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Lorefice L, Fenu G, Mammoliti R, Carta E, Sechi V, Frau J, Coghe G, Canalis L, Barracciu MA, Marrosu G, Marrosu MG, Cocco E. Event-related potentials and deep grey matter atrophy in multiple sclerosis: Exploring the possible associations with cognition. Mult Scler Relat Disord 2021; 49:102785. [PMID: 33508572 DOI: 10.1016/j.msard.2021.102785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Event-related potentials (ERPs) have been proposed as a neurophysiological biomarker to capture cognitive dysfunction in multiple sclerosis (MS). Few studies have evaluated the relationships between ERPs and brain atrophy as known marker of structural brain damage related to cognitive impairment (CI). OBJECTIVES To explore the relationships of brain atrophy, including of the cortex and deep grey matter, with ERP abnormalities and cognitive function, as defined using the Brief Repeatable Battery of Neuropsychological Tests (BRBN). RESULTS Seventy-eight patients with relapsing-remitting MS were enroled, of which 38 (48.7%) had CI. Independent t-test comparisons of the ERP parameters found a significant difference in P300 wave latency, with a latency of 343.7 ± 32.6 ms in the CI group vs. 320.3 ± 16.5 ms in the cognitively preserved (CP) group (p = 0.001). Significant differences in the MRI measurements, including the cortex (p = 0.02) and deep grey matter structures [thalamus (p = 0.001), amygdala (p = 0.030), and nucleus accumbens (p = 0.004)) were observed, with lower measurements in the CI group. Regression models were also performed to explore the impact of brain volumes on ERP parameters. This showed a relationship between P300 latency and the lower amygdala (p = 0.02) and hippocampus (p = 0.03) volumes, while the amplitude of the P300 was significantly associated with a lower cortex volume (p = 0.01). CONCLUSION Cortex volume emerged as the most significant predictor of the P300 amplitude. The amygdala and hippocampal volumes were found to influence P300 latency, highlighting the role of deep grey matter atrophy in ERPs for the first time. The combination of structural MRI and neurophysiological techniques, sensitive to diverse aspects of MS pathology, could improve the understanding of CI in MS and its neurodegenerative and inflammatory substrate.
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Affiliation(s)
- L Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Cagliari, Italy; Multiple Sclerosis Centre, Binaghi Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Italy.
| | - G Fenu
- Multiple Sclerosis Centre, Binaghi Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - R Mammoliti
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - E Carta
- Multiple Sclerosis Centre, Binaghi Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - V Sechi
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - J Frau
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - G Coghe
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - L Canalis
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - M A Barracciu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - G Marrosu
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - M G Marrosu
- Multiple Sclerosis Centre, Binaghi Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Centre, Binaghi Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Italy
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2
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Lorefice L, Fenu G, Carta E, Frau J, Coghe G, Contu F, Barracciu MA, Carta MG, Cocco E. Bipolar disorders and deep grey matter in multiple sclerosis: A preliminary quantitative MRI study. Mult Scler Relat Disord 2020; 46:102564. [PMID: 33172832 DOI: 10.1016/j.msard.2020.102564] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is frequently observed in patients affected by multiple sclerosis (MS), presenting a lifetime estimate of around 8%. However, uncertainty exists on the brain damage associated with this psychiatric comorbidity. This study aimed to investigate the effect of brain atrophy, particularly that of the subcortical grey matter (scGM) structures that notoriously regulate the affective functioning, on the co-occurrence of BD in patients with MS. METHODS A group of patients with MS affected by BD and a control group of patients with MS without any mood/psychiatric disorder, as defined using standardised diagnostic tools (Advanced Neuropsychiatric Tools and Assessment Schedule), were recruited. The patients underwent brain MRI, and the volumes of the whole brain (WB), white matter (WM), and grey matter (GM) were estimated using SIENAX. Thus, the scGM volumes of the putamen, caudate, thalamus, hippocampus, amygdala, nucleus accumbens, and pallidus were estimated using the FIRST tool. RESULTS The sample included 61 patients with MS, amongst whom 15 (24.6%) had BD. No differences in the WB, WM, and cortical GM volumes were observed between the patients with MS with and without BD. Conversely, the multiple regression analysis revealed a significant association of BD with lower volumes of the putamen (p = 0.032), nucleus accumbens (p = 0.029), and pallidus (p = 0.061; with a trend towards significance), independently from the demographic and MS clinical features. CONCLUSIONS Our preliminary results indicated that the nucleus accumbens and putamen are smaller in MS patients with BD. Further investigations in larger cohorts of MS patients with affective disorders are necessary to confirm these data and understand the structural brain damage underlying this psychiatric comorbidity.
