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Makieva S, Giacomini E, Scotti GM, Lazarevic D, Pavone V, Ottolina J, Bartiromo L, Schimberni M, Morelli M, Alteri A, Minetto S, Tonon G, Candiani M, Papaleo E, Viganò P. Extracellular vesicles secreted by human aneuploid embryos present a distinct transcriptomic profile and upregulate MUC1 transcription in decidualised endometrial stromal cells. Hum Reprod Open 2024; 2024:hoae014. [PMID: 38559895 PMCID: PMC10980593 DOI: 10.1093/hropen/hoae014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 02/06/2024] [Indexed: 04/04/2024] Open
Abstract
STUDY QUESTION Do extracellular vesicles (EVs) secreted by aneuploid human embryos possess a unique transcriptomic profile that elicits a relevant transcriptomic response in decidualized primary endometrial stromal cells (dESCs)? SUMMARY ANSWER Aneuploid embryo-derived EVs contain transcripts of PPM1J, LINC00561, ANKRD34C, and TMED10 with differential abundance from euploid embryo-derived EVs and induce upregulation of MUC1 transcript in dESCs. WHAT IS KNOWN ALREADY We have previously reported that IVF embryos secrete EVs that can be internalized by ESCs, conceptualizing that successful implantation to the endometrium is facilitated by EVs. Whether these EVs may additionally serve as biomarkers of ploidy status is unknown. STUDY DESIGN SIZE DURATION Embryos destined for biopsy for preimplantation genetic testing for aneuploidy (PGT-A) were grown under standard conditions. Spent media (30 μl) were collected from euploid (n = 175) and aneuploid (n = 140) embryos at cleavage (Days 1-3) stage and from euploid (n = 187) and aneuploid (n = 142) embryos at blastocyst (Days 3-5) stage. Media samples from n = 35 cleavage-stage embryos were pooled in order to obtain five euploid and four aneuploid pools. Similarly, media samples from blastocysts were pooled to create one euploid and one aneuploid pool. ESCs were obtained from five women undergoing diagnostic laparoscopy. PARTICIPANTS/MATERIALS SETTING METHODS EVs were isolated from pools of media by differential centrifugation and EV-RNA sequencing was performed following a single-cell approach that circumvents RNA extraction. ESCs were decidualized (estradiol: 10 nM, progesterone: 1 µM, cAMP: 0.5 mM twice every 48 h) and incubated for 24 h with EVs (50 ng/ml). RNA sequencing was performed on ESCs. MAIN RESULTS AND THE ROLE OF CHANCE Aneuploid cleavage stage embryos secreted EVs that were less abundant in RNA fragments originating from the genes PPM1J (log2fc = -5.13, P = 0.011), LINC00561 (log2fc = -7.87, P = 0.010), and ANKRD34C (log2fc = -7.30, P = 0.017) and more abundant in TMED10 (log2fc = 1.63, P = 0.025) compared to EVs of euploid embryos. Decidualization per se induced downregulation of MUC1 (log2fc = -0.54, P = 0.0028) in ESCs as a prerequisite for the establishment of receptive endometrium. The expression of MUC1 transcript in decidualized ESCs was significantly increased following treatment with aneuploid compared to euploid embryo-secreted EVs (log2fc = 0.85, P = 0.0201). LARGE SCALE DATA Raw data have been uploaded to GEO (accession number GSE234338). LIMITATIONS REASONS FOR CAUTION The findings of the study will require validation utilizing a second cohort of EV samples. WIDER IMPLICATIONS OF THE FINDINGS The discovery that the transcriptomic profile of EVs secreted from aneuploid cleavage stage embryos differs from that of euploid embryos supports the possibility to develop a non-invasive methodology for PGT-A. The upregulation of MUC1 in dESCs following aneuploid embryo EV treatment proposes a new mechanism underlying implantation failure. STUDY FUNDING/COMPETING INTERESTS The study was supported by a Marie Skłodowska-Curie Actions fellowship awarded to SM by the European Commission (CERVINO grant agreement ID: 79620) and by a BIRTH research grant from Theramex HQ UK Ltd. The authors have no conflicts of interest to declare.
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Affiliation(s)
- Sofia Makieva
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Maria Scotti
- Centre for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dejan Lazarevic
- Centre for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Pavone
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jessica Ottolina
- Centro Scienze della Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ludovica Bartiromo
- Department of Obstetrics and Gynaecology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Matteo Schimberni
- Department of Obstetrics and Gynaecology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Marco Morelli
- Centre for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Alteri
- Centro Scienze della Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Minetto
- Centro Scienze della Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Tonon
- Centre for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynaecology, IRCCS Scientific Institute San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Centro Scienze della Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Giacomini E, Pagliardini L, Minetto S, Pinna M, Kleeman F, Bonesi F, Makieva S, Pavone V, Reschini M, Papaleo E, Candiani M, Somigliana E, Viganò P. The relationship between CYP19A1 gene expression in luteinized granulosa cells and follicular estradiol output in women with endometriosis. J Steroid Biochem Mol Biol 2024; 237:106439. [PMID: 38048918 DOI: 10.1016/j.jsbmb.2023.106439] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
Endometriosis was claimed to negatively affect the intrafollicular environment, hindering oocyte competence. Previous studies evaluated expression levels of cytochrome P450 aromatase (CYP19A) in granulosa and cumulus oophorus cells collected from endometriosis women, but results are controversial. To further investigate the intrafollicular environment whose alteration may potentially disturb ovarian steroidogenesis in endometriosis, gene expression of CYP19A and of its upstream enzymes, StAR and 3βHSD was assessed in luteinized granulosa cells isolated from follicular fluids (FF) collected during Assisted Reproduction Technology (ART) procedures in women with stage III-IV disease and from subjects without the condition. In a subgroup of patients, cumulus oophorus cells (COCs) were also assessed for CYP19A, StAR and 3βHSD gene expression. No difference in mRNA expression of CYP19A1, StAR and 3βHSD in both granulosa cells and COCs was observed between the two groups of patients. No significant difference was also found between estradiol FF levels detected in endometriosis patients (median=873, IQR=522-1221 ng/ml)) and control patients (median=878, IQR=609-1137 ng/ml). To gain more insight into the intrafollicular regulation of CYP19A in patients with endometriosis, associations between expression of the analyzed genes, systemic and follicular 17β-estradiol levels and ART outcomes were assessed. While in the control group, levels of CYP19A1, StAR and 3βHSD transcripts significantly correlated with follicular estradiol levels (adjusted R² of 0.60), no significant association was detected in affected women (adjusted R² of 0.23). After stratification of the populations based on the presence of the disease, CYP19A1 expression was shown to correlate with the number of oocytes retrieved [β:- 1.214;95%CI: - 2.085 - (-0.343); p = 0.007] in the control group while this association was not present in patients with endometriosis [β:- 0.003; 95%CI:- 0.468-0.461; p = 0.988)]. These results do not support data from the literature indicating a reduced aromatase expression in granulosa cells of affected women, but they highlight a potential subtle mechanism affecting the ovulation process in these women.
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Affiliation(s)
- Elisa Giacomini
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Pagliardini
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Sabrina Minetto
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Pinna
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Fabiola Kleeman
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Bonesi
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sofia Makieva
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina Pavone
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Enrico Papaleo
- Centro Scienze della Natalità, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Masi S, Kobalava Z, Veronesi C, Giacomini E, Degli Esposti L, Tsioufis K. A Retrospective Observational Real-Word Analysis of the Adherence, Healthcare Resource Consumption and Costs in Patients Treated with Bisoprolol/Perindopril as Single-Pill or Free Combination. Adv Ther 2024; 41:182-197. [PMID: 37864626 PMCID: PMC10796571 DOI: 10.1007/s12325-023-02707-7] [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: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION The present real-world analysis aims to compare the drug utilization, hospitalizations and direct healthcare costs related to the use of single-pill combination (SPC) or free-equivalent combination (FEC) of perindopril and bisoprolol (PER/BIS) in a large Italian population. METHODS This observational retrospective analysis was based on administrative databases covering approximately 7 million subjects across Italy. All adult subjects receiving PER/BIS as SPC or FEC between January 2017-June 2020 were included. Subjects were followed for 1 year after the first prescription of PER/BIS as FEC (± 1 month) or SPC. Before comparing the SPC and FEC cohorts, propensity score matching (PSM) was applied to balance the baseline characteristics. Drug utilization was investigated as adherence (defined by the proportion of days covered, PDC) and persistence (evaluated by Kaplan-Meier curves). Hospitalizations and mean annual direct healthcare costs (due to drug prescriptions, hospitalizations and use of outpatient services) were analyzed during follow-up. RESULTS The original cohort included 11,440 and 6521 patients taking the SPC and FEC PER/BIS combination, respectively. After PSM, two balanced SPC and FEC cohorts of 4688 patients were obtained (mean age 70 years, approximately 50% male, 24% in secondary prevention). The proportion of adherent patients (PDC ≥ 80%) was higher for those on SPC (45.5%) than those on FEC (38.6%), p < 0.001. The PER/BIS combination was discontinued by 35.8% of patients in the SPC cohort and 41.7% in the FEC cohort (p < 0.001). The SPC cohort had fewer cardiovascular (CV) hospitalizations (5.3%) than the free-combination cohort (7.4%), p < 0.001. Mean annual total healthcare costs were lower in the SPC (1999€) than in the FEC (2359€) cohort (p < 0.001). CONCLUSION In a real-world setting, patients treated with PER/BIS SPC showed higher adherence, lower risk of drug discontinuation, reduced risk of CV hospitalization, and lower healthcare costs than those on FEC of the same drugs.
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Affiliation(s)
- Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Zhanna Kobalava
- Department of Internal Medicine and Cardiology, RUDN University, Moscow, Russia
| | - Chiara Veronesi
- CliCon S.R.L. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Elisa Giacomini
- CliCon S.R.L. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.R.L. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocratio Hospital, Athens, Greece
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Giacomini E, Leogrande M, Perrone V, Andretta M, Bacca M, Chinellato A, Ciaccia A, Cillo M, Lombardi R, Mancini D, Pagliaro R, Pastorello M, Procacci C, Degli Esposti L. Characteristics and Drug Utilization of Patients with Hereditary Angioedema in Italy, a Real-World Analysis. Healthcare (Basel) 2023; 11:2509. [PMID: 37761706 PMCID: PMC10530529 DOI: 10.3390/healthcare11182509] [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] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
This real-world analysis investigated the characteristics and treatment patterns of patients with hereditary angioedema (HAE) in Italy using the administrative data of health units across Italy. Patients were identified via exemption code or HAE-specific treatments (thus, all known forms, type I, II and, III, were included). The index date was that of first prescription of HAE treatments within the inclusion period (01/2010-06/2021) or of the date of exemption. The number of HAE patients included was 148 (43.2% male, mean age 43.3 years). Gastrointestinal disorders affected 36.5% patients, hypertension affected 28.4%, hypercholesterolemia affected 11.5%, and depression affected 9.5%. The frequent gastrointestinal involvement was further confirmed by the use of antiemetics and systemic antihistamines that doubled after the index date. Among patients enrolled by treatment (n = 125), n = 105 (84%) were receiving a treatment for acute attacks. This analysis provided insights into the characterization of patients with HAE and their management in Italian clinical practice, suggesting that an unmet therapeutic need could be present for such patients in terms of the clinical burden.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
| | - Melania Leogrande
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
| | - Margherita Andretta
- Unità Operativa Complessa Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, 36100 Vicenza, Italy;
| | - Marcello Bacca
- Programmazione e Controllo di Gestione, ASL Brindisi, 72100 Brindisi, Italy;
| | - Alessandro Chinellato
- Unità Operativa Complessa Farmacia Ospedaliera, Azienda ULSS 3 Serenissima, 30174 Mestre, Italy;
| | - Andrea Ciaccia
- Servizio Farmaceutico Territoriale, ASL Foggia, 71121 Foggia, Italy; (A.C.); (R.L.)
| | - Mariarosaria Cillo
- Dipartimento Farmaceutico, Azienda Sanitaria Locale di Salerno, 84124 Salerno, Italy;
| | - Renato Lombardi
- Servizio Farmaceutico Territoriale, ASL Foggia, 71121 Foggia, Italy; (A.C.); (R.L.)
| | - Daniela Mancini
- Dipartimento Farmaceutico, ASL Brindisi, 72100 Brindisi, Italy;
| | - Romina Pagliaro
- Unità Operativa Complessa Farmaceutica Territoriale, Azienda Sanitaria Locale Roma 5, 00034 Roma, Italy;
| | - Maurizio Pastorello
- Dipartimento Farmaceutico, Azienda Sanitaria Provinciale di Palermo, 90141 Palermo, Italy;
| | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
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Ferreri AJM, Zinzani PL, Messina C, Valsecchi D, Rendace MC, Premoli E, Giacomini E, Veronesi C, Degli Esposti L, Di Matteo P. Burden of Illness in Follicular Lymphoma with Multiple Lines of Treatment, Italian RWE Analysis. Cancers (Basel) 2023; 15:4403. [PMID: 37686679 PMCID: PMC10486445 DOI: 10.3390/cancers15174403] [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] [Received: 06/29/2023] [Revised: 08/13/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This real-world analysis investigated patients with follicular lymphoma in Italy receiving three or more treatment lines (≥3L), focusing on therapeutic pathways with their rebounds on healthcare resource consumptions and costs. Data were retrieved from administrative databases from healthcare entities covering about 13.3 million residents. Adults diagnosed with follicular lymphoma were identified between January 2015 and June 2020, and among them 2434 patients with ≥3L of treatment during the data availability interval (January 2009 to June 2021) were included. Of them, 1318 were in 3L, 494 in 4L and 622 in ≥5L. A relevant proportion of patients (12-32%) switched to a later line within the same calendar year. At 3-year follow-up (median), 34% patients died. Total mean annual expenses were euro 14,508 in the year preceding inclusion and rose to euro 21,081 at 1-year follow-up (on average euro 22,230/patient/year for the whole follow-up), with hospitalization and drug expenses as weightiest cost items. In conclusion, the clinical and economic burden of follicular lymphoma increases along with later treatment lines. The high mortality rates indicate that further efforts are needed to optimize disease management.
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Affiliation(s)
| | - Pier Luigi Zinzani
- Istituto di Ematologia “Seràgnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, 40126 Bologna, Italy
| | - Carlo Messina
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Diletta Valsecchi
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Maria Chiara Rendace
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Eleonora Premoli
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 40137 Bologna, Italy; (E.G.); (C.V.)
| | - Chiara Veronesi
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 40137 Bologna, Italy; (E.G.); (C.V.)
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 40137 Bologna, Italy; (E.G.); (C.V.)
| | - Paola Di Matteo
- Novartis Farma S.p.A., 20154 Milan, Italy; (C.M.); (D.V.); (M.C.R.); (E.P.); (P.D.M.)
