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Camera M, Brambilla M, Canzano P, Becchetti A, Conti M, Teruzzi G, Porro B, Muratori E, Tedesco C, Montorsi P, Bartorelli A, Tremoli E, Trabattoni D. Patent foramen ovale (PFO) and migraine: role of platelet Tissue Factor expression and oxidative stress. The LEARNER study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Migraine is a chronic neurovascular disorder with a multifactorial aetiology. A strong relationship links migraine with aura (MHA) and patent foramen ovale (PFO), with migraine regression after PFO closure. Increased platelet aggregation and oxidative stress were documented in migraineurs. Current guidelines suggest the use of aspirin or P2Y12-antagonists. To date, however, no clear mechanisms connecting MHA to PFO has been demonstrated.
Purpose
To perform a comprehensive analysis of platelet activation, inflammation and oxidative stress status in 78 aspirin-treated MHA-patients before (T0) and 6-months after (T1) PFO closure (LEARNER Study-NCT03521193-clinicaltrials.gov). Primary endpoint was migraine regression rate in relation to these parameters.
Methods
P-selectinpos-, activated-glycoproteinIIbIIIa (aGPIIbIIIa)pos-, Tissue Factor (TF)pos-, reactive oxygen species (ROS)pos-platelets, platelet-leukocyte aggregates (PLA) and microvesicles (MVs) were evaluated by flow cytometry; thrombin generation (TG) by Calibrated Automated Thrombogram (CAT) assay; oxidative stress status by mass spectrometry. Twelve aspirin-treated-healthy subjects (HS) were enrolled for comparison. To test the effect of PFO patients' plasma on platelet activation, blood from HS was plasma-depleted and replaced with a pool of plasma from PFO patients.
Results
Migraine resolution occurred in 69.7%, significant reduction in 27%, while no effect was observed in 2 patients (3.2%). Only ROSpos-platelets, and TFpos-platelets and -MVs were significantly higher at T0, sustaining a TG capacity that was associated with an altered blood GSSG/GSH (Oxidized/Reduced Glutathione) ratio. This phenotype reverted to HS levels at T1 (Fig. 1). MHA-PFO plasma, added to HS blood, mirrored the in vivo platelet activation and N-acetylcysteine blunted it. In vitro GSSG treatment of HS platelets reproduced the in vivo condition. Aspirin had little effect on the platelet prothrombotic phenotype which was effectively inhibited by a P2Y12-antagonist (Fig.2).
Conclusions
MHA-PFO patients show a platelet-associated prothrombotic phenotype, characterized by a marked thrombin generation capacity sustained by an elevated number of platelets and MVs expressing a functionally active Tissue Factor and sustained by altered oxidative stress status. This phenotype, not fully controlled by aspirin but by P2Y12-antagonism, reverted after PFO closure together with a complete migraine remission.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health
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Affiliation(s)
- M Camera
- University of Milan, eDepartment of Pharmaceutical Sciences , Milan , Italy
| | | | - P Canzano
- Centro cardiologico Monzino , Milan , Italy
| | | | - M Conti
- Centro cardiologico Monzino , Milan , Italy
| | - G Teruzzi
- Centro cardiologico Monzino , Milan , Italy
| | - B Porro
- Centro cardiologico Monzino , Milan , Italy
| | - E Muratori
- Centro cardiologico Monzino , Milan , Italy
| | - C Tedesco
- Centro cardiologico Monzino , Milan , Italy
| | - P Montorsi
- Centro cardiologico Monzino , Milan , Italy
| | | | - E Tremoli
- Centro cardiologico Monzino , Milan , Italy
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Maccauro G, Muratori E, Sgambato A, Liuzza F, Esposito M, Grieco A, Gosheger G. Bone metastasis in hepatocellular carcinoma. A report of five cases and a review of the literature. Chir Organi Mov 2005; 90:297-302. [PMID: 16681107] [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: 05/09/2023]
Abstract
Hepatocarcinoma occurs frequently throughout the world. Bone metastases are rare although incidence has increased because of progress in diagnosis and treatment. The authors report 5 cases of bone metastases and review the literature. The spine is the most frequent localization of bone metastases. Radiotherapy is the treatment of choice for this lesion. Surgery should be used to prevent and treat complications such as nerve compression and pathologic fracture, only if the coagulative pattern and the conditions of the patient allow it. The authors recommend the use of long intramedullary nailing when localization of the disease is in the femur, with prophylactic stabilization of the neck in diaphyseal metastasis.
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Affiliation(s)
- G Maccauro
- Clinica Ortopedica dell'Università Cattolica, Roma, Italia.
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Conconi MT, Tommasini M, Muratori E, Parnigotto PP. Essential amino acids increase the growth and alkaline phosphatase activity in osteoblasts cultured in vitro. Farmaco 2001; 56:755-61. [PMID: 11718268 DOI: 10.1016/s0014-827x(01)01126-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An inadequate protein intake seems to be involved in the pathogenesis of osteoporosis. Moreover, protein from animal sources appears to protect against hip fracture, while protein from vegetable sources, which present low levels of essential amino acids, has no effect. In this preliminary work, the growth, the alkaline phosphatase activity and the collagen synthesis were evaluated in osteoblast cultures obtained from calvaria of newborn Sprague-Dawley rats and incubated with lysine, threonine, methionine, triptophan and arginine. Our results have shown that the essential amino acids can modulate the growth and the differentiation of osteoblasts cultured in vitro, confirming the relationship between osteoporotic hip fracture and inadequate protein intake. The compounds have mainly enhanced cell growth and alkaline phosphatase activity, and, to a lower degree, collagen synthesis. In summary, the essential amino acids can stimulate bone formation and could represents useful agents for the prevention and therapy of osteoporosis.
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Affiliation(s)
- M T Conconi
- Department of Pharmaceutical Sciences, University of Padua, Italy
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Guazzi MD, Berti M, Dardani M, Muratori E, Guazzi M. [Two sides of the coin, or converting enzyme inhibitors in the therapy of heart failure]. Cardiologia 1989; 34:15-8. [PMID: 2655899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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