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Affiliation(s)
- L Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, ASSL Cagliari, Italy.
| | - G Fenu
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, ASSL Cagliari, Italy
| | - E Carta
- Multiple Sclerosis Centre, Dpt of Medical Sciences and Public Health, University of Cagliari, Italy
| | - J Frau
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, ASSL Cagliari, Italy
| | - G Coghe
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna, ASSL Cagliari, Italy
| | - F Contu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, ASSL Cagliari, Italy
| | - M A Barracciu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, ASSL Cagliari, Italy
| | - M G Carta
- Dpt of Medical Sciences and Public Health, University of Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Centre, Dpt of Medical Sciences and Public Health, University of Cagliari, Italy
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Lorefice L, Carta E, Frau J, Contu F, Casaglia E, Coghe G, Barracciu MA, Cocco E, Fenu G. The impact of deep grey matter volume on cognition in multiple sclerosis. Mult Scler Relat Disord 2020; 45:102351. [PMID: 32731200 DOI: 10.1016/j.msard.2020.102351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/23/2020] [Revised: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive dysfunctions are very frequent in people living with multiple sclerosis (MS). Several studies have previously indicated grey matter (GM) atrophy as useful predictor of patients' cognitive impairment. However, considerable uncertainty exists about the possible impact of deep grey matter volumes on cognition. This study aimed to evaluate the relationship of the subcortical (sc) GM volumes with the presence and severity of global and selective cognitive impairment in MS. METHODS A group of MS patients with relapsing remitting course were enrolled. Patients underwent a neuropsychological evaluation by using the Brief Repeatable Battery of Neuropsychological Tests (BRBN) and the Delis-Kaplan Executive Function System Sorting Test (D-KEFST); z scores were estimated and items with z score below 2 standard deviation were considered failed. Thus, brain MRIs images were acquired and measurements of whole brain (WB), white matter (WM), and cortical grey matter (GM) were obtained by SIENAX. After FIRST tool segmentation, volumes of subcortical GM structures were also estimated. RESULTS The sample included 50 MS patients, of which 16/50 (32%) subjects were cognitively impaired. Multiple regression analyses found a significant association of severity of cognitive impairment, defined as number of failed neuropsychological tests, with lower volumes of cortex (p=0.003), thalamus (p=0.009), caudate (p=0.011), putamen (p=0.020), pallidus (p=0.012) and hippocampus (p=0.045), independently from other MS features. In addition, an association between accumbens volume and D-KEFS ST FSC and D-KEFS ST FSD z scores was observed (p<0.03). CONCLUSIONS Our results indicated that volumes of several scGM structures, and in particular of thalamus, contribute to determine cognitive dysfunctions in MS, mainly influencing the executive functioning. Further investigations in larger MS cohorts with cognitive impairment are necessary to better understand the structural brain damage underlying this "invisible disability".
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Affiliation(s)
- L Lorefice
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy.