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Meltsov A, Giacomini E, Vigano P, Zarovni N, Salumets A, Aleksejeva E. Letter to the Editor - Pilot proof for RNA biomarker-based minimally invasive endometrial receptivity testing using uterine fluid extracellular vesicles. Eur J Obstet Gynecol Reprod Biol 2023; 287:237-238. [PMID: 37308398 DOI: 10.1016/j.ejogrb.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Alvin Meltsov
- Competence Centre on Health Technologies, Tartu, Estonia; Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Vigano
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia; Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Elina Aleksejeva
- Competence Centre on Health Technologies, Tartu, Estonia; Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
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Palladino S, Perrone V, Giacomini E, Sangiorgi D, Premoli E, Valsecchi D, Degli Esposti L, Suter MB. Real-world analysis of the economic and therapeutic burden in advanced breast cancer patients in Italy. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1041-1048. [PMID: 37459247 DOI: 10.1080/14737167.2023.2234637] [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] [Received: 12/07/2022] [Accepted: 06/29/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND This real-world analysis evaluated drug utilization focusing on wastage and healthcare costs for treatment of patients with advanced breast cancer (aBC) hormone receptor-positive (HR+)/human epidermal growth factor receptor-2 negative (HER2-) in Italy. METHODS A retrospective analysis was conducted on administrative data covering about 13.3 million health-assisted individuals. Across January/2017-June/2021, all patients with HR+/HER2-aBC were identified by ≥ 1 prescription for cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i). Cost analysis was performed and updated referring to the prices of November 2021. RESULTS Overall, 3,647 HR+/HER2-aBC patients were included (2,627 palbociclib treated, 729 ribociclib treated, and 291 abemaciclib treated). After 12 months of follow-up, 35% of palbociclib patients had a dose reduction (on average 8.9 wasted pills/patient), 44.7% of abemaciclib patients had a dose reduction (on average 6.7 wasted pills/patient), 22.1% of ribociclib patients had a dose reduction (no wasted pills). Therapy wastage added up to 528,716€ for palbociclib-treated patients (524€/patient) and 5,738€ in abemaciclib-treated patients (151€/patient). No wastage was attributed to ribociclib. CONCLUSIONS Dose reduction was associated with drug wastage in palbociclib and abemaciclib-treated patients, but not in ribociclib-treated ones. These findings might be helpful to policy decision-makers who, for healthcare strategies implementation, among several variables should consider the possible restraining of drug wastage.
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Affiliation(s)
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
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Perrone V, Giacomini E, Sangiorgi D, Tamma A, Giovannitti M, Buzzoni C, Degli Esposti L. Description of characteristics, management of care and healthcare direct costs of patients with HR+/HER2- early breast cancer in Italy: a real-world study involving administrative and pathological anatomy databases. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1077-1085. [PMID: 37638590 DOI: 10.1080/14737167.2023.2246652] [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: 03/30/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Healthcare administrative and pathological anatomy data were used to identify Italian patients with early breast cancer (EBC) with HR+/HER2- status at high risk of recurrence, evaluating drug utilization and other healthcare resource use in clinical practice. METHODS This retrospective analysis, based on 9.4 million of Italian National Health Service beneficiaries, included adult patients with hospitalization discharge diagnosis for EBC in 01/2015-12/2020. Those with HR+/HER2- status were selected; among them, patients that underwent removal of lymph nodes (LN) were analyzed. RESULTS Of 24,137 patients with EBC and HR+/HER2- status, 3619 patients (15%) had documented LN removal. Overall, 4.7% of HR+/HER2- patients and 9.9% of patients with LN removal experienced distant relapse over a median follow-up of 33.2 months (Q1-Q3: 17.0-50.6). Local relapse occurred in approximately 9.1-9.3% of patients in each group. Among the 1,175 patients with LN removal that had available pathological anatomy data, 399 (34.0%) had pathological high-risk characteristics and 13.3% experienced distant relapse. CONCLUSIONS One in ten patients with EBC who underwent LN removal experienced a relapse, highlighting the strong need to prevent early recurrence.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | | | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
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Perrone V, Veronesi C, Giacomini E, Citraro R, Dell’Orco S, Lena F, Paciello A, Resta AM, Nica M, Ritrovato D, Degli Esposti L. The Epidemiology, Treatment Patterns and Economic Burden of Different Phenotypes of Multiple Sclerosis in Italy: Relapsing-Remitting Multiple Sclerosis and Secondary Progressive Multiple Sclerosis. Clin Epidemiol 2022; 14:1327-1337. [PMID: 36387930 PMCID: PMC9648183 DOI: 10.2147/clep.s376005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2024] Open
Abstract
PURPOSE A retrospective analysis of real-world data was performed to assess the epidemiology and economic burden of multiple sclerosis (MS), relapsing-remitting MS (RRMS), and secondary-progressive MS (SPMS) in Italy. PATIENTS AND METHODS An observational study on administrative databases from a sample of Italian entities was carried-out. Between 01/2010-12/2017, patients with ≥1 MS diagnosis code (ICD-9-CM:340 and/or exemption code:046) and/or ≥1 disease-modifying therapies (DMTs) prescription, were included. Among MS-cohort, SPMS patients were identified by ≥2 hospitalizations or by ≥2 drug prescriptions related to MS progression. MS patients not fulfilling SPMS criteria were included as RRMS. Mean annual healthcare costs were reported during follow-up and stratified by DMT treatment/untreatment. RESULTS Overall, 9543 MS patients were included; 8397 with RRMS and 1146 with SPMS. Estimated prevalence of MS was 141.6/100,000 inhabitants (RRMS 124.4/100,000 and SPMS 17.2/100,000). Mean annual cost for untreated and treated patient was respectively: €3638 and €11796 (MS-cohort), €3183 and €11486 (RRMS-cohort), €6317 and €15511 (SPMS-cohort). The first-line DMT treatment duration averaged 27.4 ± 22.8 months; the mean cost was 19004€ for the whole period. The second-line DMT treatment lasted on average 31.1 ± 24.5 months; the mean cost was 47293€ for the whole period. CONCLUSION This study provided insights into the MS epidemiology in Italy and its economic burden. Healthcare costs associated with MS management were mainly driven by DMTs expenditure. A trend of higher healthcare-resource consumption was observed among SPMS-cohort.
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Affiliation(s)
- Valentina Perrone
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
| | - Chiara Veronesi
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
| | - Elisa Giacomini
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
| | - Rita Citraro
- Dipartimento di Scienze della Salute, Università Magna Grecia di Catanzaro, Unita’ Operativa di Farmaco-logia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria “Mater Domini”, Catanzaro, Italy
| | | | | | | | - Anna Maria Resta
- Struttura Complessa di Farmacia Territoriale Area Vasta 1, Fano, Italy
| | | | | | - Luca Degli Esposti
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
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10
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Perrone V, Giacomini E, Sangiorgi D, Andretta M, Bartolini F, Lupi A, Ferrante F, Palcic S, Re D, Degli Esposti L. Evaluation of the Therapeutic Pattern and Pharmaco-Utilization in Hypercholesterolemic Patients Treated with Statins: A Retrospective Study on Italian Real-World Data. Risk Manag Healthc Policy 2022; 15:1483-1489. [PMID: 35923556 PMCID: PMC9342867 DOI: 10.2147/rmhp.s358015] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The study aimed to analyze, in hypercholesterolemic patients under statin medication, patient characteristics and their lipid profile at baseline, the therapeutic pathway, and the pharmaco-utilization, using real-world data in Italy. Patients and Methods A retrospective study was conducted using administrative databases of a sample of entities covering 6.5 million health-assisted individuals. Between January 2010 and June 2019, patients with non-familial hypercholesterolemia (nFH) were identified by 1) ≥1 low-density lipoprotein cholesterol (LDL-C) measurement (LDL-C assessment date was the index-date) and 2) statin prescription during 6 months before the index-date (pharmaco-utilization period). FH patients were defined by LDL-C evaluation, statin treatment during the pharmaco-utilization period, and a score ≥6 according to the Dutch Lipid Clinic Network criteria. nFH patients were divided into four exclusive cohorts based on CV-risk class: 1) with previous CV disease (CVD); 2) with diabetes mellitus; 3) with mixed-dyslipidemia diagnosis; 4) in primary-prevention. Based on LDL-C index values, patient was defined with LDL-C “controlled” if its levels were ≤70mg/dl (CVD), ≤100mg/dl (diabetes, FH), ≤130mg/dl (mixed-dyslipidemia, primary-prevention). Results Overall 164,161 nFH patients were included (mean age 72 years, 51% male); of these, 46,782 (28.5%) were CVD (mean age 74 years, 66% male), 34,803 (21.2%) were diabetic (mean age 72 years, 51% male), 1617 (1%) were with mixed-dyslipidemia (mean age 71 years, 48% male) and 80,959 (49.3%) were in primary-prevention (mean age 71 years, 42% male). The proportion of nFH patients with controlled LDL-C was 41.2% for CVD, 73.6% for diabetic, 80.7% for mixed-dyslipidemia, and 79.5% for primary-prevention patients; 49% of nFH patients were adherent to therapy. Overall, 1287 FH patients (mean age 64 years, 42% male) were included; in 39.2% of the patients, LDL-C was controlled, and 44% of the patients were adherent to therapy. Conclusion The results of this study highlighted non-optimal therapeutic management of hypercholesterolemic patients in Italian clinical practice, with a notable quote of patients non-adherent to therapy.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
- Correspondence: Valentina Perrone, CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Via Murri 9, Bologna, 40137, Italy, Tel +39 3450316494, Email
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | | | | | - Stefano Palcic
- Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Davide Re
- U.O.C. Servizio Assistenza Farmaceutica Territoriale, ASL Teramo, Teramo, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
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11
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Giacomini E, Minetto S, Kleeman F, Pagliardini L, Pinna M, Papaleo E, Candiani M, Somigliana E, Viganò P. P-300 Evaluation of CYP19A1 gene expression in luteinized granulosa cells of women affected by endometriosis undergoing assisted reproductive technology (ART) treatments. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.073] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does endometriosis affect the expression of the aromatase gene CYP19A1 in the cumulus oophorous (COCs) and mural lutein-granulosa cells (GCs) influencing ART procedures?
Summary answer
Endometriosis does not impair CYP19A1 gene expression. However, the correlation between the aromatase expression and the number of oocytes retrieved is lost in endometriosis patients.
What is known already
Endometriosis-related infertility could be associated with a dysregulation of oocytes development. Indeed, endometriosis seems to have a negative effect on the intrafollicular environment, hindering oocyte maturation. A dysregulated synthesis of steroid hormones by GCs in the ovaries of affected women may be at the basis of an inadequate folliculogenesis. In line, some studies have investigated the expression levels of aromatase p450 ( CYP19A1 ) -the key enzyme involved in 17β-estradiol (E2) synthesis - in GCs and COCs collected from endometriosis women, reporting controversial results.
Study design, size, duration
In order to identify novel prognostic factors of ART outcomes in affected women, we set the evaluation of CYP19A1 expression in GCs samples isolated from endometriosis patients undergoing ART in comparison to control women. In a subgroup of patients, COCs were also collected. CYP19A1, StAR and 3βHSD gene expression was evaluated in both cell types. Finally, we evaluated the association between the expression of the analyzed genes and E2 levels with the clinical ART outcomes
Participants/materials, setting, methods
GCs were isolated from follicular fluids(FF) of n = 68 women with stage III-IV endometriosis and of n = 69 control patients. CYP19A1 gene expression was quantified by qPCR. 17β-estradiol levels in FF were assessed using an ELISA kit. In addition to CYP19A1 gene expression, mRNA levels of StAR and 3βHSD both in GCs and COCs (n = 20 endometriosis;n=21 controls) were evaluated in both cell types using qPCR. Differences between the two patients’ groups were estimated using linear regression models.
Main results and the role of chance
qPCR results showed no differences in mRNA expression of CYP19A1, StAR and 3βHSD in both GCs and COCs between the two groups of ART patients. These results were supported by the presence of the same concentration of E2 in the FF of controls (median: 877.7 ng/mL) and endometriosis patients (median: 878.3 ng/mL) (p-value=0.87). Linear regression model including as input variables gene expression values and ART outcomes showed that the blastulation rate was the only ART outcome associated with the expression levels of CYP19A1 (p-value=0.043, 95% CI: 0.001-0.061). In particular, a decrease of aromatase levels was associated with an increase in blastulation rate. After stratification of the population based on the presence of the disease, it emerged that, in the control group, the CYP19A1 expression correlated with the number of oocytes retrieved [β:-1.214;95%CI: -2.085 - (-0.343); p-value=0.007], while in the group of patients with endometriosis this association was no more present [β:-0.003;95%CI:-0.468 - 0.461; p-value=0.988)]. These results do not support data from the literature indicating that aromatase expression is reduced in GCs of affected women, but they highlight a potential disease-related mechanism affecting the ovulation process in these women
Limitations, reasons for caution
These findings need to be validated in a different cohort of samples. An RNA-seq approach is needed in order to validate our results and to obtain the overall transcriptome profiles of GCs and COCs in endometriosis patients.
Wider implications of the findings
Our data do not confirm previous evidence supporting a reduced expression/activity of aromatase in GCs in endometriosis. However, they suggest that aromatase may have a complex and sophisticated regulation of its expression in this cell type, which is not maintained in presence of endometriosis.
Trial registration number
not applicable
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Affiliation(s)
- E Giacomini
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory- Obstetrics and Gynecology Unit , Milano, Italy
| | - S Minetto
- IRCCS San Raffaele Scientific Institute, Centro Scienze Natalità- Obstetrics and Gynecology Unit , Milano, Italy
| | - F Kleeman
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory- Obstetrics and Gynecology Unit , Milano, Italy
| | - L Pagliardini
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory- Obstetrics and Gynecology Unit , Milano, Italy
| | - M Pinna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infertility Unit , Milan, Italy
| | - E Papaleo
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory and Centro Scienze Natalità- Obstetrics and Gynecology Unit , Milano, Italy
| | - M Candiani
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory- Obstetrics and Gynecology Unit and Università Vita-Salute San Raffaele , Milano, Italy
| | - E Somigliana
- Università degli Studi di Milano/Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dept of Clinical Sciences and Community Health/Infertility Unit , Milano, Italy
| | - P Viganò
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infertility Unit , Milan, Italy
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Vanni V, Giacomini E, Scotti G, Carnemolla G, Privitera L, Lazarevic D, Cantone L, Molgora M, Delprato D, Faulisi S, Bollati V, Tonon G, Papaleo E, Candiani M, Viganò P. P-408 IL-10 and IL-17 pathway enrichment in uterine fluid-derived extracellular vesicles (UF-EVs) is associated with failed implantation in women with recurrent implantation failure undergoing PGT-A. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.385] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Can the UF-EVs transcriptome provide markers of implantation in women diagnosed with recurrent implantation failure (RIF)?
Summary answer
Enrichment in IL-10 and IL-17 pathway transcripts in UF-EVs of women with RIF might identify those at risk for negative outcome after euploid blastocyst transfer.
What is known already
Our group has recently found that transcriptomic changes occur in UF-EVs during the window of implantation and closely resemble those occurring in the endometrial tissue. Patients affected by RIF represent a debated and heterogeneous population of patients who currently undergo several investigations, empirical therapies and embryo transfer attempts, with inconclusive results. We investigated whether UF-EVs can provide markers to define subgroups of patients within the RIF population, to predict outcomes and tailor interventions.
Study design, size, duration
We herein present the first sub-analysis of our previous larger observational study on the human UF-EVs transcriptome (Giacomini et al., 2021). RIF was defined by > 3 failed embryo transfers (ETs) with high quality embryos and patients affected by RIF and undergoing their first PGT-A cycle were enrolled (n = 19). Fertile women undergoing PGT-A+PGT-M for monogenic diseases and achieving successful implantation were used as controls (n = 29). PGT-A was performed by Next Generation Sequencing.
Participants/materials, setting, methods
RNA-Seq was performed on UF-EVs collected on day LH + 7 of the cycle preceding that of the blastocyst transfer. Differential Gene Expression (DGE) analysis was performed between RIF patients failing implantation (Group A) versus RIF patients achieving implantation (Group B) and between Group A and fertile controls achieving implantation (Group C). Pre-ranked gene set enrichment (GSEA) with WebGestalt was used for pathway enrichment analysis, with Normalized Enrichment Score (NES) indicating the strength of the enrichment.
