilardi
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Umberto Manera
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Cristina Moglia
- Amyotrophic Lateral Sclerosis Center, Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
| | - Riccardo Sideri
- Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Scientific Institute of Milano, Milano, Italy
| | - Kalliopi Marinou
- Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Scientific Institute of Milano, Milano, Italy
| | - Edo Bottacchi
- Department of Neurology, Azienda Ospedaliera Regionale di Aosta, Azienda Unità Sanitaria Locale Valle d’Aosta, Aosta, Italy
| | - Fabrizio Pisano
- Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Scientific Institute of Veruno, Pavia, Italy
| | - Roberto Cantello
- Eastern Piedmont University, Department of Neurology, Novara, Italy
| | - Letizia Mazzini
- Amyotrophic Lateral Sclerosis Center, Department of Neurology, Azienda Ospedaliero Universitaria Maggiore di Novara, Novara, Italy
| | - Gabriele Mora
- Salvatore Maugeri Foundation, Istituto Di Ricovero e Cura a Carattere Scientifico, Scientific Institute of Milano, Milano, Italy
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Pagani M, Chiò A, Valentini MC, Öberg J, Nobili F, Calvo A, Moglia C, Bertuzzo D, Morbelli S, De Carli F, Fania P, Cistaro A. Functional pattern of brain FDG-PET in amyotrophic lateral sclerosis. Neurology 2014; 83:1067-74. [PMID: 25122207 DOI: 10.1212/wnl.0000000000000792] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We investigated a large sample of patients with amyotrophic lateral sclerosis (ALS) at rest in order to assess the value of (18)F-2-fluoro-2-deoxy-d-glucose ((18)F-FDG) PET as a biomarker to discriminate patients from controls. METHODS A total of 195 patients with ALS and 40 controls underwent brain (18)F-FDG-PET, most within 5 months of diagnosis. Spinal and bulbar subgroups of ALS were also investigated. Twenty-five bilateral cortical and subcortical volumes of interest and cerebellum were taken into account, and (18)F-FDG uptakes were individually normalized by whole-brain values. Group analyses investigated the ALS-related metabolic changes. Discriminant analysis investigating sensitivity and specificity was performed using the 51 volumes of interest as well as age and sex. Metabolic connectivity was explored by voxel-wise interregional correlation analysis. RESULTS Hypometabolism was found in frontal, motor, and occipital cortex and hypermetabolism in midbrain, temporal pole, and hippocampus in patients with ALS compared to controls. A similar metabolic pattern was also found in the 2 subgroups. Discriminant analysis showed a sensitivity of 95% and a specificity of 83% in separating patients from controls. Connectivity analysis found a highly significant positive correlation between midbrain and white matter in corticospinal tracts in patients with ALS. CONCLUSIONS (18)F-FDG distribution changes in ALS showed a clear pattern of hypometabolism in frontal and occipital cortex and hypermetabolism in midbrain. The latter might be interpreted as the neurobiological correlate of diffuse subcortical gliosis. Discriminant analysis resulted in high sensitivity and specificity in differentiating patients with ALS from controls. Once validated by diseased-control studies, the present methodology might represent a potentially useful biomarker for ALS diagnosis. CLASSIFICATON OF EVIDENCE This study provides Class III evidence that (18)F-FDG-PET accurately distinguishes patients with ALS from normal controls (sensitivity 95.4%, specificity 82.5%).
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Affiliation(s)
- Marco Pagani
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy.