| | - E Carta
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - J Frau
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - F Contu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - E Casaglia
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Coghe
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - M A Barracciu
- Radiology Unit, Binaghi Hospital, ATS Sardegna, Cagliari, Italy
| | - E Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy; Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - G Fenu
- Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, via Is Guadazzonis 2, 09126, Cagliari, Italy
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Mascia G, Argiolas D, Carta E, Ibba S, Piredda GB. Successful Treatment of Anemia With Anaplastic and Microangiopathic Characteristics in a Kidney Transplant Recipient With Parvovirus B19 Infection: A Case Report. Transplant Proc 2020; 52:1619-1622. [PMID: 32389489 DOI: 10.1016/j.transproceed.2020.02.077] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/14/2020] [Accepted: 02/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of parvovirus B19 infection in renal transplantation ranges from 2% to 30%. The age and immune status of the patient influence the severity of the clinical picture. A diagnosis is made by taking as evidence the giant proerythroblasts on a bone marrow sample and the parvovirus B19 viral replication with a polymerase chain reaction (PCR) technique at the blood level. Clinically, parvovirus B19 may appear with fever and severe anemia, which can be followed by pancytopenia and thrombotic microangiopathy in some cases. The literature reports a graft dysfunction rate ranging from 10% to 36%. An infection relapse may happen in 30% of cases. CASE PRESENTATION We report the case of a 33-year-old patient who underwent a kidney transplant in January of 2018. After transplantation, he reached a creatinine value of 1.1 mg/dL and a hemoglobin (Hb) level of 14 g/dL. In April 2019, he developed mycoplasma pneumonia, with signs of hemolytic anemia on bone marrow aspiration. Eventually, he was admitted because of fever, arthralgia, and anemia, with serologic and bone marrow biopsy evidence of red cell aplasia secondary to parvovirus B19 infection. He was treated with 400 mg/kg intravenous immunoglobulin (IVIg) for 10 days; 18 days after the end of treatment, he reached a creatinine value of 1.15 mg/dL, an Hb of 12.5 g/dL, and a reduction of the viral load from 25,000,000 copies/mL to 1,600,000 copies/mL. CONCLUSIONS Anemia with both an aplasic and hemolytic component was successfully treated using immunoglobulin therapy, with a significant fall in the parvovirus B19 viral load.
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Affiliation(s)
| | | | | | - Sabrina Ibba
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
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5
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Mascia G, Argiolas D, Carta E, Ibba S, Piredda GB. Hemophagocytic Lymphohistiocytosis in Renal Transplant Recipients: A 2-Case Report. Transplant Proc 2020; 52:1566-1569. [PMID: 32389490 DOI: 10.1016/j.transproceed.2020.02.047] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome characterized by an excessive immune activation. HLH can be triggered by a variety of events that disrupt immune homeostasis, such as infections and immunosuppression. HLH presents with heterogeneous clinical symptoms and laboratory findings such as pancytopenia, elevated liver enzymes, impaired renal function, and hyperferritinemia. CASE PRESENTATIONS Case 1. A 58-year-old man was admitted because of a high fever and diarrhea. Laboratory findings showed acute renal impairment, pancytopenia, Epstein-Barr virus (EBV) DNA seropositivity with a replication index of 2 million copies/mL, and hyperferritinemia. A diagnosis of HLH was confirmed by bone marrow aspiration. He was treated with etoposide, steroids, and rituximab with initial good response and good kidney function restoration. He was discharged after 31 days but eventually died after 44 days after a disease relapse. Case 2. A 51-year-old kidney transplant recipient was admitted because of a fever of unknown origin. A worsening renal function, pancytopenia, EBV DNA of 4,356,222 copies/mL on blood, D-Dimer 7505 ng/mL, ferritinemia 9180.9 ug/L, and triglycerides 1273 mg/dL were found. Bone marrow aspiration was negative for HLH; a few days later, a diagnosis of HLH was made after a positive bone marrow biopsy. Continuous renal replacement therapy was started in the intensive care unit because of severe lactic acidosis due to sepsis. She died few days later. CONCLUSION EBV infection could be a trigger for HLH in a renal transplant patient. Hyperferritinemia is useful for differential diagnosis in a septic patient. The outcome is very poor even with prompt treatment.
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Affiliation(s)
- Giacomo Mascia
- Renal Transplant Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy.