Main results and the role of chance
RIF patients had a mean (± SD) age of 36.6 (± 3.4) and 5.1 ± 2.1 (mean ± SD) previous failed ETs. DGE comparisons between UF-EVs of RIF women who failed implantation (n = 10) showed 135 up- and 32 down-regulated genes compared to Group B, and 258 up- and 44 down-regulated genes compared to Group C, with 63 genes showing consistent significantly different ‘expression’ values in both comparisons. UF-EVs of Group A were enriched in transcripts belonging to the IL-17 pathway compared to both groups (Group A vs B, NES=2.2044, FDR <0.0001; Group A vs C, NES=2.3584, FDR <0.0001).Also transcripts belonging to the IL-10 pathway were enriched compared to both groups (Group A vs B NES=2.2741, FDR = 0.002; Group A vs C NES=2.2047, FDR < 0.0001). Among genes enriched in both DGE comparisons, C-X-C motif chemokine ligand (CXCL)1, CXCL2, CXCL8, and prostaglandin-endoperoxide synthase 2 (PTGS2) belonged to both the IL-10 and IL-17 pathway. On multivariate analysis controlling for relevant confounders (i.e. number of previous failed ETs), expression levels of CXCL8 emerged as a significant negative predictor of implantation (OR 0.675, 95%CI 0.493-0.925, p = 0.01).
Limitations, reasons for caution
As the main limitation of our study, we collected UFs in the cycle immediately preceding (and not corresponding to) the euploid ET. This approach was considered the most appropriate in relation to the current paucity of data regarding the safety of UF aspiration in the same cycle of an ET.
Wider implications of the findings
UF-EVs represent a source of transcriptomic markers related to the endometrial immune profile in RIF patients. Enrichment in the IL-17 and IL-10 pathways in this population could define the subgroup who is at risk for implantation failure even after euploid ET and who could potentially benefit from tailored immunotherapies.
Trial registration number
not applicable
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Affiliation(s)
- V.S Vanni
- IRCCS Ospedale San Raffaele, Centro Scienze Natalità - Obstetrics and Gynecology Dept , Milan, Italy
| | - E Giacomini
- IRCCS Ospedale San Raffaele, Reproductive Sciences Lab , Milan, Italy
| | - G.M Scotti
- IRCCS Ospedale San Raffaele, Center for Omics Sciences , Milan, Italy
| | - G Carnemolla
- IRCCS Ospedale San Raffaele, Centro Scienze Natalità - Obstetrics and Gynecology Dept , Milan, Italy
| | - L Privitera
- IRCCS Ospedale San Raffaele, Centro Scienze Natalità - Obstetrics and Gynecology Dept , Milan, Italy
| | - D Lazarevic
- IRCCS Ospedale San Raffaele, Center for Omics Sciences , Milan, Italy
| | - L Cantone
- University of Milan, EPIGET Lab - Department of Clinical Sciences and Community Health, Milan , Italy
| | - M Molgora
- IRCCS Ospedale San Raffaele, Centro Scienze Natalità - Obstetrics and Gynecology Dept , Milan, Italy
| | - D Delprato
- IRCCS Ospedale San Raffaele, Centro Scienze Natalità - Obstetrics and Gynecology Dept , Milan, Italy
| | - S Faulisi
- IRCCS Ospedale San Raffaele, Centro Scienze Natalità - Obstetrics and Gynecology Dept , Milan, Italy
| | - V Bollati
- University of Milan, EPIGET Lab - Department of Clinical Sciences and Community Health, Milan , Italy
| | - G Tonon
- IRCCS Ospedale San Raffaele, Center for Omics Sciences , Milan, Italy
| | - E Papaleo
- IRCCS Ospedale San Raffaele, Centro Scienze Natalità - Obstetrics and Gynecology Dept , Milan, Italy
| | - M Candiani
- IRCCS Ospedale San Raffaele, Obstetrics and Gynecology Dept , Milan, Italy
| | - P Viganò
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infertility Unit- , Milan, Italy
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Perrone V, Losi S, Maiorino A, Antonelli S, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Treatment Patterns and Pharmacoutilization in Patients Affected by Psoriasis: An Observational Study in an Italian Real-World Setting. Drugs Real World Outcomes 2022; 9:243-251. [PMID: 35041194 PMCID: PMC9114260 DOI: 10.1007/s40801-021-00290-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Real-world data can inform the use of biologics for psoriasis (PSO). OBJECTIVE The aim was to evaluate treatment patterns and analyze pharmacoutilization in PSO patients in a real-world Italian setting, with a focus on the biologics most recently introduced. METHODS An observational study based on administrative databases was conducted. Patients were included based on PSO diagnosis identified by either discharge diagnosis or exemption code or prescription of anti-psoriatic topical drugs (proxy of diagnosis). To describe patient characteristics and treatment patterns using the most up-to-date data, two different approaches were used: a cross-sectional study performed during 2016-2018, and a longitudinal study conducted with patients who received their first biological/targeted synthetic drugs (naïve patients) in 2014 and 2017 (the inclusion periods). RESULTS During 2016-2018, the number of prevalent patients diagnosed with PSO was 194,054 (2016), 210,830 (2017), and 225,171 (2018). The percentage of patients receiving biologics or targeted synthetic agents ranged from 1.5 to 2.1%. Among them, naïve patients receiving interleukin (IL) inhibitors increased from 37.5% (2016) to 69.4% (2018), while those receiving anti-tumor necrosis factor (anti-TNF) decreased from 62.5% (2016) to 30.6% (2018). The longitudinal analysis included 894 and 1218 naïve patients in 2014 and 2017, respectively, of whom 7.2% (2014) and 6.9% (2017) switched therapy after a mean of 7.1 (2014) and 6.9 (2017) months. Overall, 259 patients were prescribed ixekizumab starting in 2017, of whom 73% were naïve. Ixekizumab was prescribed as monotherapy to 52.5%. CONCLUSIONS The proportion of patients receiving biologics appeared constant over the years, with an increasing number of naïve patients being prescribed IL-17 inhibitors. Ixekizumab patients were mostly naïve.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy.
| | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
| | | | | | | | - Elisa Giacomini
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy
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14
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P342 REAL–WORLD ANALYSIS ON THE ECONOMIC VALUE OF REACHING LIPID TARGET IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.329] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The study aimed to evaluate the healthcare direct costs for Italian National Health System of patients treated with lipid–lowering drugs that do not achieve the low–density lipoprotein (LDL)–cholesterol target compared to those reaching their targets, and to analyze costs according to the distance from LDL target by using real–world data.
An observational analysis was performed on administrative and laboratory data from selected Italian Healthcare Departments. Patients were included if they presented at least one laboratory LDL test between 2012 and 2019 and if they were prescribed lipid–lowering drugs during 6 months prior the last LDL detection (index date). Mean annual direct costs were evaluated in the 12 months before index date in terms of all drugs prescribed, all–cause hospitalizations and all outpatient services. Distance to LDL target was calculated as difference between the index LDL level and LDL target. Total mean annual healthcare direct cost for patients that did not reach LDL target was higher compared to total cost of patients achieving LDL target (€3,678 vs €2,906). Costs were mainly driven by hospitalization (€1,330) followed by drugs expenditure (€1,012) and outpatient services (€563). Mean total annual healthcare costs increased with the distance from LDL target, specifically from €3,004 for patients with 10% distance from LDL target up to €4,823 for those 50% or more distance from LDL target. This trend was particularly evident for the cost item related to hospitalization, that went from €1,486 to €2,819 moving from 10% to ≥ 50 distance from LDL target. Results from this real–world study highlighted the higher economic burden for patients that do not reach the therapeutic LDL target, that tend to rise along with increasing distance from the LDL target. Overall, our findings could suggest that reducing the distance from LDL target could have a positive impact also on the economic outcomes for these patients.
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P358 THE ROLE OF ADHERENCE TO LIPID–LOWERING THERAPIES IN ACHIEVING LIPID TARGET: FINDINGS FROM REAL–WORLD ANALYSIS IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.345] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The objective of the present real–world analysis was to evaluate the impact of adherence to lipid–lowering drugs in reaching the lipid target in settings of clinical practice in Italy.
The analysis was based on administrative and laboratory database of selected Healthcare Units in Italy covering approximately 10% of Italian population. Adult patients prescribed with statin and with at least a low–density lipoprotein (LDL) determination were included between 2012 and 2019. The index date was defined as the first prescription for statin within the inclusion period. Patients fell into 4 clusters collectively exhaustive and mutually exclusive based on their characteristics assessed during the year prior index date. Patients were considered as adherent if they had a proportion of days covered (PDC)≥80%. Among overall patients prescribed statin and with a LDL determination, 1% was with familial hypercholesterolemia, 28% with previous cardiovascular events, 21% with diabetes and 50% in primary prevention. Regardless their risk profile, the increasing of adherence was related to a higher achievement of LDL–target, with an increment of + 53.2% among familial hypercholesterolemia, +43.1% in diabetes and +30% in previous cardiovascular events and primary prevention clusters while progressing from low (PDC<40%) to high (PDC≥80%) levels of adherence. However, while in diabetes and primary prevention clusters 80% and 86% of adherent patients, respectively, had their cholesterol level under control, in the familial hypercholesterolemia and previous cardiovascular events clusters only 46% of adherent patients achieve the lipid target.
The analysis showed adherence to be a key factor for cholesterol control. However, our findings underline a therapeutic need for patients that, although adherent, fail to achieve the lipid target, especially among patients with previous cardiovascular events (that have low level of LDL to achieve) and with familial hypercholesterolemia (that have high LDL basal level), suggesting therapeutic intensification should be applied.
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P357 THE MANAGEMENT OF CHOLESTEROL LEVEL CONTROL WITH LIPID–LOWERING DRUGS IN ITALIAN CLINICAL PRACTICE: FINDINGS FROM THE STREAM (SUPPORTING WITH THE REAL–WORLD EVIDENCE THE ASSESSMENT OF MEDICINES AND HEALTH TECHNOLOGIES) STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.344] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
The study aimed to evaluate the proportion of patients not reaching their low–density lipoprotein (LDL)–cholesterol target according to their risk profile in real–world settings of Italian clinical practice.
This observational analysis was based on administrative and laboratory databases from a pool of Italian Entities covering around 10% of Italian population. All patients included had at least one laboratory LDL test between 2012 and 2019. Presence of lipid–lowering drugs was analyzed in the 6 months before index date (last LDL test detected), during which time adherence to these therapies was measured as proportion of days covered (PDC). Risk profile was assessed based on ESC guidelines.1 Among patients with LDL tests that received lipid–lowering drugs, 49.7% were deemed as very high–risk (VHR), 38.3% at high risk (HR), 12% with other risks (OR). Overall, 80% of patients did not reach their LDL–cholesterol target: 87.2% in the HR–cohort, 82.9% in the VHR–cohort (LDL level target 70 mg/dl and 55 mg/dl, respectively) and 49.6% in OR–cohort (LDL level target 116 mg/dl). Statin and ezetimibe combination was observed only in 6.5% of HR and OR and 10.3% of VHR patients, while patients were mainly in monotherapy with statins (87.5 VHR, 91.2% HR, 90.6% OR). Furthermore, patients adherent to treatment (PDC≥80%) accounted for the 52% of VHR–cohort, 47.2% of HR–cohort and 39.1% of OR–cohort. Our findings highlight the need to optimize the management of cholesterol control, especially among patients at risk. Despite the high proportion of patients not reaching LDL target, sub–optimal levels of adherence and a low use of combination regimens were observed, thus suggesting LDL–control could be supported by increasing adherence and/or the use of combination therapies and, if the target is not yet achieved, by the utilization of more recent therapies.
European Heart Journal (2020) 41, 111–188
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
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Degli Esposti L, Veronesi C, Ancona DD, Andretta M, Bartolini F, Drei A, Lupi A, Palcic S, Re D, Rizzi FV, Giacomini E, Perrone V. Direct Healthcare Costs by Level of Adherence of a Real-World Population of Statin Users in Italy. Clinicoecon Outcomes Res 2022; 14:139-147. [PMID: 35299992 PMCID: PMC8922236 DOI: 10.2147/ceor.s345852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022]
Abstract
Purpose This real-world study investigates the direct healthcare costs from the perspective of the Italian Healthcare National Service of experienced statin users according to their level of adherence to therapy and to their cardiovascular (CV) profile in Italian settings of outpatients clinical practice. Patients and Methods A retrospective observational analysis was performed based on administrative databases covering approximately 6 million health-assisted individuals. Adult patients with statins prescription between January 2014 and December 2016 were screened, and first prescription within this period was the index date. Follow-up lasted 1 year after index date. Only patients receiving statins prior index date (experienced statin users) were included and distributed in clusters based on their CV profile. Adherence was calculated during follow-up as proportion of days covered (PDC) and classified in low adherence (PDC<40%), partial adherence (PDC=40–79%) and adherence (PDC≥80%). Mean direct healthcare costs of drugs, hospitalizations, and outpatient services were evaluated during follow-up. Results A total of 436,623 experienced statin users were included and distributed as follows: 5.5% in the previous CV events, 22.6% in diabetes, 55.7% in CV treatments and 16.2% in the no comorbidity cluster. Total mean annual cost/patient decreased from low adherent to adherent patients from €4826 to €3497 in previous CV events, from €2815 to €2360 in diabetes cluster, from €2077 to €1863 for patients with CV treatments. Same trend was reported for the cost item related to hospitalizations, which was the major determinant of the total costs. In previous CV event cluster, adherence was associated to a saving of €879 on total costs. Conclusion The study highlighted a decrease in overall mean costs as adherence levels increase, particularly for patients with previous CV events, showing how improving adherence could be associated to cost savings and suggesting suited strategy based on CV profile should be undertaken for adherence optimization.
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Affiliation(s)
| | - Chiara Veronesi
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
| | | | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | | | | | - Stefano Palcic
- Farmaceutica Territoriale, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina, Trieste, Italy
| | - Davide Re
- UOC Assistenza Farmaceutica Territoriale, ASL Teramo, Teramo, Italy
| | | | - Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
- Correspondence: Valentina Perrone, Clicon Srl, Health, Economics and Outcomes Research, Via Murri 9, Bologna, 40137, Italy, Tel +39 544 38393, Fax +39 544 212699, Email
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Perrone V, Losi S, Filippi E, Antonelli S, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Analysis of the prevalence of ankylosing spondylitis and treatment patterns and drug utilization among affected patients: an Italian real-world study. Expert Rev Pharmacoecon Outcomes Res 2022; 22:327-333. [DOI: 10.1080/14737167.2022.2032663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Valentina Perrone
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
| | | | | | | | - Elisa Giacomini
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
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Cermisoni GC, Reschini M, Piccinni MP, Lombardelli L, Logiodice F, Sarais V, Giacomini E, Signorelli S, Cecchele A, Viganò P. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac017. [PMID: 35475146 PMCID: PMC9024319 DOI: 10.1093/hropen/hoac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is oral Vitamin D supplementation able to modify the intrauterine milieu in terms of cytokine/chemokine pattern? SUMMARY ANSWER No significant differences were detected in cytokine and chemokine levels in endometrial secretions between patients undergoing ART with or without Vitamin D supplementation. WHAT IS KNOWN ALREADY Cytokines and chemokines secreted into the intrauterine environment are fundamental for the molecular crosstalk between the endometrium and the preimplantation embryo. Whether Vitamin D can regulate these mediators in the endometrial environment is still unclear. STUDY DESIGN, SIZE, DURATION This study was an analysis of a secondary outcome from the Supplementation of Vitamin D and Reproductive Outcomes—SUNDRO—clinical trial, a multicenter randomized double-blinded trial designed to explore the effects of Vitamin D replacement in women with Vitamin D levels below 30 ng/ml undergoing autologous ART cycles. Uterine fluid samples were collected from both patients supplemented with Vitamin D (n = 17) and from the placebo group (n = 32). PARTICIPANTS/MATERIALS, SETTING, METHODS Based on cutoff points for Vitamin D insufficiency (20–29.9 ng/ml) or deficiency (<20 ng/ml), 67% of patients in the study were insufficient, and 33% deficient, in Vitamin D, although they were considered together for the analysis. Women received a single dose of 600 000 IU 25-hydroxyvitamin D or placebo from 2 to 12 weeks before oocyte retrieval. Inclusion criteria were female age 18–39 years, with a BMI between 18 and 25 kg/m2. Serum 25-hydroxyvitamin D was assessed at the time of hCG administration. Uterine fluid samples were collected during the secretory phase of the menstrual cycle preceding oocyte retrieval. The quantitative determination of 27 cytokines in endometrial secretion samples was performed by using a multiplex immunoassay. MAIN RESULTS AND THE ROLE OF CHANCE Uterine fluid samples were collected after a median (range) of 21 (12–41) days after the oral Vitamin D supplementation. Both the supplemented and placebo groups had Vitamin D serum levels below 30 ng/ml at baseline/time of randomization ((median 23.4 ng/ml (interquartile range 19.5–28.4) and 23.4 ng/ml (17.8–25.9), respectively). At the time of hCG administration, serum Vitamin D in supplemented subjects was significantly raised compared to the placebo group ((median 52.9 ng/ml (interquartile range 40.7–64.1) and 24.6 ng/ml (19.3–29.2), respectively, P < 0.001). Our data revealed no significant differences in uterine fluid cytokine/chemokine composition of Vitamin D-supplemented women compared with the placebo group. This finding remained when the concentrations of all mediators studied were normalized to total protein. In a further analysis, no significant differences were found in the content of cytokines/chemokines in uterine fluid from women who conceived (n = 19) compared with the nonpregnant group (n = 30). LIMITATIONS, REASONS FOR CAUTION Using a randomized study design (a single dose of 600 000 IU 25-hydroxyvitamin D versus placebo), we found no significant differences between groups. However, we cannot exclude that any benefit of Vitamin D supplementation may be specific for some subgroups of patients, such as those with an imbalance of T-helper 1 and T-helper 2 cell populations. The uterine secretions were collected during the menstrual cycle that preceded oocyte retrieval; therefore, it is possible the uterine fluid collection and analysis in the same cycle of the embryo transfer might have resulted in different conclusions. Moreover, the small sample size could limit the power of the study. WIDER IMPLICATIONS OF THE FINDINGS Our analysis of the uterine secretome profiling failed to show any significant difference in endometrial cytokine/chemokine patterns between women with oral Vitamin D supplementation and the placebo group. Vitamin D may act on the uterine environment through a different mechanism. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Italian Ministry of Health following peer review in the competitive ‘Bando di Ricerca Finalizzata e Giovani Ricercatori 2013’ with reference code RF-2013-02358757. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER EudraCT registration number: 2015-004233-27.