| | - Adriano Chiò
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Maria Consuelo Valentini
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Johanna Öberg
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Flavio Nobili
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Andrea Calvo
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Cristina Moglia
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Davide Bertuzzo
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Silvia Morbelli
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Fabrizio De Carli
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Piercarlo Fania
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
| | - Angelina Cistaro
- From the Institute of Cognitive Sciences and Technologies (M.P., A. Cistaro), CNR, Rome, Italy; Departments of Nuclear Medicine (M.P.) and Hospital Physics (J.O.), Karolinska Hospital, Stockholm, Sweden; ALS Center (A. Chiò, A. Calvo, C.M., D.B.), "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; Neuroscience Institute of Turin (A. Chiò), Italy; Department of Neuroradiology (M.C.V.), CTO Hospital, Turin, Italy; Clinical Neurology Unit (F.N.), Department of Neurosciences, Ophthalmology and Genetics (DINOGMI) and Department of Health Sciences (S.M.), Nuclear Medicine Unit, Department of Internal Medicine, University of Genoa, Italy; Institute of Molecular Bioimaging and Physiology (F.D.), CNR Genoa Unit, Italy; and Positron Emission Tomography Center IRMET S.p.A. (P.F., A. Cistaro), Euromedic Inc., Turin, Italy
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Ilardi A, Moglia C, Cammarosano S, Canosa A, Bertuzzo D, Manera U, Fuda G, Chiò A, Calvo A. Persistent idiopathic hypoglossal nerve palsy: A motor neuron disease-mimic syndrome? Amyotroph Lateral Scler Frontotemporal Degener 2014; 16:274-6. [PMID: 24920472 DOI: 10.3109/21678421.2014.924144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Antonio Ilardi
- ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Torino , Torino , Italy
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Chiò A, Battistini S, Calvo A, Caponnetto C, Conforti FL, Corbo M, Giannini F, Mandrioli J, Mora G, Sabatelli M, Ajmone C, Mastro E, Pain D, Mandich P, Penco S, Restagno G, Zollino M, Surbone A, Lunetta C, Pintor GL, Salvi F, Bartolomei I, Quattrone A, Gambardella A, Logroscino G, Simone I, Pisano F, Spataro R, La Bella V, Colletti T, Mancardi G, Origone P, Sola P, Borghero G, Marrosu F, Marrosu MG, Murru MR, Floris G, Cannas A, Piras V, Costantino E, Pani C, Sotgiu MA, Pugliatti M, Parish LD, Cossu P, Ticca A, Rodolico C, Portaro S, Ricci C, Moglia C, Ossola I, Brunetti M, Barberis M, Canosa A, Cammarosano S, Bertuzzo D, Fuda G, Ilardi A, Manera U, Pastore I, Sproviero W, Logullo F, Tanel R, Ajmone C, Mastro E, Pain D, Mandich P, Penco S, Restagno G, Zollino M, Surbone A. Genetic counselling in ALS: facts, uncertainties and clinical suggestions. J Neurol Neurosurg Psychiatry 2014; 85:478-85. [PMID: 23833266 DOI: 10.1136/jnnp-2013-305546] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The clinical approach to patients with amyotrophic lateral sclerosis (ALS) has been largely modified by the identification of novel genes, the detection of gene mutations in apparently sporadic patients, and the discovery of the strict genetic and clinical relation between ALS and frontotemporal dementia (FTD). As a consequence, clinicians are increasingly facing the dilemma on how to handle genetic counselling and testing both for ALS patients and their relatives. On the basis of existing literature on genetics of ALS and of other late-onset life-threatening disorders, we propose clinical suggestions to enable neurologists to provide optimal clinical and genetic counselling to patients and families. Genetic testing should be offered to ALS patients who have a first-degree or second-degree relative with ALS, FTD or both, and should be discussed with, but not offered to, all other ALS patients, with special emphasis on its major uncertainties. Presently, genetic testing should not be proposed to asymptomatic at-risk subjects, unless they request it or are enrolled in research programmes. Genetic counselling in ALS should take into account the uncertainties about the pathogenicity and penetrance of some genetic mutations; the possible presence of mutations of different genes in the same individual; the poor genotypic/phenotypic correlation in most ALS genes; and the phenotypic pleiotropy of some genes. Though psychological, social and ethical implications of genetic testing are still relatively unexplored in ALS, we recommend multidisciplinary counselling that addresses all relevant issues, including disclosure of tests results to family members and the risk for genetic discrimination.