| | - Davide Argiolas
- Renal Transplant Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Elisabetta Carta
- Renal Transplant Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Sabrina Ibba
- Renal Transplant Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
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Argiolas D, Carta E, Mascia G, Michittu MB, Piredda GB. Successful Treatment of Focal Segmental Glomerulosclerosis Recurrence in a Second Kidney Transplant Patient: A Case Report. Transplant Proc 2018; 51:223-225. [PMID: 30580884 DOI: 10.1016/j.transproceed.2018.04.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recurrence of focal segmental glomerulosclerosis (FSGS) in renal allograft recipients after first transplant occurs in the second graft in virtually all patients. There is little evidence regarding optimal treatment. CASE PRESENTATION A 55-year-old man with primary FSGS and disease recurrence in both the first and the second kidney grafts is presented. In 1999, the patient developed FSGS 3 years after transplant, which was treated with plasmapheresis and cyclophosphamide. Hemodialysis was started at 8 years from the onset of relapse. In February 2014, the patient received a second kidney transplant, and after 2 weeks laboratory analysis showed nephrotic proteinuria (5.9 g/d) with increased serum creatinine. Biopsy results revealed recurrence of FSGS. At that time, he was treated with steroids and plasmapheresis with partial efficacy, achieving a serum creatinine level of 1.1 mg/dL with decreased proteinuria (1 g/d). After 4 months, creatinine worsened (1.6 mg/dL) with new evidence of proteinuria. Second biopsy results showed evidence of FSGS progression. The patient then received plasmapheresis and 2 doses of rituximab. Follow-up was characterized by progressive remission up to complete resolution. The patient is currently free from relapses after 3 years with good renal function and almost no proteinuria. CONCLUSIONS More evidence and prospective studies are needed to better understand the role of rituximab in FSGS in order to obtain an optimized therapeutic protocol for recurrence of FSGS in renal transplant recipients.
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Affiliation(s)
- D Argiolas
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - E Carta
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy.
| | - G Mascia
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - M B Michittu
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - G B Piredda
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
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Mascia G, Argiolas D, Carta E, Michittu MB, Piredda GB. Acute Kidney Injury Secondary to Hypercalcemia in a Kidney Transplant Patient With Pneumocystis jirovecii Pneumonia: A Case Report. Transplant Proc 2018; 51:220-222. [PMID: 30736974 DOI: 10.1016/j.transproceed.2018.04.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Persistent hyperparathyroidism is one of the main causes of hypercalcemia following kidney transplantation; differential diagnosis is required. CASE PRESENTATION We report the case of a 61-year-old kidney transplant recipient who underwent transplant in September 2016. She was admitted in March 2017 presenting with a 3-week history of asthenia, hypotension, and cough. Laboratory analysis showed acute kidney injury with hypercalcemia and elevation of inflammatory markers. She was initially treated with hydration therapy. A few days after admission she developed respiratory failure: chest computed tomography showed a ground-glass pattern. A diagnosis of Pneumocystis jirovecii was made on bronchoalveolar lavage. A subsequent graft biopsy was performed that revealed intratubular calcium deposition without signs of rejection. The patient was given trimethoprim/sulfamethoxazole, with improvement in pulmonary and renal function as well as improvement in hypercalcemia. CONCLUSIONS P jirovecii infection can trigger activation of intra-alveolar macrophages that leads to extrarenal vitamin D production with subsequent hypercalcemia. This rare event should be considered in renal transplant patients with pulmonary infection accompanied by hypercalcemia. In our case, hypercalcemia also provoked acute kidney injury.
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Affiliation(s)
- G Mascia
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - D Argiolas
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - E Carta
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy.