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Affiliation(s)
| | | | - Marie-Pierre Piccinni
- Department of Experimental and Clinical Medicine and Center of Excellence for Research, Transfer and High Education DENOTHE, University of Florence, Florence, Italy
| | - Letizia Lombardelli
- Department of Experimental and Clinical Medicine and Center of Excellence for Research, Transfer and High Education DENOTHE, University of Florence, Florence, Italy
| | - Federica Logiodice
- Department of Experimental and Clinical Medicine and Center of Excellence for Research, Transfer and High Education DENOTHE, University of Florence, Florence, Italy
| | - Veronica Sarais
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Signorelli
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Cecchele
- Infertility Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Viganò
- Correspondence address. Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122, Milan, Italy. Tel: +39-02-55034302; E-mail:
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Giacomini E, Minetto S, Li Piani L, Pagliardini L, Somigliana E, Viganò P. Genetics and Inflammation in Endometriosis: Improving Knowledge for Development of New Pharmacological Strategies. Int J Mol Sci 2021; 22:ijms22169033. [PMID: 34445738 PMCID: PMC8396487 DOI: 10.3390/ijms22169033] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/12/2022] Open
Abstract
According to a rich body of literature, immune cell dysfunctions, both locally and systemically, and an inflammatory environment characterize all forms of endometriosis. Alterations in transcripts and proteins involved in the recruitment of immune cells, in the interaction between cytokines and their receptors, cellular adhesion and apoptosis have been demonstrated in endometriotic lesions. The objective of this narrative review is to provide an overview of the components and mechanisms at the intersection between inflammation and genetics that may constitute vanguard therapeutic approaches in endometriosis. The GWAS technology and pathway-based analysis highlighted the role of the MAPK and the WNT/β-catenin cascades in the pathogenesis of endometriosis. These signaling pathways have been suggested to interfere with the disease establishment via several mechanisms, including apoptosis, migration and angiogenesis. Extracellular vesicle-associated molecules may be not only interesting to explain some aspects of endometriosis progression, but they may also serve as therapeutic regimens per se. Immune/inflammatory dysfunctions have always represented attractive therapeutic targets in endometriosis. These would be even more interesting if genetic evidence supported the involvement of functional pathways at the basis of these alterations. Targeting these dysfunctions through next-generation inhibitors can constitute a therapeutic alternative for endometriosis.
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Affiliation(s)
- Elisa Giacomini
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (E.G.); (L.P.)
| | - Sabrina Minetto
- Obstetrics and Gynecology Unit, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Letizia Li Piani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (L.L.P.); (E.S.)
| | - Luca Pagliardini
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (E.G.); (L.P.)
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (L.L.P.); (E.S.)
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-5503-4302
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21
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Makieva S, Scotti GM, Lazarevic D, Giacomini E, Ottolina J, Bartiromo L, Schimberni M, Alteri A, Pavone V, Minetto S, Papaleo E, Morelli M, Tonon G, Viganò P. P-240 Human extracellular vesicles (EVs) secreted by aneuploid embryos potentiate development of non-invasive PGT-A RNA biomarkers and stimulate MUC1 up-regulation in primary endometrial stromal cells (ESCs). Hum Reprod 2021. [DOI: 10.1093/humrep/deab127.067] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Could EVs secreted by aneuploid embryos a) serve for development of RNA biomarkers for PGT-A and b) elicit a relevant transcriptomic response in decidualised ESCs?
Summary answer
Aneuploid embryo EVs a) contain PPM1J, LINC00561, ANKRD34C and TMED10 in differential abundance from euploid EVs and b) induce up-regulation of MUC1 in decidualised ESCs.
What is known already
Embryo aneuploidy accounts for approximately 50% of all recurrent implantation failures in women >35 years old. PGT-A identifies euploid embryos to increase implantation probability but the technology is controversial as it requires an invasive embryo biopsy with an elusive long-term biosafety. The development of non-invasive methods to screen out aneuploid embryos is paramount. It is also critical to decode the embryo-endometrial dialog underlying implantation failure. We have previously reported that IVF embryos secrete EVs that can be internalised by ESCs, conceptualising that successful implantation to the endometrium is facilitated by EVs, which may additionally serve as biomarkers of ploidy status.
Study design, size, duration
Embryos destined for biopsy on days 5-7 for PGT-A were grown under standard conditions. Spent media (30μl) were collected from euploid (n = 175) and aneuploid embryos (n = 145) at both cleavage (days 1-3) and blastocyst (days 3-5) stage. Media samples from n = 35 cleavage embryos were pooled in order to obtain five euploid and four aneuploidy pools. Blastocyst media were pooled to create one euploid and one aneuploid pool. ESCs were obtained from five women undergoing diagnostic laparoscopy.
Participants/materials, setting, methods
The study was realised at a research hospital. EVs were isolated from euploid and aneuploid Day3 pools with differential ultracentrifugation and EV-RNA sequencing was performed following the SMARTer Stranded Total RNA-Seq approach. ESCs were decidualised (E2:10nM, P4:1uM, cAMP:0.5 mM twice every 48 hours) and treated for 24 hours with 50 ng/ml euploid or aneuploid EVs extracted from blastocyst media. RNA sequencing was performed on ESCs following the Truseq RNAseq protocol.
Main results and the role of chance
Aneuploid cleavage stage embryos (n = 4) secreted EVs that were less abundant in RNA fragments originating from the genes PPM1J (log2fc=-5.13, p = 0.011), LINC00561 (log2fc=-7.87, p = 0.010) and ANKRD34C (log2fc=-7.30, p = 0.017) and more abundant in TMED10 (log2fc=1.63 p = 0.025) compared to EVs (n = 5) from euploid embryos. Decidualisation per se induced downregulation of MUC1 (log2FC=-0.54, p = 0.0028) in ESCs as prerequisite for the establishment of receptive endometrium. The expression of MUC1 transcript in decidualised ESCs was significantly increased following treatment with aneuploid compared to euploid embryo-secreted EVs (log2FC=0.85, p = 0.0201).
Limitations, reasons for caution
The findings of the study may require validation utilising a second cohort of EVs samples.
Wider implications of the findings
This discovery that the RNA cargo of EVs secreted from aneuploid cleavage stage embryos is diverse from that of euploid embryos potentiates the development of non-invasive methodology for PGT-A. The upregulation of MUC1 in decidualised ESCs following aneuploid embryo EV treatment proposes a new mechanism underlying implantation failure.
Trial registration number
NA
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Affiliation(s)
- S Makieva
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
| | - G M Scotti
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - D Lazarevic
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - E Giacomini
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
| | - J Ottolina
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - L Bartiromo
- IRCCS San Raffaele Scientific Institute, Department of Obstetrics and Gynecology, Milan, Italy
| | - M Schimberni
- IRCCS San Raffaele Scientific Institute, Department of Obstetrics and Gynecology, Milan, Italy
| | - A Alteri
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - V Pavone
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
| | - S Minetto
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - E Papaleo
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - M Morelli
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - G Tonon
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - P Viganò
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
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Makieva S, Scotti GM, Lazarevic D, Giacomini E, Ottolina J, Bartiromo L, Schimberni M, Alteri A, Pavone V, Minetto S, Papaleo E, Morelli M, Tonon G, Viganò P. P–240 Human extracellular vesicles (EVs) secreted by aneuploid embryos potentiate development of non-invasive PGT-A RNA biomarkers and stimulate MUC1 up-regulation in primary endometrial stromal cells (ESCs). Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.239] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Could EVs secreted by aneuploid embryos a) serve for development of RNA biomarkers for PGT-A and b) elicit a relevant transcriptomic response in decidualised ESCs?
Summary answer
Aneuploid embryo EVs a) contain PPM1J, LINC00561, ANKRD34C and TMED10 in differential abundance from euploid EVs and b) induce up-regulation of MUC1 in decidualised ESCs.
What is known already
Embryo aneuploidy accounts for approximately 50% of all recurrent implantation failures in women >35 years old. PGT-A identifies euploid embryos to increase implantation probability but the technology is controversial as it requires an invasive embryo biopsy with an elusive long-term biosafety. The development of non-invasive methods to screen out aneuploid embryos is paramount. It is also critical to decode the embryo-endometrial dialog underlying implantation failure. We have previously reported that IVF embryos secrete EVs that can be internalised by ESCs, conceptualising that successful implantation to the endometrium is facilitated by EVs, which may additionally serve as biomarkers of ploidy status.
Study design, size, duration
Embryos destined for biopsy on days 5–7 for PGT-A were grown under standard conditions. Spent media (30μl) were collected from euploid (n = 175) and aneuploid embryos (n = 145) at both cleavage (days 1–3) and blastocyst (days 3–5) stage. Media samples from n = 35 cleavage embryos were pooled in order to obtain five euploid and four aneuploidy pools. Blastocyst media were pooled to create one euploid and one aneuploid pool. ESCs were obtained from five women undergoing diagnostic laparoscopy.
Participants/materials, setting, methods
The study was realised at a research hospital. EVs were isolated from euploid and aneuploid Day3 pools with differential ultracentrifugation and EV-RNA sequencing was performed following the SMARTer Stranded Total RNA-Seq approach. ESCs were decidualised (E2:10nM, P4:1uM, cAMP:0.5 mM twice every 48 hours) and treated for 24 hours with 50 ng/ml euploid or aneuploid EVs extracted from blastocyst media. RNA sequencing was performed on ESCs following the Truseq RNAseq protocol.
Main results and the role of chance
Aneuploid cleavage stage embryos (n = 4) secreted EVs that were less abundant in RNA fragments originating from the genes PPM1J (log2fc=–5.13, p = 0.011), LINC00561 (log2fc=–7.87, p = 0.010) and ANKRD34C (log2fc=–7.30, p = 0.017) and more abundant in TMED10 (log2fc=1.63 p = 0.025) compared to EVs (n = 5) from euploid embryos. Decidualisation per se induced downregulation of MUC1 (log2FC=–0.54, p = 0.0028) in ESCs as prerequisite for the establishment of receptive endometrium. The expression of MUC1 transcript in decidualised ESCs was significantly increased following treatment with aneuploid compared to euploid embryo-secreted EVs (log2FC=0.85, p = 0.0201).
Limitations, reasons for caution
The findings of the study may require validation utilising a second cohort of EVs samples.
Wider implications of the findings: This discovery that the RNA cargo of EVs secreted from aneuploid cleavage stage embryos is diverse from that of euploid embryos potentiates the development of non-invasive methodology for PGT-A. The upregulation of MUC1 in decidualised ESCs following aneuploid embryo EV treatment proposes a new mechanism underlying implantation failure.