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Affiliation(s)
- Adriano Chiò
- Department of Neuroscience, ALS Center, 'Rita Levi Montalcini', University of Torino, Torino, and Azienda Ospedaliera Città della Salute e della Scienza, , Torino, Italy
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Calvo A, Moglia C, Canosa A, Cistaro A, Valentini C, Carrara G, Soldano E, Ilardi A, Bersano E, Bertuzzo D, Brunetti M, Ossola I, Restagno G, Chiò A. Amyotrophic lateral sclerosis/frontotemporal dementia with predominant manifestations of obsessive–compulsive disorder associated to GGGGCC expansion of the c9orf72 gene. J Neurol 2012; 259:2723-5. [DOI: 10.1007/s00415-012-6640-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/23/2012] [Accepted: 07/24/2012] [Indexed: 12/13/2022]
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Moglia C, Calvo A, Ilardi A, Canosa A, Cammarosano S, Bersano E, Bertuzzo D, Manera U, Lo Presti A, Casale F, Montuschi A, Chio A. Does Recognition of Facial Expression of Primary and Social Emotions in ALS Patients Interfere with Social Competence? (P01.110). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Franchini M, Gandini G, Gandini A, Crocco I, de Gironcoli M, Bertuzzo D, Giuffrida A, Lippi G, Vassanelli A, Bressan F, Aprilli G. Frequency of Adverse Events during Blood and Apheresis Donations: A Single-Center Study. Transfus Med Hemother 2002. [DOI: 10.1159/000065315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gandini G, Franchini M, Vassanelli A, De Gironcoli M, Ferro I, Bertuzzo D, Antonello O, Aprili G. Immunohematological aspects of bone marrow transplantation. Hematology 2002; 7:89-93. [PMID: 12186697 DOI: 10.1080/10245330290022151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Allogeneic bone marrow transplantation (BMT) is an effective treatment for some severe hematologic or nonhematologic diseases. The blood group antigen mismatch between donor and recipient may cause immunohematological complications during or after BMT. In this review, we analyze the ABO, Rh and other red cell antigen mismatches between donor and recipient, the main immunohematological complications and the techniques to prevent them. The data reported are derived from the experience of the authors and from the medical literature. The clinical implications of the immunohematological aspects of BMT emphasize the importance of close immunohematological monitoring in patients undergoing allogeneic BMT with ABO, Rh or other red cell antigen mismatches between donor and recipient.
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Affiliation(s)
- G Gandini
- Servizio di Immunoematologia e transfusione, Azienda Ospedaliera di Verona, Verona, Italy.
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Gandini G, Franchini M, de Gironcoli M, Giuffrida A, Bertuzzo D, Zanolla L, Ferro I, Regis D, Aprili G. Preoperative autologous blood donation by elderly patients undergoing orthopaedic surgery. Vox Sang 2001; 80:95-100. [PMID: 11378971 DOI: 10.1046/j.1423-0410.2001.00020.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To assess the feasibility of a programme of predeposit in elderly patients undergoing elective orthopaedic surgery. PATIENTS AND METHODS We retrospectively studied 789 elderly patient candidates (> 65 years of age) for orthopaedic surgery (total hip and knee replacement and spinal surgery), who were undergoing a programme of preoperative autologous blood donation (PABD) in our city hospital between January 1990 and December 1998. RESULTS Six hundred and eighty-eight patients (87.2%) were transfused with autologous blood; 128 (16.2%) also received allogeneic blood. Hip arthroplasty revision was characterized by the greatest blood consumption. The predeposit programme was discontinued in 96 patients (12.2%) because of the following complications: the onset of anaemia (11.0%); vasovagal reactions (0.5%); lack of venous access (0.4%); or cardiac complications (0.2%). No episodes of reaction to autologous transfusion were recorded. CONCLUSIONS Our study confirms the feasibility of PABD in elderly patients undergoing elective orthopaedic surgery.
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Affiliation(s)
- G Gandini
- Servizio di Immunoematologia e Trasfusione Ospedale Policlinico, Via delle Menegone, 10-37134 Verona, Italy.
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Gandini G, Franchini M, Bertuzzo D, Olzer D, Crocco I, De Gironcoli M, Aprili G. Preoperative autologous blood donation by 1073 elderly patients undergoing elective surgery: a safe and effective practice. Transfusion 1999; 39:174-8. [PMID: 10037128 DOI: 10.1046/j.1537-2995.1999.39299154732.x] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Preoperative autologous blood donation (PABD) aims at avoiding the risks associated with exposure to allogeneic blood. While its use is extremely common among adult patients in connection with elective surgery, it is still uncommon in elderly patients, because of a series of coexisting pathologies. STUDY DESIGN AND METHODS A retrospective study was made of 1073 consecutive elderly patients at a city hospital from 1990 to 1996. Their responses to the PABD program were evaluated by analysis of the incidence of complications and the demand for allogeneic blood. RESULTS The PABD program was interrupted in 79 (7.4%) of 1073 patients because of the onset of anemia, vasovagal reactions, lack of accessible superficial veins, or cardiovascular complications. Seven hundred eighty-four (73.1%) of 1073 patients were given autologous blood; 151 (14.1%) patients also required allogeneic blood. CONCLUSION The onset of anemia (6.5%) was the main contraindication for continuing the PABD program: incidence increased with age. PABD in connection with elective surgery is both feasible and effective in a high percentage of elderly patients.
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Affiliation(s)
- G Gandini
- Servizio di Immunoematologia e Trasfusione, Azienda Ospedaliera di Verona, Italy
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