| | - M B Michittu
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
| | - G B Piredda
- Renal Transplant Unit, AO Brotzu, Cagliari, Italy
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Littera R, Piredda G, Argiolas D, Lai S, Congeddu E, Ragatzu P, Melis M, Carta E, Michittu MB, Valentini D, Cappai L, Porcella R, Alba F, Serra M, Loi V, Maddi R, Orrù S, La Nasa G, Caocci G, Cusano R, Arras M, Frongia M, Pani A, Carcassi C. KIR and their HLA Class I ligands: Two more pieces towards completing the puzzle of chronic rejection and graft loss in kidney transplantation. PLoS One 2017; 12:e0180831. [PMID: 28686681 PMCID: PMC5501603 DOI: 10.1371/journal.pone.0180831] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/15/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kidney transplantation is a life-saving treatment for patients with end-stage renal disease. However, despite progress in surgical techniques and patient management, immunological rejection continues to have a negative impact on graft function and overall survival. Incompatibility between donors and recipients for human leukocyte antigens (HLA) of the major histocompatibility complex (MHC) generates a series of complex cellular and humoral immune response mechanisms that are largely responsible for rejection and loss of graft function. Within this context, a growing amount of evidence shows that alloreactive natural killer (NK) cells play a critical role in the immune response mechanisms elicited by the allograft. Killer immunoglobulin-like receptors (KIRs) are prominent mediators of NK cell alloreactivity. METHODS AND FINDINGS A cohort of 174 first cadaveric kidney allograft recipients and their donors were selected from a total cohort of 657 transplanted patients for retrospective immunogenetic analyses. Patients with HLA Class II mismatches were excluded. HLA Class I allele frequencies were compared among patients with chronic rejection, patients with stable graft function and a group of 2388 healthy controls. Activating and inhibitory KIR gene frequencies, KIR haplotypes, KIR-HLA ligand matches/mismatches and combinations of recipient KIRs and donor HLA Class I ligands were compared among patients with and without chronic rejection and a group of 221 healthy controls. Patients transplanted from donors homozygous for HLA-C1 antigens had a significantly higher risk for chronic rejection than patients transplanted from donors homozygous or heterozygous for HLA-C2 antigens or with epitopes belonging to the HLA-Bw4 ligand group. The Kaplan-Meier curves obtained by dividing the patients into 3 groups according to the presence or absence of one or both of the combinations of recipient KIRs and donor HLA ligands (rKIR2DL1/dHLA-C2 and rKIR3DL1/dHLA-Bw4) showed a significantly higher cumulative incidence of chronic rejection in the group of patients completely lacking these functional units. These patients showed a progressively stronger decline in modification of diet in renal disease-estimated glomerular filtration rate. CONCLUSIONS KIR genotyping should be performed at the time of enrolment of patients on the waiting list for organ transplantation. In our study, a significantly higher risk of chronic rejection after kidney transplantation was observed when recipient (r) and donor (d) pairs completely lacked the two functional rKIR-dHLA ligand combinations rKIR2DL1/dHLA-C2 and rKIR3DL1/dHLA-Bw4. This immunogenetic profile corresponds to low levels of NK cell inhibition. Therefore, patients with this high risk profile could benefit from immunosuppressive therapy aimed at reducing NK-cell cytotoxicity.
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MESH Headings
- Adult
- Cadaver
- Case-Control Studies
- Female
- Gene Expression
- Glomerular Filtration Rate
- Graft Rejection/genetics
- Graft Rejection/immunology
- Graft Rejection/pathology
- Graft Survival/genetics
- HLA-B Antigens/genetics
- HLA-B Antigens/immunology
- HLA-C Antigens/genetics
- HLA-C Antigens/immunology
- Histocompatibility
- Humans
- Kidney Failure, Chronic/immunology
- Kidney Failure, Chronic/pathology
- Kidney Failure, Chronic/surgery
- Kidney Transplantation
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Ligands
- Male
- Middle Aged
- Receptors, KIR2DL1/genetics
- Receptors, KIR2DL1/immunology
- Receptors, KIR3DL1/genetics
- Receptors, KIR3DL1/immunology
- Transplantation, Homologous
- Unrelated Donors
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Affiliation(s)
- Roberto Littera
- Regional Transplant Center, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