Trial registration number
NA
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Affiliation(s)
- S Makieva
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
| | - G M Scotti
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - D Lazarevic
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - E Giacomini
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
| | - J Ottolina
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - L Bartiromo
- IRCCS San Raffaele Scientific Institute, Department of Obstetrics and Gynecology, Milan, Italy
| | - M Schimberni
- IRCCS San Raffaele Scientific Institute, Department of Obstetrics and Gynecology, Milan, Italy
| | - A Alteri
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - V Pavone
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
| | - S Minetto
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - E Papaleo
- IRCCS San Raffaele Scientific Institute, Centro Scienze della Natalità, Milan, Italy
| | - M Morelli
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - G Tonon
- IRCCS San Raffaele Scientific Institute, Center for Omics Sciences, Milan, Italy
| | - P Viganò
- IRCCS San Raffaele Scientific Institute, Reproductive Sciences Laboratory, Milan, Italy
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Giacomini E, Scotti GM, Vanni VS, Lazarevic D, Makieva S, Privitera L, Signorelli S, Cantone L, Bollati V, Murdica V, Tonon G, Papaleo E, Candiani M, Viganò P. Global transcriptomic changes occur in uterine fluid-derived extracellular vesicles during the endometrial window for embryo implantation. Hum Reprod 2021; 36:2249-2274. [PMID: 34190319 PMCID: PMC8289330 DOI: 10.1093/humrep/deab123] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/22/2021] [Indexed: 01/16/2023] Open
Abstract
STUDY QUESTION Are uterine fluid-derived extracellular vesicles (UF-EVs) a 'liquid biopsy' reservoir of biomarkers for real-time monitoring of endometrial status? SUMMARY ANSWER The transcriptomic cargo of UF-EVs reflects the RNA profile of the endometrial tissue as well as changes between the non-receptive and the receptive phase, possibly supporting its use for a novel endometrial receptivity test. WHAT IS KNOWN ALREADY EVs have been previously isolated from uterine fluid, where they likely contribute to the embryo-endometrium crosstalk during implantation. Based on a meta-analysis of studies on endometrial tissue implantation-associated genes and the human exosomes database, 28 of the 57 transcripts considered as receptivity markers refer to proteins present in human exosomes. However, the specific transcriptomic content of receptive phase UF-EVs has yet to be defined. STUDY DESIGN, SIZE, DURATION Two experimental series were set up. First, we simultaneously sequenced RNA species derived from paired UF-EVs and endometrial tissue samples collected from physiologically cycling women. Second, we analyzed RNA species of UF-EVs collected during the non-receptive (LH + 2) and receptive (LH + 7) phase of proven fertile women and from the receptive (LH + 7) phase of a population of women undergoing ART and transfer of euploid blastocysts. PARTICIPANTS/MATERIALS, SETTING, METHODS For paired UF-endometrial tissue sampling, endometrial tissue biopsies were obtained with the use of a Pipelle immediately after UF collection performed by lavage of the endometrial cavity. Overall, n = 87 UF samples were collected and fresh-processed for EV isolation and total RNA extraction, while western blotting was used to confirm the expression of EV protein markers of the isolated vesicles. Physical characterization of UF-EVs was performed by Nanoparticle Tracking Analysis. To define the transcriptomic cargo of UF-EV samples, RNA-seq libraries were successfully prepared from n = 83 UF-EVs samples and analyzed by RNA-seq analysis. Differential gene expression (DGE) analysis was used to compare RNA-seq results between different groups of samples. Functional enrichment analysis was performed by gene set enrichment analysis with g:Profiler. Pre-ranked gene set enrichment analysis (GSEA) with WebGestalt was used to compare RNA-seq results with the gene-set evaluated in a commercially available endometrial receptivity array. MAIN RESULTS AND THE ROLE OF CHANCE A highly significant correlation was found between transcriptional profiles of endometrial biopsies and pairwise UF-EV samples (Pearson's r = 0.70 P < 0.0001; Spearman's ρ = 0.65 P < 0.0001). In UF-EVs from fertile controls, 942 gene transcripts were more abundant and 1305 transcripts less abundant in the LH + 7 receptive versus the LH + 2 non-receptive phase. GSEA performed to evaluate concordance in transcriptional profile between the n = 238 genes included in the commercially available endometrial receptivity array and the LH + 7 versus LH + 2 UF-EV comparison demonstrated an extremely significant and consistent enrichment, with a normalized enrichment score (NES)=9.38 (P < 0.001) for transcripts up-regulated in LH + 7 in the commercial array and enriched in LH + 7 UF-EVs, and a NES = -5.40 (P < 0.001) for transcripts down-regulated in LH + 7 in the commercial array and depleted in LH + 7 UF-EVs. When analyzing LH + 7 UF-EVs of patients with successful versus failed implantation after transfer of one euploid blastocyst in the following cycle, we found 97 genes whose transcript levels were increased and 64 genes whose transcript levels were decreased in the group of women who achieved a pregnancy. GSEA performed to evaluate concordance in transcriptional profile between the commercially available endometrial receptivity array genes and the comparison of LH + 7 UF-EVs of women with successful versus failed implantation, demonstrated a significant enrichment with a NES = 2.14 (P = 0.001) for transcripts up-regulated in the commercial array in the receptive phase and enriched in UF-EVs of women who conceived, and a not significant NES = -1.18 (P = 0.3) for transcripts down-regulated in the commercial array and depleted in UF-EVs. In terms of physical features, UF-EVs showed a homogeneity among the different groups analyzed except for a slight but significant difference in EV size, being smaller in women with a successful implantation compared to patients who failed to conceive after euploid blastocyst transfer (mean diameter ± SD 205.5± 22.97 nm vs 221.5 ± 20.57 nm, respectively, P = 0.014). LARGE SCALE DATA Transcriptomic data were deposited in NCBI Gene Expression Omnibus (GEO) and can be retrieved using GEO series accession number: GSE158958. LIMITATIONS, REASONS FOR CAUTION Separation of RNA species associated with EV membranes might have been incomplete, and membrane-bound RNA species-rather than the internal RNA content of EVs-might have contributed to our RNA-seq results. Also, we cannot definitely distinguish the relative contribution of exosomes, microvesicles and apoptotic bodies to our findings. When considering patients undergoing ART, we did not collect UFs in the same cycle of the euploid embryo transfer but in the one immediately preceding. We considered this approach as the most appropriate in relation to the novel, explorative nature of our study. Based on our results, a validation of UF-EV RNA-seq analyses in the same cycle in which embryo transfer is performed could be hypothesized. WIDER IMPLICATIONS OF THE FINDINGS On the largest sample size of human EVs ever analyzed with RNA-seq, this study establishes a gene signature to use for less-invasive endometrial receptivity tests. This report is indeed the first to show that the transcriptome of UF-EVs correlates with the endometrial tissue transcriptome, that RNA signatures in UF-EVs change with endometrial status, and that UF-EVs could serve as a reservoir for potential less-invasive collection of receptivity markers. This article thus represents a step forward in the design of less-invasive approaches for real-time monitoring of endometrial status, necessary for advancing the field of reproductive medicine. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by a competitive grant from European Society of Human Reproduction and Embryology (ESHRE Research Grant 2016-1). The authors have no financial or non-financial competing interests to disclose. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- E Giacomini
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Ital, Milan, Italy
| | - G M Scotti
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - V S Vanni
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Ital, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - D Lazarevic
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Makieva
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Ital, Milan, Italy
| | - L Privitera
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Signorelli
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Cantone
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Bollati
- EPIGET Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Murdica
- Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Tonon
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Papaleo
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Ital, Milan, Italy
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Candiani
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Ital, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Viganò
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Ital, Milan, Italy
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Perrone V, Giacomini E, Andretta M, Arenare L, Cillo MR, Latini M, Mecozzi A, Pagliaro R, Vercellone A, Degli Esposti L. Italian Real-World Analysis of a Tyrosine Kinase Inhibitor Administration as First- or Second-Line of Therapy in Patients with Chronic Myeloid Leukemia. Ther Clin Risk Manag 2021; 17:617-622. [PMID: 34135589 PMCID: PMC8197625 DOI: 10.2147/tcrm.s309342] [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: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To date, litte evidence is reported about the real-life dosage of tyrosine kinase inhibitors prescribed in Italy. The present observational retrospective study aimed to evaluate the mean daily dose of nilotinib prescribed as first- and second-line therapy among patients suffering from chronic myeloid leukemia (CML) in settings of clinical practice in Italy. PATIENTS AND METHODS Data were obtained from the administrative databases of a sample of Italian entities. All adult patients prescribed nilotinib were included from January 2013 to December 2016 if they were using it as first-line and from January 2015 to December 2018 as second-line therapy. The mean daily dose was calculated considering the dosage between first and last nilotinib prescription date or last BCR/ABL test date. RESULTS Among CML patients treated with nilotinib as first-line (N=87), the mean daily dose of nilotinib was 500.5 mg during a mean treatment duration of 798.9 days and of 498.54 mg considering the last determination of BCR/ABL test (mean duration of 811 days). A total of 103 CML patients were prescribed nilotinib as second-line therapy; of them, 80.6% had previously received imatinib, 17.5% dasatinib. The mean daily dose of nilotinib was found to be 566.3 mg with a mean time duration of 302.8 days, while when the last BCR/ABL test was taken into account (mean duration of 323.1 days), a mean daily dose of 565.2 mg was detected. CONCLUSION The study reported on the real-world dosage pattern of a TKI for CML management. Our results compared with the dosage of nilotinib reported in datasheet (600 mg and 800 mg for first- and second-line, respectively) showed a trend of mean daily dose prescribed in clinical practice settings lower than the dosage currently indicated.
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Affiliation(s)
| | - Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Loredana Arenare
- UOC Farmaceutica e Territoriale e Integrativa– Asl Latina, Latina, Italy
| | | | - Marisa Latini
- U.O.C. Farmaceutica Territoriale – Asl Roma 5, Roma, Italy
| | | | | | - Adriano Vercellone
- Department of Pharmacy, Local Health Unit (LHU) Naples 3 South, Napoli, Italy
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Perrone V, Losi S, Rogai V, Antonelli S, Fakhouri W, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Treatment Patterns and Pharmacoutilization in Patients Affected by Rheumatoid Arthritis in Italian Settings. Int J Environ Res Public Health 2021; 18:5679. [PMID: 34073179 PMCID: PMC8197884 DOI: 10.3390/ijerph18115679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 01/02/2023]
Abstract
This study aimed to evaluate the treatment patterns and pharmacoutilization of patients with rheumatoid arthritis (RA) in real-world settings in Italy. This retrospective observational analysis was based on administrative databases of selected Italian entities. All adult patients with RA diagnosis confirmed by ≥1 discharge diagnosis of RA (ICD-9-CM code = 714.0) or an active exemption code (006.714.0) were enrolled in 2019. Two cohorts were created: one included patients prescribed baricitinib, the other those prescribed biological disease-modifying antirheumatic drugs (bDMARDs). Overall, 47,711 RA patients were identified, most of them without DMARD prescription. As a first-line prescription, 43.2% of patients were prescribed conventional synthetic DMARDs (csDMARDs), 5.2% bDMARDs and 0.3% baricitinib. In 2019, 82.6% of csDMARD users continued with the same DMARD category, 15.9% had a bDMARD, while 1.5% had baricitinib as second-line therapy. Overall, 445 patients used baricitinib during 2019. During follow-up, baricitinib was prescribed as monotherapy to 31% of patients, as cotreatment with csDMARDs and corticosteroids to 27% of patients, with corticosteroids to 28% of patients and with csDMARDs to 14% of patients. In line with previous findings, a trend of bDMARD undertreatment was observed. The treatment patterns of baricitinib patients could help to better characterize patients eligible for new therapeutic options that will be available in the future.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
| | - Serena Losi
- Eli Lilly Italy S.p.A., 50019 Sesto Fiorentino, Italy; (S.L.); (V.R.); (S.A.)
| | - Veronica Rogai
- Eli Lilly Italy S.p.A., 50019 Sesto Fiorentino, Italy; (S.L.); (V.R.); (S.A.)
| | - Silvia Antonelli
- Eli Lilly Italy S.p.A., 50019 Sesto Fiorentino, Italy; (S.L.); (V.R.); (S.A.)
| | | | | | - Elisa Giacomini
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
| | - Diego Sangiorgi
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
| | - Luca Degli Esposti
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
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Romano A, Xanthoulea S, Giacomini E, Delvoux B, Alleva E, Vigano P. Endometriotic cell culture contamination and authenticity: a source of bias in in vitro research? Hum Reprod 2021; 35:364-376. [PMID: 32106286 PMCID: PMC7048714 DOI: 10.1093/humrep/dez266] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/06/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION Are the primary cell cultures and cell lines used in endometriosis research of sufficient quality? SUMMARY ANSWER Primary cells used in endometriosis research lack purity and phenotypic characterisation, and cell lines are not genotypically authenticated. WHAT IS KNOWN ALREADY The poor reproducibility of in vitro research and the lack of authenticity of the cell lines used represent reasons of concern in the field of reproductive biology and endometriosis research. STUDY DESIGN, SIZE, DURATION In the present study, past in vitro research in the field of endometriosis was systematically reviewed to determine whether the appropriate quality controls were considered. In addition, we explored the performance of Paired Box 2 (Pax2) as an endometrium specific marker in endometrial and endometriotic primary cell cultures; we also characterised the most diffused endometriosis cell lines with respect to important markers including the short tandem repeat (STR) profile. PARTICIPANTS/MATERIALS, SETTING, METHODS Literature review part: almost 300 published protocols describing the isolation and creation of primary cell cultures from endometriosis were reviewed. Wet-lab part: primary cells isolated from 13 endometriosis patients were analysed by immunohistochemistry, immunofluorescence and FACS for the expression of Pax2. Cell lines Z11 and Z12, the most diffused endometriosis cell lines, were characterised with respect to the expression of Pax2, steroid hormone receptors and STR profile. MAIN RESULTS AND THE ROLE OF CHANCE From the literature review work, we underscored the lack of sufficient cell purity and phenotypic characterisation of primary cell cultures, which present high risk of contaminations from surrounding non-endometriotic tissues. Past work based on the use of cell lines was reviewed as well, and it emerged that cell line authentication was never performed. In an effort to address these weaknesses for future research, we present data on the performance of Pax2, a suitable marker to exclude ovarian (and other non-endometrial) cell contaminations from primary cell cultures; STR profiles of cell lines Z11 and Z12 were analysed and indicated that the cells were authentic. These profiles are now available for authentication purposes to researchers wishing to perform experiments with these cells. A quality control pipeline to assure sufficient quality of in vitro research in the field of reproductive biology and endometriosis is proposed. We encourage scientists, research institutes, journal reviewers, editors and funding bodies to raise awareness of the problem and adopt appropriate policies to solve it in the future. LARGE-SCALE DATA STR profiles of cell lines Z11 and Z12 are deposited at the Cellosaurus database—web.expasy.org. LIMITATIONS, REASONS FOR CAUTION There may be additional markers suitable to assess cell quality. WIDER IMPLICATIONS OF THE FINDINGS Future in vitro research in endometriosis and the reliability of outcomes can be improved by using the recommendations presented in this study. STUDY FUNDING/COMPETING INTEREST(S) The study was partly financed by the ‘Stichting Fertility Foundation’ (The Netherlands). The authors declare no existing conflict of interest. TRIAL REGISTRATION NUMBER Non-applicable.
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Affiliation(s)
- Andrea Romano
- Obstetrics and Gynaecology Department, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Sofia Xanthoulea
- Obstetrics and Gynaecology Department, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, Milan, 20132, Italy
| | - Bert Delvoux
- Obstetrics and Gynaecology Department, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Eugenia Alleva
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
| | - Paola Vigano
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, Milan, 20132, Italy
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Giacomini E, Perrone V, Alessandrini D, Paoli D, Nappi C, Degli Esposti L. Evidence of Antibiotic Resistance from Population-Based Studies: A Narrative Review. Infect Drug Resist 2021; 14:849-858. [PMID: 33688220 PMCID: PMC7937387 DOI: 10.2147/idr.s289741] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
The 20th century witnessed the dawn of the antibiotic revolution and is now facing the rising phenomenon of antibiotic resistance. In this narrative review, we aim to describe antibiotic resistance in clinical practice settings through population-based studies from different countries reporting the role of misuse of antibiotics in the development of resistance and the clinical and economic burden associated. The misuse of antibiotics was documented in the wide population as well as in hospitals and care facilities. It was mainly reported as over-use and inappropriate prescribing. Improper dosage regimens and longer treatment duration were regarded as pivotal factors related to antibiotic resistance; the emerging strategy of "antibiotic-de-escalation" could be the key to overcome these issues. The investigation of the self-medication attitude revealed widespread antibiotic use without following medical instructions or medical consultation. Moreover, several studies established the association of antibiotic resistance with increased risk of longer hospitalizations and mortality, highlighting the heavy clinical and economic burden of this phenomenon. In this narrative review, the widespread inappropriate use of antibiotics emerged as one of the main causes of antibiotic resistance, which negative outcomes call for the development of antibiotic stewardship programs and global surveillance networks.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | | | | | - Daniela Paoli
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Carmela Nappi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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Perrone V, Veronesi C, Giacomini E, Andretta M, Dell'Orco S, De Sarro G, Lena F, Menti AM, Naclerio M, Ritrovato D, Degli Esposti L. Treatment patterns, health resource consumption, and costs of patients with migraine in an Italian real-world setting. Curr Med Res Opin 2020; 36:1991-1998. [PMID: 33044088 DOI: 10.1080/03007995.2020.1835850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to describe the demographic and clinical characteristics of migraineurs prescribed ≥1 migraine prophylactic therapy, and to analyze their therapeutic pathways, healthcare resource consumption, and related costs. METHODS This retrospective analysis was based on administrative databases from two regions and three local health units in Italy. Adult patients with ≥1 discharge diagnosis for migraine or ≥1 prescription for migraine-specific drugs, or ≥1 emergency room visit for migraine from 1 January 2010 to 31 December 2016 were included if they had received ≥1 migraine prophylactic therapy between 1 January 2011 and 31 December 2015 (enrollment period). The first date of the last migraine prophylactic treatment was considered as the index date (ID). Patients were characterized 1-year prior ID and followed-up for 1 year afterwards. RESULTS Of the 166,362 identified migraineurs, 32,794 (mean age: 45.9 ± 13.9 years, 19.2% male) who received migraine prophylaxis were included in the analysis. At ID, 31,629 patients had received 1 prophylactic treatment with antidepressants (51.2%), neuromodulators (28.1%), beta blockers (12.4%), other migraine preparations (7.8%), and botulinum toxin A (0.5%). Focusing on patients with one prophylactic treatment at ID, 85.4% did not have any previous therapeutic failures whereas 14.6% had ≥1 previous failure. During follow-up, 5% of patients made a therapeutic switch after a mean period of 103.4 ± 97.9 days. Total mean annual cost for patients receiving migraine prophylaxis was 1193.64€ during characterization and 1303.86€ during follow-up periods. CONCLUSION This real-world study gave insights on the characterization of migraineurs and patterns of prophylaxis utilization in Italian clinical settings, showing an underuse of prophylactic agents.
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Affiliation(s)
| | - Chiara Veronesi
- CliCon Srl Health, Economics & Outcomes Research, Ravenna, Italy
| | - Elisa Giacomini
- CliCon Srl Health, Economics & Outcomes Research, Ravenna, Italy
| | | | - Stefania Dell'Orco
- Directorate of Local Pharmaceutical Service, Roma 6 Local Health Unit, Albano Laziale, Italy
| | - Giovambattista De Sarro
- Department of Health Sciences, Clinical Pharmacology and Pharmacovigilance Unit, University of Magna Graecia, Catanzaro, Italy
| | - Fabio Lena
- Local Health Unit Pharmaceutical Department USL Toscana Sud Est, Toscana Sud Est Local Health Unit, Grosseto, Italy
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Volterrani M, Perrone V, Sangiorgi D, Giacomini E, Iellamo F, Degli Esposti L. Effects of hyperkalaemia and non-adherence to renin-angiotensin-aldosterone system inhibitor therapy in patients with heart failure in Italy: a propensity-matched study. Eur J Heart Fail 2020; 22:2049-2055. [PMID: 33459467 PMCID: PMC7756371 DOI: 10.1002/ejhf.2024] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/17/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Aims The aims of this study were to evaluate if the risk of cardiovascular events and all‐cause mortality was higher in the presence of hyperkalaemia (HK) in patients with heart failure (HF) treated with renin–angiotensin–aldosterone system inhibitors (RAASi), and to investigate in this cohort the increased risk of cardiovascular events and all‐cause mortality among HK patients with non‐optimal adherence to RAASi therapy. Methods and results In this retrospective cohort study based on administrative databases of five Italian Local Health Units, all adult patients with a HF diagnosis between January 2010 and December 2017 were included only if they were prescribed RAASi therapy during the first 3 months after the index date, that corresponded to the date of first HF diagnosis during the inclusion period. Patients were considered to have HK if serum potassium level was ≥5.5 mmol/L. A propensity score matching was applied before evaluation of hazard ratios. Patients with HK were 37% (P < 0.001) and 70% (P < 0.001), respectively, more at risk of cardiovascular events and of dying for all‐cause mortality compared to non‐HK patients. Among the HK group, patients non‐adherent to RAASi therapy had a 39% (P = 0.105) higher risk of cardiovascular events and a twofold increased risk (P < 0.001) of all‐cause death. Conclusion Findings from this real‐world study showed that in a cohort of HF patients under RAASi therapy, subjects with HK had an enhanced risk of cardiovascular events or death compared to patients without HK. Moreover, in HK patients, sub‐optimal adherence to RAASi therapy was associated with an increased risk of all‐cause mortality.
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Affiliation(s)
| | | | - Diego Sangiorgi
- CliCon Srl Health, Economics & Outcomes Research, Ravenna, Italy
| | - Elisa Giacomini
- CliCon Srl Health, Economics & Outcomes Research, Ravenna, Italy
| | - Ferdinando Iellamo
- Department of Clinical Science and Translational Medicine, Tor Vergata University, Rome, Italy
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Mancini I, Giacomini E, Pontiggia S, Artoni A, Ferrari B, Pappalardo E, Gualtierotti R, Trisolini SM, Capria S, Facchini L, Codeluppi K, Rinaldi E, Pastore D, Campus S, Caria C, Caddori A, Nicolosi D, Giuffrida G, Agostini V, Roncarati U, Mannarella C, Fragasso A, Podda GM, Birocchi S, Cerbone AM, Tufano A, Menna G, Pizzuti M, Ronchi M, De Fanti A, Amarri S, Defina M, Bocchia M, Cerù S, Gattillo S, Rosendaal FR, Peyvandi F. The HLA Variant rs6903608 Is Associated with Disease Onset and Relapse of Immune-Mediated Thrombotic Thrombocytopenic Purpura in Caucasians. J Clin Med 2020; 9:jcm9103379. [PMID: 33096882 PMCID: PMC7589625 DOI: 10.3390/jcm9103379] [Citation(s) in RCA: 4] [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: 09/07/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022] Open
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy caused by severe ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin motifs 13) deficiency, recurring in 30–50% of patients. The common human leukocyte antigen (HLA) variant rs6903608 was found to be associated with prevalent iTTP, but whether this variant is associated with disease relapse is unknown. To estimate the impact of rs6903608 on iTTP onset and relapse, we performed a case-control and cohort study in 161 Italian patients with a first iTTP episode between 2002 and 2018, and in 456 Italian controls. Variation in rs6903608 was strongly associated with iTTP onset (homozygotes odds ratio (OR) 4.68 (95% confidence interval (CI) 2.67 to 8.23); heterozygotes OR 1.64 (95%CI 0.95 to 2.83)), which occurred over three years earlier for each extra risk allele (β −3.34, 95%CI −6.69 to 0.02). Of 153 survivors (median follow-up 4.9 years (95%CI 3.7 to 6.1)), 44 (29%) relapsed. The risk allele homozygotes had a 46% (95%CI 36 to 57%) absolute risk of relapse by year 6, which was significantly higher than both heterozygotes (22% (95%CI 16 to 29%)) and reference allele homozygotes (30% (95%CI 23 to 39%)). In conclusion, HLA variant rs6903608 is a risk factor for both iTTP onset and relapse. This newly identified biomarker may help with recognizing patients at high risk of relapse, who would benefit from close monitoring or intensified immunosuppressive therapy.
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Affiliation(s)
- Ilaria Mancini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Elisa Giacomini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Silvia Pontiggia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Andrea Artoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Barbara Ferrari
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Emanuela Pappalardo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (S.M.T.); (S.C.)
| | - Saveria Capria
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (S.M.T.); (S.C.)
| | - Luca Facchini
- Hematology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.F.); (K.C.)
| | - Katia Codeluppi
- Hematology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.F.); (K.C.)
| | - Erminia Rinaldi
- Hematology Unit, A. Perrino Hospital, 72100 Brindisi, Italy; (E.R.); (D.P.)
| | - Domenico Pastore
- Hematology Unit, A. Perrino Hospital, 72100 Brindisi, Italy; (E.R.); (D.P.)
| | - Simona Campus
- Pediatric Unit, Ospedale Microcitemico, 09121 Cagliari, Italy;
| | - Cinzia Caria
- Internal Medicine Unit, S.S. Trinità Hospital, 09121 Cagliari, Italy; (C.C.); (A.C.)
| | - Aldo Caddori
- Internal Medicine Unit, S.S. Trinità Hospital, 09121 Cagliari, Italy; (C.C.); (A.C.)
| | - Daniela Nicolosi
- Hematology Division, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (D.N.); (G.G.)
| | - Gaetano Giuffrida
- Hematology Division, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (D.N.); (G.G.)
| | - Vanessa Agostini
- U.O. Medicina Trasfusionale, IRCCS—Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Umberto Roncarati
- U.O. Immunoematologia e Medicina Trasfusionale/Officina Trasfusionale, Cesena e Forlì, 47521 Cesena, Italy;
| | - Clara Mannarella
- Hematology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy; (C.M.); (A.F.)
| | - Alberto Fragasso
- Hematology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy; (C.M.); (A.F.)
| | - Gian Marco Podda
- U.O. Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.M.P.); (S.B.)
| | - Simone Birocchi
- U.O. Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.M.P.); (S.B.)
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, AOU Federico II, 80131 Naples, Italy; (A.M.C.); (A.T.)
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, AOU Federico II, 80131 Naples, Italy; (A.M.C.); (A.T.)
| | - Giuseppe Menna
- Department of Oncology, AORN Santobono-Pausilipon, 80122 Naples, Italy;
| | | | - Michela Ronchi
- Internal Medicine Unit, Department of Medicine, Lugo Hospital, Lugo, 48022 Ravenna, Italy;
| | - Alessandro De Fanti
- Departmental Simple Unit of Pediatric Rheumatology, AUSL-IRCSS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Sergio Amarri
- Paediatrics Unit, AUSL-IRCSS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Marzia Defina
- Department of Medical, Surgery and Neuroscience, Hematology Unit, Azienda Ospedaliera Universitaria Senese, Università degli Studi di Siena, 53100 Siena, Italy; (M.D.); (M.B.)
| | - Monica Bocchia
- Department of Medical, Surgery and Neuroscience, Hematology Unit, Azienda Ospedaliera Universitaria Senese, Università degli Studi di Siena, 53100 Siena, Italy; (M.D.); (M.B.)
| | - Silvia Cerù
- Hematology Unit, Santa Chiara Hospital, 38122 Trento, Italy;
| | - Salvatore Gattillo
- Immuno-Hematology and Transfusion Medicine Unit, San Raffaele Hospital, 20132 Milan, Italy;
| | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
- Correspondence: ; Tel.: +39-02-5503-5414
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Perrone V, Losi S, Rogai V, Antonelli S, Fakhouri W, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Real-World Analysis of Therapeutic Patterns in Patients Affected by Rheumatoid Arthritis in Italy: A Focus on Baricitinib. Rheumatol Ther 2020; 7:657-665. [PMID: 32683611 PMCID: PMC7410892 DOI: 10.1007/s40744-020-00218-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction The objective of this study was to evaluate treatment patterns in patients with rheumatoid arthritis (RA), with a focus on the utilization of baricitinib, an oral highly selective Janus kinase 1 and 2 inhibitor, in an Italian real-world setting. Methods This observational retrospective analysis was based on data collected in selected Italian administrative databases. Patients aged ≥ 18 years with a diagnosis of RA defined by hospitalization discharge diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 714.0) or by disease exemption code 006 for RA in 2018 were included. The index date (ID) was defined as the date of first prescription for a drug indicated for RA during the inclusion period. Patients without a prescription for biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) before the ID were considered to be b/tsDMARD naïve. A further analysis was performed on patients only receiving baricitinib. Results A total of 41,290 RA patients were enrolled, of whom 55.6% were not treated with conventional synthetic DMARDs (csDMARDs) or b/tsDMARDs, 39.4% were receiving therapy with csDMARDs, and 5.0% were using b/tsDMARDs. In the latter group, 2.7% (n = 56) were receiving therapy with baricitinib. In 2018, 13.2% of csDMARD-treated patients switched to b/tsDMARDs, of whom 4.3% (n = 93) of these switched to baricitinib. In total, 149 patients (mean age ± standard deviation 57.6 ± 12.1; 12.8% male) had a baricitinib prescription, of whom 51% were b/tsDMARD naïve. At baseline, 61.7% of baricitinib users were receiving combination therapy with csDMARDs plus corticosteroids, 26.2% were receiving combination therapy with corticosteroids, and 8.1% were receiving combination therapy with csDMARDs; 4% were receiving baricitinib monotherapy. During follow-up, the proportion of patients receiving baricitinib monotherapy increased to 38.9%, while 26.9, 18.8, and 15.4% of baricitinib users received combination therapy with corticosteroids, csDMARDs plus corticosteroids, and csDMARDs, respectively. Conclusion This study provides a current view of the treatment patterns in Italian patients with RA in a real-world setting of daily clinical practice, with a focus on baricitinib utilization. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00218-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valentina Perrone
- Clicon S.r.l. Health Economics and Outcomes Research, Ravenna, Italy.
| | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
| | | | | | | | | | - Elisa Giacomini
- Clicon S.r.l. Health Economics and Outcomes Research, Ravenna, Italy
| | - Diego Sangiorgi
- Clicon S.r.l. Health Economics and Outcomes Research, Ravenna, Italy
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Perrone V, Giacomini E, Sangiorgi D, Andretta M, Menti AM, Naclerio M, Ritrovato D, Degli Esposti L. Treatment Pattern Analysis and Health-care Resource Consumption on Patients with Psoriatic Arthritis or Ankylosing Spondylitis Treated with Biological Drugs in a Northern Italian Region. Ther Clin Risk Manag 2020; 16:509-521. [PMID: 32606710 PMCID: PMC7293402 DOI: 10.2147/tcrm.s248390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the treatment patterns of psoriatic arthritis (PSA) or ankylosing spondylitis (AS) patients under biological therapies and to evaluate in this population the health-care resource consumption and related costs. Patients and Methods A retrospective analysis was performed on administrative databases of the Veneto region. Patients ≥18 years with at least one prescription of biological drugs and a diagnosis at any level for PSA or AS from January 1, 2011 to December 31, 2016 (inclusion period) were included. Index date (ID) was defined as date of first biological drug prescription during inclusion period. Patients were characterized the year before ID and followed-up for one year after ID. The drug utilization profile in terms of adherence, persistence and therapeutic regimen changes, and the health-care resource consumption was analyzed during follow-up. Results A total of 2602 patients were included: 1857 with PSA and 745 with AS. In the PSA cohort, 40.3% of patients were prescribed adalimumab, 35.6% etanercept, 8.0% golimumab, 7.5% infliximab, 5.6% ustekinumab and 3.0% certolizumab. Percentage of PSA patients adherent to treatment was higher among ustekinumab patients (91.3%) and lower among etanercept users (54.3%). Persistence ranged from 53.2% (infliximab) to 70.3% (etanercept). Regarding AS cohort, 45.5% of patients were prescribed adalimumab, 26% etanercept, 17.3% infliximab, 9.7% golimumab and 1.5% certolizumab. Adherence ranged from 46.9% (etanercept) to 90.9% (certolizumab) and persistence from 62.8% (adalimumab) to 81.8% (certolizumab). Mean annual health-care costs (including costs for drug treatment, diagnostic services, specialist visits and hospital admissions) ranged from €9727 (certolizumab) to €14,994 (ustekinumab) among PSA patients and from €9875 (infliximab) to €12,991 (golimumab) among AS patients. Conclusion This study in Veneto region gave a picture of biological treatment patterns among PSA and AS patients in a real-world setting. Our findings showed the high degree of variability concerning utilization of each biological drug and provided insight on the economic burden of both diseases.