- * E-mail:
| | - Gianbenedetto Piredda
- Kidney Transplant Unit, Department of Renal Dieases, G. Brotzu Hospital, Cagliari, Italy
| | - Davide Argiolas
- Kidney Transplant Unit, Department of Renal Dieases, G. Brotzu Hospital, Cagliari, Italy
| | - Sara Lai
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Elena Congeddu
- Kidney Transplant Unit, Department of Renal Dieases, G. Brotzu Hospital, Cagliari, Italy
| | - Paola Ragatzu
- Kidney Transplant Unit, Department of Renal Dieases, G. Brotzu Hospital, Cagliari, Italy
| | - Maurizio Melis
- Regional Transplant Center, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Elisabetta Carta
- Kidney Transplant Unit, Department of Renal Dieases, G. Brotzu Hospital, Cagliari, Italy
| | - Maria Benigna Michittu
- Kidney Transplant Unit, Department of Renal Dieases, G. Brotzu Hospital, Cagliari, Italy
| | | | - Luisella Cappai
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Rita Porcella
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Francesco Alba
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Maria Serra
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Valentina Loi
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Roberta Maddi
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Sandro Orrù
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
- Medical Genetics, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Bone Marrow Transplant Center, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
- Hematology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Bone Marrow Transplant Center, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
- Hematology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberto Cusano
- Center for Advanced Studies, Research and Development (CRS4) Biomedical Sector, "Polaris" Technology Park, Pula, Cagliari, Italy
| | - Marcella Arras
- Bone Marrow Transplant Center, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
| | - Mauro Frongia
- Complex Structure of Urology, Kidney Transplantation and Robotic Surgery, G. Brotzu Hospital, Cagliari, Italy
| | - Antonello Pani
- Complex Structure of Nephrology and Dialysis, Department of Renal Diseases, G. Brotzu Hospital, Cagliari, Italy
| | - Carlo Carcassi
- Medical Genetics, R. Binaghi Hospital, ASSL Cagliari, ATS Sardegna, Italy
- Medical Genetics, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Cigni A, Pileri PV, Faedda R, Gallo P, Sini A, Satta AE, Marras R, Carta E, Argiolas D, Rum I, Masala A. Interleukin 1, interleukin 6, interleukin 10, and tumor necrosis factor α in active and quiescent systemic lupus erythematosus. J Investig Med 2015; 62:825-9. [PMID: 24987977 DOI: 10.2310/jim.0000000000000085] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Several studies have investigated the cytokine profile of patients with systemic lupus erythematosus (SLE); however, their role is still controversial, mostly because SLE has a heterogeneous disease manifestation. We measured 4 of the most important cytokines in patients with SLE after dividing them in uniform groups according to disease activity and organ involvement. MATERIALS AND METHODS Eighty-two adult female patients with SLE were divided into 3 groups according to disease activity and organ involvement: Group A (SLE activity index [SLEDAI] score, 7 ± 0.4) included subjects with newly diagnosed, active SLE, investigated before starting therapy. Group B (SLEDAI score, < 6) included patients without renal involvement, treated with prednisone and azathioprine or hydroxychloroquine. Group C (SLEDAI score, < 6) included patients with lupus nephritis, treated with methylprednisolone and cyclophosphamide, reaching complete remission. Fourteen healthy females served as controls. RESULTS Interleukin-1 levels were 1.0, 0.8, 0.7, and 0.25 pg/mL in groups A, B, C, and D, respectively. Interleukin-6 levels were 3.2, 3.6, 4.0, and 1.4 pg/mL in groups A, B, C, and D, respectively; Il-10 levels, 3.05, 1.1, 1.5, and 1.65; tumor necrosis factor-α levels, 8.75, 5.8, 5.4, and 3.6. Interleukin 1, IL-6, and tumor necrosis factor-α were significantly higher in the patients with SLE than in the healthy controls; IL-1 was significantly higher in group A than in group C. Interleukin 10 showed positive correlation with C-reactive protein, whereas it showed negative correlation with C3. CONCLUSIONS Data from our cohort, one of the largest so far reported, add to the evidence that proinflammatory cytokines such as Interleukin-1, Interleukin-6, Interleukin-10 and tumor necrosis factor-α are important in SLE pathogenesis.