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Affiliation(s)
| | - Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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Perrone V, Losi S, Filippi E, Antonelli S, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. FRI0288 TREATMENT PATTERNS AND PHARMACOUTILIZATION AMONG PATIENTS AFFECTED BY ANKYLOSING SPONDYLITIS: AN ITALIAN REAL-WORLD STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Ankylosing spondylitis (AS) is a chronic rheumatologic condition requiring lifelong treatments. To date, few real-world studies on AS patients in Italy are reported.Objectives:Aims of the study were to evaluate treatment patterns and to analyse pharmacoutilization on patients affected by AS in a real-world setting of Italian clinical practice.Methods:This observational study was based on administrative databases of a pool of Italian settings. A retrospective cross-sectional analysis was performed for years 2015-2017 to evaluate AS-diagnosed patients and, among them, to estimate percentage of treated and untreated ones. Patients were included if having a hospitalization discharge diagnosis at any level of AS (ICD-9-CM: 720.0) or exemption code for AS (054.720.0). Index date (ID) was date in which patients met one of the inclusion criteria. Patients with a prescription for drugs indicated for AS [non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs) - targeted synthetic (tsDMARDs) and biological (bDMARDs)] at ID were defined “treated”. Patients without such drug prescriptions at ID were considered “untreated”. To analyse treatment patterns of b/tsDMARDs-treated patients a longitudinal cohort study was conducted considering as inclusion periods the year 2014 and a period from 01/07/2016 to 30/06/2017. ID was date of first b/tsDMARDs prescription during inclusion period. Follow-up (F-up) lasted one year after ID. The interruption of treatment was defined as the absence of prescriptions in the last 3 months of F-up.Results:For cross-sectional-cohort: AS-diagnosed patients were 4,824 in 2015, 5,357 in 2016, 5,894 in 2017. In all years analysed, about 50% of patients were male. Mean age±SD ranged from 51.5±13.7 (2015) to 52.4±14.0 (2017). Untreated patients were 33.6% (2015), 35.1% (2016) and 37.9% (2017), while patients in therapy with b/tsDMARDs were 22.7% (2015), 22.3% (2016) and22.2% (2017). The remaining percentage of patients were treated with csDMARDs/NSAIDS: 43.7% (2015), 42.6% (2016), 39.9% (2017)). In 2015 and 2016 all b/tsDMARDs-treated patients were in therapy with anti-TFN agents, while the advent of IL-inhibitors was observed starting from 2017 (8.2% b/tsDMARDs-treated patients with IL-inhibitors). For longitudinal-cohort: in 2014, 310 patients had a b/tsDMARDs prescription and during 1-year F-up 11.9% of them interrupted the treatment after a mean time ±SD of 83.3±66.9 days. Of the 183 patients who had a prescription of b/tsDMARDs at ID during 2016-2017, 22.4% had a treatment interruption after a mean time±SD of 134.4±86.1 days during F-up.Conclusion:This real-world study provided insights on AS treatment patterns. Preliminary results showed that approximately one third of AS patients are untreated and about one in five are treated with b/tsDMARDs. Despite the improvement in treatment duration observed from 2014 to 2016/17, still 22.4% of b/tsDMARDs-treated patients interrupted therapy in the most recent cohort. A larger sample size is needed to confirm results.Disclosure of Interests:Valentina Perrone: None declared, Serena Losi Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Erica Filippi Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Silvia Antonelli Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Massimo Giovannitti Shareholder of: minor stockholder at Eli Lilly, Employee of: Employed by Eli Lilly, Elisa Giacomini: None declared, Diego Sangiorgi: None declared, Luca Degli Esposti: None declared
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Murdica V, Giacomini E, Makieva S, Zarovni N, Candiani M, Salonia A, Vago R, Viganò P. In vitro cultured human endometrial cells release extracellular vesicles that can be uptaken by spermatozoa. Sci Rep 2020; 10:8856. [PMID: 32483153 PMCID: PMC7264351 DOI: 10.1038/s41598-020-65517-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
Extracellular vesicles (EVs) derived from different parts of the male reproductive tract can be internalized by human spermatozoa affecting their maturation and regulating their functions. Here we demonstrate that EVs derived from the female tract can be uptaken by sperm and affect their competence. Primary endometrial cells release EVs with a diameter between 50 and 350 nm and bear the standard vesicle and exosome marker proteins CD63, CD9, TSG101 and ALIX. The uptake of dye-labelled endometrial cell-derived EVs by spermatozoa, quantified as fluorescence intensity, was significantly higher when EVs were derived from cells in the proliferative phase. Vital, motile fluorescent sperm could be appreciated after a 48-hour co-incubation with endometrial cells previously labelled with the Vybrant™ DiO dye. EV internalization by sperm was blocked at 4 °C and by incubation with filipin, suggesting an energy-dependent process probably attributable to the lipid-raft domain mediated-endocytosis. Sperm ability to undergo capacitation and acrosome reaction was stimulated by endometrial cell-derived EVs as manifested by the increased protein tyrosine phosphorylation and evident reactivity when stimulated with a calcium ionophore. Based on these findings, EVs exchange may be suggested as an emerging way through which female reproductive tract cells can interact with the passing spermatozoa.
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Affiliation(s)
- Valentina Murdica
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, 20132, Italy
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milano, 20132, Italy
| | - Sofia Makieva
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milano, 20132, Italy
| | | | - Massimo Candiani
- Università Vita-Salute San Raffaele, Milan, 20132, Italy.,Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milano, 20132, Italy
| | - Andrea Salonia
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, 20132, Italy.,Università Vita-Salute San Raffaele, Milan, 20132, Italy
| | - Riccardo Vago
- Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, 20132, Italy. .,Università Vita-Salute San Raffaele, Milan, 20132, Italy.
| | - Paola Viganò
- Reproductive Sciences Laboratory, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milano, 20132, Italy.
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Perrone V, Degli Esposti L, Giacomini E, Veronesi C, Blini V, Oderda M. Cardiovascular Risk Profile in Prostate Cancer Patients Treated with GnRH Agonists versus Antagonists: An Italian Real-World Analysis. Ther Clin Risk Manag 2020; 16:393-401. [PMID: 32440137 PMCID: PMC7216299 DOI: 10.2147/tcrm.s249208] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 02/11/2020] [Accepted: 03/30/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose To evaluate and compare the incidence of cardiovascular (CV) events in a large contemporary cohort of patients diagnosed with prostate cancer (PCa) and in treatment with GnRH agonists or GnRH antagonists. Patients and Methods An Italian observational retrospective cohort study based on administrative databases of three local health units and two Regions was performed. PCa patients treated with GnRH agonists or antagonist were included between January 01, 2013 and December 31, 2016. Index date (ID) was the date of first GnRH agonist/antagonist prescription during inclusion period. Follow-up was from ID to December 31, 2017. Patients were excluded if they were under abiraterone treatment or combination therapy with antiandrogens during follow-up. The incidence rate of CV events (acute myocardial infarction, ischemic heart diseases, cerebrovascular diseases, cardiac dysrhythmias, heart failure, atherosclerosis, aneurism, other CV-related conditions) was calculated among patients not switching to androgen deprivation therapy (ADT) in the overall cohort and in a sub-cohort of patients without previous CV events. Results In total, 9785 (mean age 76.8 ± 8.5) patients were included: 9158 (93.6%) were treated with a GnRH agonist and 627 (6.4%) with a GnRH antagonist. Of them, 9627 did not switch to ADT and were considered in the analyses. The incidence of CV events was significantly higher in patients treated with GnRH agonists rather than antagonists (8.8 vs 6.2, p=0.002). Mean time to CV event was beyond 1 year of treatment in both groups. In the multivariable regression analysis, the risk of experiencing CV events was significantly lower in patients treated with GnRH antagonist rather than those treated with GnRH agonists [HR (95% CI): 0.76 (0.60-0.95), p=0.018]. These findings were confirmed in the sub-cohort of patients without previous CV events. Conclusion This Italian observational study shows that most patients received a GnRH agonist rather than a GnRH antagonist prescription. GnRH antagonist seems to have a better CV risk profile than GnRH agonist, both in patients with and without a history of CV events.
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Affiliation(s)
| | | | - Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Chiara Veronesi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Valerio Blini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Marco Oderda
- Department of Surgical Sciences - Urology, Città Della Salute e Della Scienza Di Torino, Molinette Hospital, University of Turin, Turin, Italy
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Degli Esposti L, Perrone V, Giacomini E, Sangiorgi D, Alessandrini D, Santoro A. [Effect of hyperkalemia and RAASi nonadherence on patients affected by heart failure or chronic kidney disease]. G Ital Nefrol 2019; 36:36-5-2019-6. [PMID: 31580544] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The presence of hyperkalemia (HK) in patients with heart failure (HF)or chronic kidney disease (CKD) increases the risk of death. The aims of the present study have been: i) to evaluate if the risk of cardiovascular (CV) events and mortality increases in two cohorts of patients with heart failure (HF) or chronic kidney disease (CKD) affected by hyperkalemia (HK) and treated with renin-angiotensin-aldosterone system inhibitors (RAASi). We have also evaluated the risk of dialysis among CKD patients; ii) to provide an estimate of the increased risk of CV events and mortality caused among HK patients by a non-optimal adherence to RAASi therapy in both HF and CKD cohorts. This is a retrospective study, based on the administrative databases of five Italian Local Health Units. All patients ≥18-year-old discharged from hospital with a diagnosis of HF (ICD-9-CM 428) or CKD (ICD-9-CM585) between January 2010 and December 2017 were enrolled. We defined as index date (ID) the date of first diagnosis during the enrolment period. Only patients that were prescribed RAASi therapy during the first three months after the ID were considered. Serum potassium level was tested in the three months before and after ID. The patients were considered as having HK if they presented a serum potassium level ≥5.5 mmol/l. Results show that patients with HK treated with RAASi were respectively 46% (HF) and 31% (CKD) more at risk of CV events and 88% (HF) and 72% (CKD) more at risk of dying. Moreover, the risk of dialysis in CKD patients increased by 458%. After the onset of HK, non-optimal adherence to RAASi in patients with HK was found to increase notably the risk of CV events (65% HF, 34% CKD) and mortality (127% HF, 122% CKD) in both cohorts.
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Affiliation(s)
| | | | | | | | | | - Antonio Santoro
- Scuola di Specializzazione in Nefrologia- Università degli studi di Bologna
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Murdica V, Giacomini E, Alteri A, Bartolacci A, Cermisoni GC, Zarovni N, Papaleo E, Montorsi F, Salonia A, Viganò P, Vago R. Seminal plasma of men with severe asthenozoospermia contain exosomes that affect spermatozoa motility and capacitation. Fertil Steril 2019; 111:897-908.e2. [PMID: 31029245 DOI: 10.1016/j.fertnstert.2019.01.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 09/17/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To characterize in depth and investigate the role of exosomes present in seminal plasma in affecting parameters underlying sperm activity. DESIGN In vitro experimental study. SETTING Research hospital. PATIENT(S) Normozoospermic, severe asthenozoospermic, and post-vasectomy azoospermic men 18-55 years of age were considered for the study. Seminal plasma was collected and processed to separate spermatozoa and exosomes. INTERVENTION(S) None. MAIN OUTCOMES MEASURE(S) Exosomes from seminal plasma were isolated and characterized by means of nanoparticle tracking analysis, transmission electron microscopy and Western blot. Exosome uptake by spermatozoa was monitored by means of immunofluorescence and flow cytometry. The effect of exosomes on spermatozoa was determined by evaluating progressive motility and capacitation, the latter assessed by means of tyrosine phosphorylation and acrosome reaction. RESULT(S) We isolated and characterized exosomes from seminal plasma of normo-, astheno-, and azoospermic patients. They display similar features in terms of shape, size, expression of canonic exosome markers and proteins involved in spermatozoa maturation, and fertilization capacity. After ejaculation, sperm cells are still receptive and are able to take up exosomes in a time- and pH-dependent manner. Exosomes derived from normozoospermic but not from asthenozoospermic individuals improve spermatozoa motility and trigger capacitation. Transfer of cysteine-rich secretory protein 1 from exosomes to spermatozoa may have a role in these phenomena. CONCLUSION(S) These findings provide evidence that: 1) sperm can still receive vesicle-derived cargo after ejaculation; 2) sperm motility and ability to undergo capacitation can benefit from exosomal transfer; and 3) semen quality is affected by male tract exosomes.
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Affiliation(s)
- Valentina Murdica
- Urologic Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Alessandra Alteri
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Bartolacci
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Greta Chiara Cermisoni
- Centro Scienze Natalità, Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Enrico Papaleo
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Montorsi
- Urologic Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Urologic Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Riccardo Vago
- Urologic Research Institute, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
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Giacomini E, Alleva E, Fornelli G, Quartucci A, Privitera L, Vanni VS, Viganò P. Embryonic extracellular vesicles as informers to the immune cells at the maternal-fetal interface. Clin Exp Immunol 2019; 198:15-23. [PMID: 31009068 DOI: 10.1111/cei.13304] [Citation(s) in RCA: 30] [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] [Accepted: 03/30/2019] [Indexed: 12/15/2022] Open
Abstract
Extracellular vesicle (EV) exchange is emerging as a novel method of communication at the maternal-fetal interface. The presence of the EVs has been demonstrated in the preimplantation embryo culture medium from different species, such as bovines, porcines and humans. Preimplantation embryo-derived EVs have been shown to carry molecules potentially able to modulate the local endometrial immune system. The non-classical major histocompatibility complex (MHC) class I molecule human leucocyte antigen (HLA)-G, the immunomodulatory molecule progesterone-induced blocking factor and some regulatory miRNAs species are contained in embryo-derived EV cargo. The implanted syncytiotrophoblasts are also well known to secrete EVs, with microvesicles exerting a mainly proinflammatory effect while exosomes in general mediate local immunotolerance. This review focuses on the current knowledge on the potential role of EVs released by the embryo in the first weeks of pregnancy on the maternal immune cells. Collectively, the data warrant further exploration of the dialogue between the mother and the embryo via EVs.
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Affiliation(s)
- E Giacomini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Alleva
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Fornelli
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Quartucci
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Privitera
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - V S Vanni
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Roberti M, Schipani F, Bagnolini G, Milano D, Giacomini E, Falchi F, Balboni A, Manerba M, Farabegoli F, De Franco F, Robertson J, Minucci S, Pallavicini I, Di Stefano G, Girotto S, Pellicciari R, Cavalli A. Rad51/BRCA2 disruptors inhibit homologous recombination and synergize with olaparib in pancreatic cancer cells. Eur J Med Chem 2019; 165:80-92. [DOI: 10.1016/j.ejmech.2019.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
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Alteri A, Viganò P, Maizar AA, Jovine L, Giacomini E, Rubino P. Revisiting embryo assisted hatching approaches: a systematic review of the current protocols. J Assist Reprod Genet 2018; 35:367-391. [PMID: 29350315 PMCID: PMC5904073 DOI: 10.1007/s10815-018-1118-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 09/26/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
Zona pellucida (ZP) manipulation, termed "assisted hatching" (AH), has been introduced in order to favor embryo hatching and ultimately improve assisted reproductive technology success but with poor proofs of safety and biological plausibility. We herein provide a systematic review of clinical outcomes following the application of different methods of ZP manipulation on fresh or frozen/thawed embryos at different developmental stages in different groups of patients. Out of the 69 papers that compared the clinical outcomes deriving from hatched versus non-hatched embryos, only 11 considered blastocysts while the rest referred to cleavage stage embryos. The ZP thinning of fresh embryos either by chemical or laser approach was shown to provide very limited benefit in terms of clinical outcomes. Better results were observed with procedures implying a higher degree of zona manipulation, including zona removal. Studies comparing the mechanical or chemical procedures to those laser-mediated consistently reported a superiority of the latter ones over the former. Literature is consistent for a benefit of ZP breaching in thawed blastocysts. This review provides the current knowledge on the AH procedure in order to improve its efficacy in the appropriate context. Embryologists might benefit from the approaches presented herein in order to improve Assisted Reproduction Technologies (ART) outcomes.
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Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Ahmad Abu Maizar
- California Fertility Partners, 11818 Wilshire Blvd, Los Angeles, CA, 90025, USA
| | - Luca Jovine
- Department of Biosciences and Nutrition & Center for Innovative Medicine, Karolinska Institutet, Hälsovägen 7, SE-141 83, Huddinge, Sweden
| | - Elisa Giacomini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Patrizia Rubino
- HRC Fertility, 333 South Arroyo Parkway, Pasadena, CA, 91105, USA
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Rupiani S, Guidotti L, Manerba M, Di Ianni L, Giacomini E, Falchi F, Di Stefano G, Roberti M, Recanatini M. Synthesis of natural urolithin M6, a galloflavin mimetic, as a potential inhibitor of lactate dehydrogenase A. Org Biomol Chem 2018; 14:10981-10987. [PMID: 27827510 DOI: 10.1039/c6ob01977c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Glycolysis is the main route for energy production in tumors. LDH-A is a key enzyme of this process and its inhibition represents an attractive strategy to hamper cancer cell metabolism. Galloflavin is a reliable LDH-A inhibitor as previously identified by us; however, its poor physicochemical properties and chemical tractability render it unsuitable for further development. Therefore, a rational design was undertaken with the aim to reproduce the pharmacophore of galloflavin on simpler, potentially more soluble and synthetic accessible scaffolds. Following a process of structural simplification, natural urolithin M6 (UM6), which is an ellagitannin metabolite produced by gut microbiota, was identified as a putative galloflavin mimetic. In the present study, the synthesis of UM6 is described for the first time. An efficient synthetic pathway has been developed, which involved five steps from readily accessible starting materials. The key reaction steps, a Suzuki coupling and an intramolecular C-H oxygenation, have been optimized to improve the synthetic feasibility and provide the best conditions in terms of reaction time and yield. Moreover, this route would be suitable to obtain other analogs for SAR studies. Preliminary biological tests revealed that UM6 was able to smoothly reproduce the behavior of galloflavin, confirming that our approach was successful in providing a new and accessible structure in the search for new LDH-A inhibitors.
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Affiliation(s)
- Sebastiano Rupiani
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy.
| | - Laura Guidotti
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy.
| | - Marcella Manerba
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 14, 40126 Bologna, Italy
| | - Lorenza Di Ianni
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 14, 40126 Bologna, Italy
| | - Elisa Giacomini
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, 16163, Genova, Italy
| | - Federico Falchi
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, 16163, Genova, Italy
| | - Giuseppina Di Stefano
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 14, 40126 Bologna, Italy
| | - Marinella Roberti
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy.
| | - Maurizio Recanatini
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy.
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Vigano P, Candiani M, Monno A, Giacomini E, Vercellini P, Somigliana E. Time to redefine endometriosis including its pro-fibrotic nature. Hum Reprod 2017; 33:347-352. [DOI: 10.1093/humrep/dex354] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/08/2017] [Indexed: 01/28/2023] Open
Affiliation(s)
- P Vigano
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - M Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - A Monno
- Innate immunity and Tissue Remodelling Unit, Regenerative Medicine Division, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - E Giacomini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - P Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, and Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, Milan 20122, Italy
| | - E Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, and Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, Milan 20122, Italy
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Bruno F, Castelli G, Vitale F, Giacomini E, Roberti M, Colomba C, Cascio A, Tolomeo M. Effects of trans-stilbene and terphenyl compounds on different strains of Leishmania and on cytokines production from infected macrophages. Exp Parasitol 2017; 184:31-38. [PMID: 29154845 DOI: 10.1016/j.exppara.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 11/07/2017] [Accepted: 11/12/2017] [Indexed: 01/24/2023]
Abstract
Most of the antileishmanial modern therapies are not satisfactory due to high toxicity or emergence of resistance and high cost of treatment. Previously, we observed that two compounds of a small library of trans-stilbene and terphenyl derivatives, ST18 and TR4, presented the best activity and safety profiles against Leishmania infantum promastigotes and amastigotes. In the present study we evaluated the effects of ST18 and the TR4 in 6 different species of Leishmania and the modifications induced by these two compounds in the production of 8 different cytokines from infected macrophages. We observed that TR4 was potently active in all Leishmania species tested in the study showing a leishmanicidal activity higher than that of ST18 and meglumine antimoniate in the most of the species. Moreover, TR4 was able to decrease the levels of IL-10, a cytokine able to render the host macrophage inactive allowing the persistence of parasites inside its phagolysosome, and increase the levels of IL-1β, a cytokine important for host resistance to Leishmania infection by inducible iNOS-mediated production of NO, and IL-18, a cytokine implicated in the development of Th1-type immune response.
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Affiliation(s)
- Federica Bruno
- National Reference Center for Leishmaniasis (C.Re.Na.L.), Istituto Zooprofilattico Sperimentale della Sicilia, Via Gino Marinuzzi 3, 90129, Palermo, Italy
| | - Germano Castelli
- National Reference Center for Leishmaniasis (C.Re.Na.L.), Istituto Zooprofilattico Sperimentale della Sicilia, Via Gino Marinuzzi 3, 90129, Palermo, Italy
| | - Fabrizio Vitale
- National Reference Center for Leishmaniasis (C.Re.Na.L.), Istituto Zooprofilattico Sperimentale della Sicilia, Via Gino Marinuzzi 3, 90129, Palermo, Italy
| | - Elisa Giacomini
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, Genova, Italy
| | - Marinella Roberti
- Department of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro 6, 40126, Bologna, Italy
| | - Claudia Colomba
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Manlio Tolomeo
- Department of Health Promotion Sciences, Section of Infectious Diseases, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
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Falchi F, Giacomini E, Masini T, Boutard N, Di Ianni L, Manerba M, Farabegoli F, Rossini L, Robertson J, Minucci S, Pallavicini I, Di Stefano G, Roberti M, Pellicciari R, Cavalli A. Synthetic Lethality Triggered by Combining Olaparib with BRCA2-Rad51 Disruptors. ACS Chem Biol 2017; 12:2491-2497. [PMID: 28841282 DOI: 10.1021/acschembio.7b00707] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In BRCA2-defective cells, poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitors can trigger synthetic lethality, as two independent DNA-repairing mechanisms are simultaneously impaired. Here, we have pharmacologically induced synthetic lethality, which was triggered by combining two different small organic molecules. When administered with a BRCA2-Rad51 disruptor in nonmutant cells, Olaparib showed anticancer activity comparable to that shown when administered alone in BRCA2-defective cells. This strategy could represent an innovative approach to anticancer drug discovery and could be extended to other synthetic lethality pathways.
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Affiliation(s)
- Federico Falchi
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, I-16163 Genova, Italy
| | - Elisa Giacomini
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, I-16163 Genova, Italy
| | - Tiziana Masini
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, I-16163 Genova, Italy
| | - Nicolas Boutard
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, I-16163 Genova, Italy
| | - Lorenza Di Ianni
- Department
of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 14, I-40126 Bologna, Italy
| | - Marcella Manerba
- Department
of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 14, I-40126 Bologna, Italy
| | - Fulvia Farabegoli
- Department
of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro
6, I-40126 Bologna, Italy
| | - Lara Rossini
- TES Pharma S.r.l., Via Palmiro Togliatti 22bis, I-06073 Loc. Terrioli, Corciano, Perugia, Italy
| | - Janet Robertson
- TES Pharma S.r.l., Via Palmiro Togliatti 22bis, I-06073 Loc. Terrioli, Corciano, Perugia, Italy
| | - Saverio Minucci
- Department
of Experimental Oncology at the European Institute of Oncology, IFOM-IEO Campus, Via Adamello 16, I-20100 Milan, Italy
- Department
of Biosciences, University of Milan, Via Celoria 26, I-20100 Milan, Italy
| | - Isabella Pallavicini
- Department
of Experimental Oncology at the European Institute of Oncology, IFOM-IEO Campus, Via Adamello 16, I-20100 Milan, Italy
| | - Giuseppina Di Stefano
- Department
of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via S. Giacomo 14, I-40126 Bologna, Italy
| | - Marinella Roberti
- Department
of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro
6, I-40126 Bologna, Italy
| | - Roberto Pellicciari
- TES Pharma S.r.l., Via Palmiro Togliatti 22bis, I-06073 Loc. Terrioli, Corciano, Perugia, Italy
| | - Andrea Cavalli
- CompuNet, Istituto Italiano di Tecnologia, via Morego 30, I-16163 Genova, Italy
- Department
of Pharmacy and Biotechnology, University of Bologna, Via Belmeloro
6, I-40126 Bologna, Italy
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Kolkovsky AL, Marty B, Coppa B, Giacomini E, Carlier P. Dynamic assessment of muscle perfusion, deoxymyoglobin and phosphorylated metabolites concentrations through fast interleaved NMR acquisitions with a clinical 3T scanner. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.551] [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: 10/18/2022]
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Gasparrini S, Alborali GL, Pitozzi A, Guarneri F, Giacomini E, Baldo V, Scali F, Lazzaro M, Boniotti MB. Characterization of Brachyspira hyodysenteriae isolates from Italy by multilocus sequence typing and multiple locus variable number tandem repeat analysis. J Appl Microbiol 2017; 123:340-351. [PMID: 28510989 DOI: 10.1111/jam.13492] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/02/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
AIMS To evaluate and compare the capabilities of multilocus sequence typing (MLST) and multiple locus variable number tandem repeat analysis (MLVA) techniques to characterize Brachyspira hyodysenteriae isolates and to investigate the relationship between pleuromutilin resistance and genetic variability. METHODS AND RESULTS MLST genotyping was performed on 180 B. hyodysenteriae isolates, and the results were evaluated considering profiles from 108 other strains previously reported in the database. In total, 37 sequence types were obtained. The MLVA approach completely characterized 172 strains and grouped the isolates into 22 different profiles. The combination of MLST and MLVA showed a slight increase in the discriminatory power, identifying 33 joint profiles. An antibiotic resistance analysis showed a reduction in the susceptibility to pleuromutilins over time, and a weak association between susceptibility to valnemulin and inclusion in clonal complex 4. CONCLUSION MLST and MLVA are reliable methods for characterizing B. hyodysenteriae strains and they have comparable discriminatory power. SIGNIFICANCE AND IMPACT OF THE STUDY The genotyping of B. hyodysenteriae isolates and a database of all the genetic profiles collected during the diagnostic activities could support traditional epidemiological investigations in identifying infection sources and routes of transmission among herds, and in developing more effective control measures.
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Affiliation(s)
- S Gasparrini
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - G L Alborali
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - A Pitozzi
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - F Guarneri
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - E Giacomini
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - V Baldo
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - F Scali
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - M Lazzaro
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
| | - M B Boniotti
- Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna "Bruno Ubertini", Brescia, Italy
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Ricci MT, Miccoli S, Turchetti D, Bondavalli D, Viel A, Quaia M, Giacomini E, Gismondi V, Sanchez-Mete L, Stigliano V, Martayan A, Mazzei F, Bignami M, Bonelli L, Varesco L. Type and frequency of MUTYH variants in Italian patients with suspected MAP: a retrospective multicenter study. J Hum Genet 2016; 62:309-315. [PMID: 27829682 DOI: 10.1038/jhg.2016.132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/12/2016] [Accepted: 10/04/2016] [Indexed: 12/12/2022]
Abstract
To determine prevalence, spectrum and genotype-phenotype correlations of MUTYH variants in Italian patients with suspected MAP (MUTYH-associated polyposis), a retrospective analysis was conducted to identify patients who had undergone MUTYH genetic testing from September 2002 to February 2014. Results of genetic testing and patient clinical characteristics were collected (gender, number of polyps, age at polyp diagnosis, presence of colorectal cancer (CRC) and/or other cancers, family data). The presence of large rearrangements of the MUTYH gene was evaluated by Multiplex Ligation-dependent Probe Amplification analysis. In all, 299 patients with colorectal neoplasia were evaluated: 61.2% were males, the median age at polyps or cancer diagnosis was 50 years (16-80 years), 65.2% had <100 polyps and 51.8% had CRC. A total of 36 different MUTYH variants were identified: 13 (36.1%) were classified as pathogenetic, whereas 23 (63.9%) were variants of unknown significance (VUS). Two pathogenetic variants were observed in 78 patients (26.1%). A large homozygous deletion of exon 15 was found in one patient (<1.0%). MAP patients were younger than those with negative MUTYH testing at polyps diagnosis (P<0.0001) and at first cancer diagnosis (P=0.007). MAP patients carrying the p.Glu480del variant presented with a younger age at polyp diagnosis as compared to patients carrying p.Gly396Asp and p.Tyr179Cys variants. A high heterogeneity of MUTYH variants and a high rate of VUS were identified in a cohort of Italian patients with suspected MAP. Genotype-phenotype analysis suggests that the p.Glu480del variant is associated with a severe phenotype.
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Affiliation(s)
| | - Sara Miccoli
- Research Center on Hereditary Cancer, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniela Turchetti
- Research Center on Hereditary Cancer, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Alessandra Viel
- Funcional Onco-genomics and Genetics, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| | - Michele Quaia
- Funcional Onco-genomics and Genetics, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| | - Elisa Giacomini
- Funcional Onco-genomics and Genetics, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| | - Viviana Gismondi
- Unit of Hereditary Cancer, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Lupe Sanchez-Mete
- Division of Gastroenterology and Digestive Endoscopy, Regina Elena National Cancer Institute-IRCCS, Rome, Italy
| | - Vittoria Stigliano
- Division of Gastroenterology and Digestive Endoscopy, Regina Elena National Cancer Institute-IRCCS, Rome, Italy
| | - Aline Martayan
- Clinical Pathology Unit, Regina Elena National Cancer Institute-IRCCS, Rome, Italy
| | - Filomena Mazzei
- Unit of Experimental and Computational Carcinogenesis, Istituto Superiore di Sanità, Rome, Italy
| | - Margherita Bignami
- Unit of Experimental and Computational Carcinogenesis, Istituto Superiore di Sanità, Rome, Italy
| | - Luigina Bonelli
- Unit of Clinical Epidemiology, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Liliana Varesco
- Unit of Hereditary Cancer, IRCCS AOU San Martino-IST, Genoa, Italy
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Garufi C, Giacomini E, Torsello A, Sperduti I, Melucci E, Mottolese M, Zeuli M, Ettorre GM, Ricciardi T, Cognetti F, Magnani M, Ruzzo A. Gender effects of single nucleotide polymorphisms and miRNAs targeting clock-genes in metastatic colorectal cancer patients (mCRC). Sci Rep 2016; 6:34006. [PMID: 27666868 PMCID: PMC5036027 DOI: 10.1038/srep34006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 02/05/2016] [Accepted: 09/05/2016] [Indexed: 01/13/2023] Open
Abstract
The circadian system is composed of a set of clock-genes including PERIOD, CLOCK, BMAL1 and CRY. Disrupting this system promotes cancer development and progression. The expression levels of miR-206, miR-219, miR-192, miR-194 and miR-132 regulating clock-genes and three functional polymorphisms rs11133373 C/G, rs1801260 T/C, rs11133391 T/C in CLOCK sequence were associated with the survival of 83 mCRC patients (50 males and 33 females). Longer overall survival (OS) was observed in women compared to men, 50 versus 31 months. This difference was associated with rs11133373 C/C genotype (p = 0.01), rs1801260 T/C+C/C genotype (p = 0.06) and rs11133391 T/T genotype (p = 0.06). Moreover women expressing high levels (H) of miR-192 (p = 0.03), miR-206 (p = 0.003), miR-194 (p = 0.02) and miR-219 (p = 0.002) had a longer OS compared to men. In women longer OS was reinforced by the simultaneous presence of two or more H-miR, 58 months versus 15 months (p = 0.0008); in this group of women an OS of 87 months was reached with the additional presence of rs11133391T/T genotype (p = 0.02). In this study we identified a subgroup of female patients who seems to have a better prognosis. Personalized medicine should prospectively take into account both genetic and gender differences.
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Affiliation(s)
- Carlo Garufi
- Division of Medical Oncology, Spirito Santo Hospital Pescara, Italy
| | - Elisa Giacomini
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
| | - Angela Torsello
- Division of Medical Oncology Azienda Ospedaliera San Giovanni Addolorata Hospital, Rome, Italy
| | - Isabella Sperduti
- Biostatistic Unit, Regina Elena National Cancer Institute Rome, Italy
| | - Elisa Melucci
- Pathology Department Regina Elena National Cancer Institute Rome, Italy
| | | | - Massimo Zeuli
- Division of Medical Oncology Regina Elena National Cancer Institute Rome, Italy
| | | | - Teresa Ricciardi
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
| | - Francesco Cognetti
- Division of Medical Oncology Regina Elena National Cancer Institute Rome, Italy
| | - Mauro Magnani
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
| | - Annamaria Ruzzo
- Dept. of Biomolecular Sciences (DiSB) University of Urbino "Carlo Bo", Urbino, Italy
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49
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Graziano F, Ruzzo A, Rulli E, Galli F, Galli F, Menghi M, Viti D, Giacomini E, Lonardi S, Ronzoni M, Massidda B, Pella N, Mucciarini C, Labianca R, Veltri E, Sozzi P, Barni S, Sobrero A, Frontini L, Magnani M. Dihydropyrimidine dehydrogenase (DPYD) gene polymorphisms profiling in colon cancer patients treated with adjuvant chemotherapy in the randomized phase III TOSCA trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw331.02] [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: 11/12/2022] Open
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50
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Giacomini E, Rupiani S, Guidotti L, Recanatini M, Roberti M. The Use of Stilbene Scaffold in Medicinal Chemistry and Multi- Target Drug Design. Curr Med Chem 2016; 23:2439-89. [DOI: 10.2174/0929867323666160517121629] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 11/22/2022]
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