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Affiliation(s)
- Alessandro Cigni
- From the Department of Internal Medicine, University of Sassari, Sassari, Italy
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10
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Pauws E, Peskett E, Boissin C, Hoshino A, Mengrelis K, Carta E, Abruzzo MA, Lees M, Moore GE, Erickson RP, Stanier P. X-linked CHARGE-like Abruzzo-Erickson syndrome and classic cleft palate with ankyloglossia result fromTBX22splicing mutations. Clin Genet 2013; 83:352-8. [DOI: 10.1111/j.1399-0004.2012.01930.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/04/2012] [Accepted: 07/04/2012] [Indexed: 12/18/2022]
Affiliation(s)
- E Pauws
- UCL Institute of Child Health; 30 Guilford Street; London; UK
| | - E Peskett
- UCL Institute of Child Health; 30 Guilford Street; London; UK
| | - C Boissin
- UCL Institute of Child Health; 30 Guilford Street; London; UK
| | - A Hoshino
- UCL Institute of Child Health; 30 Guilford Street; London; UK
| | - K Mengrelis
- UCL Institute of Child Health; 30 Guilford Street; London; UK
| | - E Carta
- UCL Institute of Child Health; 30 Guilford Street; London; UK
| | - MA Abruzzo
- Department of Biology; California State University; Chico; CA; USA
| | | | - GE Moore
- UCL Institute of Child Health; 30 Guilford Street; London; UK
| | - RP Erickson
- Department of Pediatrics; University of Arizona Health Science Center; Tucson; AZ; USA
| | - P Stanier
- UCL Institute of Child Health; 30 Guilford Street; London; UK
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Gill JL, James VM, Carta E, Harris D, Topf M, Scholes SFE, Hateley G, Harvey RJ. Identification of congenital muscular dystonia 2 associated with an inherited GlyT2 defect in Belgian Blue cattle from the United Kingdom. Anim Genet 2011; 43:267-70. [PMID: 22486497 DOI: 10.1111/j.1365-2052.2011.02255.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Two newborn Belgian Blue calves from a farm in the United Kingdom exhibited lateral recumbency, low head carriage and transient muscle spasms following tactile or auditory stimulation. DNA sequence analysis indicated that both calves were homozygous for the recessive congenital muscular dystonia type 2 (CMD2) mutation (c.809T>C, p.Leu270Pro) in SLC6A5, encoding the neuronal glycine transporter GlyT2. Further testing of animals from the index farm and a sample of Belgian Blue sires revealed an unexpectedly high frequency of CMD2 carriers. This implies that linked quantitative trait loci may be influencing the prevalence of CMD2 in the estimated 55,000 Belgian Blue cattle in the United Kingdom. We have therefore developed new inexpensive tests for the CMD2 allele that can be used to confirm diagnosis, identify carriers and guide future breeding strategy, thus avoiding animal distress/premature death and minimizing the future economic impact of this disorder.
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Affiliation(s)
- J L Gill
- Department of Pharmacology, The School of Pharmacy, London, UK.
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12
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Carta E, Marletta A, Artuso A, Chiodi S, Consoli R, Fasce V, Paccagnella F, Palmonella G, Spinelli S, Guerini Rocco C. [Epidemiological study of Chlamydia trachomatis infection in a sample of women requesting voluntary termination of pregnancy, treated with rokitamycin]. Minerva Ginecol 2000; 52:33-9. [PMID: 10851862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Infection with Chlamydia trachomatis usually involves the cervix uteri, causing no symptoms, and may easily be unrecognised and untreated until troublesome symptoms arise, such as pelvic inflammatory disease, which can affect fertility and reproductive life. Therapies include the macrolide antibiotics, and in this class rokitamycin offers marked lipophilia, excellent intracellular penetration, and bactericidal activity at concentrations close to the MIC. The present study was therefore designed to establish the frequency of intracervical infection with Chlamydia trachomatis in women applying for termination of pregnancy, and to assess the efficacy and safety of this drug in this indication. METHODS Women aged 18-40 years were admitted for termination of pregnancy, with a positive cervical swab for Chlamydia trachomatis. The study was conducted in accordance with the Declaration of Helsinki and amendments. Patients were given one oral tablet of 400 mg rokitamycin in the morning, and one in the evening, for two weeks. Treatment started ten days before the termination, within 48 h of taking the swab. Partners were to receive the same treatment. RESULTS 292 women requiring termination of pregnancy, on average at the 9th week of pregnancy, were assessed. Of these, 24 (8.2%), mean (+/- SD) age 27.1 +/- 6.1 years, range 18-39, with a positive cervical swab for Chlamydia trachomatis, were treated with rokitamycin; 22 of their partners were treated too. Forty days after the start of treatment 22 patients (92%) gave negative results; these were all the cases whose partners had received treatment. No adverse events were reported and the acceptability of the treatment was considered good or excellent in 91% and fair in 9% of the cases. CONCLUSIONS The findings confirm that rokitamycin is one of the most useful and effective macrolides for the treatment of infections caused by intracellular microorganisms; it is extremely well tolerated and has marked microbiological efficacy.
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Affiliation(s)
- E Carta
- Associazione Italiana per l'Educazione Demografica, Genova
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